Therapy doesn't always "fix" people

[ArwenUndomniel]

I've seen a lot of threads on here where the OP is advised to "get therapy" to address psychological issues and work on their self-esteem. While it's not terrible advice, I sometimes do wonder if the people recommending therapy have ever had any and what they think actually happens during a session.

I'm coming at this from the perspective of someone who has had a lot of therapy of different types with different therapists. After many years, I've found it's great for understanding why you have particular thinking patterns and recognising unhelpful behaviours, but in terms of actually changing those things it's pretty useless, if I'm being honest. I feel like I know myself and my motivations very well at this stage in my life, but I still find it impossible to override the negative thoughts (even when I know they're irrational) and I still don't really like myself. According to some ways of thinking, that means I can't ever have a meaningful relationship because you have to love yourself before you can expect anyone else to love you.

I accept that others' experience may vary and I'm genuinely interested to know if anyone has successfully found a way of making therapy "work" in a practical sense. Not just getting to the bottom of your issues but addressing them and making real mindset changes.

No, they’re not. Strange thing to say, perhaps you could elaborate?

I'm a psychologist and have on going therapy that I've found really helpful. Mostly due to the relationship I have with my counsellor who is excellent. But I agree that therapy isn't for everyone - timing, chemistry, emotional intelligence, readiness to reflect etc are all important for it to 'go well'. I think the whole NHS 6 session therapy plan is awful. By session 6 most people have only just built the rapport/trust with their therapist and started to discuss past traumas. Then... it's over. With no additional support. Many people have started to resurface terrible traumas/become aware of huge challenges and are at their most vulnerable emotionally then.. poof on their own.

what kind of homework did you have if you don’t mind me asking?

I had two pieces of homework from mine.
one was a spreadsheet which was meant to be a list of negative interactions and then the otherside was evidence that they weren’t true.
I just used this as a log of every perceived fuck up id made that week, so I stopped it after two days when I realised it was just like self harm!! She didn’t really say much when I said that’s what had happened to it.

the other one was a leaving letter, which I had no idea what it was meant to consist of, I kept asking the therapist and she just said it was not meant to be a thank you letter.
so I got chat GPT to write it!! When she read hers back, it was clear it was meant to be a summary of our sessions.

It’s knowing where and how to start though. And that’s where the support comes in

Well its not even 6 'sessions' in reality because the first session is going through a range of expectations, forms, scaling, talking about the referral and the final session is outcomes, scaling, finalising etc etc

Leaving only 4 really where you're trying to work on something.

Ive had 3 sets of this over the years at different times where it was 6 sessions each time. Utterly pointless and I was left feeling the problem was me because I was told they wouldnt re refer me after each set of sessions because my scaling showed I hadnt been able to respond to it, no shit!!!

At one point I was then assessed as needing psychotherapy and referred back to the GP to start that process, waited many months to be told that I then didnt meet the criteria. Absolutely pointless, the whole thing

Im considering againw hether to self refer to IAPT or whatever the new name for it will be, cant really afford private.

It's interesting to me how protective some people are about therapy and how, if someone says that it didn't do much for them, the conclusion tends to be that it's that person's fault. Either they did it for the wrong reasons (wanting to be "fixed"), or they didn't do the work, or they chose the wrong type (as a pp says, how are you supposed to know what type is right if you don't have limitless resources to try different ones?).

I have noticed this too.

Therapy ‘speak’ and MLM lexis are uncomfortably close.

CBT also is counter intuitive for some people, its assumed that one can always identify the thought and feeling associated with the behaviour and vice versa. Sometimes I found myself making things up (to myself) to say 'oh thats why I feel that' or 'thats why I think that', when it wasnt really identifiable. I dont think a lot of therapists/counsellors are alive to that at all, that their client is clinging on to an assumption themselves and looking at something from the wrong angle because its guess work.

At times over the years Ive suffered with a lot of panic and dread, its not about anything, it doesnt have a hook or reason, its just there as a feelilng and sensation.

This is my experience too. I did have some physchotherapy about 14 years ago which was brilliant but when I tried to get some 2 years ago I had to wait 9 months to get 6 sessions with a counsellor who refused to do zoom despite my whole issue being panic attacks when leaving the house... I can't see how a counsellor was meant to help with that, my CPTSD is way above her pay grade.

Respectfully, you’re hearing one side of this.

In some cases yes.

I have sat on interview panels for our NHS Psychological Wellbeing Practitioners. English and maths GCSE or equivalent is all that is required. On the job training. 40 study days. Qualified in six months, but treating patients well before that. All the therapy they provide is tick box, flow chart based. Band 4. Most will never qualify as we don't support them. They tend to leave after about a year. We have just taken on 13.
The patient gets six sessions, but only four are used for therapy. The waiting list for therapy is over a year.
No therapy does not work for everyone. These therapists in the main provide no new ideas to the client. I would say this type of therapy helps practically no-one.

