My therapist doesn't think she can help me.

[John D.]

Recently (about a month ago) I began seeing a therapist for deep depression/dysthymia. This has been a long-standing problem of mine (it began in my early teens and is rooted in my early family life) but in the three or four years it has become nearly incapacitating due to recent upheavals in my life (among other things). I am not presently on any medication. I have seen therapists in the past (mostly when I was much younger - I'm 39 now) but there was rarely if ever any long-standing benefit - I never felt much better or 'different' in my thinking after visits to therapists and so I usually didn't stick with it.

At my last visit to the therapist (last week) she told me at the end of the session that she didn't feel that the therapy was helping me (it was my fourth or fifth session). She told me that she feels there is some kind of "barrier" or "disconnect" between my cognitive thoughts and my emotional self, i.e. that I'm mentally quite aware of not only my problems but also my negative thought patterns but it doesn't seem to make any difference on an emotional level. She told me that it was "up to me" to decide if I wanted to continue with the therapy, and she also said that she wasn't trying to say therapy would *never* help - just that for me, it might take much longer than for other people (I didn't have a chance to ask her why).

I am wondering if this is a common occurence, and whether it means I would be better off finding someone else. She is the third therapist I have seen just in the past 12 months in my search for someone who can help me and I'm losing faith.

[Dr. Adams]

The term "therapist" is generic as you can see from those who posit opinions on talk shows and news broadcasts. In most states, one does not have to have a license to refer to oneself as a "psychotherapist" or "emotional counselor," etc. The terms "physician" and "psychologists" are registered by law. But even in those cases there are those who are Board Certified or have specialty training. You are moving rapidly between these people. Be certain you know whom you are seeing, what they are and whether they are competent to diagnose and treat you.

[John D.]

Thanks for the reply.

The therapist in question is a PhD licensed and registered as a psychologist in NY & also licensed in NJ (I've been able to confirm both licenses online, she does have the license numbers on her business cards too though).

I should also note that she suggested that I consider getting a 'work-up' from a psychiatrist for possible medication as well; although since she's said she doesn't think the therapy is helping me, I'm kind of confused now. I don't know what to think.

[Dr. Adams]

You likely have researched sufficiently on Dysthymic Disorder to determine that it is less responsive than Major Depressive Disorder to SSRI, SNRI and MAOI for treatment of depression. However, it could be that you have both Dysthymic Disorder and recurrent Major Depressive Episodes. Her diagnostic testing should have been able to tell you this. The treatment of choice would appear to be cognitive-behavioral psychotherapy, but you indicate that she feels this is not going to be effective.