Experiencing Therapy As Humiliating

[theshadowoftheliving]

I think that therapy is one of the most humiliating things I've ever done and that humiliation and shame is making me want to quit.

My line of work is based on my ability to think/process/create information about my field of study. My self-worth (what there is of it, anyways) is based on this ability to think and think well and be at the head of my field. I've worked through two college degrees to get here. I've won awards for my work. I always felt like, if nothing else, I at least had my intelligence. My traumas have stripped me of everything else, but I always thought that my thinking was intact.

Therapy (and the PTSD diagnosis) is all structured around how my thinking is problematic, avoidant, and flawed. I get that this is all part of the PTSD problem and what is keeping me stuck, but acknowledging that I'm not thinking well is cutting to the core of the only thing I thought I had to live for/persist for. I mean &&^^&(#T@(*)( I went into therapy in the first place with the goal of getting healthier to pursue yet another advanced degree. But if I can't think, then what is the point of all of this?

I'm freaking out. I want to quit. Acknowledging the PTSD is cutting down the only thing I thought I had to live for, and without that piece of myself intact, I feel like I'm just taking up space in the world.

 

[Weemie]

it's hard to break down the process of ptsd without using terms relating to your thinking, but it's not related to intelligence or comprehension. there's 2 different types of thinking, i ...think. haha, there's the cerebral kind- the "forming words into sentences" kind, the "performance & verbal" kind. and then there's the inner, self-perceptions kind. the emotional kind, the "it's my fault/survivor" kind.

and it's not that we can't make logical leaps. to say, you know, if it happened to someone else. if someone else was in that same position, how would we view them? ptsd shapes our views of the world, of people, of ourselves. it does, 100%.

people sometimes use the "ANP/EP" analogy. the "apparently normal personality" vs the "emotional personality." what we internalize, about what's happened to us, leaks out into our everyday lives. the only difference is, we can choose to work on that part. we can choose, to face it and acknowledge it and shape it. because experience is malleable, perception is malleable.

something cerebral, that's more ingrained. that's brain patterns and development. that's the fact that i can't copy a picture when i'm looking at it, ya know? (and hell, people want to call this intelligence and thinking, too, but look at me. i'm here. i'm talking. i'm imparting what i have to say and people are picking up what i'm putting down. i'm human. so live and let live. intelligence and thought is such a vastly misunderstood discipline to begin with.)

the way i see it, we change ourselves through our biology.

 

[Chava]

Therapy (and the Link Removed diagnosis) is all structured around how my thinking is problematic, avoidant, and flawed.

This is not true, though could feel true through CBT lens, which is just one way of working with trauma. And the truth is it does not work for many of us. Look up Bessel Van Der Kolk if you haven't seen or read any of his stuff. He's a trauma expert and understands the appropriate use of talk therapy and some cognitive skills, but that the real issue with trauma is in the body. Saying "I'm in danger" when I really am not does not mean I am stupid. A CBT therapist could possibly make me feel stupid though. Van Der Kolk and other body-oriented trauma therapists would say that this actually MAKES SENSE on a trauma level. The body is creating the cognitive distortion, not the mind. So it has to be worked through at the body level, or a trauma regulation level first. It does not help to just tell someone their thinking doesn't make sense.

I have a masters degree. Thank god my therapist doesn't make me feel stupid for sitting in my house, facing the door and holding a knife. I "know" it doesn't make logical sense. That doesn't matter at all...and beating myself up for it helps not one bit. What I'm looking for is safety at a physiological level. It helps if I have awareness that I'm stuck in an old state and can access some grounding resources. But none of it is cognitive stuff...that processing can and should happen to some degree, but not in the thick of it.

A team of experts recommended psychoanalytic therapy and CBT for survivors of the WTC attacks. In follow up most people didn't follow through but found more personal benefit through things like massage and yoga. That alone can't cure all traumas, but Van Der Kolk pointed to these studies as very interesting. We want to feel okay in our bodies. Challenging our thought distortions related to our deep feelings of unsafety does not actually help us feel safe. In too many cases, yes, it makes us feel more crazy or even stupid. I quit cognitive therapy because I often felt more messed up and lost. It's a great therapy but of limited value for complex trauma and many forms of trauma in general, especially if not coupled with other tools.

It's common to feel worse through a period of therapy. But if your therapy is making you feel much worse about yourself (vs just a little shaky or ungrounded at times) and you also aren't trusting it, look for a different therapy. PTSD can destabilize us but does not make us "crazy" or "stupid". The body actually acts in pretty predictable and life-saving ways in trauma...and the residue of that is what we need to deal with. My trauma thinking was positively life-saving. It's not flawed. it doesn't fit with many current situations, but tell that to my nervous system! Most, if not all, of our trauma impact is working well beneath the cognitive brain.

