Missing therapy sessions

[Hardly123]

Missing sessions

I'd love your opinion.

I've been with the same analyst for 3.5 years. For 3 years I had 3 x sessions weekly in the evenings. This is basically due to childhood abuse. I function ok, hold down a job and a relationship (just!) and friendships etc. But still find life a bit hard.

During covid I started a new job and moved my therapy sessions to mornings (7.30 am and 8 am) as my work often runs late into the evenings.

In the last six months I've changed to 2 x sessions weekly as I felt I was just covering the same ground again and again and not feeling any better. I've also been missing approximately 1 session a month, usually the 7.30 am session, usually cancelling the night before, but always paying.

For example this week I missed the 7.30 am session because I was having problems sleeping because I was stressed. At 3am the night before I was unable to get to sleep (had been trying since 11pm) and I emailed my therapist to let them know that I was cancelling the session - I wanted to try and get as much sleep as I could before starting work at 9 am (I have a stressful professional job and can make mistakes on little sleep).

Anyway I appreciate it must be really annoying for my analyst.

However in today's session he brought up that I 'don't feel like talking about things' and that's why I'm missing sessions and asked me if I still wanted to continue with analysis.

I think this annoyed me and made me feel a bit insecure. I do really struggle with insomnia sometimes and when I'm facing a night with little sleep I have to be practical about what I can do. I can't cancel my work commitments, but I can cancel analysis. I pointed out that it wasn't realistic or helpful for me to have a session when I've had a few hours sleep as I'm just not functioning properly - it's not about not feeling like talking, it's just fairly pointless and at that stage it's better for me to focus on resting so I can actually do my job the following day and not under perform at work. That is basically the reason why I cancel sessions. I've had insomnia on and off since I was a kid.

I don't really know what to do? I dislike it when people pretend that they must know the reason why I'm doing something. I genuinely believe that it's better for me to rest and try and sleep if I'm having problems sleeping. It's not that I don't want to talk. I feel like sometimes therapists are so focused on everything being about feelings that they ignore the physical reality of something like being sleep deprived and the genuine issues that can cause.

I also feel like the sessions should be to help me, not to make my life harder and that I should use them in a way that works for me. I always pay. But I do appreciate that it's annoying for my therapist if I cancel 1 a month.

What do you guys think?

Thanks in advance :)

I’ve done all sorts of therapy with varying degrees of success. Ultimately I’ve concluded therapy can be helpful - can be harmful - but for really deep seated childhood trauma there’s only so much it can do. Ultimately it’s up to you to move forward (Which is not at all an easy thing to do!). I think that is very intense therapy for a long period which sounds very much focussed on “analysis” and talking maybe rather than constructive ways forward. Maybe this type of therapy has run it’s course for you and it’s time to try. Another approach?

Yes it may be annoying for the therapist but it may have run it's course for you and a more action focused therapist might help you.

Alternatively you may just need to change your time slot! Only you know if the therapist is right - maybe there's a pattern of getting insomniac and avoidant when you get close to certain trigger issues. Therapists are trained to notice these patterns.

It sounds like it may have run its course for you. Raising this with you was the professional and responsible thing to do.

Long term continuous therapy does tend to reach the point you've described of diminishing gains. You would probably benefit from a break to focus on progressing yourself and then revisit in future - perhaps for the same type of work perhaps a different type of therapy will be right for you in future.

Realistically, you sound like you're only keeping it going now as containment and out of fear to let go? Do you think his question triggered a trauma response for you? You have been gradually winding it down yourself, but it's natural to feel scared and upset about an important relationship drawing to a close (at least for now).

I totally understand where you are coming from and sometimes I feel annoyed with my therapist about times when I feel like he is denying something that is just a fact... but I also know that often digging in a little deeper, I then see he does have a point.

What stands out for me in your post is that physical symptoms (like insomnia) are generally not unrelated to what is going on for us emotionally. I suppose it's not completely far-fetched to wonder if the insomnia is a very useful defense at times when you do want to avoid something. (You also mention covering the same ground a lot in your sessions which could in itself be a way of avoiding something else.) If this situation happens monthly then that's quite a pattern so he is right to draw attention to that, that's his job.

I would also say definitely take your anger about this to him, I think that will be very useful.

Sometimes I temporarily forget my therapy is a collaborative process with my therapist, and that he is meant to be neutral when it comes to my internal conflicts. Then I start hearing blame in everything he says. When I get into that pattern he usually says something like "I am making an observation, you are inserting the blame in there" and he is so right - sometimes we hear things a particular way because we're already feeling like that. I suppose you could see your therapist's comment in that way - it is an observation, something for you to wonder about together, not a criticism or him knowing more than you do about what is going on for you.

It sounds like therapy has become something you need to tick off on your to-do list.
It's adding to your stress/workload therefore I'd take a break.
You can't be gaining much from it when it's a chore.

That’s a lot of therapy. What is the aim of it? Is it helping you anyway?

He must be taking it in. 3 X weekly is a lot!

Be honest with him and tell him he is wrong. What model does your therapist using? Is it TA?

Thanks, that's really helpful. I definitely agree that insomnia has an emotional component, but I do also get insomnia on days when I don't have therapy. I get it on weekends, holidays, with other people, by myself... Unfortunately it's not useful at all :(

I think I just don't know what to do when I haven't slept properly. It doesn't make any sense at all to me to sit, foggy headed, through a therapy session on 4 hours sleep. How is that beneficial? I am not going to grow or learn anything in that session and in addition I'm going to be exhausted for the rest of the day and more likely under perform at work. It's the sort of thing I would have done when I was younger, when I was worried about pleasing other people and didn't think carefully about my own well being. I really don't understand why I would go to a session on a few hours of sleep. Is there a benefit to it that I'm missing?

