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Wanting To Talk About It...but Not Knowing What To Say...?!

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barefoot

MyPTSD Pro
I've been going to therapy for almost three years. I have shared trauma events with my therapist and we have held that as a context of the work. Most of the time, we have worked on here and now stressors (that may or may not be directly related to old trauma) and managing current symptoms/spikes etc.

Whenever we have attempted to do "the deeper work" around trauma, my defences massively kick in and I tend to dissociate. So, it always leaves me stuck - I think I want to do it, so I try to do it, then loads of resistance shows up and I just can't keep my head in the room. So...we haven't directly "gone there" for quite a while, which has been frustrating for me but I have been trying not to give myself a hard time about it.

Anyway - there have recently been signs that things are shifting and my therapist agrees that I have made some significant progress (esp around tapping into old feelings, feeling the feelings and not dissociating).

My therapist has said that something has clearly "been evoked" and that that's something we can work with/on together and that it's huge progress that I am feeling things and not dissociating. We both seem to think this is a promising window of opportunity. When I then asked "So, what's next, how do we do that?" (i.e. how do we "do the work") she smiled patiently and said "Well...let's just see...let's see whatever comes up and then we'll follow it..."

The old trauma stuff is now...calling to me...? It feels like it's jumping up and down, waving at me, shouting my name and trying to get my attention.

So...it has got my attention...but now I don't really know what to do with it! I feel like I want to focus my session times on working on some specific historical stuff. But I don't actually know what to say. I feel like I want to talk about it. But I don't know what to say about it.

Does that make sense?!

I don't know what "doing the deeper work" around it really means or looks like.

Any thoughts on where I go with this? Or should I just tell my therapist something like I've just written (e.g. "I feel like the old doctor stuff is calling to me and wanting attention and I feel like I want to talk about it but I don't know what to say...") and hope my therapist takes charge a bit? Though I'm not sure that she will after she said "let's just wait and see..."

I'm going to therapy fortnightly now - would much prefer weekly but it's for financial reasons - so I really want to make each session count and it feels like I'm on the cusp of something really significant and that this has been the most promising opportunity we've had for months. I'm trying not to put pressure on myself. I'm genuinely feeling like this feels like the right time - and that I'm in the right headspace - to dig into this topic again. I just don't know where to start. And I don't want that to stop me doing it because I suspect my therapist will wait for me to start bringing stuff up instead of trying to lead it herself. What exactly am I meant to bring up?!

Trying not to overthink this. I really do feel a strong desire to talk about it. But, what to say, what to say... Sounds stupid because it feels like, if I really want to talk about it that much, I should surely know what it is that I want to express...? But I don't. Or, do I and I am somehow missing something?!

I have a session tomorrow and am not sure how to make the best use of it.

Any thoughts much appreciated!
 
I don't know what "doing the deeper work" around it really means or looks like.
I used to the myself up in knots about what "deeper work" looked like - whether it was being able to talk about the trauma itself in detail, about the people involved or the feelings about the trauma - basically trying to work out how deep was deep enough. What I've realised is it looks different to what I thought it would. For me the truly healing work has been understanding what I think of myself in light of the trauma, how I feel about myself and how that affects me day to day. To give an example:-

I had a very neglectful, abusive childhood and was sexually exploited as a teenager. If I take the neglect part of that, deeper work has involved me accepting my mum was cruel and neglectful, that I desperately wanted her love and care and that despite my best efforts to be loveable, she didn't show me love. I've also had to explore how that impacts me now in terms of what I expect in relationships, how I do or don't recognise my own needs and how I allow others to offer me love and care. It's also meant me realising that on some very base, deep level I think I deserved to be neglected and still do - and how that belief has impacted how I care for myself or lack thereof. I've also had to mourn the loss of the parent I wanted, to grieve for the part of me that even as an adult still wanted to be loved by my mum and acknowledge that will never happen. The grief over this has been excruciating at times.

My T has worked with me to circle all of this, touch parts of it as and when I could manage, to be with me in my hurt and pain and grief, to show me I am lovable and acceptable and that it isn't my fault. That's been long term trusting work, in doing that we've spoken about specific incidents as they've arisen but the focus hasn't been on what happened so much as how I understand and make sense of it. And it's been at my, at times very slow pace. And has been interspersed with doing the same work around physical abuse, rape, sexual exploitation, emotional abuse...

It is painstaking work, looking at my relationship with myself and others and sharing those awful thoughts I have about myself. That's what deeper work means to me, your journey may well be different.

You need to know that I didn't just jump in to the work, it's been a gradual process and we've had very intense periods of work and times when the work has been lighter. I've completely set the pace and agenda - I get the urge to get "value" out of every session. It might be worth thinking about what that would look like for you.
 
Thanks @Suzetig That's very interesting and helpful.

