News Is Face To Face Therapy Really The Best Method For Severe And Complex Ptsd?

[Gamereign555]

I have had great fortune with just face to face meetings, I think the difference in me is nothing short of amazing. I credit the experience and skill of my therapist.

 

[OKRADLAK]

I hate face to face. I do not like people looking at me. If the T were turned around it might help.

 

[yomama]

Really interesting discussion. I love the idea of text therapy and the benefits seem obvious for concentrated work with trauma (especially for folks who prefer texting from the comfort of their own home, like me :)) Personally as a client, the process of writing and re-reading my own comments and feedback from a therapist, on my own time and in my own space, where I can break down without feeling like someone is watching, has been more effective than any face-to-face conversation. As a therapist, I work in an agency that doesn't allow e-therapy (mostly due to insurance reasons), but I stretch the rules to accommodate each family and their needs. This includes using email, phone, and face-to-face in different combinations, based on what works for parents and kids. As long as I can bill insurance for something, the agency is happy.

Anthony, I also suspect that much of the effectiveness you've witnessed is due in large part to your style, perspective, and approach to trauma work, not just the text interface. I can imagine less-informed therapists just re-creating "say more about that bladedy blah" talk therapy via email. I'd like to learn more about what you are doing via text that has been effective. Are you following a specific model or is it your own creation?

Although I've seen some movement toward e-therapy, I don't see many people doing it yet (especially in the US). It seems we are hampered by insurance companies, HIPAA, and a weird cultural phobia about the "evil interweb." My ONLY concern about doing therapy solely via email/texting, would be what to do in the scenario where the client is severely triggered and checks out, or is suicidal with a plan. Do you have safety precautions in place when this happens?

 

[anthony]

My safety net when I help people personally via the web, is that they usually must have a therapist locally that they can revert to if needed and/or have local country suicide hotline numbers handy, know a local procedure for checking in and getting locked up for a few days for suicide watch... etc.

It just doesn't matter how therapy is done when helping anyone at that degree... because the results the worst spectrum whether they do any type of therapy, self therapy, chat with a friend, family member, therapist... it just doesn't matter, the fallout is the same.

Really it just comes down to simple, plain old self commitment. If you cannot commit to yourself just how bad you will get, and that during those really bad times you won't do some basics to help yourself, then there really is no point in trying to help yourself to begin with... because at the end of the day, nobody can help another person if that person doesn't want to help themselves, first and foremost. It really is that simple, and every bit of recovery is 100% within each persons total control, whether they apply themselves or not to the process.

I don't do anything the experts don't already do... I just don't step around things that need to be said... CBT techniques are pretty much all the same, except academics keep trying to rename the same thing with some different spin. Empathy, confrontation... subject knowledge and the persons total commitment to the process, is what achieves results as far as I see it from a help viewpoint.

You could go read about 5 books in total, and have a complete and total package on what you need to do in order to completely heal... but if you don't learn from those books, understand what is being said within them, apply those techniques in your life... then after reading them and applying them for a couple of years... you would be none the better.

If you read those 5 books, did what I said above about being self empathetic, not sympathetic, be completely honest with yourself and confront your own negative thoughts... be able to identify them, then really put in a massive effort facing all fears, knowing the repercussions initially will be huge, but the longevity results will be rewarding, then over several years at the most complex levels, you will be in a much better place.

If you can do a good majority of things that you can't now, if you can use one low dose medication, or none at all, if you can attend events, work, etc... anything above and beyond what you do now after such time... then you have done very well from such extreme spectrums of PTSD IMO.

 

[yomama]

You are like the Bruce Lee of trauma healing. :) Sometimes the simple, direct path is the most effective. I like that last bit the best - it's easy to get defeatist by comparing ourselves to some imagined magical state of complete healing, when in fact we need to notice the signs of healing along the way: "low dose meds or none at all, attending events, work, etc." "Healing" might be getting out of bed, taking a shower, and eating a balanced meal! I completely agree that each of us must take responsibility for our own healing process. Therapists can help nudge, or kick in the ass, or whatever, but ultimately the only person who can make the healing happen is the individual living it.

 

[Mercy]

I have had a number of therapists over the past 20 years. I started out in Art Therapy. I didn't trust talk therapy because of some aspects of my trauma. I did trust that what came out of me was uninfluenced by the T or the group.

Honestly, most of my talk therapists were helpful but not curative. Each had a particular strength for which I am thankful. I have better coping skills but I still get flashbacks, panic attacks, disassociation and suicidal thoughts.

Writing my diary here and having the opportunity to reread earlier entries has been very good for me. Sometimes, I'll think that I am writing about something totally new only to discover I have written about it before. Now I can look for some change in how I saw or reacted to those traumas.

Some face to face time was good but most of it was not very helpful in the long run. It has cost a huge amount of money, more than my daughter's college education! I feel badly about that.

 

[ClairBear226]

Good thread, Anthony. I have to say, I ended up with an aversion to traditional therapy that I doubt will ever reverse. In 1993, I was having a LOT of difficulties with flashbacks, nightmares, insomnia and depression. I was in nursing school at the time and a single mom, and was really having a difficult time keeping my head above water. So I sought the help of a therapist. Inside of 3 sessions (in a 2 week time period) he decided that I had PTSD, that I had to "get it all out" , and that my resistance to that idea must mean I didn't really want to get any better. He inferred that he really didn't have time to deal with someone that "didn't want to get well". Long story short, I never went back. There have been plenty of times that I've thought about it... and a time or three that my hubby has really wanted me to revisit the idea, but it's been a no go.

