From Both Sides of the Couch

A therapist reflects on her time with patients, and her time as a patient.

Taking Baby Steps: The Advantage of Going Slowly in Therapy

Proceeding at a snail's pace in therapy makes what we learn more likely to stick

Having been in therapy for so long, I’ve found the best way to succeed is to take tiny steps. The slower I went, the more likely it was that I processed the meat of the issues that my therapist and I explored and that the substance of the sessions stuck in my head.

When I said I felt that I was repeating myself, Dr. Adena said that it didn’t matter, in fact repetition was a positive attribute in therapy because each time I brought up the same topic, new concerns presented themselves with new themes. The reiteration of what had initially appeared to be one issue, grew like branches from a single tree trunk, each different and majestic in its own glory.

I realize now that there were several issues it took me years to get ready to even broach with Dr. Adena. All the therapy prior to my work with Dr. Adena was necessary so I could learn coping skills to effectively deal with sensitive topics without resorting to self-destructive behaviors such as cutting or threatening suicide.

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The issues that took several years to be able to raise with Dr. Adena included accepting that my mother was human. Taking her off the pedestal upon which I had placed her took a good three or more years; prior to when I was ready, if Dr. Adena mentioned the possibility I became angry and turned the anger inward.

Another issue was my sexuality. My position was that I was asexual and would remain that way for the remainder of my life. It took literally thousands of baby steps and a lot of falls before I was able to acknowledge that I am a sexual being ready to date and enter into an intimate relationship.

There were other issues — and there continue to be even today — it seemed that we tackled each one consecutively, so year after year I’d be knee-deep in the muck of my psyche. I felt stuck in quicksand, often depressed and I thought about resorting back to cutting, back to my benzo addiction, even longing for those cocaine days, but I stood firm in my conviction that those days were in my past. There were times driving up the narrow, curvy parkway that I took from work, when in a flash, the thought came to me that with a twist of the wheel, this could all be over. But I persevered and I am thrilled that I did for it’s wonderful to be alive.

 

I don’t seem to be able to persuade my patients that microscopic steps are the way to go. They want to be restored to health at the speed that the Concorde flew across the Atlantic. They seem to want the lightening version of therapy. I am aware there are therapists who claim that they can solve a patient’s problems in ten sessions, but the patients who come to our clinic generally have complex, layered diagnoses and life stressors.

“I’ve already talked about that,” they say.

“Try talking about it again. Something new might come up,” I respond. My patients usually acquiesce and they are surprised when they discover a fresh angle or different approach.

Some patients, the persistent and thus fortunate ones, stick out the therapeutic process only to discover that they eventually will access key issues. I’ve had several patients who have succeeded in achieving this (I won’t tell their stories here for privacy reasons) but suffice it to say that it took with each of them about two to four years of therapy before they were ready to explore their core issues, the ones which were preventing them from contentment.

I’m not advocating endless therapy. There needs to be a time when I and my patients can take the skills that we have learned in the therapist’s office with us into the world and leave our therapist behind.

I’m saying that while in therapy, the steps need to be small and well-supported by the therapist. If the leaps are too big, the gaps will cause bewilderment and confusion and that will lead to frustration and dropping out of therapy.

Patience — and persistence — in tiny doses work best.

 

 

 

Gerri Luce is a licensed clinical social worker who publishes under a pseudonym.

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