Therapy Difficulties - Online Therapy An Option?

[Abstract]

I have become extremely phobic to do with anything therapy related but need to start making some progress so am posting and going to take this in baby steps. There is a lot I can't discuss yet but I had never considered online therapy as an option until it was suggested the other day by someone here. Which put the cat amongst the pigeons a bit.

There are some important considerations here:
1. Like some others here my reactions to therapy are pretty intense and I am not sure of the safety of not being face to face.
2. Dissociation issues and the impact on these.
3. Complex possible effects of further splitting of my life between my perceived reality and the world online.
4. Therapist not nearly getting the full picture as I could not be more different in person and possible consequences of that.
5. Cowtowing to my fear of being "seen".
6. I don't really believe it is relevant but people have voiced concerns that I may have an internet addiction.
7. Past inability to say when I am struggling and increased ability to hide it this way.
There are sure to more...

So what I am wondering is if anyone can both throw out personal experiences as well as opinions or questions. I am also interested in theory with this if anyone has anything relevant. I have looked in the last few days and may post a link at some point. Mostly insights would be much appreciated. I shall see if I can share more about what I struggle with as I am sure that will help.

Thank you.

 

[Leah123]

I'm glad you posted this, hope you don't mind my input.

1. My intense reactions feel safer to have in therapy online, but I do find it's important to practice grounding after sessions. My therapist is very cognizant of this, and does exercises with me at the end to get grounded. She won't leave me until I feel better, or until I end the session deliberately.

2. I feel safer online, so I dissociate less. I use music to help me connect with my emotions, and that helps a lot to reduce the dissociation too.

3. I ground my therapy in a lot of discussion of real life examples- I don't get too cerebral or generalize a lot, I stick with a lot of specific, day-to-day concerns, and specific issues of my trauma.

4. Miscommunications happen for me, but I find I can write more in online therapy- write essays/journals before hand, and share them, and give a very complete, rich picture of my situation. I also use a lot of descriptors now, about my emotions. I always try to tell her, how I look, i.e. if I am crying, shaking, heart beating fast, sighing, frozen, etc. I call her on the phone sometimes, if I want to share more of those things, so we can hear each others voices.

5. Can you think of it as a starting point? One option is to find a therapist who does chat and phone and video, so you can move up to each level as you feel comfortable. You could even do this with someone local, so you could transition to in-person if you wanted to. Also, there's more to being seen to me than just seeing my body- that does matter, but being seen emotionally and through my words works for me. I know this is a very personal issue though, and I might not be understanding you exactly.

6. I do have an internet addiction to a certain extent I think, but I work online 60 hours a week, so.... kind of understandable too. It's soothing to me to be online. But.... online therapy offers SO many advantages, I find it well worth it. It's convenient, my therapist is much easier to work with and reach in a crisis or when I feel like sharing, I can communicate a few ways, I have a written record of my work to empower me later, and reassure and ground me when I need it.

7. This one takes practice, but might make it easier for you to stay in therapy if you felt a little safer? I have had to work out this issue with my therapist and we've made great progress. She also is adept at reading written clues, like when I stop writing so much, pause, use certain words, etc. I believe, too, as you feel safer, it can become naturally easier to share.

Those are my initial thoughts, if I think of more, I'll try and return. If you have any questions for me, please ask- I know you've seen some of my struggles, but I have made amazing progress in online therapy in the last 4 months and I'm really really happy with my choice. I feel so much safer doing therapy in my own home, not having to drive to and from and worry about crying on the way, have the music to help the session flow (also we share songs, it's great!), and have grounding things around me.

 

[Abstract]

hope you don't mind my input.

Much appreciate your input! Thank you. And thanks for taking the time to do so. Shall come back.

 

[Abstract]

Sadly even just posting this thread has me freaking out.

 

[dnp]

I have started online therapy by email. I have never had face-to-face therapy in my life. My therapist sent me questionnaires by email, I filled them out, and she emailed me questions and I answered them. Each time she notes that she has professional concerns about us communicating by email alone.

My response was that this is what I can handle right now. In the past when my life was spinning out of control I became suicidal. This time I'm getting help and trying to make forward progress. When I wrote things on this forum about my childhood it is the first time I've told anyone. I left out a lot of stuff but saying anything at all was a step forward, a big one for me.

I can't force myself to do things that I can't handle. I'll become physically sick and be unable to function at work. If I can't work then I can't pay the therapist in the first place! I need to respect my limitations. Throughout my life my coping mechanism was to repress everything. To remember at all is taboo but to actually make the words come out of my mouth is impossible right now.

My forward progress right now is my email therapy and my acupuncture, and to a lesser extent this forum and my supplements. If I didn't have this forward progress I might slip into the kind of loops I used to be in which led to despair and suicidal thoughts. I know there are all sorts of limitations regarding email therapy. And do I use the internet to escape and disassociate? Oh heck yes, absolutely! So what? I'm still alive. One day maybe I'll be a whole person. Maybe not today. But I'm on the journey towards that goal, not jumping off a building.

 

[Leah123]

Sadly even just posting this thread has me freaking out.

I am very sorry and feeling sad for you right now. I know not everyone might see this as a good thing, but.... for me, honestly, sometimes it's a great thing to have the distance between me and the therapist. If I feel too scared or mad, I can stop the chat, instantly, right away, to make myself feel safer. If things feel too out of control, I can have some control doing online therapy.

My therapist understands, and she is there for me when I'm ready. It makes me feel safer in the long run and do better in therapy to have that security option. I believe control and security are critical to us with PTSD. As I trust her more and communicate better, I need this safety valve a little less, so, I see improvement and progress. :) But I think this has actually helped me, in the hardest moments to *stay* in therapy, instead of feeling threatened enough to bail, so it's been a good thing.

It is NOT a bad thing for me to get to control when and for how long I see her. I need the connection, I need the reliability, and the freedom to work at my own pace. It's been very healing for me. My best ever therapy was like this too, because it was with a school counselor- I could ask to see her when I needed to, and she was open to me. That openness and flexibility was extremely healing to me, to feel like we had a caring relationship a little beyond what I'd have with a strictly once-a-week, 50 minutes a week counselor- and it gave me the ability to emote when I was ready, not try and save all my emotions for that appointment, which for someone with dissociation issues, is especially difficult.

 

[Deleted member 1860]

To be honest, I don't think you should do online therapy. There are a number of reasons.

Your postings here on the forum make it quite evident that you painstakingly hide anything personal about yourself. That is quite easy to do online; not so easy to do in person where it is easier to read body language, etc. I think online therapy gives you too much opportunity to hide. Healing isn't about doing what's easiest. It's about pushing yourself through the hard things, knowing that if you don't, things won't improve.

 

[franciemarnie]

What stood out to me in your initial post was taking baby steps. Only what you feel comfortable doing, not what anyone else thinks you should be doing. I am meaning therapists primarily.

I am loving the relationship Leah has with her therapist. For me, having the control would be crucial - doing only what I am comfortable with for however long I am comfortable with it. And the grounding at the end of sessions and all the ways she has of trying to make herself safe, her awareness of self, etc. Really inspiring.

If I were to do therapy again, and I did face to face for decades, I would choose online next time. How I was physically perceived caused problems for me. That is, how I felt simply being perceived, how I felt I was perceived, etc.

For me, baby steps would be the key.

You don't have to do a thing until you want to, until you feel ready. It's nice to have a choice in some things.

 

[Leah123]

It's about pushing yourself through the hard things, knowing that if you don't, things won't improve.

I find that doing therapy, period, is pushing myself through the hard things. I don't feel the need to make it deliberately harder on myself- I was already abused, traumatized, dissociated, and suffer PTSD... for me... it's hard enough. And if you feel that it is an achievement, and self-strengthening to do in-person therapy, I support that fully, but if you aren't ready.... I don't see a problem with baby steps either.

For myself, this isn't about baby steps, though- it's about a wonderful, nurturing way to heal, not for everyone, but for me. I am in a place though, where I do already have some stability, though, mabye if I didn't, I would feel more as if I had to push myself outside my comfort zone- I don't know. I have a husband, daughter, coworkers, and working on making more friends. For someone who has a major issue they want to resolve with anxiety around people, I guess in-person could be more beneficial, but... I can see an online therapist working through that issue with "homework" instead or in other ways.

I just think- where there is a will, there is a way. :)

 

[Leah123]

P.S. One more thing I kept in mind was your issue with dissociation and therapy appointments. I did two years of therapy, when I was about 18, with an eminent psychologist in San Francisco. Old school analysis. I was dissociated most every appointment, completely tense, full of shame. Despite all her experience and credentials, I felt the therapy was a failure, and never could bring myself to reveal much or feel healing. So, I learned that trying to do the hard work of therapy while consistently dissociated did not work for me. It was probably a combination of factors, but that was a key one. So, I'm all for easing that symptom when trying to do the difficult work of healing.

 

[Abstract]

Thank you dnp, Leah, ScaredOfLonley and Franciemarie. You all make good points. And thank you for sharing personal perspectives too. We are all unique and it helps to hear a variety of experiences and what works and why. I appreciate the input. I shall come back and answer more fully.

While I think about it I just wanted to add that a very important factor for me is that therapy not backfire in the long term. I truly don't think I could come back from that if it happened again. So initial difficulties are one factor and long term safety is another and very important. I mean emotional safety when I say that.

I have a habit of barrelling through things without being able to access safety or overwhelm cues and therefore have found it important to try to look ahead and pre-empt things as that seems to help rectify or at least moderate this. Its a subject for another thread but that gives the basics of it. Thank you all.

 

[Leah123]

therapy not backfire in the long term. I truly don't think I could come back from that if it happened again. So initial difficulties are one factor and long term safety is another a

I would say, though it's early in my therapy, four months, of intense work and lots of appointments, that I had more initial difficulties, probably normal, and feel a great sense that it is continually feeling safer for me as we work together more, and that there is a lot of safety in the online format, because the expectations with my therapist are less rigid- I don't have to fit into the standard format, cope with the hard stuff alone in between sessions. For example, I personally had a very hard time being emotionally ready for a couple sessions. My therapist held the spot open for me, didn't charge me if I was late or missed, and was willing to have long or short sessions with me.

I have a habit of barrelling through things

I too can do this at times, and it's been very hard, but she's helped me through it. I like having the online chat records, too, so that when I go through things too fast, I can go back and process them! I have it all in writing, and can deal with the exposure at my own pace, and refer back to it when I need. Makes it easier to remember things, to be compassionate, to see some progress, and areas to still work on, and more.

my reactions to therapy are pretty intense

I wanted to admit something, in hopes it might help a tiny bit. In therapy, I've felt suicidal a couple times. I've had some very difficult moments, though in fairness, will say that I've never made a suicide attempt. My therapist helped me with it, trusted me to be honest about how serious I was, and asked me not to do certain things. I was afraid she'd report me or stop working with me, but she trusted me and did not. If you don't trust yourself not to self-harm if you are alone, or do not trust yourself to tell your therapist your intentions or fears, then I appreciate your concern about reacting badly to therapy and being alone.

P.S. When you get tired of me advocating, let me know, lol. I'm really passionate about the things I like. And I had a truly wonderful session today, almost two hours, so.... I'm really feeling positive about it.