How To Tell If Your Therapist Is Working For You.

[JEKBreatheandBelieve]

The worst part about this all is I'm actually doubting the diagnosis of PTSD, I'm assuming this is something I can get a second opinion on... As in literally go to another T and be re-assessed?

I think it is completely fair to approach another therapist and be re-assessed and if it comes back with the same diagnosis, hopefully this new therapist will take the time to sit down and explain how you meet the criteria and what it all means. I had to have my therapist read the diagnostic criteria to me several times even though I accepted that I had PTSD, but I needed to hear and have explained the criteria again and again even though I was living it. So yeah, I think it is definitely something you can get a second opinion on and a third if you need to until you get what best helps you.

 

[AlmostFellForIt]

I think that rhetoric was highly manipulative. @Born to Run is right in that he was using a solid kernel of truth (saying that building coping mechanisms before diving headlong into trauma is a sound therapeutic approach), but he then laced that kernel with a sinister powerplay that--to me--was thinly veiled as a contextually appropriate thing to say rather than a suggestion of power. Y'dig? ;).

I do and I think you're spot on. I remember coming home from therapy one day and I actually remember saying to myself "who can you trust if you can't trust yourself" now I think about it, I'd said it at the time because my confidence was being undermined....I shudder at the thought that I even passed that rubbish through my mind (I'd forgotten about it until you posted) but it goes to show the effect it was having on me. It wasn't until a bit later I realised I can, should and will trust myself.. I always have and will always continue to and my efforts outside of therapy instigated by me are just as important as the paid advice of a professional (and in this case were propping me up somewhat).
Thanks to everyone who has replied, sometimes you just need perspective.

 

[AlmostFellForIt]

I had to have my therapist read the diagnostic criteria to me several times even though I accepted that I had PTSD, but I needed to hear and have explained the criteria again and again even though I was living it. So yeah, I think it is definitely something you can get a second opinion on and a third if you need to until you get what best helps you.

Thanks, the fact you were even able to do this shows the contrast between therapists (yours and mine) DSM was off limits to me!

 

[barefoot]

I think it sounds like he feels undermined by you. And that's your fault - this is his stuff and he's not managing it as he should be.

Sounds like he's maybe threatened by your research/reading/by the knowledge you're gaining on your own. He may be a therapist who likes clients to look to him as the expert and who has quite an ego that needs feeding. And by criticising you for being too controlling, he's putting it all back on you whereas it sounds like it's actually his stuff.

I agree with him on the session 5 assertion about establishing safety etc first and not rushing in to trauma stuff too early. I actually think that's responsible of him and that he's taking care of you in this way. Trauma work is difficult, slow work - rushing it and not treading carefully can easily retraumatise you. However, the way he worded it....again, it seems to put him more in the centre of things and more in control. When my therapist talks about this sort of stuff, she says things like "we need to go slowly", "we need to tread very carefully" etc - it's always "we", as in we're a partnership, we're both in this and doing this together. It's not her saying about what she will or won't "do to me" if that makes sense?

That's where I think your relationship with this therapist feels off.... From what you've said, it doesn't feel like a partnership. It feels like there's a bit of a power struggle in the dynamic. And I think it sounds like it's your therapist who's trying to get/maintain the position of power is the relationship. His stuff!

Hope you find a better match with your next one.

 

[Sandstone]

When I did the PTSD Questionnaire I actually had to state that I didn't get these to which I was told "you don't necessarily need to in order to qualify" ....I pressed on this for a session or two because it didn't seem to fit what the questionnaire was getting at nor fit tightly with my interpretation of the DSM diagnostics

What were the symptoms that made you go to therapy? How do you feel they are related to trauma?
I don't have flashbacks as such, and this is regularly a barrier to me believing I have PTSD. Yet I do accept that it is the diagnosis of best fit.

 

[AlmostFellForIt]

I think it sounds like he feels undermined by you. And that's your fault - this is his stuff and he's n...

