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I had three different therapies in my life so far. The first one was a bad experience, the other two helped me a lot. I like both therapists but never felt like we are close or connected in any way this article writes about.

Always I knew I'm dealing with a professional. I saw other patients leave the room before my session started. We needed to look for an appointment because of vacations and stuff, it was always just a person doing his job.

And I'm fine with that. I also think it is necessary to have a person who is not too close to you helping you some times. Family members and friends want you to have as little pain as possible and doing better as fast as possible which is natural but often not the right thing.

"On this view, the good therapist becomes a temporary attachment figure, assuming the functions of a nurturing mother, repairing lost trust, restoring security, and instilling two of the key skills engendered by a normal childhood: the regulation of emotions and a healthy intimacy."

The therapist can't repair lost trust or security, only you can. A good therapist will help you do that.

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A good therapist is a debugger.

Debuggers show you a step by step at a low level, but some are better at highlighting "interesting" modes of operation that are not necessarily what we expected. Just like race conditions and those tricky concurrency issues, a debugging session with our brain can help identify how we get stuck.

Sometimes, just the way we frame something gets entangled with another underlying issue and reframing a topic can free up that deadlock. Othertimes a trigger can be uncovered and we can apply a patch to temporarily avoid triggering it while we go delve deeper in the issues that are awoken by that trigger...

But like any debugger, it's only as good as how we use it: it's not a magical tool that operates on us passively. Beyond the trust factor, it can take a while to figure out how to best leverage the therapist for our needs.

A good therapist can also be a mirror, reflecting your own unconscious reactions to things back at you so you can see yourself in a new light. When I sought therapy I wasn't experiencing difficulty maintaining rational thought. Everything I was thinking about myself and others was perfectly reasonable given what I knew. What my therapist did was expose the fact that what I knew was a very limited slice of the facts of the situation. She never halted my thought process or exposed every little thing. She asked interesting questions and challenged me to consider a different perspective in some situations. That was enough to get me on a path to self-leadership. And once I had that, she helped me change how I thought about myself and others so that I could trust instead of fear. I learned to have courage and it saved me.

A personal question, if I may.

I think seeing a therapist would be good for me, I have issues I'm struggle to fix myself but how does the conversation even start ?

What I mean is, I can go to a regular doctor for a regular problem and he will say "what is the issue?" and I can explain it pretty clearly even if I don't know the underlying cause. e.g. "My leg hurts here when I move it in such a way"

But I can't imagine how this conversation starts with a therapist. If they asked me what is wrong, I genuinely don't know. I don't know where to point to the pain. Then I just see myself sitting there with someone awkwardly, them thinking I'm an idiot.

When I went the question wasn't "What is wrong" it was "What brought you here, and what do you want to be different at the end of this". I think if you give an honest answer to either question that can be a pretty good starting point. Even if you feel your honest answer isn't specific enough (e.g. "I just want to feel like I am worth something" or "after this maybe I don't want to kill myself" or "I want to be able to enjoy myself more") the therapist can start there.

And really a large part of therapy seems to be diagnosis, with the added benefit that the clarity you get from working towards diagnosis (and the ability to confide in someone) already being helpful.

I would suggest just going to see someone and being as honest about why you are there, and what you hope to change as you can bear. The therapist will take the conversation from there. And if you ever feel resistance to being honest about something, just say that. You aren't required to be fully open about everything.

And no therapist is ever going to sit there thinking you are an idiot. They are there to help people, and they probably recognize that seeking help is hard. I think they will appreciate and respect the effort it takes for someone to seek help. They certainly won't ridicule someone for not knowing exactly what they want. Because they know how hard that stuff is when it comes to mental well-being.

It's literally their job to deal with this. In fact, I think most therapists assume the problem their patients walk in with is not the true problem, and it will take months to just get to the real thing. So, if you walk in without a fully fleshed-out theory of yourself, the therapist will be privately relieved.

In my experience, they will be happy to start anywhere, like just how is your day today for example. You can just talk and they will listen and ask about stuff that they think might be relevant. Whatever is “wrong” it will probably come up in some way if you just talk about your day with an experienced therapist. You don’t need a clear statement to come with, they know that they’ll have to talk and that it might even take several sessions to start formulating something.

