Trust In Therapy Situation - Advice Needed

[Meadowsweet]

I've been with this therapist for a few moths now. The positive effects are that I feel more confident with having my own thoughts and opinions. I feel less dissociated at work and am able to recognise that I am the same person who goes to therapy while I'm there (I used to completely shut it out for work). Also, I have one friend, still only online, but I've handled the challenges that friendship brings well, and we're still friends.

But in therapy I still find incredibly difficult to talk in detail about trauma. I want to talk about it, but I feel uncomfortable doing that. I've been trying to work out why.

One problem is that there is no structure or forward planning to the sessions. I get in, therapist says, how was your week, and sort of leaves it up to me to talk about whatever. Or she will ask questions about the lighter stuff (relationship with my mother etc) and we end up talking about that, when I've gone there wanting to get trauma out.

She says this is my time to talk about whatever I want. I've never been allowed to talk about emotion, so this free for all type of session, is a bit like opening the door for an animal born in captivity, and expecting it to know how to be a wild animal. In life I look at what other people are doing, I look for indications of how I'm meant to be in situations, of what is considered normal, right or wrong and what it is safe to be like.

I know in therapy I'm allowed to talk about trauma, but in what words? can I go into detail - re-live it? How do I start? With my last therapist we did a re-living session, where she helped me ground, then I closed my eyes and went through a trauma. She'd suggested doing it the week before, so I knew what was going to happen, then we prepared with grounding and then I talked. Somebody asking me how my week was doesn't give me any indication that it's ok to go from that into talking about something traumatic in any detail.

Then, because I was struggling I wrote down 2 traumatic memories for her to read. She read them and said we would talk about the easier one, and do the more difficult one another day. So that indicates to me that the more difficult one is too difficult. She also has a thing about my nervous laugh, she asks me if I find it funny. I've explained that it's a nervous laugh, but she still asks and I'm starting to feel very self-concious about it. It's an inappropriate expression of feelings, but it is me expressing my feelings.And her question indicates that I'm doing it wrong. But this is a place I NEED to feel comfortable expressing feelings without criticism.

On top of this, because of work commitments that I can't get out of, I can't go to therapy weekly. So last week she started off by asking me what I wanted out of therapy. I told her that I would like to talk in more detail about trauma. She responded by challenging me and saying well why don't you do that, now. So I did, and it was a relief to be able to. But at the end of the session, she brought up that she didn't think the limited number of sessions was going to work - that she would have a think, and she wanted me to have a think about 'where we go from here'.

It really is my worst fear - that I will talk about trauma and be rejected. I've worked through this a bit, and realise that she isn't rejecting me because of what I talked about. But I've lost trust, because her timing showed such a lack of understanding for the issues that I come to her to help me with.

If I was in a country where I could choose therapy, I would leave and find something that suits my needs better. But there isn't anywhere I can go from here. It's this or nothing. For next time we meet, I thought I would put what I've written here in a letter for her.

I'm terrified that she will either say it's not going to work and get rid of me, or that she will tut and put herself out going to the trouble of bothering with me. I need to trust and feel comfortable with my therapist, but that trust is broken right now, and I feel over-reliant on her words and actions to prove that she can be trusted.

I don't know how to handle this situation. Any advice please.

 

[zaniara]

Sorry about your situation. Is there a chance that you can try to find and pay for a therapist on your own? (I know it can be expensive, but if it is possible in any way it might be a good solution, even if it would mean that you would be poor during the process it can a great investment in your self.) And just wonder, is she a trauma-therapist? If she isn't, I can understand why she doesn't seem to have more knowledge about how to deal with trauma. I've been in therapy before that wasn't specialized for trauma, and it never helped me with my PTSD. Only worsened the symptoms at times. I did get some CBT though that actually helped a bit with some of the symptoms, but that therapist specifically told me that he did not work with trauma(I'm so glad he knew his own limits and took responsibility for them!).

Talking about trauma IS hard. That's sort of what makes it trauma: it isn't "stored" the way in the brain that more "normal" memories are, and thus starting to talk about them can worst case scenario re-active them and make you very ill at first. But also it can be pretty impossible to talk at all, to find the words, simply because they're effecting the parts of the brain that doesn't have any words. My therapist is(among other things) a CBT therapist, and even though we do talk a bit about the traumas, we mostly DO stuff; and he is very active and doesn't just "sit there". If he would I think I would freak out! And it wouldn't do me much good.

Not all therapist know at all how to deal with PTSD or severe traumas. And most of them who doesn't should avoid working with it and refer you to someone who can handle it.

