Dealing With Trauma In Therapy - Is It Neccessary?

[Draiocht]

I've been having weekly sessions at a specialist psychotherapy service for around about 2 years now. The structure of the work has been fairly standard; to identify symptoms that are causing problems in my personal and professional life (also to get a formal assessment from a psychiatrist), and to work on strategies to counter them or reduce the frequency/intensity of symptoms. We've just recently reduced our sessions, something I think would have happened sooner had there not been major stressors in my life making it difficult to implement coping strategies consistently.

As I've been adjusting to this new structure (or lack of) it got me thinking. I know, logically, that therapy does not and cannot reverse what happened to me. But emotionally I'm still a little stuck on that point. I also feel like there's something else bothering me. We have done very little direct talk about the trauma itself. I've been in and out of psych services for almost 13 years now and having been moved around a few times I've repeated the general basis of my trauma to several doctors and nurses and so on, all through a numbing fog of dissociation. I don't feel like I've really come to terms with it now I have a good relationship with my therapists and am starting to be more emotionally vulnerable.

I worry because the sessions are further apart which means we're moving towards the end, and I still haven't really accessed my trauma. I still have a blackout or two in my memory that leave me with a hollow sense of dread. I have a lot of shame around who did these things to me and how. And I still have avoidance behaviours when it comes to sex and intimacy. I wish I didn't have to have sex ever again but part of me feels that is deeply unhealthy and knows there is something missing.

So I guess my long-winded question is - do I NEED to come to terms with these things through therapy, or is this something I have to deal with by myself? What part of it is rebuilding my identity and rediscovering myself, and what part is something that needs clinical supervision?

It really hit home in my last session when I kept bringing up the nightmares I had to my male T. He asked me if it would help me to talk about it, and I wasn't sure at the time. I gave the general impression of it and we talked about the way current events can have a huge resonance through subconscious thoughts and feelings. But after the session I wish I had spoken about it. I feel like I missed an opportunity for something. I don't know what I would have gained from doing it. Maybe it would help me put my shame in better perspective. I don't know :confused:

 

[Friday]

The first time I dealt with my PTSD, I completely ignored trauma stuff (except to compartmentalize the hell out of it / lock it in a box), and only focused on symptoms. It worked. For about 10 years, I was virtually symptom free. Then new trauma & bam! Everything came exploding outward again. I had to start all over. Was like getting hit by a freight train of my past. Not just the new stuff, but all the old stuff, as well. Every trigger I'd sorted was as fresh and raw -or worse- as it was the first time. Nightmares, panic attacks, flashbacks, emotion storms, etc. I was completely non-functional within a year.

It took me roughly 5 years to get to being asymptomatic the first time. I'm on year 6, now, and still not stable. Some of that is just bad luck, but a lot of it is in addition to everything from Round1? I have all the Round2 stuff & intervening years piled on as well :wtf:

I'd probably STILL only be focusing on symptoms (and locking trauma away, again) EXCEPT that I'd accidentally sorted/processed some of my trauma way back when. Guess which traumas *havent* piled on to today's clusterf*ck :shifty: ? Yep. Those ones are fine. Their triggers? Non-issues. So no f*cking way am I doing that, again. This time around? We're sorting everything.

So, necessary? No.
A really good idea? Yes.

 

[GWhizz]

First of all, I like your screen name.

Secondly I hear you in terms of how indirect time spent in therapy can seem. And feeling as if you have fallen short in expressing yourself. But as you've put it, it is about how it affects you now, for example, intimacy. It may feel easier to avoid but you know you're selling yourself short, that decision ultimately something you could never be comfortable with if it were truly your choice (ie. had you never experienced related trauma). For me, learning to be "good at" (moreso having effective therapy Sessions) is an evolving process in itself. Some days I feel I'm really moving forward, others I just don't see the point. But then it's natural to block ourselves from recovery when we're still battling our fear system. And getting stuck isn't necessarily a bad thing, in fact it's usually the point at which we're showing ambivalence about change - ambivalence being seen as the first step in negotiating effective changes

You said part of the aim of this treatment was to get a psychiatry assessment. Just wondering has this been completed and a formal diagnosis with a clear treatment plan been given?

In terms of whether you "NEED" to come to terms with things through therapy. Well it's less about the how and more why it's important to you imo. You can identify that your perspective of your own shame is imbalanced. Is this something you believe therapy can help you with or is there anything else? Or is it that therapy is the most confronting option? I wonder what's holding you from moving forward. Personally, I find it hard to completely separate the whole identity rebuilding because that's really key to whatever approach you take. Do you feel like you can attain such goals without this type of therapy?

Finally, do you think this T is a good fit for you? As in, is the issue with therapy in general or something more specific to your current treatment?

Sorry to throw a million questions back at you? It's just such an individual process - therapy - you really need to weigh it up, look at your goals, where you've come so far etc. Importantly, it would be a good idea to try to discuss this post with your T. If they're worth their weight at all they will give you unbiased input to help you consider everything in more depth.

