View Full Version : How many counselling sessions for improvement?
Hi,
I realise that this question is a bit like "how long is a piece of string?", but I'm getting concerned that, after twelve weeks of counselling for anxiety attacks, I'm not seeing any obvious improvements.
As I wrote in my initial posting in the "Introduce Yourself" section of this forum:
I've been attending weekly counselling sessions for the last three months, but I haven't noticed any improvement -- indeed, my anxiety seems more pronounced now than it was when I started. I trust the counsellor and she seems to be doing the right things, but the sessions don't seem to be getting through to the problem. I'm starting to wonder whether I'm somehow blocking my own progress.I'm sure that I read somewhere that therapy ought to produce some positive results within six sessions. Although the counselling has helped me to identify some long-term issues, I don't feel that it has yet given me any keys to recovery. Either that, or the keys are there but I'm refusing to grasp them -- a possibility which I'm willing to accept but which feels dispiriting.
I may have complicated matters by going on to medication in the middle of the counselling. My counsellor had previously advised against this approach, but I felt that I had no alternative when I hit a serious low just after Christmas:
In desperation at the New Year, I visited my GP who suggested starting me on Citalopram (20mg per day). I've been taking that for two weeks now and getting side-effects (tiredness, headaches, nausea) but no clear signs of improvement yet (hopefully soon!).I'm now unsure whether to persevere with the counselling (not least because it's costing me money for each session). I've been tending to regard it as a "lifeline" that I'd be foolish to discard, but I wonder on the other hand whether this attitude is unhelpful in itself.
I'd be very grateful for any thoughts that anyone can offer to help me make a decision on this.
Many thanks. :)
margaret jones
19-01-10, 18:38
Hi I think you have to make the decision yourself re councelling whether to carry on or not .
I had a lot longer 6 mnths of councelling firstly weekly for 3mnths then every 2 weeks until it was 1 session a mnth i finished in Nov last year i feel it worked for me , i did not take any meds so cant comment on that , it is expensive i had to pay .
Try and think back to when you started and how you felt ?? then think about how you feel now thats how i decieded if it was working or not .
Not a easy one i am sure you will make the right decision .
Take Care Margaret
nomorepanic
19-01-10, 19:14
Are you having counselling or CBT?
Maybe if you aren't having specific CBT you need that instead.
Thanks, Margaret. I'm glad to hear that a longer course of counselling can achieve lasting results. I'll bear in mind your suggestion about comparing back to how I was feeling before starting the counselling, although that's problematical. During the course of the counselling, I've developed some depressive aspects, presumably due to the longer-term effects of the anxiety, so I actually feel rather worse now than when I started. As you say, it's definitely my decision whether to continue or not, but I appreciate receiving views from other people in helping me to reach it.
Thanks, Nicola. The counselling isn't specifically focussed on CBT, although I believe that the counsellor has been applying some CBT techniques. Most of our attention has been on identifying underlying issues and motivations for my anxiety. Whilst I've made some progress on those, my insights don't seem to have enabled me to change -- hence my suspicion that I'm blocking myself.
Just.A.Girl.x
20-01-10, 03:13
Hello Aquarian,
From my personal experience, I had councelling on the NHS which didnt work for me with the anx..though I did talk about other underlying problems. I then had CBT private and I didnt like the therapist and as I was paying I stopped doing that. I then got on the CBT list with the NHS and it was amazing...it really helped me!!
I really do think CBT is the best way to sort out anxiety as it is very planned and homework based...you actually have to go out and do something about it opposed to sitting talking about problems which are good to be sorted but dont change the anxiety.
As I say this is just my view on the subject and I am now on the waiting list for CBT again after a set back..and have also bought a book on CBT to keep me going while I wait but I do recommend getting yourself on the waiting list even if you change your mind later on :)
Good luck
Candy xxx
Hi Candy,
Many thanks for your thoughts. I can imagine that it's very difficult for any form of therapy to work if you don't get on with the therapist.
I'm encouraged by what you say about CBT. I've just signed up for the free online CBT course at http://www.livinglifetothefull.com/. I'm hoping that it will provide me with a more structured approach to coping with the anxiety symptoms while the counselling addresses my underlying issues. I'm aware, though, that I'll need to put in the necessary time and effort in order for it to pay any dividends.
