Deciding between two therapists

[piratelady]

I have been seeing my current therapist (we'll call him T-1) for quite some time. He helped me a few years ago until I felt like I was cured! I've gone back to him when I started slipping again. After reading some things on here, I thought it might be best to look for a different therapist (we'll call him T-2) who would provide more of a structured "trauma therapy" that I read about on here: starting with building coping skills, then like EMDR or CBT or something. T-1 is more insight based.

T-1: He is more insight based as I just said, but I can tell him nearly anything. He knows almost all of it, so there are no surprises. He does identify my negative core beliefs and tries to help me change them, such as helping me learn that I'm not broken. It's usually super helpful, but I can't seem to hold on to it. Once things get bad, I revert. I also don't think he's taught me much as far as grounding and coping skills are concerned. All that I've had I learned here.

T-2: I've had two appointments with him. The first one was the highest level intake I've ever had. I was told not talk about the trauma, we wouldn't be doing that yet. Yesterday was the second appointment. He fumbled around on his stupid laptop trying to find the intake form he typed up last time and couldn't remember some basic things about me. That I found frustrating. As the appointment went on, it was more or less him trying to ask me questions and me being unable to answer them like: Tell me something good about yourself, something you're proud off, what makes me anxious, how do I deal with anxiety, more about good things about myself.

Then he tried to do what I assume is CBT stuff. He said I looked anxious sitting there and wanted to know what thought I had walking into his office. I told him I didn't want to be there because I feel like I should be better by now and shouldn't need therapy. He started trying to make a list of things that make that true or not true. I couldn't think of anything to make it untrue and just wanted to cry. Eventually he gave up on that and went to reading definitions of things like generalizations, perfectionism and asking me questions. By that point I was so triggered by some other things he did I could barely follow what he was saying. I did tell him that I was just trying not to cry and he was shocked.

Eventually he said I couldn't have the handouts he printed (that he was reading from) because I was in no way ready for that. He said I need to try to walk for like 15 minutes every day over the next week. At the end he said my first therapist might be better for me.

My questions are: Is this what CBT is like? When do you normally start talking about trauma? Does the appointment with T-2 sound normal..or good?

 

[MyWillow]

Take this with a grain of salt but T-2 doesn’t sound like a great match. It sounds like you were outside your Window Of Tolerance from the beginning and he had no idea! T-1 might be good but there may also be a better option.

So my psychologist - who I’ve been seeing for about 18 months - is really great. I like her. But she realised she was out of her depth a bit when I started getting much worse.

She referred me to a pdoc and I’ve had 2 sessions (1-1.5 hours each) so far, with another 2-3 just for intake. She’s really, really good was my first instinct. Direct but gentle and calm and so damn centred. I dissociated in that first session (apparently she said something about family) and she not only picked up on it quickly but she has slowed the pace even further. She talks about the need to feel safe and teaches ME how to do that for myself whilst she is controlling the pace. That’s empowering. Having me sit with emotion. Looking at coping skills and life stressors. Assuming nothing. Being hopeful.

I have no experience with this at all but somehow I can sense that this is what I need. It’s not going to be fun, or easy or painless or short term. But as she said, there’s room for growth.

I hope you find the T you need and deserve.

 

[grit]

Hi Piratelady,

First I really like your posts. You contribute so much good discussions and you are so good articulating. So I want to say thanks. I am learning a lot from your post.

In this post, my feelings are I am actually (personally) interested in what the second T2 was trying to do. I am also in therapy that focuses on insights and such but I find I do not like talking about trauma because my memories are limited. I do not mind if the topics come up or not or I make a connection to it but I rather not sit and yap about my trauma...it is like talking bout a bad break up with my g/fs and they are like getting sick and tired of the story. That is my feeling.

The second one T2 was trying to make you become aware of who you are here and now! What are you proud of? If nothing, OK obviously maybe because of your trauma - and then you can see how trauma is still impacting you that you cannot even find a thing to be proud of today? I am only paraphrasing these to make a point.