I can imagine even starting by saying “I don’t really know what is wrong and what to say, so I’m afraid I’ll just be awkward and you’ll think I’m an idiot” and they’ll be like “Haha, that’s interesting, do you often feel like other people might think you’re an idiot?” and you’re up and running!

>> [...] Haha, that’s interesting, [...]

Sounds like something Dr. Sbaitso would say.. And he's a lot cheaper! :)

I'm just glad my therapist doesn't wipe off his memory contents after I leave...

You don't actually have to say anything. The therapist is expert in asking questions. There is no burden on you to self-diagnose.

You can even truly leap the conversation forward with something as simple as what you wrote in your message:

"I have issues I'm struggle to fix myself"

That is as good a place to start as any, but there is no expectation for you to come to the meeting ready to say that. And you will lose nothing by not saying it.

My advice, after long experience, is simply to go in the moment and see what becomes of it. The prize of health is worth it.

Make a list while not with a therapist -- what do you want to fix?

Another way to start is checking if you match these (though you could be suffering from one and not even recognise it by reading the abstract description): https://en.wikipedia.org/wiki/List_of_maladaptive_schemas -- if you match any, this is a great place to start, regardless of the therapy affiliation.

I really like Schema Therapy, though I've only seen one therapist qualified in it, and while she started great -- gave me a long questionnaire that pointed out my maladaptive schemas I already knew were present(she made me feel "wow, finally, a great professional, just like I read in the manual they should be"), she just didn't stick at all to the Schema Therapy session protocol I read in the manual and the sessions just devolved into the usual "so how have you been since our last session .... bla bla bla ... you're making great progress" that I'm all too familiar with all the therapists that I know.

So whatever therapy you choose, try to find a therapist that's also sticking to the therapy method.

How do you prioritize the list if you match a couple of them.

You don't have to do the prioritization yourself, you could do it with the therapist.

You could ask yourself witch bothers you the most.

Also if there are clusters of schemas, start with the ones in the same cluster, but your therapist should also be able help with what to start.

I do know of such a prioritization for BPD where you first have to learn to answer back to your internalized "punitive/critical parent" mode, and eventually eliminate it, because it will sabotage your progress, just like a real life punitive/critical parent would.

You've already prioritized it! If you've found a few things from there that match how you feel that's a great place to start. You could even bring that list to a therapist and go over it with them.

Are you familiar with rubber duck debugging?

The idea is that when you (as a developer) run into a software bug you can't fix, you try to describe it out loud to a rubber duck. It turns out that the act of formulating these thoughts into speech is massively effective as a debugging method.

So my challenge to you is to revisit this statement:

>If they asked me what is wrong, I genuinely don't know.

Instead of shutting down because you don't know, just start speaking. Keep speaking. Deliberately turn off your filter. If that's hard, narrow the question. Instead answering "what's wrong?" answer "what's wrong today?" or "what's the strongest emotion you felt last week" or etc. And then expand around it. Describe the experience. Etc.

RDD works because talking is really powerful. Ever had to teach a class on something you thought you knew? The act of turning an amorphous blob of 'knowledge' into a linear presentation will often show you that you didn't understand things as well as you thought. The therapist's "Tell me more" forces you to tease out of the blob the distinct threads of the issue.

Journaling can also be useful in forcing you to produce words that describe what's going on, but it's also easier to slack off when there's nobody else in the room. If you worry about what you'll say in a therapy session, start writing and you'll likely come up with plenty to talk about.

RDD works because most of the people really don’t understand what they don’t understand without a direct linear thinking about the problem. They have this blob in their head that creates an illusion of knowledge.

I have the same thing. Every time I start thinking “big” I need to consciously stop myself and ask “what do you not know?”/“what needs to be measured?” Instead of continuing making assumptions.

You don’t need to speak to a duck to do that though. Speech has got nothing to do with your ego/laziness that makes you believe there’s nothing to be done and everything can be solved by thinking.

There is probably a name for it, but I do the equivalent, except by writing an email (or just writing it down any way). I noticed that if I am saying things out loud I can just skip over what are often unnecessary details. But by writing it down in some way, I am forced to think it all through. Nine times out of ten, I solve the problem before I finish the email or ever send it.

