Time Limited Dynamic Psychotherapy, Anyone?

[JCray]

TLDR: Anyone ever try time limited psychotherapy? Think it's a good fit for PTSD? Know of other methods that work well with a skeptic mindset?

Hello all, I hope everyone is doing well tonight,

I just started therapy three weeks ago, and have just been diagnosed with PTSD last week. I suppose I have had it for about 4-5 years though. In any case, I am new to therapies. I am new to treating PTSD. You guys have more valuable opinions than any PsyD, or whatever you call them :)

To start, I am mainly looking for therapies from a skeptic and scientific viewpoint. It's not that I don't think other methods are valid, quite the opposite. I believe that different therapies are right for different people. Depending on your belief system, different things will help you. PTSD is hard and I applaud any method that helps someone out. Dealing with myself personally, I am a skeptic. I believe in science. Finding therapy that reflects that is paramount to me. As I have been burned, so to speak, by religion and religious therapists before, perhaps I even put a little more focus on this than necessary, but hey, it's important to me.

Having said that, I just started seeing this therapist who I think is the bee's knees. I like her and trust her for very many reasons. One of those reasons, however, is that she is very openly skeptic. Her methodology is rooted in science, and she practices only techniques that have a solid foundation of scientific evidence to back them up. Not for everyone, but perfect for me. And believe me, this is incredibly hard to find in the bible belt.

The methodology she prescribes to is called "Time Limited Dynamic Psychotherapy," and I haven't seen that mentioned on the forum, though I am new, I did try searching for it. Essentially, it is an evidence based therapy. The "dynamic" meaning it utilizes several approaches, it is an attachment based therapy, has many elements of cognitive therapy, and other things, like exposure therapy for me in particular, is utilized as well. So it isn't stuck to one method, only methods that have scientific evidence. The "Time Limited" portion of that meaning is that the point is to not be in therapy for extended periods of time, to keep the process rolling and to give you the skillset needed to not have to be in therapy sooner rather than later.

The way my therapist describes the timeline to me made sense. She said that everyone is different, dependent upon the case and severity. Generally speaking, however, the first 4 weeks are spent unpacking and unloading. This is the part where you feel worse instead of better. Then we work on identifying maladaptive coping behaviors, lies I tell myself about life, defense mechanisms for emotions, negative relationship traits I always have, and work on fixing those. This is supposed to be the hard part, requires a lot of work, but I should see a difference in my quality of life at around 20 sessions in for most people. She says that the "time limit" is different for each person in case, because the point is not to let you go before you are ready, but the point is to have a definitive time goal so that you work to reach it. Most people in her office tend to go for 6 months, though one year is not uncommon, and even a year isn't necessarily going to be your limit. Even after you graduate, it is best to come in once or twice a year or so, for a "check up," so to speak.

I don't know what my timeline would look like, but I do know that I am going for my fourth session tomorrow and don't feel mostly "unpacked" at this moment. I need to catch her up when I get there, and mention this childhood memory that has appeared to come back this week, but I know her goal was for me to attempt to tell any story with a clear negative emotion about my life without smiling or laughing. (I compartmentalize and refuse to process, I don't mind telling her about my verbally abusive relationship or my violent gang rape, but I will be giggling and smiling the entire time. I don't know how to turn that off in front of other people).

In any case, I like the idea of not being in therapy forever, but is that short a time frame really feasible with PTSD? Have any of you ever tried Time Limited Dynamic Psychotherapy? How about other therapies that really pair well with a skeptic mind?

Thanks!

 

[Seasounds]

In reality, I found psychodynamic therapy to give me an unexpected transformation, once I found the right therapist.

The first therapist, messed me up, because I couldn't recognize his mistakes.

The 2nd therapist in this style, offered me a chance to bond to a heathy person, and to internalize that bond, and to carry it with me/as a part of me, for the rest of my life. It changed my sense of self, decreased my triggers, and truly, organically, brought me into the present by giving me a new internal reference point.

