So I just got home from therapy, and this is the session where I told him I'm leaving. Now, not leaving therapy entirely mind you, I am in a gay men's interpersonal therapy group, and I'm going to go to that therapist for individual therapy. Now, this decision wasn't made hastily - I think that the group therapist is better qualified to talk about what happened in the group that he runs. This is because a lot of times, what we talk about in individual therapy stems out of something that has happened in group, and I have to recount the entire thing, from my perspective which may be distorted, to the individual therapist. Seeing one person for both modalities just seems to make sense to me. He had the opportunity to be there during the group, to form his own impressions of how I reacted and of what was said during the group. There's also a quality about the group therapist that I can't articulate. He connects with me, understands my experiences, and seems to be able to relate. I could tell from our first session that he was someone that I really liked. However, at the same time there's some disadvantages - namely not having two therapists . Each of them could possibly offer different perspectives and insights, and be there if for whatever reason the other is not. There's no "problem" as such with my current individual therapist that would make me look elsewhere in the absence of this group therapist, but there are some financial considerations at the same time - my insurance is changing next year, and neither one of these therapists is in-network with my insurance (the group therapist doesn't even take insurance, but can get reimbursed as out-of-network). I got the plan that has the best out-of-network coverage since I know I'm going to need it at any rate, so I figure if I'm going to be paying more out of pocket anyways, I should get the absolute best possible care for me. My current individual therapist did say that I'm currently doing important work with him, and he said that even in talking about leaving him, every theme that we've been working on for the last year came up (and that's true). He said something like "I'm not telling you this because I'm a used car salesman trying to convince you to stay", and I think he's being truthful, but you can never know. What do folks think??
RainbowMan, if I could save the 2/3 of my time in therapy that I usually spend just providing the back-story, I'm sure I would jump at the chance. Seems to me that by the time I'm finished explaining something, time is up. If your gut told you this was the way to go, I'd say follow it!
You're doing good work RainbowMan! I've been in therapy off an on for years. The past year has been the most productive for me ever. I set goals with my shrink every couple months. I write up what I want to accomplish and set a date, more as a strawman - knowing that some things just don't do as expected. Reality is -- I pretty much make my goals and pretty much on time. Don't hesitate to switch shrinks or to consolidate shrinks. Your work with him/her is your work -- take charge of it and make sure its honored and followed. Articulate to yourself and your shrink why you're there and what you expect to get out of your sessions. Hold each other accountable! No reason you can't take "your work" to any shrink you like. I think you made the right decision!
Situations like this are always difficult for the therapist, because there's an inherent conflict; the needs of the client against the income value to the therapist of having the client. If you have a good connection with the group therapist, I see no reason that you shouldn't also see him individually, and it therefore makes sense to switch. I don't think you're really going to lose anything meaningful in the transition, as the group therapist already knows you fairly well from group. Stylistically, what you see in group from the therapist will probably be very different than what you see individually, as by necessity, those are pretty different modes of interacting and, depending on the group and its purpose, can also have different theoretical underpinnings. But switching to someone new can sometimes "jump start" change for you as well, because of the difference in styles and interactions, so I see no reason not to make the shift. And, of course, if you decide (after a half dozen sessions with the group therapist) that you don't feel it's progressing as much as you want, you can always switch back.
Exactly,. and that's why I don't quite buy the "I'm not a used car salesman" line - there's definite economic loss to him losing me as a client, and there was economic gain to be had by keeping me - my new insurance plan covers out-of-network stuff at billed charges, rather than "usual, customary, and reasonable" which is really none of those, so what he was getting as an in-network therapist for me would have effectively been doubled. See, there's the problem with me. I'm incredibly hard on myself (which is one of my problems,. actually) - I think of things in terms of "broken" and "fixed" - and something broken should be fixed in the shortest amount of time possible. Even this kind of thinking is broken, and needs to be fixed . I'm not seeing progress in this with my current individual therapist, and group can obviously not focus on me and only me, and when this does come up, other group members seem to think that I'm unwilling to change - which is pretty far from the truth, however, I find it extraordinarily difficult to change this way of thinking, and I'm certainly not going to change it within 90 minutes. However, I think that the change should occur relatively quickly - perhaps not within 90 minutes, but within 2-3 months for sure, and it's not happening. This is one of the reasons that I think change might be for the best. This is something that I haven't been doing with my current individual therapist, and one of the things that my group therapist insisted that I do immediately upon joining the group, which is one of the reasons that I think that his approach to therapy in general is better.