I came to therapy very late in life and it was similarly opaque to me. I was very fortunate to come across someone who listened to me talk about my life and distilled it into insights I had never made on my own. I can only assume they've seen so much and treated so many patients they have a deep well of patterns to start with and it's mostly of matter of seeing where you fit plus whatever is unique to you.

I've always had a good relationship with my mother but it was only though my therapist I even realized I did in fact have some attachment issues. Anecdotally when I mentioned that to my aunts they immediately starting sharing stories about mom. Family knew all along but they remained silent until I asked for detail. The point is for both the therapist and family just talking is enough to prime the process of discovery. You won't start with a giant epiphany.

My current therapist had an intake questionnaire which focussed on 'getting to know you' conversational questions: there wasn't an expectation that I would need to prepare anything in advance.

It was immediately clear to me that she was warm and personable - for this reason, the article linked above resonated with me a lot.

I don't feel that I have any more ability to explain the state of my mental health than I did at the start of the sessions, but I'd definitely credit her with improving it.

To reflect on what you have said: If you ask me how my mental health has improved, I genuinely don't know. I just know that it has.

I also thought about that every time before I started therapy. Often multiple problems are leading to symptoms and you are not able to pinpoint the exact problem. You don't have to. And often it is not just one thing, it never was for me. That's exactly why you going to therapy. You can start by telling you're needing help because you at a point where you cannot fix your issues anymore yourself and then just start with one of your issues, it will flow way easier than you think.

Never forget, the therapist probably had hundreds of patients like you with the same problem getting started which means he probably knows a thing or two to help you get started :)

I've only had one therapist but she was extremely good. And she would ask a lot of questions. She'd get me to untangle a lot of my thought processes. She'd ask me about the past and have me dig into that and really ask tough to answer questions that forced me to think about why I thought the way I did. It took probably a good dozen or so sessions to get to the point where I was relatively healed and even then it took some time after, but by then I was able to regulate my anxiety on my own.

From an erstwhile therapy procrastinator:

First of all, don’t stress about explaining “what’s wrong” to a therapist before you meet them, or let this become a barrier to you getting started (I fell into this trap for years myself). A simple “Hi my name is X and I’ve been been thinking about finding a therapist to work on some issues with. When would you be available for an initial call?” is perfectly sufficient.

A thing people say about therapy is that it’s like a bit like dating. Don’t be discouraged if it takes a few tries to find someone who is accepting new patients and feels like a good fit (most will offer a free consultation as well to help you evaluate this). Give them a fair shot, a few sessions at least (I was skeptical of a therapist I was randomly assigned ~10yrs ago, but he swiftly cured a very acute case of hypochondria that had bubbled up out of nowhere. However, you should move on to the next one if it really isn’t working—unlike dating, your therapist won’t be hurt (or if they are, then they have the tools to deal with it right?). This is probably the best directory for finding local therapists: https://www.psychologytoday.com/us/therapists

Most will give you a set of questionnaires to complete before or during your first appointment (e.g.: https://www.uwgb.edu/UWGBCMS/media/Continueing-Professional-...). This gives them a coarse baseline of what’s going on.

The conversation simply evolves from there. Over time, you will occasionally pull out surprising memories and insights from the depths of your mind like the proverbial Mary Poppins bag. There’s a lot in all of us to unpack, and they are there to facilitate that process.

A common attitude (again, one I’ve suffered myself) toward therapy is: “What will a therapist tell me that I don’t already know? I can solve these problems on my own if I actually tried.” Maybe, but the operative word phrase here is “actually tried”. Actively reflecting on your thoughts/emotions/actions and vocalizing them to another person for an hour is challenging, but it is therapeutic in and of itself. It’s very hard to do on your own, and sometimes take a probing question or two to dislodge a blind spot.

Also, if you want to listen to some real therapy sessions (intermixed with lecture content on the theory and research behind a common type of therapy), these lectures on Cognitive Behavioral Therapy are excellent. It follows a few different people from the very beginning (skeptical of or unsure about therapy or what their deeper issues are) through their process of improvement via weekly sessions/assignments. It can really help demystify therapy for the unfamiliar: (https://www.audible.com/pd/Cognitive-Behavioral-Therapy-Audi...)

PS—Keep asking good questions.

It's like dating where each bad date costs $250+. (Around here, the initial appointment is not free and often costs extra.) Obviously the process works for some people, but it is dauntingly difficult. And phone/video therapy, these days, is especially ineffective.

I don't like listing complaints, instead of a productive comment like yours. Obviously, some people make it work, but maybe you need to know people with similar personalities and similar issues, to get recommendations?

The process is daunting, and the mental healthcare system is deserving of extensive complaint. I have had my own “bad dates”. My fav: I was suffering extreme burnout and had just had my car stolen, among other things. I found a therapist. On our initial appointment, he bloviated about his academic pedigree and how it “wasn’t his first rodeo”, then dismissed my problems as not knowing what I wanted out of life (I was getting an MS in math while working full-time). Cost? $400.

Not long after that I (spoiler alert) needed a psychiatrist. It took me 30 calls to find someone with availability. I punched a hole in my wall around call #20.

As recently as last Fall, I was still spinning my wheels, delaying the unpleasant search process for a therapist. I was so frustrated with “the system” that it short-circuited any desire to make the effort. There were at least four major barriers:

1) communication anxiety — worried about explaining myself and my problems to a prospective therapist. [addressed in my previous comment—keep any introduction email/call extremely simple.]

2) financial anxiety — as with all healthcare in the US, the amount you pay is a random variable. Maybe it will be a waste? Maybe I will go bankrupt? [if you have insurance, find someone on your plan using the Psychology Today search filters—they also often list the cost. if not, there are other free or low-cost resources available, but it’s context/location dependent. some potential options include the VA, school/college therapy, counseling programs @ your employer, therapists in-training, various community/nonprofit organizations. ask a trusted friend to help you search, it can alleviate some of the frustration. you can ask me.]

3) avoidance anxiety — embarrassment around explaining my life story. Why and how should I explain the fact that I smoke weed 10x a day (a true 10x developer over here) to cope with my issues, when I could simply roll another joint? [one role of the therapist is to be a non-judgmental sounding board and co-strategizer—they aren’t your coworker, parent, partner, etc. this is a hard mindset to learn, even for me to this day. I find myself saying things I think my therapist wants to hear. as a corollary: ER docs have seen the full Cartesian product of injuries from {objects} x {orifices}. whatever you come in with is not as unique or embarrassing as you think. they do this all day long.]

4) perfectionism — “Yeah I’m sure this therapist can help someone get over a breakup or their dead cat, but I’m a special brand of fucked up and they won’t get it. I need to find a someone that is perfectly specialized in my personality/problems, or it will be a waste. Also they need to have a PhD from a good school, female, not too young or too old, not ...”. [just a reminder that this is not a search for your soulmate. a student therapist or MSW may be more effective for you than a famous professor with books and accolades (see above). anecdata: the two therapists that I hand-selected didn’t pan out for me at all. the two that were chosen for me at random were a wonderful fit.]

Finally, I would push back on the idea that remote therapy is ineffective. Telehealth in general is proving to be pretty effective, and with therapy they don’t need to interact with any physical structures. The only thing that is slightly diminished is nonverbal cues, but that’s not insurmountable. There are a lot of advantages: significantly more options (no location constraints), easy to schedule and keep appointments, can be more comfortable to not be physically present, and no stressful driving. I recently did a therapy appointment call from the Appalachian Trail!

    I'll need some information first
    Just the basic facts
    Can you show me where it hurts?
    …
    When I was a child I had a fever
    My hands felt just like two balloons
    Now I've got that feeling once again
    I can't explain you would not understand
    This is not how I am

Very relevant: A lot of Pink Floyd deals with themes so universal everyone can relate. Time, money, trust, madness.

I had similar experience, but can't say my therapy was a huge success. When gotten familiar with my situation, my therapist said the we need to build trust and that she's gonna do the work that my parents failed to do.

I was initially much more inclined to have "here's my habits and behavior patterns, tell me what to fix there" type of sessions. Then I tried to play this game of trust, but the idea of trusting and leaning on someone who sees me once a week to do job and get paid seemed just wrong.

"she's gonna do the work that my parents failed to do"

That is a psychotherapy cliche, but it has a lot of merit to it.

Significant adults in your life have imprinted/caused MOST of the ways you approach love or work. Just think of how vital those adults were to teach you language -- without them you wouldn't be speaking at all; with other adults you would be speaking a completely different language -- it is the same with your emotions, bounadries and limits, beliefs about yourself and others, how to meet your needs and so much more.

So, do not dismiss exploring your relationship with your parents -- it is the foundation for everything else in your life.

Not at all, I actually liked the idea a lot. It's just hard for me to take a any positive feedback from a person I pay to listen to the said feedback.

I think you're interpreting "trust" mostly in terms of "this person will tell me true things", but telling you the truth is pretty far down the list of what therapists do. "Truth" is often not even well-defined when it comes to your internal mental state.

Most of the truths that you hear in a good therapy session will come out of your own mouth. You just didn't know they were in there until the therapist guided you to them.

Try to think of "trust" more in terms of safety. With a good therapist, you can trust that if you share your truth with them, with all it's ugly dark aspects, that they will not use that knowledge to harm you.

Don't think of it as an exchange of money for a service. Think of it as making sure your therapist can continue helping you and that he or she doesn't have to take a part time job to pay for their vocation. It's like how some people tithe to a church and put money in a priest's collection plate. They're making sure the priest can follow his or her vocation full-time. The money doesn't create the vocation.

> It's just hard for me to take a any positive feedback from a person I pay to listen to the said feedback.

If someone is crying, you are getting emotional feedback from that person that they need help. They could cry for any number of reasons but the feedback they provide you by crying remains the same until you discuss it more. Paid feedback or not - outsiders will provide you similar feedback that will be relevant to you because they are able to empathize (that is if you are honest).

But I get you. if you think of paid feedback as fake reviews on playstore, you will get discouraged. It's hard to give a fake plausible review and it's quick to spot for human interaction though.

You should tell this to your therapist and see what happens. To me I've learned a lot following this line of thought.

For you, it sounds like you think that the therapist "might just be doing it because I'm paying them", and that their emotions care towards you might not be genuine? Maybe that you want a kind of selfless care and the monetary aspect would make it feel less selfless or sincere?

> the idea of trusting and leaning on someone who sees me once a week to do job and get paid seemed just wrong

It seemed wrong to me at first, too, but eventually I saw how it made sense. The aspects of the relationship that would normally be fraught with fear and uncertainty -- is this person invested in my happiness, will this person respect my confidences, will this person use what they know about me against me, will this person turn against me if they learn my shameful weaknesses -- are encoded in their professional obligations. That's not enough for it to be a great working relationship (you need some personal chemistry as well) but it's a great foundation to start from.

I would agree with you, you can't pay someone to replace what your parents didn't do with a session once a week.

Did you ever consider looking for another therapist?

Yes, I'm overall optimistic about therapy in general. I did get some valuable things out of my sessions, and I think it would've been hard to find these things somewhere else.

Therapists tend to get expensive though, when I improve my financial situation I'll definitely look for some more.

I've been diagnosed with BPD.

I've seen three personal therapists and a couples therapist. They all helped and I learned some tricks from them, clarified things, my BPD symptoms have diminished, but they tend to do so with age without any therapy.

All therapists sucked in the same regard -- they fail to follow through -- I've heard so many times "oh, for this issue I know this great exercise and this great technique, we'll practice, bla bla bla", only to forget about it by the next session.

I have seen a couple therapists as well. In my experience, their service is a partnership, not a one-way fix. If they forget something, remind them. If you are feeling something they aren't bringing up, bring it up yourself. Therapists are not parents who will carry you through your problems, they are advisors to help you see the problem and learn some techniques to help. You still need to do the work, which includes directing the conversation at times.

If the therapist doesn't have its shit together it undermines trust that they can help other people get their shit together.

Also a BPD. I see therapists on and off. I’ll do a session every two weeks and then drop off, sometimes I’ll find a new therapist because I want something new.

That's not good and not bad. As far as I know, if you want to help with BPD by therapy, its better to have the same therapist, given you two have a plan to improve certain aspects.

I'm currently seeing a female therapists that runs some groups for DBT for BPD; but given that I'm (highly)functional and male(that's just me being mean), it's just 5% of the sessions(after an occasional flare up) that she acknowledges my BPD.

Yeah. I’m sad that men with BPD are recognised so much less... I had a psychiatrist in a big hospital tell me that my diagnosis is wrong because men can’t get BPD.

To whoever downvoted GP: please don’t unless you actually have experience.

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