I honestly think you are at a place to benefit from both types of therapy maybe simultaneously if you can afford. I know therapy is an expensive privilege in North America.

I think your personality did not click with T2 but I think you would probably benefit taking those insights into action in your every day life. Otherwise, I do not know said it but there is a saying that insight alone is not cure; only a change of behaviour is cure.

I hope I did not overstep trying to give you a feedback.

 

[Suzetig]

Tbh I would stick with T1 if you’ve got a good relationship. T2 sounds a bit hapless and really there are lots of resources for grounding and distress tolerance, you really don’t need a T to teach you that - your time and money is better spent with your T making sure your coping strategies are enough to hold you while you do the work on your trauma and then doing that work.

Some skills based stuff can be useful I know but in terms of stuff you can’t do elsewhere, you can develop skills outside of T.

 

[piratelady]

Take this with a grain of salt but T-2 doesn’t sound like a great match. It sounds like you were outside your Window Of Tolerance from the beginning and he had no idea! T-1 might be good but there may also be a better option.

The more I talk and think about it, the more I tend to agree. I hate the idea of finding yet another therapist and starting over. That's just the worst part..unpacking all my baggage so to speak. The thought of doing it again is daunting.

I am also in therapy that focuses on insights and such but I find I do not like talking about trauma because my memories are limited. I do not mind if the topics come up or not or I make a connection to it but I rather not sit and yap about my trauma

I think maybe I'm not describing it well. We talk about trauma some. He listens, makes notes, notices things I say repeatedly that I don't notice. Then tries to change those ways of thinking. I just can't explain how he does it. I call it therapy magic, lol. He talks more than I think a psychodynamic therapist would..I don't know how to explain it lol.

I think your personality did not click with T2 but I think you would probably benefit taking those insights into action in your every day life.

I agree. Thanks :)

Tbh I would stick with T1 if you’ve got a good relationship.

Thank you for your insight. T1 just doens't offer any of the therapies that you hear associated with PTSD like CBT, EMDR, etc. That's what made me think I needed someone different. Sometimes who offers those modalities.

 

[Skywatcher]

I would list what your personal goals for therapy are and bring them to T-1 and ask him if his therapy type can help you achieve those. My therapist does emdr and relational therapy. On our first appointment she told me that some people see her for emdr and follow up with their regular therapist as well. She also has clients that only see her. I choose to only see her because the only other therapist that I have seen referred me to her and the first T was making me worse and did nothing to help me during the transition.

 

[piratelady]

I would list what your personal goals for therapy are and bring them to T-1 and ask him if his therapy type can help you achieve those.

This is a fantastic idea! Thank you!

 

[Suzetig]

My T specialises in trauma, but she doesn’t offer the PTSD alphabet of therapies either - but she has been amazing, the reason I’m as functional as I am is down to her knowledge and insight. Regardless of modality, research shows over and over again that the therapeutic relationship is the biggest influence on recovery and growth in therapy. So, if I had my choice between skilled practitioners I’d go for the one I could build a good relationship with.

In saying my T doesn’t do the alphabetti spaghetti of trauma treatments, looking back over our work together I can clearly see her working through all the stages of a three stage treatment model, but without being specific or restricted by this. If you feel you’re getting what you need in therapy, assuming there are no red flags, I’d stay out and talk explicitly about what your next goals are.

 

[EveHarrington]

The more I talk and think about it, the more I tend to agree. I hate the idea of finding yet anothe...

Why only 2 therapists in this comparison/choice?

The truth is that it’s pretty rare for one therapist to take you from start to finish in healing. I don’t think it’s really a wise choice to stick with an inadequate therapist just because you don’t want to unpack the baggage again. IMHO you’re looking at therapists/healing in the wrong way. Each new therapist helps move us forward in a different way.