A competent therapist wouldn’t be opening up trauma or complex challenges when they knew they only had 6 sessions. The 6 session model is wholly about symptom/distress management it’s never intended to deal with deeper issues. It’s a sticking plaster/holding mechanism.

If you are responsible for employing PWP’s, I would hope that you understand that they are not therapists and are not delivering therapy

they are low skilled workers delivering basic guided self help principles for people to use independently- if the patient requires therapy they should be allocated a therapist or counsellor within the NHS talking therapists system - but make no mistake - PWP’s are NOT therapists

If you had therapy and now have insight but haven't changed, then it might be you've been doing the wrong sort of therapy (compared to what you wanted to get out of it). Not all therapy approaches focus on change, but some are very change-oriented in a practical way.

I've had counselling with somebody that was helpful for moving on from difficult feelings, but didn't really 'change' much in my life (but was invaluable), and also hypnotherapy that was very life-changing and resulted in a lot of change in me. Completely different people and approaches, but both excellent in their own way. I also saw somebody a couple of times who I didn't gel with at all, they didn't seem good, but perhaps I didn't give it enough time, or it was the wrong type of therapy for me.

It certainly is a standard response here and I agree OP. Therapy frequently does not “fix” people.

I have had years of therapy both cbt (which I found worse than useless) and psychotherapy (which was more helpful) and neither helped me to the extent of addressing deep seated trauma which determines much of my behaviour and mental health issues.

Cbt is a often like putting a sticking plaster on a gaping, festering wound. More hinderance than help for people like me although I accept it could be useful for other more straight forward issues.

Psychotherapy was a good chance to understand the effects of the trauma but I am still the same. I just understand why a bit more. Which is good but not the “fix” that some expect.

I would agree with you. I’ve had several bouts of therapy and all have been helpful in terms of understanding myself. I have also struggled to use therapy to understand what I actually need to do to change because understanding something doesn’t mean you change. I’ve found delving in to the psychology of my brain and human behaviour the most important for helping with change.

I thought psychotherapy was just a word that grouped taking therapies together, of which CBT was one. What is psychotherapy in terms of attending a regular session? Google isn’t telling me either!

I found CBT Amazing.
Beat therapy hands down - I like to be proactive.
I found therapy was just focusing on a problem - which just made it bigger.
However, I did mention an incident with my Dad to a friend ( who was a therapist) and she said ‘but is that what actually happened?’
I thought about it , and realised , my interpretation was skewed … and something clicked… I got really close to my Dad in the 6 months we had left …. Thanks to that therapist.
Dad didn’t change , but I did.
Maybe I saw him through the eyes of an adult for the first time …..I was just pleased I was given the time we had.

To be a psychotherapist instead of just a counsellor, you need deeper post-graduate training (often a Master's level qualification) focusing on complex, long-term mental health issues, involving extensive theoretical study (like psychology, philosophy), personal therapy, significant supervised clinical practice (eg 450+ hours) and often specialization in specific modalities, making the training more rigorous and academically rooted than typical counselling courses, though the lines blur in practice.

The woman I had for 6 sessions of psychotherapy was amazing - talked though key life events and got me to consider more angles, explained some of my choices with me and why they made sense at the time and told me I was a perfectionist and had to give myself a break. The counsellor, as I said didn't even grasp that I wouldn't be able to drive 20mins to see her for 6 weeks because I struggle to leave the house.

I think that therapy can also be actively harmful sometimes and this should be acknowledged more, although I do see more discussion of this nowadays than there used to be.

I've known a few people have therapy
It seemed to work really well for some and not good for others. I don't know if that's down to the individual, the therapist or the type of therapy. Maybe it's a mix of them all.

But what was the difference in the type of therapy they offered? You said you had CBt which wasn’t helpful but psychotherapy was. What is it?

or do you mean it was just the person you did it with who made a difference?

This might help

What is the difference between counselling and therapy?
According to Psychology Today, “[Counselling] tends to be shorter term, goal-oriented, and it addresses concrete, specific life challenges. By contrast, therapy tends to be longer term, more exploratory and holistic and it treats mental illness. [Counsellors] often [specialise] in a specific area, such as marriage, addiction, grief or abuse.” So, if you are dealing with a mental disorder, neurodiversity or trauma; you may find a therapist more helpful. However, if you have a life event or lifestyle issue that you need support with in the short term; a counsellor may be more suitable.

https://greatermanchester.ac.uk/blogs/what-is-counselling-vs-therapy

The psychotherapist did a bit of CBT but there was more on some trauma's from childhood we went into. I assume that because she was a more proficient therapist she got to the nub of the issues quickly and effectively. I felt very comfortable with her and she made me feel she understood and competent. She actually gave me confidence somehow as well. Obviously I am no expert so I don't know which techniques she used and it was 14 years ago. Counsellors do often not have much training or life experience, from what I can see, particularly knowing 2 people who have magically "become" counsellors, according to social media, with a very sketchy grasp on psychology and seemingly no thorough training.

Im lucky i dont have to pay and its helping me