 

[ladee]

I had been fairly symptom free for a number of years...depression and anxiety, my two constant companions, were manageable... then a new trauma that lasted for 9 days.... I felt I had been shot out of a cannon back into PTSD land and had no safety net... I went for counseling.... go thru the whole intake... at the end she asked if I was suicidal... told her no... and they couldn't take me!!! I had to be seriously suicidal.... I started crying, again, and asked her if we couldn't just lie, go back and say I said yes.... she couldn't do it.. or wouldn't do it..
I had no money , was living in a new small town... had no transportation.... and for a couple of years I just simply lost my mind... for all the work I had done in previous therapies.... it's like it never happened....

I felt like I had covered most of my family issues... but not down to the core apparently... my not coming forward, or T's inability to understand I needed to go deeper? Who knows.... IF I had it do over, I would talk about that f*cked up family until there was nothing left to say.

Do you have to cover it all? That's up to you... as long as you know there is a possibility down the line you may have to go back to Therapy to deal with some deeper issues....

In my case, the SA I have no memory of, the emotional abuse, I can't forget any of it... the abandonment.... still here, I just now how to deal with the feelings today.... glad you asked this question....

There were no Trauma specialist when I started my healing journey... possibly had there been.... It would have been dealt with then...

 

[amosmorris]

IF I had it do over, I would talk about that f*cked up family until there was nothing left to say.

--this is so helpful for me too, @ladee (and I'm sure the OP), as I sometimes get stuck in this sense of self-conscious anxiety about wrapping it all up, "getting over it," just moving on....this push comes from me, not my T, who has assured me that she practices "long-term therapy" and that so far I'm a "blink of an eye"...but...I need these kinds of models to help me go forward. And in fact--two years in and I'm just confronting more awful, "new" stuff that I hadn't remembered--but now I sure do--or thought to share--or thought not to share but now it's out.....

 

[Abigail7]

Maybe look at things this way...

The current state of your therapy is reactionary. See a problem, try to fix the problem. It's kind of like running around trying to put out fires.

Not a bad concept, but it gets exhausting. Simply exhausting.

Not to mention the fact that this method may not come close to having much of an effect on certain symptoms.

Tackling the trauma by talking about it and truly processing it is a different approach as its not reactionary, but more on the preventative side of things in that processing will prevent those sparks from even happening.

When I did my major round of processing, it was amazing how certain symptoms simply vanished. Maybe this doesn't happen to everyone, but I doubt my experience is all that unique. No more simply trying to cope, certain issues, struggles, symptoms just went away.

I have no doubt that I wouldn't have achieved this kind of symptom relief without dealing directly with the trauma.

 

[The ST]

Thank you so much for raising this subject. like you, i have been in therapy for quite a while with focus on getting the skills to deal with the shit in my life - especially with relationships, my total fear of trust and shame that raises its ugly head way too often. And the only way I have coped with sex in an abusive marriage was by dissociating completely.

I have trust in my therapist but the problem is I have felt for some time is that I am forever papering over the cracks and not dealing with the problem underneath - childhood SA. so I in some ways I agree with Abigail7. Not that the therapy has been reactionary because i think that all good therapy is preventative - but that it has had a day to day or short term focus dealing with the symptoms. Partly this makes sense because I started this round of therapy with this T after adult trauma and I really needed help just to stay safe and functioning at all. But now I know that I need to delve deeper and look at the root causes or i won't ever be truly better. Each time I am really triggered or stressed, my skills just aren't enough. I get it now that largely that is because I effectively regress and dissociate so that my rational brain is completely off line.

I know that for me, I need to talk about and really feel what happened to me in my childhood in therapy and have that acknowledged so that i can integrate it and place it in the past so that it doesn't pervade my current reactions. I only see my T fortnightly and we are just starting the process of allowing me to feel safe and grounded enough to let memories, emotions and physical sensations come up. And its going to be a slow process i know but it sometimes seems that the last 5 years of trust building with T and all the good stuff that has let me deal with the symptoms has been necessary to put me in a place where I can finally get to the bottom of it.
So yes, i think that to really feel like you can move on you do need to deal with the trauma itself. A book called "The Body Keeps The Score" has been really helpful for me in understanding how I can start to actually get in touch with my trauma safely and hopefully start to learn how to actually put it in the past.

A long winded response and purely personal observations. If you feel safe with your T, I recommend that you give it your best shot. - but be prepared for the pain

 

[Draiocht]

Hey GWhizz,

I had an assessment with one of their psychiatrists in December 2015 and the outcome of that was Complex PTSD - I don't know how that holds up medically given that it's not really a diagnosis, but it was helpful to me at least. And it backed up their desire to put me on 200mgs Sertraline/day with the GP.

I've got mixed feelings about my Ts. Female T has been seeing me since I was referred to the services, male T has been involved for just over a year. It's muddled because I have transferrence issue with him. Not exactly sure on the nature of it. But I feel overly attached to him. The female T and I are out of synch. She is more focused and strategic about therapy. I'm meandering and metaphors help me anchor things - male T is better at this and it turns out has similar interests, which is probably why she thought he would be a good fit.