Cheers and all the best.
Hi Again,
You could try keeping a diary. Since no-one else will ever see it, it might help you get to the bottom of the "blocking" issue.
If you think there are things worrying you that you think might seem silly or trivial for instance it might be that you are reluctant to discuss them, possibly without even realising it.
I'm quite happy to say here that something as stupid as a malfunctioning washing machine, when added to some other stuff, definitely contributed to my anxiety last year. I'm not sure if I'd be be prepared to acknowledge that away from this forum though!
Hi. Im been having CBT on the NHS since the just before christmas and its just recently turning me around. I started a new medication after the first few weeks too which didn't help with the counselling coz of the side effects but they are lessening and I'm eating better and exercising. CBT is good because its proactive. When you leave the sessions that isn't the end of it until your next appointment. You actually put what you discuss into practice and with the help of the CBT therapist, analyse the results the following week.Have you asked your GP to refer you on the NHS?
By the way, at the moment I keep a diary and three times daily I mark my stress levels from 1 to 10 (10 being mega stressed) and identify what Im doing at the time. . I can see a significant improvement over the last few weeks and it has been interesting to see where patterns emerge so that I can come up with coping strategies with the help of the CBT counsellor!For example I always feel worse at the weekends and there is one particular social occasion that rates a 10 on the stress level. Rather than avoid it, Im learning how to cope with it. To come up with a plan etc...You might like to try this, you would be amazed how useful it is. Good luck.
Hi, I agree with Nic, if counselling isn't helping you to deal with the anxiety you need specialist treatment. I was referred on to an anxiety specialist by my counsellor when we realised that as helpful as counselling can be, it is not really appropriate when there is a medical issue like an anxiety disorder.
Aquarian, suffering from anxiety in the long term can lead to feelings of being depressed, and I would say it's normal for the anxiety to feel slightly worse with time if you aren't receiving the correct treatment. In cases like yours the depression tends to disappear when the anxiety starts to back down.
Many thanks for those replies.
You could try keeping a diary. Since no-one else will ever see it, it might help you get to the bottom of the "blocking" issue.
If you think there are things worrying you that you think might seem silly or trivial for instance it might be that you are reluctant to discuss them, possibly without even realising it.
Although I'm quite an emotional person, I do find it very difficult to write about emotional stuff. I may be hampered by my science and engineering background which drives me to strive for precision in my written expression. Of course, it often isn't possible to achieve that with "feely" issues.
I'm quite happy to say here that something as stupid as a malfunctioning washing machine, when added to some other stuff, definitely contributed to my anxiety last year. I'm not sure if I'd be be prepared to acknowledge that away from this forum though!
I'll admit to very similar issues! Much of my current anxiety centres on technology -- or more specifically my feelings of helplessness in the event that equipment malfunctions. The irony is that I have fairly strong technical skills, so I ought to be well-placed to deal with these problems, but that seems to make things worse as I'm also capable of imagining nasty failure scenarios which most people probably don't think about at all.
My recent major episodes of severe anxiety have all related to problems with computers. I've come to rely on computers a great deal in my day-to-day life -- not least for my work -- but I've been increasingly feeling that they're in control of me rather than the other way round. If something goes wrong, then for me this setback takes on epic proportions. It's no exaggeration to say that it dominates my thoughts and my life until it's solved.
Hi. Im been having CBT on the NHS since the just before christmas and its just recently turning me around. I started a new medication after the first few weeks too which didn't help with the counselling coz of the side effects but they are lessening and I'm eating better and exercising. CBT is good because its proactive. When you leave the sessions that isn't the end of it until your next appointment. You actually put what you discuss into practice and with the help of the CBT therapist, analyse the results the following week.Have you asked your GP to refer you on the NHS?
My GP agreed a few weeks ago to refer me for counselling on the NHS, which I believe is based on a CBT model. I think it's likely to take several months to get an appointment through.
By the way, at the moment I keep a diary and three times daily I mark my stress levels from 1 to 10 (10 being mega stressed) and identify what Im doing at the time. . I can see a significant improvement over the last few weeks and it has been interesting to see where patterns emerge so that I can come up with coping strategies with the help of the CBT counsellor!For example I always feel worse at the weekends and there is one particular social occasion that rates a 10 on the stress level. Rather than avoid it, Im learning how to cope with it. To come up with a plan etc...You might like to try this, you would be amazed how useful it is. Good luck.