I think it would be better to have the session at a different time of the day, but it's just too difficult to fit it in anywhere else.

Alternatively maybe I do need to take a break from it, as it's feeling more overwhelming than helpful currently. I can always come back to it.

The difficulty is that I do feel overall that it's been great for me. Thanks for your advice.

I think you're right. The difficulty is that it's very stabilising as well.

Yes, possibly there is a bit of a trauma response, I think his comment that I wasn't attending because I didn't feel like talking felt like he wasn't interested in the reality of my experience or what I was struggling with. That I had to adhere to some kind of routine he'd determined and he was telling me what was going on for me and what I should do with my time rather than being genuinely concerned about my wellbeing, health or career.

Sometimes with therapists it's crossed my mind that if I lost my job because of underperforming at work because of multiple early morning therapy sessions,having tried to persuade me into attending them when I'd said I was struggling, they genuinely wouldn't think they were in any way responsible! I feel like therapists sometimes really struggle with the fact that my job and career and health comes first and therapy is there to support that, not the other way around. Sorry, I am super annoyed!!

Your first paragraph really resonated with me and I actually had an argument with my psych on a similar point this week. He kept going on about how some things were clearly too difficult for me to talk about and the reality was that I was frustrated with him for trying to find meaning behind things which were purely practical and therefore I felt like he wasn't listening to me. He did a bit of a non-apology but I think he got it and it was helpful to clear the air. For what it's worth, I cancel for practical reasons (including lack of sleep) on a regularish basis and/or leave sessions early. Sometimes it's just not a priority.

It does beg the question that how long is it going to last? If you aren't feeling better after 3.5 years (that's around 500 sessions) and it's not helping your insomnia then it's not unreasonable to assess whether this method is working for you.

That is really helpful actually. I feel like sometimes therapists don't seem to accept that life happens outside of sessions and the sessions are meant to support your life, not detract from it. Some things are purely practical and don't need to be analysed in terms of defence mechanisms! It's reassuring to know that I'm not the only one who cancels for various reasons. Thanks.

Psychoanalysis can go on for years or decades :) It's a long term treatment.

There is therapy beyond psychotherapy. But definitely do explore your anger with your therapist- it can be an important part of the therapeutic relationship.

I’m a therapist and I have had therapy for many years and I still find Thais kind of thing annoying sometimes. Psychoanalysis doesn’t tend to focus on the concrete or the things outside the room but obviously they remain part of our reality.

i also know that when I miss sessions something is being avoided - not saying it’s the same for you, but maybe just go back and tell him you’re angry see where it goes?

Genuine question - why?

Ah so it's Psychodynamic? I have just finished a counselling course and a module covered psychodynamic. I'm unconvinced about that model tbh. Not totally unconvinced but some of it seems stretch. It seeks to bring issues which are in your subconscious and unknown to you out in the open. The therapist is the expert on you rather than you being the expert on you. The module covered some psychodynamic theories about why clients may avoid therapy, including what he said to you. It sounds as though rather than get into your frame of reference he has just applied his learning to you cancelling. It's not very nuanced or treating you as an individual. Maybe he thinks you should prioritise therapy over everything else but he ain't gunna get paid if you jeopardise your work.

Just tell him you flatly disagree with his analysis.

It is a long term therapy. It's one of the oldest models and takes a long time to train in however I am not sure it has the robust evidence base that other models of therapy have. Perhaps a psychodynamic therapist will come along and say different though.

Worriedpanda some of what you say is not accurate at all, in particular around the lack of nuance - if anything, psychoanalytical therapies are much more individualised than much of the cognitively based approaches favoured by the NHS. I also wouldn't say the therapist is the expert at all, they are on a journey of exploration with you and trained to listen in a particular way.

Have a look here for the evidence base:

psychoanalysis.org.uk/resources/evidence-base-of-psychoanalytic-psychotherapy

@fernz - page not found but from the same website;

"At the heart of psychoanalysis is the recognition that our complex and often unconscious emotional life is a fundamental part of being human. Sometimes we don’t understand the beliefs and fears that shape our way of looking at and living in the world, as they have become ingrained and automatic. We can find ourselves repeating destructive behaviours, feeling stuck in unhappy relationships and stunting our emotional, creative and professional development.

Psychoanalysis can significantly diminish psychological suffering and improve our health and wellbeing, opening up our capacity for greater fulfilment in life."

Absolutely agree with the above but still can't understand why it takes years. As a hypnotist (or mind coach, if you prefer) I communicate directly with the subconscious and can resolve deep seated trauma in 4 sessions.

Hm. I think your analyst noticed you cancel some sessions and is wondering with you whether you don't feel like doing the analysis. He might be making a space for you to get in touch with your anxieties about it, and think together with him about those things - is it worth it, is he any good, can he help you, and for it to be ok to talk about that.

But I think you hear him telling you that this IS what you are thinking, feeling and doing. And that he is extremely disappointed in you for that and annoyed that you cancel.

I think the reality is that your analyst is not going to be annoyed. Let's face it - who doesn't like an unexpected lie in from time to time 🤣

But I expect he is very interested in why you assume he will be so annoyed. And that you ascribe all sorts of things that I don't think (from what you have said ) he is actually saying.

Do you lie on the couch?

HTH.

Random question - how much is this costing you?!

Need to change time of session

Is there a benefit to it that I'm missing?

Yes, commitment