Angry with therapist and I don't know if I am being unreasonable, if this is transference?

Goldballoon

New Here
I've been seeing my therapist weekly for 9 months. I feel angry with him for a number of reasons and I don't know if I am being unreasonable, if this is transference, if this is a stage in therapy that was inevitable, if this is what is meant by "rupture"?

Therapy is done over video link. He has a habit of reading notifications or messages or something on his phone while I am talking. I can see him focus on this and then I feel distracted and upset about this and I go quiet while I wait for him to bring his attention back to me, sometimes feels like he has to drag his attention back. I don't want to have a conflict or have to pull him up on how to do his job properly. Last session I was in a particularly depressed mood and I fell silent, he asked what is on my mind - I said I can see you doing something off-screen and it distracted me. He was a bit abashed and said - I'm not doing anything off-screen, I just touch my phone sometimes to see the time. In my head I just thought "Liar", but then I changed the subject as I had his attention after that anyway. Feel like he was gas lighting me a bit there. It takes a second to check the time, I know he is doing more that just checking the time. Isn't the first 'rule' of therapy to at least be present with your patient?

I asked for his opinion on whether I have avoidant personality disorder. I have been reading about this pd and I really identify with a lot of the traits, I can see I have this pattern of behaviour across all areas of my life. His response was to ask why I am interested in this question, and then to give me his opinion that he doesn't think its helpful to label people with diagnoses such as this. Evaded the question of the ways in which the diagnosis does fit, or the traits which do apply to me. When I read the criteria, I feel angry with him as I think - I've been talking to you for eight months and actually you don't know how this criteria fits as we haven't talked in detail about all these aspects of my life - he hasn't asked questions or shown interest in these areas of my life, so his knowledge is limited. I think diagnoses are useful - you can relate to them, relate to others who have that diagnosis, find material to understand better what is going on with you, understand what treatment methods might work for you?

I sought him out as he is certified in Mentalisation Based Therapy and I listened to an inspiring radio programme about this treatment method. He is also psycho-dynamically trained. I've always struggled with knowing what I'm supposed to talk about in these sessions. I feel like he is following an mbt strategy of focusing on issues in present relationships. I dated someone for a couple of months and therapy seemed easy in this period as I could bring my anxiety and insecurity about the relationship to the sessions and he could calm me and help me think about things from different perspectives. But now I am back to being single and quite isolated in my life - no ongoing relationship conflicts to bring to sessions so not sure what to bring to sessions. We never discussed what we would cover in sessions, but I feel like he got some information about my relationship with my parents - aloholism, emotional neglect, pattern of me just listening and absorbing whatever was going on or of interest to other people in my family - and then has lost interest or feels that bit is figured out now. I told him early on that I wanted to have a more coherent understanding of my past as my memories are so vague, when I said I remember so little - he suggested writing things out in a journal to spark memories. But I thought, but that is what I have come to therapy for, because I don't want to just write things in a journal anymore? I feel like he has taken an mbt approach and not a psychoanalytical approach, but we never discussed that, I've always felt confused by lack of structure, and not knowing what is supposed to be happening or what I'm allowed to talk about.

I wish that he would explain more to me, I also wish he would discuss how our relationship is going and how I feel things are going, that stuff just isn't on the table so I don't feel comfortable bringing any of this up. I feel like I've just been trying to be "good" and guess the right way to do things but not really knowing how. And I still feel so inhibited when speaking with him, there's so much I don't feel comfortable discussing or bringing up, and generally my inhibition feels high and trust low, considering I've been talking to him for so long. Whereas I know you should feel comfortable discussing anything with your therapist. I just feel like he hasn't been actively trying to help me heal and think about my behaviours and who I am - just feels like he's taken a laid back approach to responding to whatever I bring up during a session. I feel like I need a bit more direction than that.

I presume I should discuss all this with him but I just don't know where I would start, I'm afraid of conflict and I feel inhibited. I would like to hear that this is somehow positive and if it's worked through then things will be better as a result. Have I just knocked him off a pedestal I had him on and now I feel crushed and am being overly judgemental and critical and externalising blame for why I feel so bad lately? It's all very confusing.

Any thoughts are very much appreciated, thank you.
 

enough

MyPTSD Pro
I presume I should discuss all this with him but I just don't know where I would start, I'm afraid of conflict and I feel inhibited.
Been there. If you feel he needs to know, he needs to know. If you think he needs to stop being distracted, he needs to stop. It can be hard to remember that he works for you, and harder to be assertive about it, but that is the basic situation here. You don't hope for his approval, he hopes for your continued approval as he helps you from point A to point B.
Afraid and inhibited is like a carryover from being in a parent/child relationship, a teacher/student relationship, a boss/employee relationship, it just falls into place that you are now in a counselor/patient relationship and inclined toward keeping it friendly and positive.