 

[Meadowsweet]

My therapist works specifically with people who have experienced rape and sexual abuse, but not necessarily PTSD.

Regarding money, I'm a single mum and work part time, and my pay only just covers the bills. So I really really don't have anything spare for regular therapy. I looked once and therapist charge between £50 and £100 per session here.

 

[Hashi]

I think it's a really good idea to put what you've written into a letter for her. I hope you and she can come to an approach that's going to work for you.

I had a few thoughts when I read your post, but before saying anything could I ask what you meant by your limited sessions with her. Is the overall number of sessions limited?

 

[Abstract]

I too have some thoughts Meadowsweet but will wait for your reply to Hashi. I also wondered what feedback you have given her so far. In other words what was your response to the situations you describe above? What was said initially about why you are in treatment?

Maybe give yourself a pat on the back for having gone to therapy over a period of time for the first time.

 

[Meadowsweet]

My work has changed the day that our area meetings are on, and they land on the only day that my therapist works in my area. So I can do 2 sessions, then I have to miss two. I know that's not ideal. But it's not something that I can change.

 

[Meadowsweet]

Abstract, I have said that I want to talk more about trauma, and that I didn't know how to start, and that's when we decided that I should write it down. So I did that. But it takes me a while to work out what it is that's stopping me.

 

[Hashi]

I have to say, I would share her concerns about doing trauma work when your sessions aren't weekly. I don't think that makes it impossible but I do think you need to put things in place to make it possible. A regular weekly session on the same day and time creates some stability and grounding in itself. If you can't arrange that, I'd suggest you try for the closest thing you can get.

For example, are the two sessions out of four that you do always on the same day at the same time? Can you email or phone her at a regular time each week, even if only for a brief check in? Do you have any other weekly arrangement that makes you feel supported or stabilised?

Regarding how to start talking about trauma in the empty space of the session, if you need her to provide more structure then I think that's a good thing to ask for. For example, maybe you could agree that she'll ask you questions to help you start talking. I would hope she'd understand.

If you try that, I'd be prepared to have to remind her a little at first. If she's used to working in a different way she may revert to habit and not do it, without that necessarily meaning she's uncaring or rejecting of you. I had to ask my first therapist to ask me more questions, and she did forget until she got used to it. I had to remind her "You need to ask me questions" and then she would.

I hope it's OK to say I'm wondering if you might be coming to conclusions about your therapist a bit too quickly, when maybe you just haven't had clear enough discussions with her yet. I'm thinking about this because I do it so much myself, so apologies if it doesn't apply to you. I often think my therapist has to walk through a minefield of my sensitivies and assumptions, and I may be getting upset by her response to me without realising that it doesn't have the meaning I might be giving it - sometimes it's just that we haven't understood each other enough.

When you talk about your nervous laugh, I'm not sure exactly what you've said to her about it but maybe you need to talk with her more to clarify what it's about. I experience this in therapy myself. I wouldn't say it was an expression of my feelings, and I wonder if you've put it that way to her this may be causing her to ask about finding it funny. For me, it's a nervous reaction and not expressing how I actually feel. Maybe in asking about it, she's not criticising you but trying to understand better. I don't know, but I think it's worth talking about it more. I think it's worth talking more about anything that's concerning you like this.

 

[BloomInWinter]

I hate being asked how my week has gone because I hate rehashing anything. But that question is a crucial diagnostic tool every therapist, especially a trauma therapist, must ask.

The way our body language responds to that question allows our therapist to detect defensiveness, dissociation, or agitation.

The words we choose give clues as to whether or not it's ok to proceed into processing, or do work in the present to help ground us and stabilize our current personal lives.

The feelings we express and tone of voice help our therapist identify possible triggering of the past directing our felt sense of our present. If so, a target for trauma processing has been identified.

It's no small question to our therapist. It's not being dismissive of our distress, or ignoring our therapeutic goals. It's like getting our vital signs checked before a medical procedure.

I know that, and still dislike it immensely. Ick. But I do try to give my more honest answer.

I laugh inappropriately, too. My therapist draws my attention to it not because I'm doing it wrong, but as a way of slowing down the rate of conversation so I am able to look more closely at that issue. Most people reward dismissive laughs out in the real world because it helps them not feel discomfort at an appropriate display of emotion, such as sorrow or grief.

But a therapist fears no such display of our true, underlying emotion. A therapist's response lets our psyches eventually learn..."oh, yeah. I don't have to do that in here. I can actually say what I feel about this and I won't be ignored or dismissed."

