To ask whether this is what I should be expecting from therapy?

[Circlesandsquares10]

My workplace offers a access to a confidential therapy service with a limited number of free sessions. I decided to access this to get some help with anxiety, in particular how to deal with a completely irrational fear / avoidance I've developed around presenting in work meetings and how this occasionally overlaps into normal social situations with friends and family.

I had my first session 2 weeks ago and got off to a good start with the therapist. She asked exploratory questions and got me to describe my anxiety in more detail etc. She followed up with a few resources - all quite generic e.g. mindfulness tips but no issues.

Second session rolls around and it just felt... Inadequate? The first time we met via a video call which worked well, I was expecting the same again and was sat waiting in the virtual meeting room, but she called my mobile instead, so that threw me off on instantly. Then after initial pleasantries she kicked things off by asking what I'd like to discuss today.

I was expecting some sort of recap from what we talked about last time and for her to take the lead by drawing back into the discussion etc. To be asked what I'd like to discuss made me feel like everything we talked about the week before had gone out the window somewhat.

I said that I wanted practical support for the issues I'm facing with the anxiety I'd described before, particularly how to deal with the presenting at work situation. She then asked me to basically go through everything I said last time. The phone kept losing connection so we stopped and started 3 times during this!

I didn't feel like I got anything out of it other than her asking me what I think triggers the anxiety. The answer that I gave is that I genuinely don't know, I just think I've trapped myself in a negative cycle of behaviour / getting in my own head about this particular thing I need to do.

She was going down different angles to try and get me to pinpoint the route cause i.e. childhood issues, general happiness in my job, self esteem. We didn't really get anywhere and I felt frustrated that I didn't get any guidance of how to deal with the anxiety when it's actually happening in the moment. I feel like I need to understand how to deal with the physiological responses of my body - that fight or flight affect - that is telling my brain that I'm in danger in that scenario when obviously I'm perfectly safe!

It felt like because I wasn't able to give a clear rationality of where the issue stems from, she kind of gave up halfway through the session. She even asked me if I had anything else I wanted to talk about?! I was just really confused and didn't feel like I'd received any useful guidance.

Is this normal for therapy? The first session she said we would use CBT approaches to support my anxiety. Should I be expecting more from her or am I just being awkward / not making the most of the sessions?

Finding the right therapist is like finding the right anything - you often need to talk to a few to find one that clicks! Most will offer a free chat before you ‘sign up’ with them, I am not sure how it works when only a few sessions are being offered though. Is there a team of therapists you can choose from?

Therapist here. What did you agree with her in terms of the format ie video, phone, face to face? I offer a variety but would contract around the clients preference. I would inly move to phone from video if the client requested or in extenuating circumstances such as an Internet failure.

Re the content, sounds normal for your first session & many models of counselling encourage the client to drive the focus of each session. However other models, such as CBT, would often be more directive & therapist driven. It sounds like you're looking for behavioural support ie how to practically manage rather than exploratory therapy (the why). Even to look at behavioural strategies it can be incredibly helpful to understand more about the triggers & circumstances of your anxiety _ as you can then adapt strategies accordingly or challenge unhelpful thinking etc.

It sounds like you might not have had a clear enough discussion about what you want and/or the therapist hasn't explained clearly how their approach is aimed at supporting what you've asked for. Transparency is important I would always explain to a client why we're doing what we're doing. I'd encourage you to say how you felt & what confused you and/or didn't feel OK. It should always be OK to ask you're building a trusting relationship which takes openness & a willingness to engage. Don't give up yet, try & have a chat about what you were expecting vs what you got & be open to hearing your therapists rationale. If you aren't met with willingness to discuss & explain can you request a therapist with a more behavioural approach ? Good luck .

If that was only the first "real' session after the introductory one it doesn't sound that bad. They are not going to give a 'solution' to your specific issue within this time, if at all. Or even get into practical coping mechanisms before they try and establish the route cause of your issue. For me, offering 3 free sessions is bound to be inadequate unless your MH needs are frankly pretty uncomplicated (unlikely). It could be they are hoping you will go on to purchase more sessions with them I suppose? The phone thing isn't great, and can easily throw people when they have to talk about really deep stuff.
I think it would be useful to seek out your own therapist that you can work with and do as many sessions as you will need, and you get a better feeling about.