Inhibited is the hard part- follow along here with me and see if this might fit-

we are wired for survival. fight or flight is there in the basic chassis that the rest of the brain is built on. If we upset someone, most of us feel a little bit of that survival response kick in. We are supposed to be accepted, respected, happy in our relationships with the people around us. If it goes awry we fear being voted off the island, abandoned, set adrift on an ice flow, things like that. Saying something that might get us the sideways glance is just not an easy thing. We feel like it is best to hide it and never open it up for the world to see. It might hurt our chances for survival after all.

What are we hiring these people for? To teach us how to get along in life carrying the huge unseen burden that they must surely know is there?

I try to be open and let the bad stuff out in session with no fear of reprisal from them. I also fail, time after time to truly get everything out where we can both poke at it.

Sometimes you just have to stand back and admire our condition. We want help, we pay for help, we get help, and then we shy away from the things that will get us where we need to go because we are afraid to be laid bare in the presence of a counselor that has seen it all before and should be trying to encourage us to do what we need to do to be helped. Mine does, and my intent is to do it, but human nature keeps the truly unthinkable fears unsaid because it is all too awful to verbalize.

This is an employer/ employee relationship and it is unlike any you may have experienced so far. Best thoughts to you as you work through this
 

Goldballoon

New Here
Sometimes you just have to stand back and admire our condition. We want help, we pay for help, we get help, and then we shy away from the things that will get us where we need to go because we are afraid to be laid bare in the presence of a counselor that has seen it all before and should be trying to encourage us to do what we need to do to be helped.
Thank you this made me laugh and it is so true. I wish he would be a bit more encouraging about what I need to do and discuss, although I can't expect him to mind-read I do think he needs to verbalise certain things to make them ok for me to bring up and talk about.

For example the points you made about the nature of the relationship and falling into that previous pattern:
Afraid and inhibited is like a carryover from being in a parent/child relationship, a teacher/student relationship, a boss/employee relationship, it just falls into place that you are now in a counselor/patient relationship and inclined toward keeping it friendly and positive.
Yes I think you're right and it makes me feel better to hear you say it, but it also makes me think we should be talking about this in therapy, so why hasn't he been bringing this up?

Thank you also for your comments on the unique employer / employee therapy relationship. It is useful to remember this perspective that this is so new to me, and not automatically easy to navigate, so naturally it will need working through.
 

Friday

Moderator
I asked for his opinion on whether I have avoidant personality disorder. I have been reading about this pd and I really identify with a lot of the traits, I can see I have this pattern of behaviour across all areas of my life. His response was to ask why I am interested in this question, and then to give me his opinion that he doesn't think its helpful to label people with diagnoses such as this.
I’m mostly curious to know if THIS by preference or inability.

Lots of highly trained specialists who have the ability to diagnose & work with personality disorders simply prefer not to. Others are incapable of doing so.

Does your therapist have the training/education to diagnose or even be able to work specifically with Personality Disorders? Yes, MBT is often used for BPD by doctorate level practitioners, but it’s also used by 3month certified Chemical Dependency Counselors. Similarly, psychodynamic training/certification can be a 1 year online program anyone can take, or can be masters/doctoral work, or can require advanced degrees and licensure to start a multiple year course of rigorous study & supervised hours.

I feel like he is following an mbt strategy of focusing on issues in present relationships. I dated someone for a couple of months and therapy seemed easy in this period as I could bring my anxiety and insecurity about the relationship to the sessions and he could calm me and help me think about things from different perspectives.
What’s his speciality?
 
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Goldballoon

New Here
I’m mostly curious to know if THIS by preference or inability.

Lots of highly trained specialists who have the ability to diagnose & work with personality disorders simply prefer not to. Others are incapable of doing so.

Does your therapist have the training/education to diagnose or even be able to work specifically with Personality Disorders? Yes, MBT is often used for BPD by doctorate level practitioners, but it’s also used by 3month certified Chemical Dependency Counselors.


What’s his speciality?

He's a UKCP registered psychotherapist. I gather (from internet sleuthing) that he worked with BPD patients in the NHS previously, so he has experience working with that particular personality disorder. My question might have thrown him as he may not have given much thought to AvPD since his training. I don't think there is much research available on how useful MBT is for other personality disorders, and I just feel a bit concerned that he isn't working out what's wrong with me or what my diagnosis is before deciding what approach to take with me.

