Why am I unresponsive to counsellors help?

I am a clinical psychologist trained in many therapy interventions including acceptance commitment therapy. I have used more traditional therapies such as CBT for many years, however some clients have been less responsive to these approaches. As a result I undertook training in acceptance commitment therapy which focuses on learning to embrace challenging emotions while focusing on valuable living. I am experiencing excellent outcomes with this intervention. To read more about this therapy and to find an acceptance commitment therapist in your area please visit www.actmindfully.com.au I hope this information is helpful.

If you have, in your words, “severe depression” then it is possible that anti-depressant medication may help you. A psychiatrist may be able to help you with this.

In my experience (as a client) rapport between a client and a clinical psychologist is just as important as whatever therapeutic approaches may be used.

I benefited from both CBT and Acceptance and Commitment Therapy (ACT, which Kylie has mentioned). CBT and ACT are related but different approaches.

Maybe it would help if you found a clinical psychologist who has experience of using ACT in working with his/her clients.

Your questions are not offensive at all. In fact I often wish more clients would report these kinds of experiences - it pushes us in the psychology world to work harder on improving our methods. In the end, your wellbeing is the most important thing.

I endorse Kylie and Simon's comments about ACT - often clients who've tried other approaches report that ACT “feels different”, and more importantly, they experience improvement not made with other approaches. I've practised ACT for nearly 10 years now and am a big fan. But…

There may be something else going on. Here are a couple of ideas.

One of the most highly replicated findings in psychotherapy research is that the relationship between therapist and client as perceived by the client is the most powerful factor in producing a good outcome. This holds true across therapy approaches, across professional disciplines (e.g. psychologist, psychiatrist, social worker) and across diagnostic categories.

You mention that you felt you were being manipulated. That is a sure sign that the therapist's rapport with you is lacking. Therapists should be regularly checking with their clients that the rapport is there, otherwise the client is likely to leave before the therapy has had a chance to work. I am sure you can see how this would happen from your own experience.

Secondly, it may be that you have a disorder that is not going to improve via talk therapy. If it is something that responds to medication or other interventions, this might mean you have been looking in the wrong place. That's not to blame you, rather that these conditions can be difficult to diagnose and psychotherapy is a good first-resort treatment because it is rarely harmful. If you do respond well to medication as Simon suggests, you might still benefit from psychotherapy. But then the goal of therapy would not be to change your mood, but rather to live the best life you can no matter what mood you find yourself in. 

And that therapeutic task is something that ACT is ideally suited for.

I'm sorry to hear you have had such unsatisfactory experiences. I agree with most of the other comments that have been made about your situation - and particularly, it is important to feel there is a positive rapport between you and your therapist.

There is some research that suggests that one particular type of depression ‘melancholic depression’ is not as responsive to counselling as other types and  it has been shown in some research to be more likely to be treated effectively with medication. You could find more information about this from the NSW Black Dog website - they also provide an assessment service to help work out what sort of depression it is that you have been affected by.

Other professionals might take the view that longer term psychotherapy with a psychoanalyst or psychotherapist (ANZAP registered for example) might help you to understand the persistent depressive symptoms more. You could do some research on this by calling the appropriate professional body. While you don't necessarily in my view need a clinical psychologist - you do need someone who is appropriately qualified and registered with professional bodies in your state.

I am also a fan of ACT but i think in your situation, i would suggest a clinical review with a specialist clinic such as the Black Dog Institute - not sure where you are writing from though but they could probably put you in touch with similar options in your area  - hope this helps. I'm struck by your tenacity with resolving this and am sure this will stand you in good stead in the long run.

I fully agree with the views expressed by all the others who have commented on this. I, too, think it's good that you have mentioned your experience here. If you haven't already trialled anti-depressants this might be worth exploring. As Psychiatrists are not limited in the number of sessions they can offer you, it might be helpful to find one who offers therapy as well. Insight oriented and psychodynamic approaches are sometimes experienced as more meaningful by clients. Of course the content of discussions with Psychologists and Counselors can appear to be mere common sense because all of what they say will not be unaligned with common sense. However you might have noticed a great similarity in what you experienced with various professionals. This is part of standardized care which is well informed by evidence based guidelines of practice. And because professionals are careful not to use any technical jargon, it can seem to be just a conversational 'chat'. Hope this helps.

Many excellent points have been made above. There may be something else going on here too - at some stage you have developed depression as a coping response or your best solution to problems you were having. While unpleasant in many ways, depression can be self-protective - for example, symptoms such as feelings of hopelessness and lack of motivation may result in us staying away from situations we find hurtful or distressing in some way. The problem of course is that our attempted solution to a problem then causes a different set of problems - it's really awful to feel hopeless and sad.

If this has been the case in your situation, it may be that seeking out help becomes quite problematic - on the one hand you may want relief from your distressing symptoms, on the other hand you may not be ready to let go of depression without having alternative ways to deal with difficulties. Counselling can help you work through and make sense of this, but it will involve you having to tolerate feelings of ambivalence about going through a change process. 

You may find it helpful to seek out a counsellor who is skilled in motivational interviewing as well as ACT. Motivational interviewing is an approach that helps you tackle directly any ambivalence you may feel about change, and to make changes in a way that honours the ‘gifts’ of depression whie equipping you with alternative ways to meet your needs.