Thanks...You may be right... Crazy to think someone of that stature would let their ego impede, sure it happens though

Trauma work is difficult, slow work - rushing it and not treading carefully can easily retraumatise you

This is where my thinking starts to digress. I don't think trauma work needs to be slow and long winded. I think the psychodynamic approach to trauma (person centred) is slow and long winded. I've thought about this a lot recently. Hypnotherapy and CBT short cut the process and perhaps give results quicker but without understanding. Having said this I think ultimately if one can afford it (both emotionally and financially) the psychodynamic approach is good. The thing I'm most upset with is that it took a blow up for me to even be told of this and to be honest it's only through insight gained from forum members such as yourself plus my critical tinkering have I found this out... My own (ex) therapist still right up to the last minute couldn't even name the approach/style used but now thanks to this post I have the insight.

 

[AlmostFellForIt]

What were the symptoms that made you go to therapy? How do you feel they are related to trauma?
I don't h...

Initially just for Anxiety... Work related stress type stuff.I wasn't even aware of the trauma aspect until I was diagnosed with PTSD. I just went there for CBT to help me with my day to day stuff.

I don't have flashbacks as such, and this is regularly a barrier to me believing I have PTSD. Yet I do accept that it is the diagnosis of best fit.

Yeah, I don't doubt you can have PTSD without the flashbacks, I just don't understand it well yet as it hasn't been explained... Still though, I thought flashbacks were the hallmark of PTSD?

 

[JEKBreatheandBelieve]

Still though, I thought flashbacks were the hallmark of PTSD?

Flashbacks are very common in PTSD, but not a requirement in meeting the criteria. There is a section called "Intrusive recollection" which includes flashbacks, nightmares, intrusive thoughts, reacting to things that cause you to think about the trauma, etc.

I don't think trauma work needs to be slow and long winded.

I don't know about being long-winded, but I know for me trauma work has to be slow. The reason is when I dove right it, I was retraumatized and that certainly didn't help. I think with a good therapist, you can go at your pace, but I think the caution is to not go too fast because it's too much to handle so you may need to be patient at first.

 

[barefoot]

I think it sounds like he feels undermined by you. And that's your fault

Ooh...I've just spotted this when you quoted it in your post. I meant it's NOT your fault! Hope you realised that was a typo! Definitely NOT your fault - it is his stuff/his ego/his poor self-management!

 

[Born to Run]

I don't get flashbacks, painful memories, trauma memories, nightmares, day/night terrors ... I simply just don't get them and never have.

Flashbacks can have different ways of manifesting themselves. I only have emotional flashbacks and those are reliving/re-experiencing an emotional situation from the past in the present. It does not need to manifest as in the movies where you flash back into time and remember painful things previously unknown to you. There are many threads on flashbacks here, and I believe a real explanatory article by Anthony. I also never had nightmares, triggers, terrors in my life, but I have PTSD despite that. I just never remembered any of the trauma.

This is where my thinking starts to digress. I don't think trauma work needs to be slow and long winded.

If you have complex trauma there is no short cut unfortunately. It is your nervous system that is the limiting factor here, it is not able to process everything at once or within a short period of time. It would overload and damage you if all would be done too quickly.

I just don't understand it well yet as it hasn't been explained...

You can start reading on it to get more grip on it. There is a lot of information on this forum and many books on trauma.

 

[barefoot]

Yeah, I don't think "slow" and "long-winded" really mean the same here. Of course, we're all different, we all do therapy in our own way, some find it harder than others, some need more time than others... But I think diving into unprocessed trauma too hard, too fast and too heavy handedly is unhelpful (to say the least!) I got badly triggered quite out of the blue in a session a few months ago and the fall out from that was awful. It was brutal at the time and felt very intense afterwards - it took a few weeks to fully recalibrate from that level of being retraumatised. Hopefully, with your next therapist, you can go at whatever pace you find is manageable for you.

I tend to dissociate when we do the deeper trauma work and just get very shutdown and find it hard/impossible to express myself. So I guess those things alone slow the process right down for me....if I can't speak/am not present, we're not going to make very pacey progress!

From my own experience, I don't believe trauma work can be rushed or forced.... It just doesn't seem to work like that, however quickly you may want to make progress and 'do the work'.