Keep in mind, some therapeutic orientations are better suited than others to setting specific goals and accomplishments. And group-focused work is usually goal oriented in some way, especially if it's a time-limited group, so it would be normal to set expectations and milestones for yourself. Depending on the type of therapy you've been doing with your therapist, the goals are less clear. For example, CBT (of which Pete is a huge fan) is really good for dealing with specific types of anxiety, depression, and the like, because its focus isn't on the underlying cause, but rather on how it's directly affecting you in the now... and it offers specific actions that can help improve the immediate situation in the short term. So for that, goals are really helpful. On the other hand, when you're doing insight-focused work that looks at the core causes of why you're not happy, that's harder to set clear milestones/goals on, because the nature of the work is exploring the family-of-origin issues and, for nearly every LGBT person, the underlying issues of shame, poor self-esteem, and feelings of self-worth and love and belonging. Those take time to explore and understand, and the major "aha" moments tend to come in fits and starts, in part because it takes time for the unconscious to be ready to address and own them. So what I'm trying to say is... the goals can definitely be helpful, but depending on the sort of work you're doing, they may nor may not be easy to clearly set and evaluate. In insight-based therapy, it isn't uncommon to uncover deeply painful material, which makes you feel like crap in the short term, but once you process it and are able to let go of it, then the long-term value of that work is generally a lot greater than the equivalent CBT because you've dealt with the underlying issue, rather than finding ways of covering up the feelings using cognitive strategies. The best therapists use a combination of both insight and cognitive-based approaches, so it might also be worth asking both therapists what their theoretical orientations are, and letting that weigh into your decisions as well. Finally, regardless of theoretical orientations, there are a lot of therapists who can sort of meander around with their patients month after month and never get much of anywhere, regardless of their theoretical orientation. Therapy is more of an art than a science, and there are a lot of crappy artists out there Talking about this sort of thing is not the easiest thing to describe so I hope I've made it reasonably clear.
would seeing the group leader as your only therapist put you at odds with other group members I wonder ? Have you discussed the idea with your group leader yet?
I met my therapist six months ago in a gay counseling session. I plan to stay with him until we can get at the root of my depression. Which I am convinced comes from coming out at a mature age, and letting go by separating myself from my biological family. Once I have understood that my decisions do not have to be met with any grave consequences and do not imply that I am any less suitable to join the human race. I feel I can overcome my doubts, which come from a great deal of sensitivity and transitioning.
I just got back from therapy, too, about an hour and a half ago. It was a rough session, because we talked about a traumatic life event. He was understanding. It's a bummer that your group therapist isn't your individual therapist, and vice-versa. Is it possible for your group therapist to also see you, or would that be against protocol, cost prohibitive, or against the insurance rules? The new insurance rules are affecting everyone and you may not want to lose the ground you've covered, but if (1) you're not enthralled with your individual therapist, and (2) it is way too expensive for you, I'd say stand your ground. It's impossible to tell if he was salesman like with you or not, without hearing the inflection and the context. I once did EAP through a job and he was a salesman before I ever went in. Then I found out why. He was toward retirement age and I think his clients were tapering off, so he needed the revenue. I only got 7 sessions and felt he was a prick and rude. At the end of them, he told me "I'd like to keep seeing you." I thought "I've got a therapist I like more than you contemporaneously." I just sort of shrugged and didn't schedule beyond the allowed 7 visits. I think the individual therapist is more important than the group therapist, if you had to pick one. I'd choose individual therapy to group therapy. The group therapy doesn't hold the participants to the same professional standards expected of a licensed mental health professional. Can you justify the cost for continuing the individual therapy versus the savings from starting over with someone who works better with your insurance? ---------- Post added 15th Nov 2013 at 06:09 PM ---------- Thanks for bringing this up, Pete. Today I was faced with goal setting. I've never had this occur before in therapy. I think it's a good thing and it actually sounds like it should be a standard. How does one set a goal you can't quantify? And I'm asking this for everyone's benefit. Is stopping depression and getting past grudges a goal? And how does one measure that? Food for thought.
On issues specifically written for gay men: like self-acceptance, commitment, healthy relationships 101 and healing (whether healing addictions or what does it mean to have healthy life as a gay man). I guess reading about insight therapy got me curious because I'd like to learn what how things work when the therapist has a lot of experience dealing with gay men. Which issues are addressed, how, and why? ---------- Post added 15th Nov 2013 at 10:47 PM ---------- Also, I honestly appreciated your input on relationships and age difference because it seemed like common sense to me, so I'm wondering how to educate myself on whatever obstacles lie ahead rather than learn from experience, lol
On specific issues for gay men, hands down probably the best book out there is Joe Kort's "Ten Smart Things Gay Men Can Do to Find Real Love" which, in spite of its title, has little to do with finding love and everything to do with finding and understanding yourself as a gay man. It covers a lot of the issues that gay men have to face as they come out, accept themselves, and navigate not only their own feelings/fears/confusion, but also some very practical things, such as dealing with your spouse if you're in a heterosexual marriage and a lot more. Two other books I very highly recommend are Brené Brown's "The Gifts of Imperfection" and "Daring Greatly." There's some overlap between the two, but both are excellent and cover the same material in different ways. She talks about shame, vulnerability and authenticity (arguably the most crucial issues any LGBT person has to deal with), and the things that "get in the way" of living wholeheartedly and fully.
Thanks for recommending books! I've read some of Joe Kort's book yesterday via Amazon (Kindle) and it was very insightful, intense, even uncomfortable yet it's so important to write and talk about this, plus I believe in WORK and getting to the core issue. I'm gonna look into this more. I like Brené Brown a lot, thanks again
I have been really badly burned in therapy, having stayed with a very experienced senior psychoanalyst for 13 years who failed to help me, despite numerous signs and symptoms, to accept my sexuality. At the same time, I loved this man as a father and felt he cared about me very much. Nevertheless, I have to conclude that the therapy was damaging to me because it didn't help me solve the core issue of my lifelong depression, denying my true self. So painfully I wrenched myself free and began a search for a gay therapist; fortunately I live in the NYC area. I started with the group therapy first. The therapist was a very nice guy, clearly more oriented in a cognitive behavioral approach, but not entirely. However, I had the opposite experience with my group therapist; I didn't want him as my individual therapist. I wanted the privacy of going to someone the group members didn't know. So I picked the gay therapist I had a crush on and who didn't say anything stupid, patronizing, off putting, etc. Ultimately I left the group because the group therapist let too much shit happen. I hated that he encouraged group members to trash someone who wasn't present for that session. I also felt that one group member was exalted by everyone, including the therapist (not me) but he was a destructive, mean spirited asshole. I felt if I spoke up about his superiority and his bullshit, everyone would turn against me. So I left. I just didn't like the party. Anyway, I have had so much therapy, i should write a book. I think a personal fit is important but not as important as knowing that the person can help you and understand you. I stayed for 13 years with someone I thought was great and it fucked me up. Therapy is touchy-freely and squishy, especially if you're trying to uncover the truth about yourself and understand your family, patterns, character, etc. This is long but right now I feel it is just so important to find someone who can help you accomplish what you need to. On a related issue, my daughter needed a wicked inflamed and infected cyst removed from her neck last spring. It took 4 doctors to get the right diagnosis and surgical plan. And, we were lucky that my brother in law knew a chief of head and neck surgery at NYU. Everything that we were told by the previous experts was wrong. The surgery was potentially dangerous and we were close to going with the clearly wrong option. Fortunately she is doing great, no complications or problems. But the conclusion is, all medical matters require the patient or the patient advocates to do their homework, ask questions, don't be passive.
