How Do You Prioritize In Therapy

[watundah]

I have been thinking about this big mountain of a project that sits in front of me, the one called "healing". Sometimes it feels impossible to find a way. My therapist occassionally asks what my goals are and usually I mention something about trust. I am pretty guarded, still so with her, although she has made big chinks in my protective wall. But trust? May as well say I want a million dollars. Then there is anxiety, depression, abandonment issues, dissociation, sleep issues, on and on. How do you even address all of these things? I feel as though I am scraping the icing off of the cake and there is so much work to do. I am not sure I am making progress with trust. We have spent time on anxiety which may impact my trust, etc., etc., etc. Anyway, I am sure for some folks you may attack the biggest monster in the room first. For me, trauma began before elementary school, so is my brain permamently messed up from developmental trauma? I dont have a trauma to address - I have many. So confusing. Where's the f*g map?

 

[Bristol]

I have been thinking about this big mountain of a project that sits in front of me, the one called "he...

I totally get this, i dont have any answers but i will be sneaking a look at any responses you get.

It seems like such a massive task doesnt it and how do you know when you are making progress? I dont know but i am sure someone will :)

 

[BoN-bOn]

I understand completely!! I have recently started therapy & I am already discouraged because I don't even know where to begin.

 

[watundah]

Therapists say you are not intended to see them forever, yet it feels like the old Pink Floyd song..."there' s no way out of here when you come in youre in for good."

 

[Suzetig]

I feel as though I am scraping the icing off of the cake and there is so much work to do. I am not sure I am making progress with trust.

I can understand this - I too have a shit load of developmental trauma and have had to deal with massive trust issues and relationship stuff and honestly, I've found that turning up, working on whatever was around for me session by session has really made a difference. By that I don't mean "weekly reporting" that x, y and z happened - I mean really taking about how I feel about myself, my relationships with others, my relationship with her, what Ive struggled with, why I think I'm struggling, how I feel about how I'm doing, where I feel stuck, where I feel I'm moving all has helped.

Sometimes that means talking directly about something traumatic, sometimes not but there's always something of depth in our work. To work at any kind of depth means trusting, so as you gradually deepen the work, trust deepens too, and as you learn to trust your T, it becomes easier to trust other people - or to know who you can and can't trust.

I don't think it's possible to work on trust without trusting - so at some point you need to take risks, maybe tiny steps but if you find yourself thinking "I can't say that, take that, be that way with T", it's probably the thing you need to take.

For me recovery hasn't been an orderly working in one thing st a time, set goals, tick things off the list and move forward thing. It's been a back and forth, one step forward, two steps back thing without clear tick box steps to follow but that relationship, the intimacy and trust I find there, has been the most healing thing ever. Not tidy, but very healing.

Think about your relationship with T when you first started seeing her, are you able to talk about stuff now that you couldn't then, are you more or less anxious, more able to be a bit open (try not to think about what you would like to do but haven't yet, look at what's changed, what you're able to do that you couldn't when you started). Trust is a gradual thing - so don't look week to week or even month to month...

 

[The Albatross]

Yeah, I wished there was a map... but really there's not one. It has more to do with learning/establishing or relearning stunted skill sets to better assess who/what/when/where we "give" our trust I think. No one can give us that, we have to recognize (and you have) the issue and endeavor to do the work and heavy lifting for ourselves... autonomy, self awareness, mindfulness, self efficacy, resilience if not spontaneous resilience... you can get there gal and you're askin' the right questions.

 

[The Albatross]

Doubled back to add, how I prioritized in therapy was putting out the biggest "fires"/threats. And I kept putting out the fires until I got a semblance of experience and confidence. I think a lot of times we get so hung up on the idea of being wounded or broken we forget that we got a hand in how we deal with it.

 

[Panda Bear]

No map, unfortunately. Go where the trauma takes you and when it finally comes to a bit of a rest or creates another branch, follow the branch. Follow the web and maze until you've circled back around to a starting point.

T likes to make a web of sorts for me on his big white board. He puts the issue and then makes a maze of lines. Some people's brains make a 1:1 connection(like a straight line) and other people's brains take one issues and make a million different connections(mine does this) So we start with one issue and my brain takes off to a 100 different issues, creating a massive web of intangible issues, built out of the one primary issue. No map....just a maze. We follow the maze my brain makes.

It's messy, and I wish it was smoother and that my brain would tackle one issue at a time. But it doesn't, it tackles a dozen and once, it's more painful, time consuming, stressful and tends to create a mess of symptoms. But then...BAM! I've worked through the beginning issues and a few others.

I think it's more about knowing how your brain works, and less of a map. Maybe you make a map, a maze or web.....

Also, my trauma is developmental and long term....maybe this is why I create more of a maze? And yes, we do tend to be in therapy a long time. I'm finishing up a five year stent, this month. I'll always need T on some level for check ups(like yearly exams) and as issues arise/symptoms worsen at times.

 

[Crow]

17 years and we just tackled the big stuff. So glad I followed T's lead and didn't push. I would have never had the resiliency necessary to handle facing this if I would have rushed. We hope to finish up by the two decade mark.

 

[holdfast]

I have been thinking about this big mountain of a project that sits in front of me, the one called "he...

I say go full depth analysis, early childhood all day. For many CPTSDers, begin at the beginning. Erode the base, the towers fall. My two cents...

 

[watundah]

Thanks for these excellent responses.
I agree that trusting your T is the first hurdle. We've come a long way in that area and have worked thru a few ruptures which is like any relationship tho not without it's challenges given the objective. Two forward, one back.

I wasn't talking only of trust, it just seems like the biggest hanger-on to me. And is it the right thing to focus on? Perhaps the necessary starting point to get to healing a potpourri of wounds.

I did start into the deep, hard work of the childhood abuse and it left me on my knees. I had to take a break for a while and am hesitant to start back as it leaves me with such sadness. Grieving to heal, I guess.

@CrowFeather you inspire me. I have no doubt I will need that much time but my therapist is already 61. ;)

I made some good notes about this topic and will be discussing it in session today.

 

[barefoot]

I wasn't talking only of trust, it just seems like the biggest hanger-on to me. And is it the right thing to focus on?

I've put together a few brainstorms to take into sessions and share with my T over the last couple of months. It was a really good exercise in taking a meta view, making connections, summarising our work to date, reflecting on where I am with stuff now compared to earlier on etc.

But it also made me think, wow, it feels like there's so much still to do and I don't know where to start!

When I told my T that she said we can look at the sheets together, see what I'm drawn to and then start there. And she was very insistent that I would definitely be drawn to something in particular. I don't think there's a right or a wrong place to start and a right or a wrong order to do things in (obviously grounding/stabilising skills before you tackle big trauma tuff, but I know you are already past that point)

I quite liked that idea of simply going to what I'm drawn to and us spending some time with that together. No judgment about whether it's the right or best or most important or whatever. Just following a curiosity, I guess, or an intuitive pull. Just a "this is calling to me, so let's put the attention there for now." It felt less pressurised and more flexible and organic that way.

It sounds like trust is the topic that you're drawn to. Unless it's that you think you "should" start with trust, which maybe isn't quite the same driver?