to think most therapists/counsellors are underwhelming??

[UncleBunclesHouse]

Have posted similar in MH...I am hoping someone can give me hope! Or maybe not and I'm right...

I am really struggling at the moment with my anxiety and depression. I have just started some CBT through my local authority over the phone - it's ok, but this isn't the first time I have sought help and found it extremely underwhelming. I have then given up in the past as I just don't want to talk to them, which ends up actually making me feel much worse than if I hadn't bothered. I feel like everyone says 'speak to someone', 'reach out for support' blah blah but it usually doesn't actually help anything at all and I feel more hopeless.

I have had one really good therapist in the past through my employer scheme, however I moved so she is no longer an option. I have a great coach I use for professional development but she is very business-focused and doesn't deal with personal issues and is not a therapist/counsellor. I can talk to my DH to a point and he tries his best but I can't tell him everything I feel and I am also conscious not to worry him. None of my friends I have that type of relationship with. Talking to my mum generally ends badly as, although well-intentioned, she starts preaching to me as to what I should and shouldn't do based on zero knowledge and very much through her own lens. I find her advice particularly hard to swallow and get annoyed as she certainly didn't apply any of her own nuggets of wisdom when I was a child and although was loving and not a bad person, she was pretty awful a lot of the time TBH. Current situation of not being able to do F2F really doesn't help as I struggle to open up on the phone or via video call.

Sorry I am rambling - so is this the case others have found too?? Or has anyone found a really good therapist who is an asset to your life and who you actually want to talk to? Where/how did you find them? How do your sessions work? I don't mind paying if it actually works and they are any good! But so far I feel like it's not worth the effort and disappointment.

can you not contact the person you saw through work and see if he/she does online private therapy? At the moment, and I imagine for the foreseeable future it doesn't matter where the therapist or client resides as it's all being done via zoom/facetime/calls anyway. if later on down the line you need to see someone face to face then you can start looking for someone closer to home albeit you might not ever get to that point

What are you looking for from therapy? A space to talk and process things that have happened? Are you looking for something to help you make changes?

CBT is very change focused and goal oriented E.g it’s not enough to say I don’t want to feel depressed or anxious- it’d be thinking about what life would look like if you weren’t e.g I’d have more motivation, more of a routine, I would be more assertive or wouldn’t avoid things etc. It works on areas of your life that are currently impacted.

If wanting to focus on things that have happened in the past but aren’t necessarily impacting your life now then more of a counselling approach might be useful.

There are definitely good therapists out there, even within the NHS just sometimes need to be assertive about what your needs are.

Do you have any particular concerns about your current therapy or anything in particular you find underwhelming?

I use an excellent therapist and have done for a while. I pay for it. She does zoom calls. If you’re interested In her details then PM me.

I have NHS counselling and it is good. I had to wait a year for it because counselling is difficult to get as they try and push everyone into CBT.

My tip would be if you get asked the following or similar in the first session, your counsellor/therapist isn’t very good:

You are walking down the road and you say hello to a friend you see. They don’t reply and keep on walking. What do you think about this?

@Stripesnomore that doesn’t mean they aren’t good, it’s a question asked when working with thoughts/distorted thinking but would usually mean you’re partway through CBT (when at the part you’re working on cognitions and starting to look at core beliefs) not counselling and wouldn’t be asked in an assessment.

I have been asked that three times by three different workers. One in an assessment, one in mindfulness and one in the first session of group work. None were in CBT.

To me that is someone working from a script who isn’t interested in the client or skilled enough to talk naturally.

Ah that’s no good, I think that’s the therapist not the question. It definitely has no place in an assessment and can see how it’d fall flat in group work and especially in mindfulness. It’s effective when used in the right context. Sorry you had those rubbish experiences

I’m a trainee therapist and just wanted to say please don’t give up. Lots of NHS stuff is short term CBT/solution focused/general well-being advice etc and for some people it works well but for others it’s a bit rubbish and not what they need.