The therapy isn't suppose to be forever. It is meant to give you a transforming 'with-ness' as you go through your process/life. I would compare it to, at any point someone can continue with or leave a painting class.

Different people learn at different rates. At different points, the patient can decide they have what they need to be on your own. The therapist should work with that goal as well.

 

[Weemie]

Basically I am in that right now.

It's interesting. I understand the therapeutic process of forming a "bond" with one's therapist and due to the time limited nature of the sessions I'm attempting not to do so. I don't know why. I mean, you just make connections with people sometimes. You carry them forward with you. Maybe it doesn't matter, in the end. You're trying to protect yourself from getting burned by having it end, but in the long run, a person's influence on your life never really ends. Unless you choose. Unless you cut it away. Even then, that's a choice based on their impact. That's just how people work.

Maybe that's all right.

 

[Suzetig]

I can see the appeal but it wouldn't have worked for me, I could never have unloaded everything in the first four weeks, it took me 7 months to even say I had been abused much less talk about it in any depth. My therapy is much more relational and while I've been there a while, it really works for me.

Do have some coping strategies at hand for the "gets worse before better" stage of things, cos worse can be truly horrible.

 

[joeylittle]

How about other therapies that really pair well with a skeptic mind?

Honestly, Prolonged Exposure therapy is the evidence-based practice that I think has the most common-sensical foundation. It will not deal with personality functioning issues that developed as a result of coping with trauma - for those, CBT is still very much the gold-standard.

EMDR, the other evidence-based trauma therapy, can strike many as being somewhat woo-woo. Though, it shares much in common with PE therapy, when in action (the repeated telling of the story, the reduction of emotional response).

I found this quote interesting, and useful:

Weiss and Marmar state that the prototypical candidate for time-limited (12 session ) psychodynamic psychotherapy is a relatively well-functioning individual with no remarkable premorbid psychiatric history, who has experienced a single traumatic event as an adult (Weiss & Marmar, 1993). Because a substantial proportion of patients who have PTSD do not fit this description, however, they also note that individuals who have a history of prior trauma and psychiatric disorder may require longer and more intensive treatment.

- from Link Removed

I'm all in support of structure, and the notion that therapy can be goal-oriented. I'm personally a little more skeptical of someone thinking they can put a modality inside a structure. PE it's it's own thing, and 'typically' takes 9-12 sessions of 90-120 minutes each to fully implement the four phases.

Time-limited Dynamic therapy, according to what I'm reading, is all about the treatment blueprint. In that regard, yes, it seems like a great way to structure a frame around an overall therapeutic approach. It was not, however, developed with the intention to treat trauma, or mood disorders, or any 'concrete' diagnosis. It was developed to provide effective therapy to individuals struggling with making the relationships in their life work, usually due to the kinds of esteem problems that are typically addressed through CPT/CBT.

This interview with Hanna Levenson, who pretty much wrote the book on TLDP, is super-interesting to read:
https://www.psychotherapy.net/interview/hanna-levenson

And this gloss is very helpful (make sure you look at the 'Approach' tab:
Link Removed

What matters most, is that you feel good about the therapist, and that she has credentials in what she's purporting to want to do. If she's a TLDP person, she should have training hours in it, and potentially some level of certification. If she's just read the book and thinks it's neat...not so much. And if she's going to incorporate PE, she should have specialized training and experience in it, as well. It doesn't sound like she'd be hard to ask those questions of.

Thanks for your post! I learned a lot.

 

[EveHarrington]

I was thrown by the skeptic/scientific thing, thinking "whaaaaaat? Isn't all therapy like that unless you have a pastoral counselor?"

And then I saw the Bible Belt bit and it all made sense!

I guess here it's the opposite. You only get religion in therapy if you seek it out.

As for the time limited part-----I'm thinking this is reflected in the structure? I mean I honestly think all therapy should be "time limited" but what seems to set this apart is the structure.

I'd give it a go. I'd try it out if I could find it locally!

 

[JCray]

A lot of really useful information from you guys! It is so appreciated, I really just feel like I don't know too much about what works and doesn't. (Maybe paranoid that there isn't anything that will?) I just got back from this week's session (which does add to the opinions of how this will or will not work) and am stuck at work right now, but I'm definitely going to parse through all of this information and respond to some when I get home tonight!

 

[JCray]

Well essentially, the fourth session was today. I took that, combined it with all the things you guys said. I so appreciate all of you guys' insight; it kind of helps make sure my expectations are on track.

She did stress today that she was feeling like she was beginning to get a diagram of what my issues were, and what my patterns of relating to people were, so that soon we will start disrupting those patterns. On the one hand, this sounds great and something I really need. I can't form normal bonds with other humans right now and I really think this will help. On the other hand, while that all is great, it does seem to feel more focused on the surface problems and not the deeper one. I also really need someone to talk me through this whole entire river of shit running through my brain right now. But honestly, I will keep you guys posted, because maybe that does end up getting covered this year as well, and hell, more information about all the therapies can't hurt :)

Luckily, she's time limited. And I really like her. And I do think I need the things she's offering. I think what I am going to do is stick with her for the 6 mos - 1 year. Then go to CBT, something more fitting to PTSD, maybe take a short break first, if this deep shit-river doesn't get addressed. So I think I will hang with this for now, especially since this is my first time really doing a therapy, and then I will go from there. You guys mentioned some great options.

The 2nd therapist in this style, offered me a chance to bond to a heathy person, and to internalize that bond, and to carry it with me/as a part of me, for the rest of my life. It changed my sense of self, decreased my triggers, and truly, organically, brought me into the present by giving me a new internal reference point.

This sounds beautiful. I could take some of this. It gives me hope that even though the therapy is time limited, the relationship formed still makes a lifelong impact.

I can see the appeal but it wouldn't have worked for me, I could never have unloaded everything in the first four weeks, it took me 7 months to even say I had been abused much less talk about it in any depth. My therapy is much more relational and while I've been there a while, it really works for me.

Yeah, I think today was session four. I feel like I've barely scratched the surface. We will see how it goes by the end of the time period - perhaps then I'll need a therapist more like this

Honestly, Prolonged exposure therapy is the evidence-based practice that I think has the most common-sensical foundation. It will not deal with personality functioning issues that developed as a result of coping with trauma - for those, CBT is still very much the gold-standard.

CBT sounds like the thing I need, but not with the therapist I want. Perhaps after this round of TLDP I'll try some of that, and it will give me time to find a therapist in this state that doesn't feel inclined to pray my brain better. PE, I don't know about yet because I'm still trying to pinpoint my triggers.

EMDR, the other evidence-based trauma therapy, can strike many as being somewhat woo-woo.

People on this forum have seemed to have great experiences with it, I just have this kneejerk reaction to not like it as that's how it strikes me. I definitely need to do more research.

I found this quote interesting, and useful:

. It was developed to provide effective therapy to individuals struggling with making the relationships in their life work, usually due to the kinds of esteem problems that are typically addressed through CPT/CBT.

These quotes were incredibly insightful, thank you. I plan on reading that whole book this weekend. I definitely don't fit the description outlined in that quote, and that is definitely something I should bring up in therapy, or consider. My issue was I could find articles about TLDP, but none that tied it to it's efficacy in PTSD, and this article does just that. I'm the type who has to research everything, so it was kinda driving me crazy. THANK YOU SO MUCH.

What matters most, is that you feel good about the therapist, and that she has credentials in what she's purporting to want to do. If she's a TLDP person, she should have training hours in it, and potentially some level of certification.

I really really do like her, which is the main reason I think I need to stay put for now. I think she did trauma work after her masters, and then studied under the founder of TLDP for her doctorate, so she's super into TLDP but does have the trauma experience. She sounds a lot like that person in the interview, actually. What they describe really appeals to me I just don't know how feasible that is for PTSD instead of the run of the mill "adjustment issues" my therapist generally sees people for.