Just please know that trauma therapy comes in many shades and there is no perfect one-size-fits-all approach. What you are doing might simply not be the best fit. You should feel somewhat validated in your experience, not more crazy. Validation and understand helps us actually move forward. If you're questioning your entire self worth, please tell your therapist and research any other options. This has nothing to do with your ability to be a great logical thinker in the area of your work.

 

[Deleted member 1860]

It's obvious that part of your problem is all or nothing, black and white thinking.

Start by fixing this cognitive distortion.

 

[Chava]

@itsKismet

Cognitive therapy was a bad fit for me, and not because I had cognitive distortions preventing good use of it. It's not a good therapy for many trauma survivors. Plus, telling her to "start by fixing this" without any "how" is almost just another way of shaming. She went into therapy to "fix" some of her struggles but it's pretty obvious she doesn't feel safe enough to move forward. Or they are simply the wrong tools. Black and white might be true, but some cognitive therapists really do hound you for flawed thinking when really, you are having a flashback, or some response that has NOTHING to do with your cognitive processes. And it's very confusing if you believe it's supposed to work.

 

[Chava]

p.s. @theshadowoftheliving ...I know you were doing a short time-limited therapy. Where are you on that? Will there be an extension or does your therapist have ideas/resources for you once your sessions are up? Do you have other options?

Anyway, please tell her how you are feeling and maybe she can try to reframe her use of cognitive focus. But also know this is not "THE" trauma therapy and you are not failing or fundamentally flawed. You're traumatized, which means its own things that your therapist should be able to help you understand. I know this has been a pressured situation on a few levels.

 

[theshadowoftheliving]

@Chava I have four sessions left. I'm currently fighting with my insurance company, and it looks like there is a good chance of continuing, although that would mean switching therapists. I asked mine for some referrals last week, and I think I want to try something less structured/a bit slower and kinder. The intrigue of CPT was that it was supposed to fix things fast, but that obviously isn't happening, and as the weeks have gone by and I've done more research, it seems much less effective on complex trauma, which is what I'm dealing with.

Thank you for your kind words as well. I know, cognitively, that this has nothing to do with my line of work, etc, but converting that cognitive knowledge into emotional knowledge is the hardest and most humiliating thing ever. I'm working so so so so hard on fixing everything and getting better, but therapy is making me so much worse in terms of my sense of self worth (and lack thereof), and I think I probably went too hard, too fast into the trauma material. I think that my high level of functioning made my therapist think I was more emotionally stable than I was, and so she pushed me hard - which is what I purported to want - but now there is part of me that just feel so incredibly awful about myself that I just want to give up completely......

I'm working on fixing my thinking. Really, I am. It's just so hard and change isn't happening soon enough.

 

[Born to Run]

Maybe this thread from yesterday will resonate with you:

https://www.myptsd.com/threads/does...e-as-part-of-their-therapy.53613/#post-857116

Ptsd strips us naked from all our competences until we heal and can pick them up again. Maybe you could accept it as being temporary? I was fired from a brainy ;) job as I started to make mistakes due to ptsd, and was not even diagnosed then. WTF I had no idea what was happening.
As @Chava has mentioned it depends on what type of therapy you do. I have never ever discussed what you have -about your thinking- in my therapy, and I know it would not work for me, as in behavioural therapy it is the symptoms you are looking at, not the root of the trauma. The most humane therapy I have ever done and do is SE. I had 12 therapists before over 20 years.

change isn't happening soon enough.

It will take a lot of time to get through trauma, until today there is no quick solution yet. Please be prepared for that fact. :(

 

[Chava]

It would be great if you could get an extension!! (and consider a different therapy). It really does take time. It helps me to think that I don't actually want to change everything quickly...I would be so ungrounded. And in trauma research, this is not helpful...because of the ungrounding. "Pendulation" is a coming term from Somatic Experiencing and those who follow similar techniques. We find safety first, then move slowly into trauma stuff, then back out. Part of my struggle has been allowing some of my old forms of "safety" to still help me (but with growing awareness and not too much harsh judgment), but slowly replacing the old patterns by more healthy forms of safety and positive resource. This has taken me a few years.

For complex trauma, some cognitive tools can be helpful, but maybe you can look for a therapist who has a more multi-faceted and process-oriented approach. I'd run away from anyone who listed their one method or approach as "cognitive" or "CBT". It's too limited for trauma. It was simply not designed for it. You can't access and process that stuff. Some behavioral approaches are helpful for working on the regulation stuff, but it has to be part of a bigger process. If you want to really work with the trauma, a process-oriented approach is more helpful than a set and structured model, because our traumas and adaptations are so very individual.

My therapist is primarily body and trauma oriented. Her main approach is process-oriented (meaning she's largely following what I need and my speed vs trying to fit me into a structure)....amazing how much I've learned and how validating it has been vs previous work with therapists and hospitalizations. I also feel like I have gained some really usable skills. Anyway, my therapist has a lot of somatic training (including SE) and also background in family systems, attachment, and early trauma. I don't think a load of detailed specializations are necessary, but if you can find a new trauma specialist, maybe it would help to look for a broad background and range of tools (but all for trauma focus)...I think especially important with complex trauma.