Thanks for that. It's an interesting idea and I can see that it might be worthwhile. I can see that it might serve two purposes: (a) identify the times and situations that are worst (and best) for you; (b) break down "all-or-nothing" thinking which might lead you to believe that a day has been terrible all the way through when it's actually just been overshadowed by one bad period.
I've just started the routine (suggested by my counsellor) of making a list as I go to bed of all the positive things to have come out of the day, with no negatives allowed! I think it's another way of tackling item (b) and my bad habit of turning a drama into a crisis.
Hi, I agree with Nic, if counselling isn't helping you to deal with the anxiety you need specialist treatment. I was referred on to an anxiety specialist by my counsellor when we realised that as helpful as counselling can be, it is not really appropriate when there is a medical issue like an anxiety disorder.
OK -- thanks. I'll bear that in mind. I need to visit my GP again soon for a review of the medication, so I might ask him about that.
Aquarian, suffering from anxiety in the long term can lead to feelings of being depressed, and I would say it's normal for the anxiety to feel slightly worse with time if you aren't receiving the correct treatment. In cases like yours the depression tends to disappear when the anxiety starts to back down.
That makes sense. Certainly the anxiety serves as a constant reminder that I'm not functioning properly at the moment -- and that's very dispiriting in itself. I'm hoping that the medication will help to reduce the symptoms and get me back onto an upward trajectory, and that counselling/CBT can then help me to address the underlying issues which caused me to get into this state in the first place.
Originally Posted by Brunette
I'm quite happy to say here that something as stupid as a malfunctioning washing machine, when added to some other stuff, definitely contributed to my anxiety last year. I'm not sure if I'd be be prepared to acknowledge that away from this forum though!That sounds like stress is a major trigger for you. It's usually the little things that seem to push people over the edge, nobody ever seems to lose it when something major happens, it's always when technology won't work or someone walked into the house wearing muddy shoes or that kind of thing. That extra little bit of stress just makes us kick off.
Aquarian - depression and anxiety are as much about feelings as they are about thoughts. Science and logic can be used to fight them but in order to move forward as a person it's important to embrace your emotional side and recognise that you don't need to be afraid of it. As your recovery starts to gather pace it might be easier for you to express emotions. The whole process sort of opens itself up to you.
Logic is very comforting and it can be a useful weapon, but it can be too inflexible sometimes. Feelings can be messy but we were made to experience them and using them correctly can be the key to living a happy life. Think about Kirk and Spock, those two were always at loggerheads over something, but they usually both had something to bring to the table ;)
Right now you might be scared that exploring your feelings will trigger you or make yourself feel worse. It might happen like that to begin with as recovery is like being born again. Birth is painful. When the time is right to express these feelings, you'll know. :hugs:
Thanks, PsychoPoet. Sorry that it's taken me a while to reply. I've been feeling a great deal better over the last few days (perhaps due to the Citalopram kicking in at last). I've been a lot less wrapped up in myself and I've been getting on with stuff -- to the extent that I had forgotten to check out this forum!
I understand your points about feelings and logic. Internally, feelings have dominance over logic for me, but I'm generally uncomfortable about admitting that to the outside world (which seems to put greater value on objectivity). As a result, I tend to invalidate my feelings and try to justify myself using unemotional language, so I'm lacking practice at expressing my emotional side. It's probably an area that I need to explore some more.
bellabessnjet
31-01-10, 14:54
Hi, I'm currently having CBT. Initially for what I thought was the main prob an ant phobia, after a while it was my low self esttem and then the ant phobia came back when I found an ant over christymas in the house. After a lot more exploring my head (good luck to the guy lol!!) its because I cant control the ants thats the problem. So I've now been diagnosed with a mild OCD. I think just because we think that A is the main problem, B,C,D and more also add into the equation so therefore your therapist may be trying to find the rooot cause of your anxiety. Hope that makes sense.
Good luck and keep on trying to recover
All my best Angela:hugs:
Hi Angela,
Many thanks for your reply. That's an interesting thought. A great deal of my anxiety seems to be triggered by problems with technology (ironic as I'm a technologist!) and my fear of losing control of it (as with your ants). I worry regularly about how I could possibly cope in the event of something going wrong. Recently, I've found myself obsessed with trying to anticipate and find solutions to all potential problems even before they've shown any sign of occurring. Of course, that's an impossible task.
I don't generally show up as a strong candidate for OCD, but it strikes me that I'm possibly experiencing OCD in a narrow range of situations. I suppose it also fits that those trigger situations are the ones in which I have a strong vested professional stake in being in control.
One big reason why I find it difficult to challenge my current condition is that I can see that it's at least partly rational (unlike, say, a fear of doorknobs). I think most people would agree that computer technology in particular is becoming more difficult to fathom, even for relative experts, but that it's also becoming more critical to modern living. My discomfort stems from a very real and widening gulf between the level of control that I'd like to have and the amount that is humanly achievable.
Thanks for your input. You've definitely given me something to think about.
bellabessnjet
02-02-10, 23:34
Hi Aquarian,
Another thought reading your posts,we all use atomatic thinking but sometimes it goes a little wrong. I was given a whole page full of 'differnent' thought processess. If your interested I'll try to dig them out, here are a few that I remember,
1, Fortune telling - you predict whats going to get worse or danger is ahead,ie I'll fail that exam I wont get that job.
2, Negative filtering - You dwell on negatives not positives, ie look at all the people who dont like me, instead of look at all the people who like me.
3, Shoulds- "I should do well if not then I'm a failure" Thinking of how thinks should be rather than how they are.
4, Mind reading - you assume you know what others are thinking about you, ie. he thinks I'm an idiot.
Catastrophizing - Believing what has happened or is going to happen will be so bad and unbearable you wont be able to stand it. ie,It would be terrible if i failed
These are just a few that I frequently do yet if you can question your thoughts and challenge them, take them to court, then when you find the evidence to support the thought and look at the prosecution case for not believing that thought then you can change how you think.
Hope that makes some sense, I'm struggling with this a lot of times, one example of mine is, I recentlky had an ant in the house, did my CBT therapy managed to bring my anxiety down, but felt so low afterwards that I felt a failure. When I quetioned that thought there was absolutely no 'evidence' to support it, in fact I DID it, I should be proud of myself were the true thoughts I should have been having.
Hope you can understand this and if I can help in any way let me know
Angela
Hi Angela,
Thanks. That does make sense to me.
I can relate to your recent ant incident. I find it difficult to think back on any event involving my anxiety as a success. Even when I've battled through and reached a satisfactory outcome, I tend subsequently to dwell mainly on my nasty feelings at the time rather than the actual result. I also tend to regard it as a failure merely that I've succumbed to anxiety in the first place.
I understand that I need to modify my thought processes, and I've discussed this with my counsellor, but my attempts so far to follow the CBT approach haven't seemed to work. Although I can follow the logical steps to reach a more positive interpretation, it feels to me as if I'm not really accepting it deep down. I'm not sure whether it's stubborn denial or a lack of belief on my part.
It probably doesn't help that I'm an instinctive sort of person, driven much more by feelings rather than logic (so CBT may not be speaking to me in my natural internal language!), and that I find it uncomfortable to re-visit previous incidents, as explained above.
I'm certainly not giving up on the CBT approach. I'm just finding it much more difficult than I expected. My internal negative beliefs seem to be firmly entrenched and unyielding, although I don't understand why I'm so attached to them.
Many thanks for your thoughts. It may be that you've illuminated a dark corner which contains a vital piece of the jigsaw puzzle!
bellabessnjet
03-02-10, 07:44
Hi Aquarian,
No exactly what you mean, said as much to my therapist on Monday. Yes I can chaleeenge my thoughts, yes I can change my thoughts Do I then believe the new more positive thoughts NO!!! He just said to stick with it and eventually it will begin to kick in, he also said I'm now starting to use a different part of my brain, so it needs time to grow and become stronger. Nice to know that I'm not the only one struggling. Also I told him I can come on here and be so positive to others, and he suggested maybe treating myself as 2 people and offering the 2nd me the same asvice I would give to others.
Take care Angela.
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