I think that's why I've been stuck/confused/not sure what to expect or how to proceed. I keep thinking "well, I've already told her what happened, so it can't just be that I have to keep telling her again. But if I'm not talking about that, what am I supposed to be talking about?!"

So, your example makes sense.

So...it is maybe partly about the beliefs I now hold? About myself, what happened, in relation to other people etc...?

The thing about wanting to get value from every session...it's not about giving myself a hard time about doing things properly or getting impatient with myself and wanting to do it quicker. It's more that it really, genuinely feels like there is an opportunity that's opened up here and I want to try to leverage it. I suppose what it comes down to is that I feel hopeful. Hopeful that I can do something to chip away a bit more, which may ultimately make a positive difference. And it feels good to feel that hope.
 
So... it is maybe partly about the beliefs I now hold? About myself, what happened, in relation to other people etc...?
That's what it's meant for me, being able to honestly talk about how I feel about me in relation to whatever situation, how I react to situations and why.

By way of example, because my needs were rarely met as a child, or used to ridicule, punish or reward I find it very difficult to acknowledge that I need anything from someone else so I just don't ask. It has felt very shameful for me to ask others for help because I was raised to think I wasn't worth helping. So looking at this in the context of my relationship with my mum and with others and how I relate to T has helped me change my view of myself.

It's tricky to find your way into that kind of work but it's incredibly rewarding and very healing but it means really being able to look at how you feel about yourself in light of your trauma.
 
Ok...so I can see that we have done some stuff like this...though generally it has been my therapist pointing things out/making these kinds of connections and I have felt...er...well..I think it has felt excruciating and I have dissociated...or I have felt defensive so the shutters have come down and I haven't engaged...or I have been interested in listening to her insight but my voice got hijacked so I haven't been able to speak to any of it myself..

Hmm...suddenly not feeling so hopeful!
 
It does feel excruciating - which is why you go slowly, at your pace. There are still things I can't talk about yet - not about the trauma directly but what it means to me or how it impacts me and my relationships. As you make the links for yourself you'll eventually be able to voice what you need to, remember the chipping away thing, that's what it'll be like - sometimes you'll see a big lump chip away and sometimes just a shaving.

Btw, the deeper work I'm doing just now I'm doing fortnightly - the time between sessions helps me to not feel overwhelmed, the trick is to do journaling or some form of expressive work to help with your feelings between sessions and to make sure your T helps you to ground yourself before you leave. Don't expect to hold on to the intensity of feeling from one session to the next, it's ok to let it settle in between times and trust that you'll know what to bring to your next session.
 
Ok....on further reflection, I'm now thinking that perhaps I'm being a bit harsh on myself...perhaps I haven't always been totally useless when these sorts of things have come up. Perhaps there is still hope!

I think the biggest obstacle - as it probably is for many of us - is shame.
Once I get a flood of shame, that's when I tend to dissociate and it can happen in an instant. So, I guess I should maybe be looking at taking tiny, baby steps and just dipping my toe in around the edge to see how I manage (or not!) to regulate myself...

Helpful to hear that you are doing fortnightly deeper work too. I have been worrying a bit that this is poor timing - that the window of opportunity has opened up (hopefully!) just as I have to reduce my session frequency so I've been concerned that we won't be able to build up momentum or that I will really struggle to wait two weeks to pick things up again. So, it is also encouraging to hear you say that about not expecting to hold on to the intensity between sessions. I have been thinking that fortnightly will be harder and that the intensity between sessions will be "worse" - I already found waiting a week between sessions very intense! But, actually, maybe it will feel more manageable if I can find a way to let things settle between fortnightly sessions rather than churning everything up on a weekly basis. I hope so!

My therapist has never really given me homework but perhaps it is worth me asking if there's anything I can do to help with processing/my feelings between sessions. I can definitely start journaling again but wonder if she has any other suggestions.

Thanks for talking this through with me :-)
 
I have been thinking that fortnightly will be harder and that the intensity between sessions will be "worse" - I already found waiting a week between sessions very intense! But, actually, maybe it will feel more manageable if I can find a way to let things settle between fortnightly sessions rather than churning everything up on a weekly basis.
I found it difficult initially because I knew I couldn't hold on to the intensity of feeling for two weeks and worried I'd loose momentum - and in some ways I did but letting things settle a bit helped me not become overwhelmed so I could think things through in my own space and time. That's meant my actual time in session has been much more productive because I go in knowing what I want to talk about and knowing how far I can go before feeling overwhelmed.

There are many schools of thought that say trauma work needs to be long term, intense, weekly sessions but that's not necessarily the case. And different things work at different points in the process too. If I were you I'd give it a try, start the sessions with what you want to talk about (as in literally this is what I want to work on this session) and see how it goes.
 
my actual time in session has been much more productive because I go in knowing what I want to talk about and knowing how far I can go before feeling overwhelmed.