Building a strong therapeutic alliance requires our therapists to respond differently to us than most people have in our past. It feels scary because validating responses, compassion, and attunement to our true selves wasn't safe in our past. It's new, and new things are scary.

Hang in there. Trust yourself. Tell your therapist what you think and feel. You won't offend her. Also, you'll learn to start speaking up for yourself with others.

 

[Meadowsweet]

For example, are the two sessions out of four that you do always on the same day at the same time? Can you email or phone her at a regular time each week, even if only for a brief check in? Do you have any other weekly arrangement that makes you feel supported or stabilised?

I really can't change the day of the meetings at work, because they are the meetings that involve all staff. Also, work for me, is part of my way of coping. I have a really strong need to give my all to work and do everything properly. It's part of my work persona, and I understand why I need to go to those meetings, and it would be viewed very bad if I didn't.

I think she would have to suggest the phone call thing, because she has her own working hours and we don't have any contact outside my hour a week. I don't know what you mean by other weekly arrangements to feel supported?

I feel that I can manage the time out of sessions if I have homework and goals, and know that I am going back for another session.

I hope it's OK to say I'm wondering if you might be coming to conclusions about your therapist a bit too quickly, when maybe you just haven't had clear enough discussions with her yet.

Yes, that's why I wrote this thread. I don't want these feelings and thoughts to solidify into something I believe to be true - otherwise I'm likely to go into our next session with all barriers up and locked in place, which would just be destructive. So I'm trying to look at it from different viewpoints.

When you talk about your nervous laugh, I'm not sure exactly what you've said to her about it but maybe you need to talk with her more to clarify what it's about.

She has said that she knows it's a nervous laugh, but that if she was someone else, she might not see it that way.

Most people reward dismissive laughs out in the real world because it helps them not feel discomfort at an appropriate display of emotion, such as sorrow or grief. But a therapist fears no such display of our true, underlying emotion. A therapist's response lets our psyches eventually learn..."oh, yeah. I don't have to do that in here. I can actually say what I feel about this and I won't be ignored or dismissed."

That sounds very wise, and is perhaps what she is trying to do. I just feel like I'm being told off when I'm trying to share something. And when she said that the therapy arrangements weren't working, I thought that maybe she believes that I find abuse funny or something, and doesn't want to work with someone like that. Jumping to conclusions, I know.

The way our body language responds to that question allows our therapist to detect defensiveness, dissociation, or agitation. The words we choose give clues as to whether or not it's ok to proceed into processing, or do work in the present to help ground us and stabilize our current personal lives.

Maybe she is misreading me though. I do get anxious about going into therapy and about discussing trauma, but I want to use my therapy sessions for that. I kind of feel when she asks about my week, that it's a bit chitty-chatty, and then it feels inappropriate to go from that into something as heavy as trauma. She doesn't do grounding with me, she just talks about something easier. Which doesn't help me in the long run.

Building a strong therapeutic alliance requires our therapists to respond differently to us than most people have in our past. It feels scary because validating responses, compassion, and attunement to our true selves wasn't safe in our past. It's new, and new things are scary. Hang in there. Trust yourself. Tell your therapist what you think and feel. You won't offend her. Also, you'll learn to start speaking up for yourself with others.

Thank you. You have given some very wise responses I think. I think there is such a lot that I don't understand about therapy and how it's meant to be, feel etc.

 

[Hashi]

I don't know what you mean by other weekly arrangements to feel supported?

Any regular weekly thing that you can do that feels sustaining. That's very individual but could be a walk in nature, family time, going swimming, going to church, a weekly class. If you can't have therapy or a therapy check-in every week, I think it's good to have something supportive in place instead. It's something to give you an anchor in the gap between sessions.

For example, are the two sessions out of four that you do always on the same day at the same time?

I really can't change the day of the meetings at work, because they are the meetings that involve all staff. Also, work for me, is part of my way of coping.

Hi Meadowsweet,

I understand that you have no choice over your working hours, and how important work is to you. I'm only trying to clarify about the two sessions that you can make in four weeks - are they always on the same day at the same time? Maybe they're not, and that might be out of your control too. I'm not questioning the situation, only trying to clarify what it is.

I'm going to tentatively say that you seem to be feeling challenged about the fact that your working hours limit your therapy sessions, when there is no challenge. I think the same thing happened before when I asked if the overall number of therapy sessions was limited. (I know that the NHS and some charities have a limit on how much counselling they provide.) You responded not about that, but about why you can't attend a session every week because of work.

Please, please know I'm not saying this to criticise you or make you feel bad. That's not my intention at all. I wouldn't be in a position to anyway - since this is exactly the sort of thing I do myself. I'm saying it because I'd like to suggest that your therapy situation (with regard to working hours) may not be as difficult as you're perceiving it to be - things might be better than you think.

