Setting An Expected Time For Therapy

[Hashi]

I was asked to do this last week by my therapist who I've been seeing for two months now, and am stunned by even being asked. She wasn't talking about setting a review date - we already have that - she was talking about deciding on a finish date to have as a goal.

I had just explained that I had a horrible time last year because the time limited therapy I was having with someone else (one year plus some more months which were constantly interrupted and disrupted) wasn't long enough, and I was told that it was usually enough for people. This was compounded by the complementary therapist I was seeing also hinting that I was too stuck, and my GP directly saying i ought to be over it by now. So I felt not only still traumatised, but also a complete failure.

I'm trying to recover from multiple traumas beginning at birth, some of them life threatening and leaving me with permanent injuries. I was still recovering new memories when I had to stop seeing my last T. I worked incredibly hard the whole time.

Why do people think that should have been enough?

How could I possibly estimate how much more therapy I'll need? What could I possibly base that on? Am I supposed to say, well I reckon 3 weeks to talk about this, 2 weeks to talk about that, 3 weeks to be unable to say anything because I'm overwhelmed by what I just talked about then I'll give such and such a go... but the terror when I even think about that is bad so better give that 4 or 5 weeks... ?????

In the session when she asked me, I only said I didn't know and she suggested we leave it and keep to our review date that we already have and see where things are then. But I've been getting more and more angry since the session. It's compounded a feeling that I have that it will be helpful to work with her on skills for a short time, but then I need to find someone else to work through the trauma with. So maybe she'll get her answer after all, but not how she originally meant.

If anyone else has set an expected time for their therapy, could you say what you based it on? Every health/therapy professional i've dealt with has expected me to get better enough to stop therapy within a specified time. So I can't help thinking they must be right and I must be wrong and - even though I work very hard at therapy - failing.

 

[Queen Boudica]

So sorry this has happened to you Hashi.

I can totally relate to what you are saying. I think having the time pressure thing just adds more pressure and stress and makes you panic in the sessions you do have or after because you are afraid that you will not cover enough in the time frame and get frustrated if progress is slow or you did not get to cover what you thought you were going to cover etc..

Although some would argue it is good to have a time frame it means you know you have to work to get better in that time.

But I agree, with you; like you, I feel I have so much trauma stuff to work through and I don't even recognise the whole picture so how would I be able to set a time frame to say when I am going to be better? I have no idea. And my life is very turbulent. Multiple things coming up every week, I can't even cover those in a session.

Over here in Australia Medicare limits the no. of sessions you can claim in a year to 10 actually I think it is 5 and then a review for an extra 5. So that for someone who cannot afford private sessions it is really limiting. I can't see, how someone with complex trauma can manage on ten sessions in a year. But maybe that is me?

 

[maddog]

Hashi. This stinks of the obnoxious, yet all too common, reality when the unique nature of psychotherapy becomes poisoned by the intrusion of bureaucracy and administrative restrictions. As I say all the time, this stuff isn't like doing your tax return - it doesn't have formulas, defined pathways, rigid milestones or pre-defined outcomes, it's just not that sort of work and shouldn't ever be squeezed into a box it isn't designed to fit into.

My T is addament that on the contrary, complex trauma takes as long as it takes and is inherently incompatible with the tried and true structure of a lot of therapies, ie, set length of time for sessions, set numbers of sessions, set processes for working through issues etc. While obviously some level of regulation is needed to keep the process on track, I think that if any form of therapy needs to be person and situation specific and sensitive to change, then trauma therapy with complex trauma is it.

I feel horrible that I don't actually haveany advice for you, other than to suggest that perhaps your thought that this mightn't be the right trauma T for you, might well be a good instinct. Just wanted to give you a little hope that your take on this seems utterly valid and realistic to me though.

Maddog

 

[Queen Boudica]

Well said Maddog as always.

 

[MyStarryNight]

I have been doing a lot of reading lately and found a bit of information on recovery time. Basically the author said that complex trauma generally takes two to three years to recover from but that it can take up to twenty years. A lot depends on the person, their personality, the nature of the complex traumas and life circumstances.

For instance I have recently encountered a lot of life stressors such as money problems and a sick family member. This has significantly lessened my ability to deal with stress thus hindering me in therapy and reducing my functionality in life in general. If those life circumstances weren't going on right now I think I'd be able to progress faster in therapy.

Though I don't think faster is necessarily the goal in the first place. From a lot of books I've read it seems that slow and steady really is the best way to work through trauma. If too much is tackled too quickly it can cause more problems instead of helping you heal.

I think Maddog is right in saying that trauma therapy can't be pinned to a time frame and that indeed it really just takes as long as it takes.

Could you talk to your therapist about how you felt about her trying to pin you down to a specific time frame? Maybe you could tell her about your reaction and asky why she feels a time frame to be necessary.

She might not be so fixated on the time frame but wanting to initiate goal setting or trying to get you to see that you will be able to recover some day.

Remember though that the relationship between therapist and client is really important. In fact it's the therapist as a person and their relationship with the client that has been shown to have the biggest impact on the client's recovery. So if you are worried about this therapist there is no shame in looking for a better match.

 

[Tinyflame]

I have read all different things, from 1 to 2 years, from virtually 'instantaneous' if you truthfully spill your guts, to for some it's not possible (eg ends in suicide, etc).

But Mir reminded me of something, above, recall reading that past studies have shown a strong correlation between the confidence of, or positive feedback from, a T that you will. Who knows if that's simply because of the support/ vote of confidence, or re-framing it in one's own mind. No doubt 'hope' and 'motivation' or even belief in the possibilty of it (healing), can take a beating.

Good luck to you, I would guess it would help to say what you feel about the question.

 

[Tinyflame]

I think I would focus on specific smaller goals.
xox

 

[doglover]

It may help to let her know that her question about a time frame left you feeling - what? threatened? overwhelmed? ashamed? all of the above?

Therapists can only adjust their approach as much as they get feedback about where it goes wrong, and having that chance to change course is a good source for building up trust. Harder to trust if the question hurts you, but even harder if T doesn't know how much it hurts and can't reassure you in the aftermath.

That said, my current T has not asked such a question - I would probably feel triggered by it myself. It's likely the insurance companies pushing time-limited therapies. If that's the case, there are some sliding scale clinics where you pay out of pocket, but on your own dime it's you - not the insurer - who decides how long you go.

 

[SimplyComplex]

My t wont ever tell me a time line, and I have asked. I guess it "wont be forever" but I imagine she plans on retiring before forever.

I could see how that timeline thing could be really challenging. but if they are more solution focused then psychodynamic, they might have that as their regular MO. My t doesnt even have a review date.

 

[Meadowsweet]

I hope you won't mind if I just give a different angle on this. I'm scared of feeling pressure to 'get over it' myself and I get scared of retribution because of failure, so I do understand how such a question might cause alot of distress.

But at the same time, I'm scared of co-dependency. In my experience there are people who act like the stronger person, the helper/saviour. But their image depends on me being the weaker, more faulty person. When I'm not acting weak enough, such people will attempt to show me that I'm weak and incapable without them.

This is part of my trauma and part of my thinking. And I'm very aware going into therapy, that I mustn't fall into the role of acting weaker than I am, or showing dependence in order to please and verify the therapists role of 'helper'. Or try to act stronger than I am in order to repel the co-dependent 'helper'.

So just from my own circumstances, I can imagine a therapeutic reason why a therapist might ask me to consider the end of their imput.

From what you've said, this therapist is giving you the opportunity to give your input into this idea of ending therapy. They're not necessarily telling you that you should end it, they are asking you to think about there being an end.

But I think it would be positive to discuss your feelings about this question with your therapist.

 

[Hashi]

Thank you for all your helpful thoughts and views.

Lizio, I can't think how anyone could see 10 sessions a year as sufficient. That sounds like the sort of bureaucratic calculation that Maddog talks about - presumably someone came up with it by averaging budgets, staff, conditions, client populations etc and along the way forgot to actually think or care?

I should have said - this is private therapy. It has particularly upset me because I thought going private would allow me the ability to continue as long as I needed, in comparison to my previous time-limited therapy which was through a charity. And to be honest, having to pay when I can barely afford to is enough to keep me mindful of having some sort of end date. When I'm ready for that. But I've been seeing her for only two months, we haven't even had the thrree month review yet and already I feel under pressure because of this.

Working with her on DBT skills is helpful. But I'm feeling that the other aspects of the counselling are too much by the book compared to what I want. She's careful, competent and professional, but that's not enough for me. I feel like she wants to tick the stages of trauma therapy off a list rather than be with me on a journey that I'm making. I've been increasingly feeling this in the short time I've known her, but it's only now that I'm admitting it to myself.

What people have said about discussing how it made me feel makes sense - except that I seem to have been doing a lot of that already. She's open to deciding jointly how we work, but some sort of natural baseline of understanding between us doesn't seem to be there. It would be a completely negotiated and manufactured relationship.

So I need to continue seeing her a bit for skills work, then start another search for a new therapist. Someone who's happy for it to take as long as it needs to.

I'm so glad to have this place to talk things through. Thank you for your support and understanding.

 

[SimplyComplex]

Maybe look for a t with eclectic or psychodynamic influences. It sounds like you just ended up with a t who has a style that you aren't looking for.