What Do You Want From Therapy?

[Smushroom]

When I go back in a couple weeks I think I know what I am going to say. I will tell him that I want to be able to have the memories of my trauma but not to be controlled by them. I want to figure out how to build up my self-esteem (it seems my lack of self-esteem contributed to my being caught in an abusive relationship). I also want to keep learning healthier ways to cope. I will tell him that as far as what that looks like in therapy each week, I have no idea. I hope he can take that and be sort of a guide.

I think those are great, and realistic goals. I think self-esteem is a big one for all of us

 

[piratelady]

We talk about the beach, surfing, what i did on the weekend. She seemed to focus on work a lot, although that is not my main issue.

I find this happens a lot for me in therapy too. My therapist suggested the appointment before last that I am using other life stressors to cope with my trauma - like it is a distraction. This last appointment, when we talked about me dating and my trauma came up a little. I could barely speak about it, but I was trying and yet he tried to stop me. Well, kind of - he told me I didn't have to. On one hand I really don't want to talk about it because it is so painful, but I recognize the need to. I don't know I'm kind of torn and sometimes I wish he would just say, "Today we will talk about ____."

One therapist I interviewed, and turned down said that a therapist cannot force someone to talk about something because that is just like being abused all over again. I can kind of see that, but I think the patient/client still needs to be pushed some or they will likely opt not to talk about it at all.

 

[DharmaGirl]

I'm having CBT, CPT and PET, and I usually have an agenda. I guess I'm a control freak. We just start talking about whatever, then I talk about what's on my mind. Except for the time I wasn't talking to him.

 

[Abstract]

I don't know how to world, how people, how therapy works. I too am lacking that important bit of knowledge.

Hoping Piratelady doesn't mind me answering here Smushroom.

I so wish I had understood more about therapy way way back. And that I understood me enough to know what I needed.

What approach does she use? Do you know? Is she a trauma T? What other types of T have you had? Shall wait until you answer but different approaches to T can mean that the experience is totally different. And I think different approaches suit different people and also different points in recovery.

I mostly ended up with the wrong types at the wrong points of where I was for me. I look back and think :(. Such a shame.

 

[Smushroom]

She is a registered psychologist, specialising in trauma. I'm not exactly sure what type of therapy we are doing. We never sat down and did a plan or made goals or anything. She is the only T I have seen. I started seeing another, at the same time I was seeing her, but things didn't work out.

We literally go in there and talk about random stuff. Work, parents, home life, medical issues. When i first started seeing her, we looked at mindfulness and tapping and all these other approaches, but have never actually followed through with anything. It's odd. Hard to explain.

I know I need to see someone else...but it's just hard taking myself away after all she has done over the past 18-20 months. But, one more opportunity. I have just set up another appointment with her, she feels I need to talk about 'it'. Well, I've been ready to do that for a long time. But we will see what happens.

 

[Smushroom]

I find this happens a lot for me in therapy too. My therapist suggested the appointment before last that I am using other life stressors to cope with my trauma - like it is a distraction.

I think this is what I did for quite a while. 'Making mountains out of molehills' as the saying goes. I never really thought about it until you wrote it here, but I feel maybe that is what I've been doing... Anything to stop me from going back to what hapened.

On one hand I really don't want to talk about it because it is so painful, but I recognize the need to. I don't know I'm kind of torn and sometimes I wish he would just say, "Today we will talk about ____."

I know i need to talk about it, and feel i have been ready for a while, and you are right, it's not something I WANT to talk about, but know I need to. I need her direction. I need her to say what you have said... 'Today we will talk about...'

but I think the patient/client still needs to be pushed some or they will likely opt not to talk about it at all.

Exactly. It's not the kind of thing you just bring up in random conversation. She knows what happened. I have told her everything through email, text and we have briefly, very basically, touched on it before. I feel she should be the one to start exploring this. I have made it clear to her before, on a couple of occasions, that I'm ready to talk about it, but nothing so far.

It's a hard one..

 

[Abstract]

She sounds like she probably uses a combination of approaches. Skills training is usually CBT or DBT based and is really important to make sure that the person has some ways of staying safe for when you process the trauma. Lots of T's don't do this and just go into it and that can cause problems.

Then the other stuff seems to me that she would be person centred or possibly psychodynamic. These approaches are not structured in the way that CBT would be as they emphasise letting the client feel empowered and feeling they are taking the lead and also work a lot with relationship itself and how that can heal other parts of our lives. This type of therapy has helped me very, very much but it is not everyone's cup of tea at all. The therapist would still ask pointed questions throughout to channel the therapy in the right direction and it doesnt sound like that is happening very much.

The T should still be strongly guiding therapy into the right direction. It would be usual for the therapist to point out that you are maybe bringing up small life events to avoid doing what you need to. All T approaches should do that and certainly shouldn't be complicit in you avoiding.

Has she only eased off pressure when you were very destabilised or is it something she has done regularly throughout? Even if you are destabilised it isnt usual to talk about the beach and normally there would be a lot of important discussions you could have about what ways you were choosing to cope with it.

 

[Pencil]

different approaches to T can mean that the experience is totally different. And I think different approaches suit different people and also different points in recovery.

I mostly ended up with the wrong types at the wrong points of where I was for me. I look back and think :(. Such a shame.