And then I saw the Bible Belt bit and it all made sense!

Haha. Yupp. Most of them don't mention it during sessions, and some don't mention any religious affiliation, but I have had one that did. I generally want them to specifically state that they are secular (Richard Dawkins has this list that I chose my therapist now from, the names in my state that deal with trauma are very very few. I think I have the only female one at this point), because living here has made me scared that even though I hear them do their whole therapy spiel, deep down I am thinking that they are secretly thinking that my life would be so much better if I had spirituality, and judging me for it, because that's what you generally see in people as a whole around here. I like having the security I'm not secretly judged, though it limits my options, as I am sure there are some secular therapists that don't mention that because they don't want to scare away potential religious clients. Also, I have a bit of hatred for how I was raised, some of that includes christianity, and I don't particularly want to worry about offending someone whilst in therapy.

 

[Seasounds]

Yes, let's keep in touch via this post about psychoanalytic work. In the beginning, I was totally not able to form livable, workable close relationships. (Especially after the first therapist.) Over my 3 years of work with my therapist that is all gradually and very clearly changing.

I thought to share some thoughts, below, that I wish I would've known in this work.

I've found that in this style therapy:

1. Behind he scenes, the therapist is always working to transform the deepest issue-traumas through relationships in life, by giving/offerring a healthy bond that gives you freedom from the traumatic bonds/experiences, in moment to moment experiences throughout the sessions.

The therapist will wait for you to bring them up. And sometimes, they may need to take it bits. As you are telling your experiences, they are actually processing your experiences through themselves.

Some patients have more trauma than any therapist can imagine.

2. It may not 'look' like that, because of the visit by visit discussions, disagreements, etc. A good therapist should be available to have a dialogue through easy and tough moments, as a person who cares for you. It is their job, to be able to give the optimal emotional environment, while being 'human' themselves, in a professional role.

Patients can speak up when they need support or when they disagree. I found it worked best if -I realized I was dealing with another sensitive person (not a robot), and respectfully, framed my feedback in "I feel" rather than "you make me" statements (aka non-violent communication) that support good relationship communication.

3. There most likely will be lots of space where you can share and feel your traumas. And through that support-of being heard from someone who has empathy for their patients; the 'shit' naturally gets processed and the patient gradually comes into their own clarity; to know they are a good and lovable person, who didn't get the respect and love the needed.
Be patient with the flow.

4. A good therapist will 'chime in' when you need support to keep the constructive view of yourself. Like, helping a child grow into their own sel-esteem. It may seem like the therapist doesn't say much, yet all the while they are supporting your processing, of coming into your own truth and confidence.

5. As the past traumas are worked through, the client releases the gravity of the past and becomes more emotionally available to form an emotionally cohesive, present-based bond. It is quite magical when the shift becomes evident. Like when a child learns to walk, all the elements come to fruition, and then the healing continues, building new relationships/healthier bonds, based on the healthy therapeutic relationship.

6. And my therapist made mistakes, which I was patient with, and which I was challenged by. I'd be happy to share a couple of examples.

7. It did really help my therapy to gradually to take distance from friends who were not consistently kind to me.

For me, right now, my therapist is on vacation.
Cried for rthe first two days, now I am better. Have friends for good support.

Good luck!

 

[theshadowoftheliving]

I think I'd like to echo what @joeylittle said: this sort of time-limited approach is designed for singular, adult traumas. If you have more complex trauma/childhood trauma, it might not be as effective.

Keep in mind "evidence-based" treatments hing on rigidly controlled studies. The controls almost always eliminate anyone with comorbid conditions (read: depression, anxiety, etc) as well as high levels of dissociation. So, that means that they are essentially studying much healthier people than others (like me) would be. Of course those therapies are successful if there isn't a lot to fix.

For me, I melted down with the time-limited approach. Things are just too complicated for me to sort through so fast and the performance anxiety made all my symptoms so much worse. Just my experience.