Resident Psychiatrist Is Not A Therapist

[Sideways]

Yes, I agree that therapy should be a space where you go in and get to talk through the big issues. We don't go to therapy for a friendly chat - that's what friends are for. And friends do it for free!

Having said that, it may be asking a bit much of a T to 'go there' at the first appointment? Maybe? She needs to assess your mental health wholus bowlus, find out what your situation is (stable job? Stable accommodation? Family and friends? Meds and are they working? Coping skills? Etc etc). Then there's trust - it's easier to talk to friends; because they know you and have an established rapport... After all that, she needs to ascertain that, okay, this is ptsd, but where is this person at and what issues should we start with?

This is basically a complete stranger. And as frustrating as it is, it would be kind of inviting disaster for her to start digging away at trauma or depression or any of the real issues until she knows you, your situation, has assessed you sufficiently to establish a preliminary diagnosis and ascertained whether you are going to be able to go home and cope with the conversation without crashing.

Would it be possible for you to approach that initial "getting to know each other" period with an open mind? If so, hang in there, the frustration will turn into the usual nightmare of having to talk about the real stuff soon enough. If not, this T is probably a waste of time.

 

[Dana1010]

may be asking a bit much of a T to 'go there' at the first appointment? Maybe?

This is a reasonable. I still feel like something is just different about a therapist who will go there and one who won't, and you can feel it right away.

the usual nightmare of having to talk about the real stuff

Usual? Not in my experience.

 

[joeylittle]

I still feel like something is just different about a therapist who will go there and one who won't, and you can feel it right away.

I don't disagree with this. I wonder how much what you are encountering is that there seems to be no specific modality you are looking to work within. Just doing basic psychodynamic therapy is kind of meander-y, slow, not really result-oriented. Whereas, any modality has much more of a time frame around it, a structure, and it's a lot easier to get right to work.

Do you have an opinion about a working method you'd like to engage in?

 

[Dana1010]

Do you have an opinion about a working method you'd like to engage in?

Somatic Experiencing, but there are no practitioners in my network. The network is so paltry, you'd get nowhere asking for a specialist.

 

[joeylittle]

That's a perfect reason to ask your network to pre-auth someone certified in SE who is out of network. A referral from the resident you saw would be helpful.

I can imagine a possible issue with SE not being considered an evidence-based trauma modality....but you could also reach out to potential SE therapists and find out if they have advice on how to work with your specific network.

Therapists, when they take insurance, usually know a great deal about how to make it work for potential clients.

 

[Dana1010]

I can imagine a possible issue with SE not being considered an evidence-based trauma modality

Just curious-- is there an evidence-based modality?

 

[BlueOrange]

The evidence base seems to favor CBT, also EMDR for civilian PTSD. http://consults.blogs.nytimes.com/2012/03/02/the-evidence-on-e-m-d-r/

 

[joeylittle]

is there an evidence-based modality?

Yep. Prolonged Exposure (PE) is the most impactful/reliable. EMDR and CBT are the other two. This is a little .pdf from 2011, showing the meta-analysis of an efficacy study run by the veterans administration: Link Removed

Which approach you use can be influenced by your trauma. Obviously, it's easier to process single-event traumas, and more complex to process 'complex' trauma - trauma which was ongoing over years, especially in childhood.

So, if there is not a therapist in your network who provides one of these evidence-based therapies, it's usually pretty straightforward to get one that is out-of-network approved.

Just going in for dynamic psychotherapy (talking) is really not sufficient, and would leave many people feeling like there was no organization to the sessions.

 

[Friday]

Just curious-- is there an evidence-based modality?

Yep. Several. :)

- CBT is the gold standard which includes the modalities of TF-CBT, PE, CPT, DBT
- EMDR is (roughly) equally effacious for trauma as TF-CBT
Treatment - PTSD: National Center for PTSD

Somatic Experiencing, but there are no practitioners in my network.

Did you know that SE (somatic experiencing) & PE (prolonged exposure) are the exact same therapy, conducted in the exact same way? SE uses different words to describe than PE does, but that's just because they're from 2 different branches of Psychology :) That happens fairly often in psych, because it's not a unified field. Schools of Thought often share therapies between them, but name them differently. Same durn thing, though.

Techniques include "titration" of the client's experience. Titration allows the client to experience small amounts of the event's distress at a time in order to release the stored energy and allow their nervous system to return to balance. The client is not retraumatized and can experience successful resolution.

Sessions often do not focus on talking about traumatic experiences. Clients are educated about how the body regulates stress and learn to track the related physical sensations, feelings, thoughts and images that arise from traumatic memories.

ETA... Whoops. X-posted with Joey!

 

[joeylittle]

Did you know that SE (somatic experiencing) & PE (prolonged exposure) are the exact same therapy, conducted in the exact same way?

I think it'd be more fair to say that they accomplish the same thing, but from different angles. The PE protocol really is just telling the trauma story over and over again. You write it out, record yourself reading it aloud, listen to that recording a certain number of times/day, tell it again and again in therapy until the memory has become 're-integrated'.

My personal observation is that all the trauma therapies work on the same principle as PE. In EMDR, you're doing it differently because you are dealing with smaller chunks, one bit at a time (instead of the whole arc of the event) - but, you're still just focussing on the narrative and applying techniques until the emotional impact decreases to neutral.

EFT is really just the same thing, with more flexibility in terms of the protocol. SE is the same thing, but doesn't deal with the verbal narrative, it deals with the body memory. I think choosing a modality really has to do with finding the organizing principle that is going to be the most manageable for you as an individual.

 

[Friday]

Spoiler: Me being all hyper analytical & weird & OT. Apologies.

I think it'd be more fair to say that they accomplish the same thing, but from different angles.

I'm not getting the different angles, bit? But I may well be coming at it from the other direction* & be completely wrong; I'm just not really seeing any difference between titration and spiking & monitoring SUDS, pendulation vs working with triggers, resources vs tools, discharge vs grounding, (and so on and so forth) right on down the list. I'm just seeing the same concepts with different terminology used to describe them. Blunt vs Flowery seems to be the only really difference in everything I've been studying.

But A) I'm coming from a physiological psych background (if it's physiological, it's psychological, if it's psychological it's physiological) so right there is my inherent bias (my background is in a 3rd school of thought); and B) everything I've learned about PE over the past few years is that the listening to your own narrative is only one option of many / it's just one of the most popular. Since that's something I would never do given other options (I just don't like the sound of my own voice :wtf: Not so incidentally I'm a kinetic learner, not an audio-learner, so it makes sense for me to use different methods of processing first, play to strengths instead of weaknesses) I've mostly been looking at the other methods of exposure... Which are all -I think, or at least mostly- repeated in SE?

In trying to sort out what's maybe different, the only thing I can think of -again, not an expert I could clearly be wrong- is that SE doesn't necessarily require details the way PE does? One can focus purely on symptom management / you don't need to know what happened if you're just focusing on conscious control. But, PE allows for that, also. As that's what I did, before. I didn't touch my big bad trauma stuff with a 10 foot pole. Focused purely on symptoms & retraining responses. Automatic (bad), Conscious (good), Automatic (good). So I would say PE has the extra step. Except SE takes that step, too? Or can but doesn't require it, is maybe better? IDK. The more I try and see the differences outside of branding, the more they seem the same.

* Ofher direction = I may not be seeing the trees for the forest. I'm seeing all the same principles, applied in the same way, causing the same effects.

think choosing a modality really has to do with finding the organizing principle that is going to be the most manageable for you as an individual.

Couldn't agree more.

 

[joeylittle]

@Friday - I understand what you mean. I think I'm talking about, in the most basic of ways - PE uses the spoken narrative memory and SE uses the physical/experiential 'unspoken' narrative. For someone who doesn't naturally separate head-space and body-space (like how you are describing your thinking) would probably combine both without much effort. I agree that it's all one system (mind/body), but am definitely aware that I'm not integrated that way. I can remember in words, or in physical sensation. Both rarely happen together for me. And I can control my memory better linguistically, when I have body memories it's just a major hot mess.

They both deal with the arc of the trauma, but SE has more flexibility - because it's not tied to a linear narrative it can go to whatever aspect of the trauma arc one is present to. PE relies predominantly on the language-based narrative, which is almost always linear by default.

But at bottom - they are all the same thing.

Someone who is more literal/linear/head-based would likely work better in the PE framework. Someone more intuitive/circular/gut-based, probably in SE. I also think anyone with trauma 'repeats', where they might have trouble separating their narratives, would possibly prefer SE.