Yes, this is what I want to achieve. For me to have clarity and a sense of purpose so that sessions are focused and productive. Which will also need to include me not being avoidant and going off on loads of tangents to distract myself or to feel the need to entertain her!

At the start of the year, I reduced session time from 90mins to 60mins - again, it was a practical, logistical decision rather than me actively wanting shorter sessions - and, although the time flies, I have been surprised by how much we can achieve in an hour.

Focus, barefoot, focus! :-)


start the sessions with what you want to talk about (as in literally this is what I want to work on this session) and see how it goes.

Yes...again, this is what I want. But I think this is where I am struggling. Because I feel a topic is strongly calling to me but I don't know what I specifically want to say to her about it...I guess what I'm saying is, I don't know how to get an "in".

So, the session before last, I told her what had happened during my recent hospital stay when I had a bad, very triggering experience with the anaesthetist (but there was some progress there because I felt the feelings and didn't dissociate!) I basically talked at her all session, which also involved mentioning links to historical trauma, then I finished by saying "can we pick this up again next time?" and she said yes, definitely, let's build some momentum.

Two weeks later, I had just been to see my GP and things has taken a totally unexpected turn and we bizarrely ended up having a conversation about historical doctor-related trauma stuff. It was unsettling...esp since I was already still unsettled from the hospital. So we spent last session talking about the GP thing.

The old doctor/medical stuff seems to be calling me - the universe keeps throwing more related things at me, which we both think is leading to some shifts.

But I have no idea how to dip back into these topics today. Because I don't know what else to say about them. I've told her. So, now what, because they feel like they're just out there, hanging, along with every other doctor/medical related thing I've ever told her. It feels like we now need to do something with it. Maybe the sort of thing you mentioned last night - what impact these things had in me and how I feel about myself and others etc. But I don't know how to start that.

I'm on my way to session now. She will ask how I've been/whether I had a good Easter/how I've been feeling over the past couple of weeks etc. And, if I'm not careful, I will start chit chatting about all sorts of here and now stuff. And I don't want to do that because I want to stay with the doctor stuff. I just don't know what to say next about it.

Feeling rather frustrated with myself today! Maybe I should just tell her this?
 
That might be a good place to start - or say that the medical stuff is still hanging around for you. Do you know what about it feels "unfinished"? Is there an ongoing anxiety about medical stuff, did the people concerned remind you of someone else. Try thinking about what it means to you, how you understand it rather than thinking about what actually happened. Do you have a physical feeling when you think about it - for me it's usually shame so that's where we start, among the lines of "I realised after I left that I felt shameful about x", or "I'm feeling anxious because I need to talk about Y and don't know how/where to begin", or "Z has been on my mind since we last met" and go from there.

Or maybe it's ok that it's hanging there and as you let it rest the thing that still needs space will become more evident. I've left so much stuff just "hanging" in her room I'm amazed there any space left! Sometimes I've really needed to unpicj something else before I could make links to the thing I left hanging.

Good luck for your session.
 
I really identify with this- wanting to stay on one topic and get some momentum but always losing steam for so many reasons. Either I can't say what I want to, or other things come up, or I'm not in the mood that day, or I chicken out. It's like this endless dance of feeling like I'm doing it all wrong. Because we are all over the place and I have no idea if that's how it's supposed to be. She keeps saying there is no formula and it's not linear. But that makes it hard to monitor and recognize progress because it feels like whack-a-mole.
If I were you I would say something like "I know we've talked about this already. But xyz has really been on my mind lately and I feel like somehow it needs to be processed but I don't know how to do that or what that looks like." I tend to bring those things up in email in advance and then she'll bring it up in session and usually have some thoughts and questions to help me talk about whatever it is.
I hope it went well for you!
 
Thanks @Suzetig

I think maybe a big part of what has shifted is denial. I used to insist that it hadn't been that bad, that it didn't really matter, that I had made mistakes so it was my fault and I totally rejected any notion of abuse or assault. And now I think I can see that he did do something wrong. It was his fault. He shouldn't have done what he did. And that's what my therapist thinks and my partner (not that she knows all the details) and my GP. They all agree and I have run out of justifications. I don't feel I have any "evidence" left for why it wasn't that bad and it was a misunderstanding and he didn't really do anything wrong...

It feels like this realisation should be freeing and should make me feel...better in some way...? Like it should feel easier now I can give him responsibility rather than blaming myself. But it doesn't. It feels...unsettling. I think because, if I accept their narrative...it makes me feel quite anxious to think what that makes me...or who that means I am now...? Or something!

Yes, shame is a big one. And fear. With the anaesthetist, I felt pure terror, which I think was a feeling that belonged in the past though I hadn't been conscious of feeling it at the time - probably because I dissociated.

Shame and denial feel a bit overwhelming though in the context of keeping my head in the room!
 
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