I feel like I've not really understood the treatment plan. I assumed we'd improve my day to day coping skills and then broach the trauma more in depth. But it looks like step 1 is all there is to it, if we're moving sessions further apart. This beginning of the end has kind of snuck up on me a bit. We'd talked about it for a while and then our schedules clashed for 3 weeks and now that seems to be the standard on which female T thinks we should proceed. It happened really fast. I think she wanted to take advantage of the opportunity, so it wasn't exactly planned.

We've just had the second big break and I struggled a lot more with it this time around. I'm feeling quite cold to my female T because despite me saying that and talking about fantasising a lot about self harm she actually ended the session by suggesting we make it a 4 week break this time. I nearly didn't tell her how upset that made me. But she was keen to push on and said she didn't want to "lose sight of our goals" on breaking up the sessions. Male T picked up on my distress a lot better and booked me in for the next week. I'm seeing both of them on Thursday.

I have made one hell of a lot of progress since I started. I definitely want to continue sessions. I would say with male T only but I've always had male Ts before and I end up putting them on a pedestal and not being completely honest with them because I am scared they will be disgusted with me. But there are definitely avenues I want to explore in therapy, and male T is a bit more clued into what I need. Female T I think is more focused on functionality. But I've applied so many mental bandaids before and my trauma keeps tripping me up in ways I can't prepare for or even notice until I'm up to the eyeballs in it. For instance I think my current work issues with my supervisor, while definitely not all to do with me, may have links to a female abuser from my childhood. There are echoes of it there. Male T has been the one to point out that my supervisor seems to really upset me in a way that suggests there are some deep emotional scars it's aggrevating. I want to understand them and understand what happened to me and learn to live with it, not just learn to live with the way it makes me behave. I think I need to process it. No one has really talked me through it, though I don't know what to expect in that regard. I just think that given the way things were minimised or dismissed, not even mentioned or discussed, for years after the fact, and that the majority of therapy for me has been this kind of first response triage for whatever ails me - anorexia, anxiety, depression, and now the main symptom I reported when starting this round of therapy, dissociation - at what point do I actually lay it all out with someone and talk about how it made me *feel*? Every diagnosis I've racked up has been a way to distance myself from the reality of it.

Thanks for the barrage of questions :p it's helped me sketch out what I need to say to the therapists this week.

I think everyone has highlighted what I was thinking here. I am letting reactionary therapy convince me I don't need to look any deeper at myself and what happened, because that's easier.

 

[Draiocht]

I wonder if that's amplifying my feelings of guilt over being in therapy for 2 years so far with this team. Feeling like there are more people out there in desperate need of help and if I can limp along now I should make room for someone who's really ill. UK has a mental health services crisis at the moment and me moping around in therapy isn't helping it any.

 

[Tinyflame]

Yes papering the cracks.

:hug:

 

[JG75]

I'm in a similar situation to you in that I'm debating whether it's necessary to look into my trauma in depth so I guess I don't really have any answers for you although I'm swaying towards it being necessary.

I mostly wanted to say though that you should put your foot down if you want therapy to continue regularly. The NHS is a mess and once you walk away it's hard to get help again and you shouldn't feel guilty for needing the help, you didn't ask for a traumatised brain and I bet you'd give up therapy in an instant if you knew you were guaranteed a healthy mind. Also the healthier we are the more likely we are to work so the more taxes we pay so it benefits the NHS to treat us properly first time round so we don't need it again.

 

[Quakegirl]

The first time I dealt with my PTSD, I completely ignored trauma stuff (except to compartmentalize the hell out of it / lock it in a box), and only focused on symptoms. It worked. For about 10 years, I was virtually symptom free. Then new trauma & bam! Everything came exploding outward again. I had to start all over. Was like getting hit by a freight train of my past. Not just the new stuff, but all the old stuff, as well. Every trigger I'd sorted was as fresh and raw -or worse- as it was the first time. Nightmares, panic attacks, flashbacks, emotion storms, etc. I was completely non-functional within a year..

I'm really sorry to hear you are dealing with this all over again, Tempus - but so grateful to read this. I have just had all my trauma come crashing back down on me after another big event 7 years ago...and an unsuccessful attempt to hold myself together since then. It has just got worse and worse - and things I thought were dealt with 15 years ago are well and truly alive in my life. I a realizing that really, I had stuffed them all back down again after my good PTSD therapy turned very bad. And now I am left not only with the original load, but also the therapist-induced trauma and the big event on top of that.

I am now working very hard to do something I never was able to learn to do the first time around: stay in my body and stay in the world. It's absolute torture, and there are days I am not sure how people survive this. But I am determined, this time around, to go the distance. I have held it all together with chewing gum and rubber bands for as long as I could. It's beyond the point now that patch up measures are effective.

It's very frightening. But I am starting to see small changes - situations I can stay in when I couldn't before...times I catch the anxiety before it gets so bad, I dissociate...times I sit it out and uncover what the real feelings are, underneath.