In the decade before I started working with Group Therapist, not counting one-off assessment sessions (but including single sessions where ongoing therapy would have been available), I saw – and left – a total of 16 counsellors and therapists. There have been various reasons for leaving. Sometimes, as with the NHS, it was not my choice; other times I had valid reasons for quitting therapy and getting out was probably the best thing to do. All the same, it worries me that I have left therapy so many times. I think there’s a bit of an underlying pattern of me convincing myself I’m better before I am, of not wanting to get attached, of jumping so I can’t be pushed. At some point over the next few months, I intend to make a decision as to whether the group analytical therapy I’m currently having is the right approach for me, and I don’t want to make this decision for the wrong reasons – so I think it could be helpful to reflect on why I have ended therapy in the past.
Here, then, is my potted history of leaving therapists.
#1 : Uni counsellor whom I saw once on 9/11, and wrote about in Ten years. I was quick to jump to the conclusion that I didn’t actually need help and that she didn’t see me as needing help (in retrospect, I’m 99.9% certain I misunderstood her there).
#2 : Another uni counsellor some eight months later, when I was very unwell. I think he could have helped me a lot, but I had to stop seeing him when I left uni.
#3 : J, a counsellor based at a youth centre. I saw her for about five months without really getting anywhere; we sat in silence a lot, and if I did tell her how shit I felt, I only left feeling more shit. I desperately needed guidance but she was unable or unwilling to offer it. She occasionally tried to get me to talk about my childhood, but I was barely managing to stay alive as it was, and didn’t want to relive the bullying and abuse. I left when a referral for NHS group CBT came through.
#4 and #5 : Ran an eight-week CBT group on the NHS. Taught me some much-needed ways of coping with depression, but when the group ended I was told I shouldn’t need any more help or support as I’d now ‘had’ therapy. I was still too depressed to work.
#6 : Counsellor based at my GP surgery. Reminded me a lot of #1 and J and as such I didn’t expect great things from her. Again, I could have asked to see a different counsellor, but didn’t, partly because I knew I could only have six sessions anyway. Fearing a repeat of what had happened with the CBT group, I decided to keep looking for somewhere to access longer-term help.
#7 : Uni counsellor (during another attempt at a postgraduate course, which didn’t last long as I was still too ill to cope). Seemed nice, but at the end of our first session told me there was a six-session limit, so I didn’t go back.
Interlude : Spent a year believing I was on the waiting list for long-term NHS CBT, before discovering my psychiatrist had never actually made the referral.
#8 : Counsellor at a carers’ centre. My depression had now lifted thanks to meds, but my partner was very unwell and had attempted suicide twice, which I found difficult to cope with. I don’t remember much about #8, how many sessions I had or how and why it ended. Perhaps as my partner’s mental health improved I felt I no longer needed the support, or maybe I stopped seeing her because my referral to #9 had come through.
#9 : C, a trainee psychologist at the ‘long-term’ NHS CBT service. I had finally been referred and got an assessment quite quickly. I wasn’t currently depressed but was offered treatment for social anxiety disorder and depression relapse prevention. As they took no responsibility for my first psychiatrist’s cock-up, I had a choice of 12-18 months on the waiting list or agreeing to be treated by a trainee.
I’ve written about my therapy with C before – it’s the CBT for social anxiety I described in What’s wrong with CBT? She helped me set goals, supported me as I worked towards a couple of them, then discharged me. I had about ten sessions in all – hardly long-term. As for the ‘depression relapse prevention’, this consisted of telling me if I thought I was becoming depressed again, I should look for alternative explanations. I wasn’t happy about being discharged, but C was convinced I could carry on with my goals on my own, and I gave it my best shot. Unfortunately, without her support I couldn’t manage it.
Interlude : After a relapse of depression I was referred back to the CBT service. As a previous patient I should have been seen immediately, but it took a year to get an appointment. I gave up on the NHS for therapy and turned to the private sector.
#10 : B, a private clinical psychologist specialising in CBT. I could only afford to see him once a month, which he didn’t view as a problem. He said he didn’t understand why I had recovered, then got depressed again – looking back, this was probably something he intended to explore with me, but I thought he meant he might not be able to help as my problems didn’t fit with his CBT theories (I was starting to lose faith in CBT). He also said I had a deep, unmet need to be mothered – something I was unsure about at the time but know now to be absolutely true. I left after about four or five months (i.e. four or five sessions) when he set me some homework I was unable to complete. I could have gone back to discuss why the homework was so difficult for me, but only having one appointment a month seemed unworkable, so I began the search for a cheaper therapist..
#11 : F, the private therapist I’ve written about often. I initially saw her fortnightly for about six months and she helped me an incredible amount. Thanks to her I’ve recovered from social anxiety disorder, and I didn’t have a relapse of depression for about three years.
#12 : Clinical psychologist at the NHS CBT clinic, when they finally got their act together. I’d recently started seeing F, but #12 suggested I attend a few appointments with her as well so that I could make an informed choice about which route to take. This informed choice was made very early on when #12 failed to show up for our second appointment (and hadn’t contacted me to cancel).
Interlude : During my six months with F, I took a couple of short breaks from therapy. I found that sometimes there was nothing I wanted/needed to talk about, and paying for a therapy appointment when this was happening didn’t seem worth it, especially since I could only just afford therapy. The breaks were a mutual arrangement between us and I came back feeling refreshed and as though I had benefited from some time out.