I’d encourage you to check out BACP, Counselling Directory or Psychology Today to try to find a private therapist. Most will be working online at the moment but a well-skilled counsellor will still be able to make you feel at ease in these less than ideal circumstances.

I’d definitely give it a shot, and remember it’s fine to try taster sessions with a couple of different counsellors until you click with one. In fact, any decent therapist would encourage that you find one you really click with.

Plenty of different styles too, depending on what the issues are.. e.g deeper stuff looking at childhood issues, or more present-day stuff with helping to manage current issues. Most therapists will likely offer a blend of multiple approaches tailored to your needs. Good luck

It is fine because I now have a really good counsellor. I have always thought getting the right help with mental health requires some tenacity because different types of approach will help different people.

There are some great counsellors/therapists out there. And there are some..less good.

CBT is used too widely as it has a fairly linear path to follow. Trouble is, that while it works for some things, not everything in our lives is linear.

It's hard to advise but generally "counselling psychologists" are a safe bet in terms of knowing different modalities, having good (very) training and experience. They have PhD level training. Critically (in my opinion), they've also had a decent amount of therapy themselves. This helps in breaking down the attitude that some CBT practitioners have if "you have a problem, I'm the expert".

There has been a study done that found that we (therapists) consistently think we are better than we really are so you might be onto something.
Using therapies and models that work rather than freestyling is important, but short term therapy has become too manualised I think. When I heard that psychological wellbeing practitioners were being given 'empathy dots' to circle on the side of the page to remind them to express empathy I thought stop the world I want to get off. But then one of the doctors I worked with was heavily involved with researching artificial intelligence psychotherapy . The real problem is that the services don't grow and develop therapists now, they view them as expendable because there will always be someone newer and cheaper who wants to do the job.

@ScrapThatThen I definitely agree. Definitely doesn’t help that the majority of psychology services are staffed by Psychological Wellbeing Practitioners, I get they’re cheaper and do great work where appropriate but means anyone above mild problem aren’t actually getting the course of therapy they need, not helped that the PWPs often give their patients the impression they’re delivering CBT instead of guided self help. I think it’s disheartening for clients to think they’ve hadn’t course of CBT and that it’s another thing that hasn’t worked for them when they haven’t actually had it. Empathy dots! I have no words for that! Sounds awful.

Go for an HCPC clinical psychologist. Too many charlatan therapists/counsellors out there. They cost more, but train for 10 years to doctoral standard. You get what you pay for, sadly.

IMHO CBT is not worth the time it’s given by the NHS. It does absolutely fuck all in terms of understanding or unpicking or resolving any issues, it just focuses on doing nice things for yourself to make yourself feel better (this is all in my experience). Utter utter utter waste of time. I’m so sad the NHS wastes so much time and money on it. It’s usually all you can get, it’s a postcode lottery.

I paid for therapy, EMDR, and my therapist was amazing. She changed my life.

PND this year, my therapist was from a charity and she was also wonderful. Kind, empathetic, and insightful. Helped me heal.

Change therapists OP, or find a different type of therapy if CBT isn’t working.

@Syal I’m just in a mess. I don’t know what I need, I know I can’t continue like this forever, but the advice everyone always gives is to talk to someone, try counselling...so I do. I kind of hoped that the practitioner would be able to ask the right questions to determine what I need. It’s like going to the GP and telling them my diagnosis and what prescription I need. Isn’t the professional meant to be the expert? I went on ADs in the end even though I don’t want to as professional helping just doesn’t seem to be achieving anything

It’s like the sessions I’m having now - I have explained I am feeling so low and completely overwhelmed so what do I get - reams of ‘homework’, x2 long questionnaires I have to do in advance of every session and send the day before, have to attend the session at the same time each week, if I miss x2 they discharge me as not committed. In context, I haven’t managed to brush my hair today and there is some sick in the dog basket that has been there since yesterday. That’s where I am in terms of available time.

It makes me want to cry. But I can’t. I can hardly get through some days and this is their plan to help?!

