Miri has a great post up about a common therapy failure mode, which is really a common interact-with-humans failure mode, which is really a common do-things-at-all failure mode - not determining your actions with goals:
The trouble starts when venting about their problems is all the client is ever asked or allowed or encouraged to do. [...]
And that’s about all I recall doing when I went to therapy. Of course, because I was depressed, the things I vented about frequently had to do with depression in some oblique way. But the key thing on my mind as I headed off to my weekly appointments wasn’t necessarily, “I have depression.” It was, “I just had a fight with my partner and now I’m convinced they’ll dump me and I’ll be alone forever.” Or “I’m terrifying about this exam and if I don’t do well then I am a failure.” Or “I hate myself.” Or whatever.
And my therapists, for the most part, did succeed in creating a space where I felt slightly comfortable with sharing these things, and so I shared them. They would say, “What would you like to talk about?” and I wanted to talk about my conversation with my mother or how much I miss my siblings or my fears about my partner leaving me. The therapists would attempt to understand why I felt the way I did, but they did not seem to do much to change the way I felt, even though I continued seeing the same ones for a few months at least. By then, the real work of therapy should have begun.
Whereas what I’ve now been taught to do as part of my own training in mental healthcare goes more like this: A client comes to you. You ask for some basic information from the client about their life, family, history, cultural/ethnic/religious background, reasons for coming to therapy, and so on. You ask the client what they would like to accomplish in therapy. [...]
Together, you set some concrete goals for therapy that are as measurable as possible. For instance, “I would like to stop having panic attacks when I leave the house.” Or “I want to find ways to deal with feeling very upset that do not involve self-harm.” Or “I want to learn how to approach people and make friends with them.” Or “My partner and I would like to find ways to manage jealousy.”
I would have liked to read “Part 0: Should You Get Therapy?” It seems like we shouldn’t expect this to be an easy question for people to answer for themselves. Examples follow:
Zohan considers himself a hard-headed person. He has some personal problems that might respond well to therapy, but he thinks that most people with those kinds of problems are doing it for their own personal sense of well-being. Zohan doesn’t care much about his personal experience of happiness, and prefers to focus on concrete achievements and helping others, so he is not interested in therapy for himself, though he appreciates its value for others. He would change his mind if he were convinced that therapy would help him achieve his goals, but seeking out this information himself feels suspiciously like rationalizing a self-indulgent behavior.
Ygritte has a severe mental illness that affects her life adversely in many ways, and would respond well to therapy. One of the ways her mental illness affects her is that it causes her to believe that therapy is a bad idea, and would not work for her. She is self-aware enough that she would provisionally defer to an expert’s judgment that she would benefit from therapy, if it were specific enough to her case that it obviously applied to her.
Xamander has no major problems in his life of the sort where therapy is an efficient solution. One day he reads a magazine article on people who don’t seek therapy when they need it. This article quotes an expert saying, “if you don’t know whether you need therapy, go to therapy.” Because Xamander is overly literal, he reasons that since he has never considered going to therapy before, he does not know whether he needs therapy – and therefore he dutifully heeds the advice of the expert and dutifully finds a therapist and meets with her regularly. His therapist patiently helps Xamander work through the very minor issues in his life, expecting that his major problems will surface in therapy once he’s comfortable enough with the process to share them. Xamander wastes a lot of money and many hours of his and the therapist’s time to no effect.
Wendigo feels stressed out and tired and resentful of their family and employer and friends and doesn’t understand why. They go to therapy to try to figure this out. Since the actual problem is that they have a big extended family with lots of people to take care of and they don’t have enough time to get everything done in a day and take care of theirself, spending money and time on therapy makes things worse and tips Wendigo into a downward spiral.
Victoria has lots of things she could make better in her life, some of which might be responsive to therapy, some of which might be responsive to other life improvement strategies. She is not sure how much benefit to expect from each approach, and since her time is finite, the time investment in therapy – not just the sessions, but applying what she learns in them to everyday life – uses time and attention that could be applied to other strategies, she can’t just “do both."