Going Back?

[kilted]

The three stage process is contained in the draft treatment guidelines from the ISTSS (International Society for Traumatic Stress Studies). These things are often iterative..... each step in therapy contains the process in a smaller form, right down to the session level.

 

[Sandstone]

I understand the concept of it being spiral form. What I'm saying is that in general Ts don't do much that I'd recognise as Phase 1. T3 in particular only encouraged me to work on deep breathing. I duly worked, reported to her after the first week that all I was achieving was overbreathing, then mentioned four weeks later that I'd finally found and established a pattern that worked for me. We never talked about why it works or when I might use it. That had to come later from posts I read here. I do think she believed the relationship should be stabilising in itself, but I need something more concrete than that.

I've done some work myself on grounding and soothing tools since, but no-one has ever looked at it with me. Even the best of them, T5 who tried cautiously to go into what I label my half trauma stopped after I ran, and said that it was too risky to go further. Surely it will always be to risky if I'm not equipped with tools and coached in using them?

From my viewpoint, I think they see me as calm and measured (ANP) so they think I am stable. But it is classic pressure cooker stuff. As soon as we go near the trauma, EP explodes all over the place.
So T1 said he wouldn't go on without meds to stabilise me, and they proved impossible to find,
T2 pushed on rashly and I ended therapy to save my life,
T3 tried, I did attempt so she refused to go any further,
(T4 was just weird),
T5 tried then decided I could only tackle it Inpatient.
Every time they wanted to depend on something external to "control" me, rather than working to build my capacity to manage myself. Ts 1 & 4 nodded to safe place, because they both did EMDR, but even that was hurried. T5 talked about recognising where I was in the Window of Tolerance, but didn't equip me to shift myself to a better level.

I have wondered if they actually did more and amnesia has taken it away, but I've checked my journals and it wasn't there. I was pretty conscientious about doing any homework, so I think I'd have noted something. Oddly, both T2 and T5 gave me wads of relevant handouts when therapy ended.

Are there things you couldn't talk about in T that you can now?

It is hard to be sure because I haven't been in therapy for nearly fourteen months. I don't think there was much of a change in what I could talk about. In fact everyone has commented on how open I am in therapy.. I have wondered if I should have more of a filter. T3 in particular commented "Most people wouldn't tell me that, and certainly not so early" I can't see the sense in hiding stuff. I'm there to do a job.

I think that a very early part of any work is going to be coming to terms with the DDNOS diagnosis, and understanding how my particular form of dissociated aspects works. I know I will be disturbed and distressed by that; it feels dangerous, but I know it is clamouring to be explored. I will need a safe way to do that, and I don't know where I can find that safety.

This post sounds shrill and whiny in my head. I know I'm frustrated, because from T2 onwards I've been saying "I need this", and they have all skated over that need. I even know that I ned it to be an overt part of the therapy, not something I work on alone and smuggle in. I think there is something that I'm not communicating, probably because I haven't moved it into rational thought yet. Possibly it is fear for my life, but I suspect there is more. I'll go away and think.


(Does the Herman book contain survivors stories? I don't do them)

 

[digger]

Sorry, I think I probably misread you a bit before.

For me, I don't think there's been anything specific at the time that has been clear to me as working on a particular stage, but when I look back at it, I can see where my T has been using the model (if that makes sense) It sounds like for you, you can't see where that happened in your experiences, and I think that's a really valid thing for you to bring up before moving forward with anyone.

There are times when I would really like my T to say more - we are doing x because y - but mostly I'm okay with it not being so black and white. I think it's absolutely okay for you, especially given your history and prior experiences, to say that you need clearer input on the process and what your T is doing/planning to take these stages and needs into account.

ETA - also wanted to say that I think you are better informed now about processes and what you might need from a therapist that I think that will benefit you and put you in a stronger position this time around

 

[barefoot]

As I so often find myself doing, I'm going to say - I agree with @digger :-)

I too can look back and reflect and see how the different stages have been present but it wasn't that it was explicitly sign-posted at the time - so, at the time, I probably wasn't consciously aware that that's what we were doing.

I would like my therapist to explain EVERYTHING, all the time to me - why we're doing x, how y works, what the whole concept of z is about. If she did as much as I think I want her to do, I think it would probably get in the way of the work as we'd spend too long talking about what we're talking about! But I do feel that I need some of that clarity to get my head round what we're doing and why and to then be able to go with it.

I do think it would be reasonable and helpful for you to put this on the table at the start with your therapist, requesting that she gives clear direction and explanation about the process. And also to let her know that you want some tools that you can take away to use - but that it's important that you know which tool to use, how to use it, when to use it and perhaps an explanation of why/how it works.

Perhaps give her the breathing exercise as an example where she introduced a tool but then you went away a bit lost with how best to use it? Breathing exercises have been really effective for me but my therapist spent quite a lot of time showing me how to do it, explaining the science behind what's happening and why it helps, suggesting ways when I could use it. So, tools/exercises can be great - but not if you're not really clear about how to use them effectively.

I really do think this all sounds promising @Sandstone - I am getting my hopes up on your behalf!

 

[The Albatross]

"If she did as much as I think I want her to do, I think it would probably get in the way of the work as we'd spend too long talking about what we're talking about!" - yup, exactly. At some point it is less about intellectual or control... or thinking and more about trusting. Trusting the process and just rolling with it. Which is sort of what I do when I get up out of bed every morning now... trust and roll with it.

 

[Suzetig]

(Does the Herman book contain survivors stories? I don't do them)

No, not really. She gives examples of her work with clients, what they needed and how it panned out in practice. I'll properly check though if that's a no go for you but I'm away from home til tomorrow.

 

[Sandstone]

I'm still ploughing on with this thought stream, trying to get to clarity on what I think, on what underlies my discomfort at the idea of going back to T3 and on what to decide.

The two words for my recent thoughts are assumptions and permission.

I had assumed that I didn't need to articulate to Pottergate my expectation that they would treat along the lines of the ISSTD guidelines. I had assumed that this would include something like the skills building programme in the Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists that I have tried to work on before. I was probably also assuming that T3 wouldn't work in this way, based on my previous experience of her free-form approach. I need to articulate all of these things and check whether they are valid, and how they apply for my therapy in the views of these experts.

I know that through that workbook and others I have built some of these skills. I'm afraid of some of them at the moment, and I need knowledgable input on which would be productive to push and which might not. Much more though, I realise I need permission to bring them into therapy, and to refer to learning and applying them. I'm still trying to understand what makes this not permissible. There is something about being the only child in a house with four adults, and now functioning as a child in a world of adults, who is not allowed to grow up. So it would not be acceptable to have independent knowledge and opinions. Leading from that, there is a fear of being seen to challenge T, and that was reinforced by dreadful T2.

There may be the old thing about self care not being acceptable as well. It can only be done in secret.

That means I now have 6 areas
fear of attachment
failure,
chronological dissociation
safety,
assumptions
permission ( or maybe autonomy )

I can see a strong argument for working with T3 to unpack them all. If I can be sure of being safe. If I can be open about them.

 

[Sandstone]

Bit more rabbit. I'm rather prone to thinking that I should hold my nose and jump in. If it feels as though I'm forcing myself to do something just because it ought to be good for me, does that make it a bad thing? Am I saying that T3 would be difficult, so I should see her?

 

[Deadman]

Hi @Sandstone . Have you heard the term 'paralysis by analysis'?

You are obviously an intelligent and thoughtful person. You've put a lot of effort in to figuring out what to do. But sometimes we need to stop thinking and just do it.

 

[Sandstone]

Just do T1 or T3 or asking for another one?

 

[Deadman]

I'm not suggesting any particular course of action. I'm saying you are smart. You've thought this through. Now do it!

I see a lot of me in what you write. Think, think, think. Oh wait, there's one of those pesky feelings. Better think about that. ;)

 

[Sandstone]

The trouble is, I haven't thought it through to a conclusion. To some extent it is happening anyway, because I asked the provider to contact T3 and see if she would work with me again. I'm still not sure I can be assured of safety with her though. I'm inclined to think I should also find out about T1, and see if he would be wiling to work with me. Maybe meeting both would help to clarify it.

Whichever, I will still need to work on the things I've identified here. It has been useful to me to chew it over with you all as a way to reach a bit more clarity