What HAS helped me to process the garbage is writing. I keep a private blog that helps to process the details that I'm trying to work through, and , of course, I visit this forum from time to time. I find it far easier to bare my soul and be really, truly honest about what I'm thinking and feeling, when I'm behind the safety zone of a keyboard. I think there are plenty of people that would benefit better from a face-to-face therapist, but I doubt I'll ever be one of them. Text based therapy sounds like an awesome idea. Might even be something I would be willing to look into for myself, if such a thing existed. Have you put any thought into how to implement the idea?

 

[Jacquie]

Face to face my words come out wrong. I start out saying one thing, then it connects to something else and I end up ==> over there somewhere, then forget where I was. Combine that with wrong words and not being able to find or say certain words, and how could anyone get the right picture from that? By email I can 'think out loud' without being interrupted, having questions thrown at me, assumptions made I then have to dispute, but end up ==> somewhere else again. When I write I dont have to 'say' words and if I type something wrong, I can backspace.

Half sentences or half events or truths can mislead even the best of people. Then they treat you for something that is not there, while not addressing what you're having trouble with.

I made quite a few errors writing this, but was able to go back and fix them. Writing 'why' instead of who for example is something I seem to be doing a lot. And saying it. I dont know why words are jumbled up now, and I cant begin to describe what its like losing my ability to express myself clearly.

As an aside, I lost it for a while when I read here this is an 'injury' like a broken brain and that its permanent. I came here looking for ways to 'fix' it. This is not me living inside this body. Not even anything like me. And I want 'me' back.

 

[anthony]

As an aside, I lost it for a while when I read here this is an 'injury' like a broken brain and that its permanent. I came here looking for ways to 'fix' it. This is not me living inside this body. Not even anything like me. And I want 'me' back.

I could lie to you if you want? I would prefer not to though.

There are two ways of looking at things...

1. Blinded by the truth and fixated to being something you can never actually ever be again, or
2. Not focus on who you were, but more using the experience you now have to become the person you want to be, like a new, improved, version of your old self, with some new flaws.

The first is called denial, the second is realistic. A person diagnosed with cancer will make the same choice, either accept their illness, focus on healing it and growing from it, or fall into despair of doom and gloom, roll over and die. Fight or die... PTSD is quite similar... it can kill you through many ways or you can heal it and become an even better version of your old self.

 

[Jacquie]

I'm sorry but I can't accept this

I could lie to you if you want? I would prefer not to though.

There are two ways of looking at things...

1. Blinded by the truth and fixated to being something you can never actually ever be again, or
2. Not focus on who you were, but more using the experience you now have to become the person you want to be, like a new, improved, version of your old self, with some new flaws.

The first is called denial, the second is realistic. A person diagnosed with cancer will make the same choice, either accept their illness, focus on healing it and growing from it, or fall into despair of doom and gloom, roll over and die. Fight or die... PTSD is quite similar... it can kill you through many ways or you can heal it and become an even better version of your old self.

I don't even recognise myself in the mirror. But I still have a clear knowledge of 'who I am'. I had realised long before this happened that few people know 'who' they are and only see themselves as 'roles' or cogs in someone else's wheel, and which defines them. When thats the case yes you can restructure. Make the next lot of conscious decisions on 'what' you will become this time.

Anyone can do that. Please the master or play the role. But under any 'role' or any persona, or any belief system is a 'person' with faults and failings and talents that were born in us. Strengths and weaknesses that are just a part of 'who' we are...things that make up the whole. If people dare to even recognise, and accept, thats just how we're made. And celebrate it for how it really is.

I know 'who' I am. And 'who I am' hasnt changed. Only what I am doing and the fuzziness in the world I live in right now. And I think that is bound in fear. It feels like fear is a thick fog cutting 'me' off from seeing so many details in the world around me. And not being able to see those details keeps making me do dumb shit for lack of information.

If I can get past the fear and get my adrenal glands to shut down, get out of fight or flight mode.......be able to 'see' properly again without the fog, *I* will be able to emerge again.

I'm not a piece of plasticine, someone else gets to mould. I was a whole person, strengths and weaknesses, talents and screw ups, who shone, in the knowledge (and acceptance) of who I am.

Even if nobody else wants to accept 'who I am' in my current situation, I will, I do, and I am not going to be 'remodelled'.

 

[This Ends Now]

Possible advantages:
1. It would feel safer since the patient is already hidden behind his/her phone.
2. It could really bring down the cost of treatment since it would be possible to treat several patients at once.
3. It would reduce missed appointments since the patient does not have to physically leave the house.
4. It would give a real time way to monitor the patient's symptoms.
5. It would reduce distorted memory issues since all the information would be in a format that cannot be altered.
6. It would reduce the threat of having an episode in public because the therapist is always with you.
7. It would reduce redundancy issues since all sessions could be reviewed at any time.

 

[Kb3]

I like the idea of text based therapy a lot.

Writing helps me process my emotions and I express myself better with the written rather than spoken word. I also wouldn't have to repeat myself if the T forgot details. Writing feels safe, so I don't avoid important aspects of my traumas. As others have mentioned, it can also be a concrete benchmark of progress/lack of that has been made.

I kept pen and paper journals in the beginning, and when I was ready to come out of isolation and look for support, I began writing on various blogs and forums such as this one. I can look back at what I have written and see how far I have come. It would have been great to have done that in partnership with an engaged therapist, but it has still been tremendously helpful in any case.