Frightened of Failing Therapy

Jassy:

I value your opinion as someone who has journeyed through counseling & someone who has "studied" counseling. I need your advice & wisdom. Today in therapy, my therapist said that we need to "re-look at the treatment plan and re-evaluate: see which goals have been met and what new ones can be created". (I THINK she mentioned new ones.) We completed the original treatment plan in 7/04. It has really not been mentioned much. This freaks me out. Am I failing therapy? Am I not working hard enough? (Please don't say, "why don't you ask your therapist?"-that will piss me off.) I think i MIGHT bring it up, but that is 11 days away, but besides that, what do you think? Is she going to kick me out? Am I too dependent on her? Am I not needy enough? Why did she decide on this particular day to say we needed to re-evaluate? She told me I should journal about "why I am choosing to stay stuck; safe vs. unsafe." This was after I shared for the second time this entry I wrote around 8/15ish "Now if I don't want my life to continue as it has been, then obviously I need to make some changes..." and I listed 7 things. We briefly talked about the need to do something different, and about the quote "Mental Insanity equals doing the same thing over and over again, expecting the same results."

Spill it and preach it.

Frightened of Failing Therapy

PS: I am going to sleep on it tonight whether I should ask her for a copy of my original goals (I know I should have it but....), and whether I can see her earlier instead of waiting 2 weeks, because I am really freaking out. I know I need to create attainable goals. But I don't know...in therapy do you do SMART goals like in the business arena???? I am going to go through my therapy journals from the last 2 years. I am going to talk about what positive steps I have taken as a result of therapy, and what negative steps I have taken because of/maybe not because of therapy; and think about new goals I can work on.

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Dear Frightened:

Wow, you really do have yourself in a tizzy here, don't you? I apologize for taking time to respond to your email and yes, of course I am going to suggest that you show the email you wrote me to your therapist. I don't know you inside out like she does, and therefore can't possibly respond with as much insight about you as she would be able to. Go on! Take the bull by the horns and risk it.

However, for what it's worth I will respond to your "spill it and preach it" invitation.

First of all, you can never fail therapy. Your therapist can fail you, but you can never fail. Just by showing up week after week, you show your willingness to make changes.

Let's start by addressing the purpose of treatment plans in therapy. Some therapists, as part of the early work in your therapy, formulate a treatment plan with input and guidance from the client. When used correctly, a treatment plan is a kind of road map for the work that you will do with your therapist during your course of treatment. The therapist, and the client, will use it as the beacon that lights the way for it contains the goals, aims, objectives and ways in which you are planning for your recovery. The treatment plan will often inform all the work that you do with your therapist and is YOUR definition of the ways in which you want your life to change. This plan will include what you are choosing to work on ("I don't know how to stand up to my father. I want to learn how to do this"), what you will do to work on it ("I will identify in therapy the specific things that scare me about standing up to my father. I will identify various ways to practice standing up to my father and work on the feelings that come up as a result, using role play, talking to my therapist about my fears and reading books suggested by my therapist "), and how long you think it will take to do this ("I will use these techniques over the next 3 months and re-evaluate the changes in my relationship with him at the end of that time"). Sometimes they address specific tasks such as consulting with a psychopharmacologist about medication, sometimes they make suggestions about groups to join or meetings to attend. Treatment plans seem very hard and fast, but actually they most often are used flexibly as things get worked on and problems figured out, and also as new issues emerge. Some of the goals may be long-term and some short-term. But the point of the plan is to concretize the direction of the therapy and to make clear what you, the client, hope to get from all your hard work.

Okay, so onto your fears. If you are clear that you and your therapist worked on the original treatment plan together and as you say it has not been mentioned since, my guess is that you met all your goals. This is a good thing, not a bad thing. Give yourself a pat on the back for all your hard work, Ms. Frightened! As goals are identified, worked on and successfully treated, you will move onto the next goal. I suspect this is what your therapist is referring to when she talks about identifying which goals have been met. More than a performance review for you, it's more like a strategic planning session for you and your therapist. Actually, it sounds like you already have plans to do that for yourself, based on your statement that you are going to "go through my therapy journals from the last 2 years. I am going to talk about what positive steps I have taken as a result of therapy, and what negative steps I have taken because of/maybe not because of therapy; and think about new goals I can work on." You are clearly a pro-active kind of client , and this is wonderful - we therapists LOVE working with folks like you!

The insecurity that you display about your relationship with your therapist could probably benefit from attention. For example, unless you are (1) threatening your therapist with physical violence (2) not paying him/her or (3) repeatedly cancelling without notifying her, then it is highly unlikely that you are going to be "kicked out" of therapy. Tell your therapist about your fears. No doubt this isn't the only place in your life that you fear rejection, but it does give you a safe place to work on these feelings so that they have less power over you in your life.

I'll be rooting for you, Frightened!

Jassy