I understand that in the UK therapists can't give a formal diagnosis but given I'd been reading about this and perceiving that some of the criteria fit I would have liked to have explored that with him. His view is that he has worked with personality disorders, he has expertise there but prefers not to use those labels. He likes to see things according to attachment theory. There are criteria in the diagnosis that I agree I don't meet but I worked at that over the years and again would have liked to have discussed that rather than just taking it off the table. I know there is a lot of controversy around BPD diagnoses and lots of people do feel uncomfortable with that - I feel his perception may be coloured by his previous experiences. Conjecture I know.
 

Goldballoon

New Here
My update - I had my session and it went quite well. He suggested talking through the different criteria and how I felt about it, how I identify with it or how it fits. Also how they relate to mentalising. So we started to discuss one of the criteria - it is helpful I think as it gives me something to focus on so I can pull out relevant data about my life. Although upsetting, a useful session all in all, hopefully with more to come. Thanks all.
 

whiteraven

Not Active
I asked for his opinion on whether I have avoidant personality disorder. I have been reading about this pd and I really identify with a lot of the traits, I can see I have this pattern of behaviour across all areas of my life. His response was to ask why I am interested in this question, and then to give me his opinion that he doesn't think its helpful to label people with diagnoses such as this.
Sounds like you have talked with him, with good results, but I wanted to respond to this.

My therapist does not like to label with diagnoses. He's absolutely qualified, but he believes that labeling (in any way) is dangerous, or at least not helpful in the long-run. So I suspect there are others who feel the same.

I had questions about a diagnosis as well and got the same response. He wanted to know why the *label* was important to me. After all, the criteria for all diagnoses are created by humans - by telling myself I *am* or *have* DID (or whatever), I'm potentially limiting who and what I think I can be. I, of course, understand that providing a diagnosis helps a therapist plan treatment, but I've come to understand it can also be harmful.

My view only. It *really* helped me to not be associated with a diagnosis.

I presume I should discuss all this with him but I just don't know where I would start, I'm afraid of conflict and I feel inhibited.
I see you did. Yaaaaay!

My update - I had my session and it went quite well. He suggested talking through the different criteria and how I felt about it, how I identify with it or how it fits. Also how they relate to mentalising. So we started to discuss one of the criteria - it is helpful I think as it gives me something to focus on so I can pull out relevant data about my life. Although upsetting, a useful session all in all, hopefully with more to come.
This is so awesome!
 

enough

MyPTSD Pro
@whiteraven
My therapist does not like to label with diagnoses. He's absolutely qualified, but he believes that labeling (in any way) is dangerous, or at least not helpful in the long-run. So I suspect there are others who feel the same.

Do you belong to an HMO? I have been suspect of that argument for a long time. HMO's have a set of criteria that have to be met before higher levels of coverage are available to their memebers. They do it to be sure that all less expensive possibilities have been explored before they open up the next levels of treatment. It could be that the diagnosis of PTSD brings about more frequent visits, a deeper dive into the pharmaceuticals, maybe even higher level therapists and techniques.
 

Goldballoon

New Here
Sounds like you have talked with him, with good results, but I wanted to respond to this.

My therapist does not like to label with diagnoses. He's absolutely qualified, but he believes that labeling (in any way) is dangerous, or at least not helpful in the long-run. So I suspect there are others who feel the same.

I had questions about a diagnosis as well and got the same response. He wanted to know why the *label* was important to me. After all, the criteria for all diagnoses are created by humans - by telling myself I *am* or *have* DID (or whatever), I'm potentially limiting who and what I think I can be. I, of course, understand that providing a diagnosis helps a therapist plan treatment, but I've come to understand it can also be harmful.

My view only. It *really* helped me to not be associated with a diagnosis.


I see you did. Yaaaaay!


This is so awesome!
Thank you Whiteraven :D My trust in him has been restored somewhat, I've come back from the brink which is nice. I think me finding this diagnosis and asking him about it has helped overall as we're focusing in now on the things which I need to focus in on, even if it's happened in this roundabout way. We've got past his concerns about labeling and now we can discuss it, which is what I think I needed. Diagnoses are not a perfect science, but I think the attempt to accurately describe and categorise is worthy.
 

whiteraven

Not Active
@whiteraven


Do you belong to an HMO? I have been suspect of that argument for a long time. HMO's have a set of criteria that have to be met before higher levels of coverage are available to their memebers. They do it to be sure that all less expensive possibilities have been explored before they open up the next levels of treatment. It could be that the diagnosis of PTSD brings about more frequent visits, a deeper dive into the pharmaceuticals, maybe even higher level therapists and techniques.
I don't, but you are right about insurance often driving the diagnosis. And not just with psychiatric ones. Insurance also determines what kind of tests you have to have. It's one of the reasons I've lost all trust in the medical community. Doctors aren't always doing what's best; they are often doing what is required by the insurance companies.

My T doesn't take insurance.
 
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