I think it's great you've made this step and there is nothing lost in learning even what does not work very well for you. You can be more empowered in looking for help the next time around, which is very much how my process went. All my past therapists had something to offer me, but at the point I felt it wasn't working or making me worse, I eventually turned that into some kind of insight that helped me in finding my current therapist, which feels like a very good fit.

 

[theshadowoftheliving]

Chava, I think you are right about the cognitive style being too oriented than a set and structured system. Originally, i was so intrigued by the idea of "evidence-based" therapy, but the result has been that there are times when I feel like I am drowning and we just hurdle along anyways. I'm also starting to think that the idea of twelve weeks as effective for solving PTSD is just ludicrous and certainly not helpful at all. It makes me question the format, for sure.

And I do want to go slower …. I understand that people think I should just solve this as fast as I can, but almost thirty years of coping mechanisms and strategies are hard to unlearn in just twelve weeks. And because I am somewhat functional still, I'm terrified to undo that and completely fall apart - I'd rather lead a slightly restricted life emotionally that one where I lose everything in the name of "confronting my problematic thinking patterns". (I hate that this therapy actually uses language and words like that - it makes me feel so so so patronized).

 

[Chava]

Originally, i was so intrigued by the idea of "evidence-based" therapy

The evidence of cognitive approaches working well for most cases of PTSD is actually pretty weak (and I would be very interested in seeing the research behind healing from PTSD in twelve sessions or so). But CBT and therapy relatives stand out still because not much else has been researched. The neat part about things like your structured therapy and CBT is that they are easy to research. More multi-faceted and process-oriented forms are simply difficult to research. There is little way to make comparisons based on evidence because there just isn't enough of it.

It's important to do some research and look for credibility, but also trust yourself and know that you are the major player in your healing. And you have to feel like you trust the therapy and therapist.

"confronting my problematic thinking patterns".

Yes, I feel that as shaming, and also limiting in light of the real mechanisms of trauma.

 

[joeylittle]

@theshadowoftheliving, a lot of what you are describing reminds me of things I'm dealing with - so it's good to know I'm not alone, thank you for that.

It strikes me that a big part of the issue might be you conflating your core belief thinking patterns with your functional thinking patterns. I know, for myself, I developed a coping system almost 30 years ago, and it has to do with two things: an enormous amount of partitioning, and a deep acceptance of my 'wrongness'.

The first one - partitioning - is not a bad skill, and it's still what keeps me functional, where PTSD and the cognitive side of my depression is concerned. Whatever your skill has been that has created a way of coping for you - can you articulate more about what that is, or how it works for you? It's helpful to understand it, and figure out how to keep using it - or maybe I should say, allow yourself to keep using the aspects of it that are genuinely helpful, not harmful.

But the second - which is this acceptance of my wrongness (I don't have a better word for it, it basically could translate as "I am completely unlovable, I am a mistake, I am a monster") - that's the core belief part, and that is not a very helpful side of my coping. It is very maladaptive, but it's a huge part of how I have gotten through my life. It would always cause me pain, sometimes, but most of the rest of the time it was how I shut down my pain - because it was a reason for feeling the way I did. Of course I was deeply sad, monsters are probably sad. Accept it and move on.

It's filtered into my life in a very tangled way, and ultimately, it's where I hit the wall with CBT, because I don't know how long it would have taken for the constant challenges to my core beliefs to finally start working, but my sense was that I could spend 12 hours a day, every day, doing thought records and I'd never even keep up with the daily negative thoughts, let alone getting to their origins, or the older ones. It just didn't feel like it would work for me.
So, putting more focus on the trauma processing itself, and just continuing to identify and challenge that negative thinking, but also recognizing that it's likely not going anywhere until I've dealt with the trauma....that's what has made it doable for me to be working on all this stuff.

It was a real white-knuckle moment when I started having to make my work life adjust to all this stuff, because I don't want one to affect the other. But it's going to happen. What has been good, though, is that I really haven't lost my ability to think, at least 90% of the time. I don't know if my partitioned, analytical brain is always helpful - but it's often helpful, even in therapy, because I can step back and observe myself, what my responses are, and how they fit into the scheme of my treatment goals.

I guess this is all just to say - it's not all-or-nothing. You aren't going to have to lose your coping mechanisms entirely; if you can first start with getting a better understanding of how they work, and which parts of them are keyed into those negative core beliefs, and which parts aren't - you can maintain a conscious awareness of them, and still get good mileage out of the things that aren't actually maladaptive.

? Sorry it's so rambly. Look at me, giving myself credit for knowing how to think.:bag: My only excuse is I'm still low on coffee this morning. :coffee: