A woman once proudly told me that she had overcome her assertiveness issues in group therapy. She spent five years in a group with a member who savaged her, put her down and berated her incessantly, until she learned to stand up and defend herself. It seemed inconceivable to me at the time that someone would need therapy for so long to get help. She must be a real head case, I recall thinking, rather uncharitably.
Little did I suspect then that I would one day exceed that woman's therapeutic tour of duty by a wide margin. It's been 13 and half years and counting. And, if you're wondering, that is over $80 thousand worth of group and individual therapy (so far), not to mention workshops, seminars and the like.
Not long ago, I looked back on my years of therapy and realized it hadn't gotten me where I wanted to go. I had spent a lot of time thinking I was getting help when I was not getting the right help or all the help I needed. I had been led astray by compelling theories, lofty ideologies, strong personalities, respected authorities and social pressure. I was angry and disillusioned.
If you are considering therapy, I want you to get the help you need in less than a decade and a half. Therapy can greatly benefit you if it's done well, but it is expensive and time consuming. I offer from my own experience the following guidelines for getting the most from your therapeutic investment in time, tears and money:
Be clear about your therapeutic goals. While I am not a fan of formal diagnosis a la the DSM-IV, I do think it essential to be clear about why you want therapy. Sit down and with the help of a close friend or family member, decide what you want from therapy. Be as concrete as possible. Fully accept where you are now and envision where you want to be in the future. If your therapeutic goals were fully realized, how would your life be different? Imagine it, feel it and remember it. Would you be in a healthy relationship? Would you have a new career? Would you be happier, friendlier or more outgoing? Would you be less angry, have closer friendships or live a more productive and meaningful life? Spell out the desired therapeutic outcome so you know whether therapy is succeeding or failing. You can be specific, but not too specific, as in "By July 19, 2011 I will be married, expecting a child and living in Spokane, Washington with a cat and two dogs." Something more like, "Within a few years I will be in a healthy romantic relationship with the potential to result in marriage and family," would be better.
Reach a clear understanding of your goals with your therapist and group. Your therapist (in particular) and fellow group members (if you are in group therapy) must know your goals and agree to help you achieve them. They may even be involved in helping you decide what they are. Imagine for a moment that you are an aspiring tennis player. You hire a coach to help you develop your full tennis-playing potential. While the coach can't determine your full potential, he or she can do everything in their power to make you the best you can be. Demand that level of commitment from your therapist and from your group, then make the same commitment yourself.
Do the work. Therapy isn't something done to you, it's an activity you engage in with another person or persons. It's work. While the therapist (and group) must hold up their end of the deal, the onus is on you to work in each therapy session and afterward. It can be challenging to talk openly about your thoughts and feelings, especially in a group context, but there is no way to get help without discussing the issues that brought you into therapy. Do the best you can and ask for help when you find it particularly difficult. Be willing to take direction from the therapist and act on what the therapist tells you to do, in session and out. When you're given "homework," that is, something to do between therapy sessions, do it as best you can.
Remember the tennis analogy: No coach can turn you into a great player if you don't put effort into it yourself. Therapy isn't magic. It requires as much effort on your part as learning a challenging sport.
Discuss your progress with your therapist and group. Not every week or two, but on occasion, discuss how you are doing with therapy, how you feel about being there and whether you are doing as well as you'd like. Every person is different and some issues are more challenging than others, so there is no easy way to determine whether you are making as much progress as you should or could. But you can raise the following kinds of questions (and be open to the responses you get): Are you making good progress? If not, why not? Is there more that you could be doing? Are you stuck? If so, how can you get unstuck? Be honest. Do you need to work harder, or should you ask for more from your therapist and/or group? Don't be shy about demanding more help and voicing your concerns. Stand up for yourself!
Move on if you are not getting the help you need. There may come a time when, with or without agreement from your therapist and group, you conclude that you are not getting the help you need. In this case, you must move on. It's hard to say why therapy does not work. It can be a bad fit between you and the therapist. It can be the therapeutic approach, or it can be you. Therapy is as much an art as anything else, and a murky one at that, so the reasons for failure (or success) can be hard to identify. Don't become too concerned about differing psychotherapeutic theories and whether one approach is better than another. Therapists and psychologists (and others) endlessly debate the merits of one approach over another. The bottom line, as far as you're concerned, is simple: is therapy working? Is it helping me achieve my goals, or not?
If you take away only one thing from the advice I've given you here, let it be this: When it comes to therapy, be a hard-headed pragmatist. Give it your best, good faith effort and expect results. If you don't get what you need in a reasonable amount of time, move on.