@Showers3 is this a different practice/qualification? Is there a register I can look at? Thank you

@UncleBunclesHouse

It’s like the sessions I’m having now - I have explained I am feeling so low and completely overwhelmed so what do I get - reams of ‘homework’, x2 long questionnaires I have to do in advance of every session and send the day before, have to attend the session at the same time each week, if I miss x2 they discharge me as not committed. In context, I haven’t managed to brush my hair today and there is some sick in the dog basket that has been there since yesterday. That’s where I am in terms of available time.

It makes me want to cry. But I can’t. I can hardly get through some days and this is their plan to help?!

OP I am not a MH professional but it doesn’t sound like CBT is right for you, that’s so much work to be doing. Is this through the NHS? Can you ask about talking therapy?

@UncleBunclesHouse That sounds tough. I agree the questionnaires are annoying but we have to use them as service as in my service our funding is dependent on the results of them (ridiculous I know, not the services fault it’s government mandated). If someone’s struggling to complete them weekly I usually suggest they just do it at the start, middle and last session. Maybe see if this is an option.

If you’re feeling overwhelmed etc CBT can be helpful but sounds like the therapist isn’t adapting it to you or setting “homework” in line with how you’re feeling currently. Definitely rubbish of them.

HCPC accredited psychologists would have done an undergrad (if not in psychology will have done a 1 year conversion course after). Then to get the doctorate will have done the 3 year doctorate course with a mix of uni and placement. (Some might have done masters courses/diplomas in between undergrad and the doctorate). They train in a range of modalities (CBT, systemic therapy etc) but will usually have one or two modes they prefer to work with.

There’s a registry of therapists here and tells you a bit about them e.g type of therapist and what they work with. www.counselling-directory.org.uk/service/depression.html The letters with their qualifications/who they’re accredited with can be confusing so feel free to message me if you have any questions (I’m a psychotherapist).

You are totally not being unreasonable.
I tried telephone counseling and it was a bucket load platitudes and pointlessness.

Eventually I reached the point I was in a very bad way and ended up seeing a proper psychologist and she was incredible. The sessions were genuinely transformative.

Since then DH and I spent some time seeing a very well qualified therapist (because we were both struggling to cope with my abusive ex) and she was also very good. Not perfect but definitely made me feel like we were making progress. I would like to book more sessions with her once covid is over.

So my advice, if you can, is to see a proper psychologist or therapist rather than a "counsellor"

@OrangeSlices998 CBT is a talking therapy so if she asks for that they’ll probably say she’s having it. Could ask for counselling but it’s unfortunately usually very limited on the NHS but def worth a shot.

YANBU.

I hate CBT and all the stupid questionnaires.

I found Alastair Campbell’s book very helpful. It’s a quick read, the first half is more a reflection on where his problems came from and the second half covers the tips and strategies he uses to keep his depression under control. Given his background, there is a bit of politics but you don’t have to be Labour to read it (I’m not).

I recently did some training under the author of 'empathy dots' and it was truly truly awful. The IAPT system in theory and practice is not fit for purpose imo.

To be fair, CBT delivered by a psychological wellbeing practitioner who has to deliver a highly structured intervention as dictated by the service they work for is a different beast to CBT delivered by a highly skilled, experienced doctoral level psychotherapist who has the autonomy to adapt the course of psychotherapy to the needs of the client. So, don't write off CBT altogether if you do decide to seek private therapy.

Also, one of the biggest predictors of positive psychotherapy outcomes, regardless of the particular type of therapy offered, is feeling that the therapist understands and cares about what's going on for you. So, finding a therapist you feel comfortable with may be as important as what particular type of psychotherapy they trained in.

My therapist is highly reputable, very knowledgeable and yet she is still not good.,she had chosen to fixate on my leaving my relationship and nothing else. My issues go as far back as childhood and I know I need to work on me, not spend each week discussing plans to do leave. Heartily fed up of counsellors that just don’t get it,