If you're going too quickly to your own concerns and projecting them onto your therapist, then that's obviously a difficult thing to untangle. The same with any kind of misunderstandings or miscommunication between you and her. But at least knowing that it might possibly be happening gives you a way through the problems you have feeling trust. These are things you can address.

I've had several discussions with my therapist about me projecting my thoughts onto her. It was very hard for me look at that, and it actually brought up feelings of shame. But it was really helpful to talk about it, both as a general tendency that I have, and to do with particular issues that were upsetting me. Those discussions were some of the most helpful we've had. They helped her to understand me better, and they helped me to feel more trust.

I've also had discussions about misunderstandings. These are sometimes purely her misunderstanding, it isn't always me! Again, difficult discussions to have but also very helpful in the end.

I think working on communication, understanding and the therapy relationship is as important as talking about trauma. I often find it difficult to use my precious therapy time to talk about the therapy relationship, when I feel that takes me away from processing trauma and moving forward. But it's an essential part of it. It takes time and work, on both sides, to create the trust and build the relationship that allows the trauma processing to take place.

I'm holding hope for you to be able to talk with your therapist about how you can work together, and build up a good partnership.

 

[Abstract]

Hi Meadowsweet,
I think I really understand where you at with this whole process. Please feel free to disregard it in relation to you if it doesn't fit but this is how I see the therapeutic process. You are doing a great job working through this. :)

It took me so long to figure out that so much of it is reliant on a type of honest communication that I had never had. Speaking about my reactions makes me feel very exposed and even now that I know I should do it I find it hard.

When we have sensitive areas or vulnerabilities it is easy to feel the T should know they are there and negotiate around them but sadly the truth is that each of us is wonderfully unique and different and even if they are very intuitive they are not mind readers. I hate that that is the case but sadly it is true.

One person will react just as strongly to trauma talk being suggested as someone else will to it not being for example.

The process of good therapy relies on us telling our T's how we are reacting and what we are thinking as well as what we would find helpful. If they are not able to do that enough of the time after a period of time then I think that is the time to look for another t. Sometimes there is a bad fit and that can be damaging. When we go through this process we also learn enormous amounts about managing other relationships too which is incredibly helpful even though painful to learn.

Many of of reactions to what our T says will help them understand more about our past and our world in general. Like you I automatically feel I am being criticised a lot and there is good reason for that. I don't know about you but that was a reality in childhood and still is when exposed to family. Everything in the therapy should be about us and is an opportunity to look at it and heal and discuss it.

It can be extremely hard to realise we are projecting but helpful in more than one way. It reveals past wounds and it helps us manage relationships better as well as helping the T process. The only way we know another persons intent or what they mean by something is to ask them.

As for the laughing thing: I would need her to stop mentioning it after the first time - for me on an individual level. It is a very common thing to deal with therapy as it is usually meant in just the way Bloom described so well.

Most people reward dismissive laughs out in the real world because it helps them not feel discomfort at an appropriate display of emotion, such as sorrow or grief. But a therapist fears no such display of our true, underlying emotion. A therapist's response lets our psyches eventually learn..."oh, yeah. I don't have to do that in here. I can actually say what I feel about this and I won't be ignored or dismissed."

We are normally taught to hide our real distress through smiles and other incongruent expressions because of minimisation, rejection and worse responses to our emotions as children. Part of being able to express the painful emotions and therefore process them involves feeling them and laughter and such stops that from happening. It is also a way to stop ourselves from feeling the feelings.

If you are curious and want to see a very aggressive form of therapy dealing with this issue then look on youtube under "the gloria tapes gestalt - fitz perls".

As for therapy times - I again suspect she is being a responsible and caring therapist. Sometimes we haven't thought ahead how destabilising trauma work can be and even dangerous if not managed well. Have a chat with her and see what you can come up with. A lot of therapists won't do trauma work if there are not enough sessions as they fear for the safety of their clients. The two of you can come up with something I am sure.

I imagine there isn't but is there any way at all of seeing if the meeting could be done on a different day? The only reason I ask is that I know I would always try to everything perfectly at work and never ask for anything. Rocking the boat felt dangerous. I have discovered that people can just say no and no harm is really done and sometimes I am surprised by the outcome. It depends on the situation and persons involved of course. If the person in charge is a problem then it is another matter.

Sadly T doesn't come with a handbook much is the shame and I think you are doing quite well actually. It took me much much longer to start looking at these things. I was very switched off. :bag: