How much do you tell your therapist ?

[NewGirl280]

Hi! I’m New here. I’m new to PTSD and therapy altogether. It’s a weird thing for me, but I’m really working hard to reduce and hopefully eliminate these PTSD symptoms.

My progress has been so up and down - I’ll have a few great days which is AMAZING. And then symptoms come tumbling back in. I excitedly tell the person I see how well I’m doing, only to later reach out in desperation for an extra appointment or really needing help.

I had a great week last week - first week with nearly NO symptoms. I was so excited and relieved and spoke of how well it went. 48 hours later I was ten steps backwards and actually landed in the ER (the physical symptoms scare me so much sometimes) terrified of what my body was doing.

My question - do I tell her? I’m on the rebound. I can probably share that it was just an OK ish week but not the greatest and still get the help I need. I don’t want her to think I’m not trying to be well. I don’t want to be a failure either !

What would you do?

 

[EveHarrington]

Yes, tell her.

She cannot help you unless you are honest with her.

Is it that you think going to the ER makes you a failure? (It doesn’t.)

 

[NewGirl280]

The ER part was pretty extreme - but in the moment I thought I was really sick/dying. Silly I know.

It’s more of just the up and down part that makes me feel like I’m not where I should be from, from her perspective. She’s given me lots of tools and I’m so thankful - and I hate having to say I’m not doing well or had a setback. That HAS to drive her insane ? How many times can she tell me “these are just sensations” etc etc.

Does that make sense ? I don’t only want to be better for me, but I don’t want to disappoint her either, or be “that” client who just can’t get it.

 

[Friday]

One of the things that really helped me was learning that this is a cyclic disorder.

I have another disorder that is static (born with it, the level of symptoms you have is pretty much what you’ll always have, it’s all about your ability to cope with it & arrange your life to bring out the strengths/minimize the weaknesses) and dealing with it is very linear. Problem arises? Fix it, adapt & adjust, and things get better. Static disorders tend to be pretty straightforward.

PTSD isn’t like that. Cyclic disorders? Are a lot more complicated. But that’s also super normal / expected. Symptoms come & go, and are crazy responsive to both treatment & stress. It’s extremely normal for a single person to both have severe PTSD, and be asymptomatic, it’s that responsive to treatment... but? That also means that dealing with it isn’t linear. No matter how good a run there are going to be bad times, and no matter how bad a run there are going to be good times. Good days can have bad hours, bad months can have good weeks, etc. You’re going to be looking for trends rather than a straight line. Consider it maybe like a heartbeat line. Ups and downs and that’s expected. Now, is that line generally pointed upward? Or downward? Are there long periods of time in highs with a few sharp jabs down, or is it fairly equal, or the reverse?

How you’re doing in the moment, and how you’re doing overall? Can be very very different pictures.

It’s not about not trying to be well. It’s just the way this disorder works.

 

[NewGirl280]

One of the things that really helped me was learning that this is a cyclic disorder.

I have another di...

This was really helpful to read - thank you for normalizingt experience !

So - do you share the ups and downs? Or do you just take a middle road and continue to learn and apply without divulging how bad or how good things are/were?

 

[EveHarrington]

The only place you “should” be is exactly where you are.

I see lots of mind reading going on.

With PTSD, up and down is the name of the game, the rule and not the exception. Let’s just say that if your healing was linear, you’d be a unicorn. Your therapist most likely knows all of this and doesn’t judge you for the ups and downs.

 

[Still Standing]

Yes, do tell you therapist. Mine always wants to know if I have stayed stable or have had the ups and downs as you are describing. If you are not forthcoming with your lows (and what causes them if you know), like your hospital visit, it is harder for your T to know how to fully support you. It will take longer for her to really know you and it could delay progress in your therapy. She has heard everything under the sun, so our traumas and shame are familiar to her. She is not going to judge you or expect you to be a model patient who excels at 'getting better'. It does not work that way. You have embarked on a journey or process. Your therapist is your partner. She can only serve and support you by what you share with her. If you have a bad week tell, tell her. To give her the impression that you are doing better than you are is not going to benefit you in the long run. Like @Friday said, having PTSD is cyclical. Your therapist also knows this. So, be more open. Be a team player in your care.

 

[blackemerald1]

Yeah agree with ^^ everyone thus far. If you have gone to the ER or taken yourself there because you are symptomatic to the point where you were so unwell or not certain what was happening and needed external reassurance then I think your Therapist should definitely be told.

Please try to stop the 'good pupil' attitude with your therapist. It will probably be detrimental for you long term.

If you tell your therapist that the 'tools' are not working so well, or you didn't use them when you should have...then you may get into a discussion that may assist you when you have the off days/weeks etc.

 

[Friday]

So - do you share the ups and downs? Or do you just take a middle road and continue to learn and apply without divulging how bad or how good things are/were?

If you’re a cop, or similar, and your job is riding on you sucking it up it therapy and being fine? Do what you need to do there, BUT get a private therapist you can be completely honest with, about everything, at all times.

Makes about as much sense lying to YOUR therapist to make them feel good about themselves, as it does lying to a doctor about a broken leg to make them feel good about themselves. IE none. Being all better isn’t what makes them feel good. Doing their job, and doing it well, is what makes them feel good. Lying to them just keeps them from doing their job, and keeps you from mad skills. Let the doc set and cast your leg (and don’t come in the next day, because it’s magically unbroken, because they’re SUCH an amazing doctor ;)), let your therapist help you. If the break is healing badly? If therapy isn’t going the way you think it should be? Hiding it from them doesn’t help anyone. Not them. Not you.

Be honest. About everything. Even about lying. (I really want to lie right now // I wasn’t completely truthful just now -or last week, etc.-)

They didn’t hire you to make them feel good. That’s not why either of you is there.

You hired them to help you.

Lie to your enemies. Not your allies.

 

[Suzetig]

Your idea of what makes a “good” client in therapy is a bit twisted around, it’s not about how well you are or how quickly you get better - it’s about how you engage in the process.

Your T needs to know about the ups and downs - not in a “this happened, then this happened, then this happened” kind of way but in a “I’ve had a really good week but yesterday I really struggled with feeling X, or having flashbacks” or whatever. She can’t hekp you if she doesn’t know what’s going on - and more importantly she will be pacing the work you’re doing together based on how you are between sessions. If you tell her you’re doing ok, she may push ahead into work that you arent ready for which could really set you back.

Telling her how you actually have been gives you the opportunity to explore triggers, look at coping strategies, process and understand yourself better. Telling her everything in the garden is rosy totally denies you that opportunity.

 

[barefoot]

I agree with everyone else here - be open with her about it. Pretending away the lows and difficulties isn’t ultimately going to help you. Nor will it help her to help you.

I’d also encourage you to mention your want to be a “good client” for her so that you can both explore what that means to you and unpick what may be true and false about that.

 

[MyWillow]

Yeah I totally relate to not wanting to “fail” therapy. I’ve been a high achiever all my life and it ain’t gonna stop now. What’s struck me is that no matter what I say my T can read me like a book. She doesn’t even ask how I am now but gently remarks - with empathy - on my energy. So yeah I’m starting to be more open but it feels really dangerous.