Ask a Psychiatrist and Get Answers to Mental Health Questions ASAP
Thanks for writing to JA.
Your problem, as posted, was direct and to the point. I appreciate your honesty with us here. I will try to be as direct and honest with you in response:
It sounds like you're experiencing fear about not being able to "break down your wall" and finding excuses for not doing so. If you believe that you "should go into and open up" to him, then it is your responsibility to do so. I believe (and likely most Clinical Psychologists, believe) that it is a client's responsibility to bring to the table what needs to be discussed.
In the "old days," the belief that therapy would reveal hidden truths about you was simply accepted as fact. This belief no longer holds much currency - and clients are expected to provide the material from which to work. Yes, the psychologist/therapist can provide additional insight (less important) and provide strategies/actions to solve problems (more important) - but we "can't build a house if the bricks aren't delivered."
If it truly is the case that you are seeking that kind of relationship with your therapist (the kind who digs out truths and breaks past your wall), I would encourage you to consider looking for a psychodynamic psychotherapist. They specialize in this kind of work... but I suspect you already know what the truths are that need to be discussed... and, again to be direct and honest, you need to put them out there so you can work on them. It's not his job to do this - it's your's.
[Note: I honestly appreciate how frightening it might be to disclose the issues you're withholding. Perhaps one way to begin this conversation with your therapist is to say, "I've been thinking about how to discuss some things that are pretty scary for me to talk about. What suggestions can you give me to get myself ready to just spit it out so we can work on it together?" You're not talking about the issues... you're talking about how to talk about the issues. Sometimes this is the "toe in the water" that some folks need. I also believe that sometimes just "taking the plunge" can be more productive! In either event, don't wait for him to ask just the right question or provide just the right answer to give you permission to talk about what you need to talk about. You already have the permission... and you've already paid the bill... now's the time to leap over your fears and say what you want to say. You'll be amazed at how freeing it can be.]
With regard to depression and anxiety, research has consistently demonstrated that treatment plus medication is more effective than medication alone or treatment alone for depression and/or anxiety. Further research has shown that Cognitive Behavioral Therapy (CBT) is the most effective form of psychological treatment/intervention - particularly in dealing with mood and/or anxiety disorders.
A licensed psychologist/psychotherapist with specific training in CBT modalities would be able to address your concerns. I would encourage you to find a licensed mental health professional with whom to work, employing CBT. Be sure when you speak to a possible licensed mental health professional that s/he employs CBT techniques - not just "influences from CBT" or "an eclectic approach."
With regard to medical treatment, many/most physicians appear to begin with a Selective Serotonin Reuptake Inhibitor (SSRI) to treat anxiety. Because I am not an MD, it is beyond my purview to address medication concerns, however.
Again, the mantra of years of research says: medication or treatment alone is not as effective as both working in tandem. Some research has also indicated that insight-oriented talk therapy is counter-productive with some forms of mood and/or anxiety disturbance... it actually exacerbates the condition(s). So, seek out a CBT therapist who will provide targeted, efficient, and effective therapy - not someone who signs you as a "lifer." If you're going to a therapist for years, something about the therapy isn't working.
Your psychiatrist *may* know of a CBT licensed mental health professional. Please make certain, however, that they employ CBT practices.
If $$ is a super-big issue, you might want to consider contacting your local Community Mental Health Center. These tend to offer free or greatly reduced cost mental health services, including therapy and/or med management, depending upon your ability to pay.
Thanks. I hope you're well and that this was helpful.
* FEEDBACK ENCOURAGED. Please contact me prior to leaving negative feedback so that we can resolve the matter. I am eager to work with all JA clients to provide them with useful/helpful answers. Thanks again.