When I took my third break, though, I didn’t come back. Life was going swimmingly, I found I was able to cope with problems on my own, and I was continuing to gain useful insight into my issues without needing to pay for it. Our arrangement was that I would contact F when I wanted to come back, so I just didn’t contact her. It never occurred to me to meet up to discuss ending therapy permanently. I did, however, believe that I could go back and see F at any time if I needed to.
About a year later, I was badly betrayed by some friends at the same time as a bereavement, and I did go back to F, feeling her support would be useful. I think I only had one appointment (it may have been two). I remember her telling me how well I was coping, which gave me the impression that perhaps I didn’t need further therapy. She then started asking me about a specific event in my childhood, something we had previously discussed in a lot of detail, and I didn’t see the point in going over it all again. Later, when I blogged about it, I realised there was a clear link between the invalidation I had experienced then and the way I was being invalidated (by myself and others) now, but at the time I was fairly unresponsive and F realised I didn’t want to ‘go there’. At the end of the session, she told me she hoped I had a wonderful wedding – as I wasn’t getting married for several months, I understood she didn’t intend to see me again. Looking back, it seems obvious there was some sort of misunderstanding, but I didn’t question this at the time.
#13 and #14 : Relationship counsellors with a national charity. I had a lot of problems accessing their services: sliding-scale charges I couldn’t really afford; lack of flexibility over appointment times and frequency when I was working shifts; appointments cancelled at the last minute; voicemail messages offering appointments which had already gone to someone else when I returned the call. In the end I simply gave up.
#11 : Not a numbering mistake. I went back to F when I had a relapse of depression, but as with the first time I’d gone back, it didn’t seem to work out. She kept telling me how well I was doing when I was trying to communicate that I was really struggling, and when I told her I was close to self-harming (something I hadn’t done for years), she just brushed it off. Ironically, now that I was ready to really engage with therapy again, she seemed to believe I was basically recovered and just needed a bit of encouragement and a reminder of what I’d learned before. Did I discuss this with her? Of course not – I told her I could no longer afford to see her, and left for good.
#15 : The Life Coach, an online therapist specialising in trichotillomania. For the same monthly cost as fortnightly appointments with F, she was able to offer me weekly sessions in a chat room with as much email contact as I needed in between. Although I knew the Life Coach had no conventional qualifications as a therapist, I jumped at the chance of this much support. At first I found her very helpful, but soon I started to feel overwhelmed by her constant emails and the many, many goals she insisted I set. I came to realise that she was constantly telling me what to do, and I got little say in deciding what my goals should be. This was all feeding into my issues with perfectionism and needing to be the ‘good little girl’ in a way that was not at all conducive to me growing as a person. For the first time ever, I raised my concerns about six months into our treatment. The Life Coach said she was essentially a goal-focused therapist and couldn’t work with me any other way. When I decided to leave therapy, she tried to force me to stay against my will and pay for another six months of sessions. Needless to say, we parted on bad terms.
#16 : Another uni counsellor, before I dropped out of my PhD. I liked her a lot. I was only entitled to six sessions, and she acknowledged this was far from ideal, but said she would help me as much as she could in the time available. After four sessions, I was feeling a lot better and we agreed I would leave the remaining two sessions for later in the year, when I might need them more. As it happened, my assessment with Group Therapist then came through and I went from that almost straight into long-term group therapy, so I haven’t been back to see #16 (and can’t now that I’ve left uni).
So, there you have it. There may have been more that I’ve forgotten; I’ve actually remembered about and added three since writing the first draft of this post. But let’s focus on the 16 that are here. What patterns can I see?
I have been let down a lot. I’ve had problems accessing therapy that should have been available, have been made to leave therapy when I still needed it, and I’ve also chosen to leave a variety of unsuitable therapists for a variety of good reasons. My chequered therapy history is by no means all my own fault. But the other pattern that really stands out is how little I have discussed problems with therapy with my therapists. Maybe in some cases these battles were not worth fighting, but in others it seems I’ve really missed out on help and support because misunderstandings were not cleared up.
I’m not yet sure whether group therapy, as the main mode of treatment, is right for me. I’m not yet sure whether analytical psychotherapy, as opposed to the person-centred stuff that’s helped in the past, is the right approach for me. But through writing this potted history it’s become abundantly clear that I need to discuss these issues with GT and the group before deciding to look for help elsewhere. I could spend the rest of my life running from one therapist to another because they’re not perfect. I don’t want that. So I owe it to myself to stay for as long as it takes to raise and discuss my concerns, and to collaborate with the professionals – I may be unsure about his therapeutic orientation, but GT has proved himself to be nothing but caring and trustworthy – when deciding what the best way forwards is.
It’s also encouraging to see that I have already made progress with this. I was able to discuss my concerns with the Life Coach, having never done that before. And while I rejected #6 and #7 before they could reject me, when #16 offered me six sessions I was happy to use them as a stopgap while on the waiting list for longer-term therapy. Admittedly I only used four of those sessions, and I can’t say whether I would have gone back if GT hadn’t come through so quickly, but hey, four is better than none. :)
(I just remembered another counsellor in between #12 and #13. I’m not going to add her to the list. You get the picture.)