And this is exactly why I think that Ts should be more 'in charge', so I reiterate my point made earlier about hairdressers - of all things. I think the T should be able to say: "My approach is xyz, which is not the best for un-recovered or un-recalled trauma, and therefore what you need is someone whose approach is abc and will do mno with you."

I've had exactly the same experience, Abstract, where I had the wrong types at the wrong time, or the T and I just did not gel.

What does anyone want from therapy? We basically want to heal, in order to function and be happy. Does anyone else want more? Does anyone want less? I'd like to know. But how therapy will get me there - that I don't know. Use this technique? I don't know. Address that issue? I don't know. Talk about it? I don't know. Go for some progressive method that excludes talking? I don't know. What works best - psychoanalysis or CBT? How the hell should I know?

When people go to therapy when they are basically whole (i.e. no trauma), THEN it makes sense to ask them what they want: uuuh, I want to have a more fulfilled life / I want more romance in my marriage / my kids are growing up and I wonder where my life went, etc etc. The majority of people who go for therapy have such issues that to me - from my perspective - seem incredibly minor to the point of being ridiculous (I am NOT making a universal statement here - I am saying that it is my subjective and highly coloured/skewed view). Someone with trauma? What does such a person want? Deal with the trauma and the repercussions (that could be anything from DID to anxiety to ... whatever) and get to the other side and try to have a normal life which mainly revolves around not having stuff constantly intruding. And the repercussions only the T will be able to diagnose correctly. I've had stuff that I was never consciously aware of, but one very astute T spotted.

So, what do I want from therapy?

I want a sharp, compassionate T, who has the insight to see the things I can't even see, to hear more than I can ever tell, and to work with me in a way that will not re-traumatise me or bore me to tears or waste my money.

My very first (and in a way, my only) T was like that, but gave up her practice in the wake of a family tragedy. So, what I want from therapy is not wishful thinking - I've been there, done that, only never got very far in the process. And I've been looking for the same qualities ever since.

I really DO understand that there are people who go for therapy without envisaging an outcome, or even the possibility of a life-after-trauma. But this exactly the point Pirate (or someone else - I can't check now without risking losing all this blather) made when he/she said, 'I know what I want to end-result to look like, but this was not what the T meant " - or something to that effect. Why is the END-RESULT not the answer to give the T?? Why would a T ask you for a road map? And so, when a T diagnoses me with complex trauma, yet asks: What do you want from therapy?, I will scream. Loudly.

 

[Pencil]

But I guess I am wrong. Some people may just want to deal with their symptoms in a way that will alleviate some of the difficulties with day to day stuff, and should be able to say so. Some may want to deal with the trauma itself, and should spell that out.

Kinda changing my tune here, or perhaps not. :laugh:

 

[Abstract]

And so, when a T diagnoses me with complex trauma, yet asks: What do you want from therapy?, I will scream. Loudly.

Well to be devils advocate: I can see why it irritates you but actually think it can be a very good vehicle for discussing ones expectations.

By asking that they would find out that you as an individual have these concerns. Someone else may be under the impression that they need to just sit back and T will fix them. Someone else something else entirely. That is the thing with human beings - we are all unique and our concerns, triggers and needs are different. I don't believe someone asking this means that they are waiting for the client to decide everything about their treatment. I see it more as a way to for the t to get insight into the client and focus them on what they want to achieve.

An obvious directive approach in T has been very bad for me at certain points and it was their lack of insight into that and lack of understanding of my symptoms that was the biggest problem. But you are right that we are not normally equipped to know what we need and that is why they should know for us. Making correct general decisions about what would help and making sure we get it is different to having very directive T.

In retrospect mine did not have the training to have the knowledge to know what was best and I certainly didn't know I needed someone with that knowledge as as far as I was concerned the only problem I had ever has was that I was fat (I was actually underweight).

I just think all T's should screen people for things such as dissociation and trauma which they don't. And i think those who are wobbly on knowledge of trauma should refer people on which they don't. Most of my problems were as a result of T's not understanding dissociation and me not realising what I was dealing with.

Now I have to get past the damage done by therapists along with everything else.

 

[Pencil]

Well to be devils advocate: I can see why it irritates you but actually think it can be a very good vehicle for discussing ones expectations.

I just think all T's should screen people for things such as dissociation and trauma which they don't. And i think those who are wobbly on knowledge of trauma should refer people on which they don't. Most of my problems were as a result of T's not understanding dissociation and me not realising what I was dealing with.

Now I have to get past the damage done by therapists along with everything else.

Abstract, your points are valid, and I think it can help me to clarify things for myself.

BUT: I'd like to know if the answer to the question: 'What do you want from therapy?' will actually have any bearing on the process and outcome anyway? This is actually another issue altogether - meaning that they don't seem to pay attention anyway, or do their own thing anyway, and, judging from many posts here as well as my own experience, often sit around and actually do nothing (apart from chat about the beach, that is).

And yes, it amazes me that so many T's have no clue of what to do with trauma, and don't seem to recognise dissociation or trauma or re-traumatisation or traumatic transference when they see it. What DO they do in psych school??:wideeyed:

 

[Pencil]

Thinking about all of this, and all the f*ups in the past - canceled the follow-up appointment with T4. Just can't do it anymore.