I am no expert, but surely therapy isn't about a "quick fix"? It might take many weeks to get to the root of any issues, and for both you and the therapist to fully understand what's going on. Then the therapist works with you to decide what outcome you want and how to achieve that. It takes time to understand behaviours and work out if and how you want to change them.

This is very poor CBT for an anxiety problem. You've had the assessment session, so the first treatment session should involve developing a collaborative formulation of the problem (which looks like a diagram). The therapist absolutely should be directive and make links to the previous session. The formulation should lead in to active work on practising strategies. YANBU op- she definitely doesn't sound like an accredited CBT therapist so her CBT training may not be very good. I'm sorry you're having this experience and I hope it doesn't put you off continuing to seek help.

Agree with Newnamesameoldlurker.

To me, it sounds like the therapist was not in her usual set up for some reason, had forgotten what you’d gone over in the first session and what she’d said she’d do (maybe as no access to notes) and was winging it.

Yes I agree with PP newnamessameoldlurker above. I was given ten free sessions on NHS for anxiety with CBT therapist. Had pretty low expectations but she was fantastic. She offered phone contact but I held out for face to face and so glad I did though sounds like you were fine with cideo and she shouldn’t have just changed that last minute as it’s so different.

She gave me a booklet which we worked through and which gave focus to the sessions with homework. She did ask for what I wanted to work on each time but with reference to the whole of what we were talking about over all the sessions. I was given clearmodels for how to think about situations such as your work presentations. It was extremely practical and I think would help you if you can get a better person. It seems for perfect for such specific needs and there was no delving into my childhood (like psychotherapy) just ways to deal with in the present. Good luck OP.

I've had solution focused hypnotherapy at times over the last year and it's been brilliant. Helped me to deal with various issues that were bothering me and making life different. Sessions with the hypnotherapist have always been face to face as he works at a centre not far from me. I have, of course paid for sessions, which I can fortunately afford.

Sounds like she uses the humanistic approach which is client centred. So you lead the sessions, using them how you choose to. Her role is to reflect back to you to help you explore your thoughts and feelings in greater depth.

It might be worth looking at counselling styles to see what may suit you. CBT for example is more directive and you often get homework/ tasks to work on so it can feel more tangible.

If you'd agreed on a video call for your second session and you turned up for it that's what should have happened.

Is it part of the humanistic approach to say she’s going to use CBT and then not?

@RawBloomers I use to be a humanistic counsellor and yes some counsellors mix models. This would probably be in the form of occasionally making suggestions of things to try to support you. Or doing a work sheet to help with clarity.

I've received CBT therapy which involved minimal discussion (after first consultation) and was focused on targets. I would be given home work each week and the homework would be reviewed in the next session. My progress would be monitored each week.

Do you feel it would be helpful to ask her on more depth what to expect from the sessions. It can be daunting not knowing what to expect each week

Wow. I think I would find your type of counseling to be exceedingly frustrating. Can’t imagine building a constructive relationship with a counselor I couldn’t trust to that extent.

Thanks for your responses everyone, very interesting and helpful to hear your views and experiences.

I had my third session this week and feel a lot better about the whole situation following that. We were back on video call so no idea what happened last week in terms of the phone thing. Immediately felt a lot more comfortable with the VC setup again and I was a lot more directive in terms of what my expectations of the sessions were.

Interestingly she picked up on my frustrations around wanting to find a quick fix to the issue when actually it's a longer process that requires different routes and explorations. It was just a lot more of a valuable and fulfilling session and I got a lot out of it. As a pp said I think maybe last week she wasn't in her usual set-up and it just disrupted the whole vibe, but I'm pleased that we got back on track this week!

Great news OP, well done on persevering after that wobble. Hope it's helpful! 😘