 

[joeylittle]

Lots of great responses, here.

Then he tried to do what I assume is CBT stuff. He said I looked anxious sitting there and wanted to know what thought I had walking into his office. I told him I didn't want to be there because I feel like I should be better by now and shouldn't need therapy. He started trying to make a list of things that make that true or not true. I couldn't think of anything to make it untrue and just wanted to cry...My questions are: Is this what CBT is like?

So, sounds like he tried to jump you right into the middle of a CBT tool called a 'thought record', without you having the proper foundation to understand what that is or why it's hard. He may have made an assumption based on the number of years of therapy you've had - which in itself is not so awesome, because those first few sessions are not the best time to start assuming things about the client.

(It also sounds like he was either having a pretty bad day - the organization problems - or, he's really just not that good.)

T1 just doens't offer any of the therapies that you hear associated with PTSD like CBT, EMDR, etc. That's what made me think I needed someone different. Sometimes who offers those modalities.

I think it can be useful to have a chat with T1 about how they trained, what they incorporate, what they think about what they do. It would be surprising if they weren't using aspects of CBT - it's rather hard to avoid, especially when talking about shifting thoughts - and having an eclectic style is not necessarily a bad thing. It would also be useful to talk about T1's philosophy on trauma work, specifically, and what they think about how to approach that, and even whether or not they think they are right for you, going forward. It sounds like you have built a strong therapeutic alliance with T1, and that would make such a conversation very possible and potentially helpful - if nothing else, it'd be interesting stuff to talk with them about.

I would list what your personal goals for therapy are and bring them to T-1 and ask him if his therapy type can help you achieve those.

(so, basically, what @Skywatcher said)

In saying my T doesn’t do the alphabetti spaghetti of trauma treatments, looking back over our work together I can clearly see her working through all the stages of a three stage treatment model, but without being specific or restricted by this. If you feel you’re getting what you need in therapy, assuming there are no red flags, I’d stay out and talk explicitly about what your next goals are.

(and what @Suzetig said)

Final thing - If you want to know more about the nuts and bolts of something like CBT, you may be able to find a four-week introductory course on it, somewhere. Or, T1 could give you the basics. It's on one hand, apparently simple stuff - but on the other hand, quite complicated to just apply it to yourself, without any guidance from someone who has studied it thoroughly, and understands it's usefulness and it's limits.

I remember the first time I tried to do the 'evidence it's not true' column...I completely broke down. And also when set with the task of making a list of things I'm good at. I tried to be honest, instead of making the list I knew I could/should make...and could only come up with one thing. It was devastating and - later - helpful.

Overall, I'm voting with T1, at least to get more clarity on what you might do next. It will maybe springboard your work with them into a new purpose - or, it will help you go to a next T with that solid list of things you want to learn and do, and you can cover that in the first consultation.

 

[piratelady]

Regardless of modality, research shows over and over again that the therapeutic relationship is the biggest influence on recovery and growth in therapy.

I actually had appointments with both this week. The appointment with T1 was supposed to be for me to tell him I was moving on, and I did want to ask him a question that has been bugging me about sexual assault that I wouldn't be comfortable asking the other. Honestly, I could have told him I was moving on via phone, but I really needed to talk to him about my question. That made me realize how strong that therapeutic relationship is and how important it is to healing my trauma.

Why only 2 therapists in this comparison/choice?

Well, I already have one, and I found another who I had an initial appointment with who says he is a trauma focused therapist that I was taking for a test drive so to speak, so it created a choice between the two. I do see your point though. I do also think it's possible, albeit rare, for one therapist to be able to take someone from start to finish. Back when I was first diagnosed, like 6 years ago, I went through several therapists until I found T1. He was able to get me functioning and I trust him. I think that says a lot.

On another note, my options are limited. Honestly, I can't talk to women healthcare providers (doctors or therapists) and there aren't a lot of male therapists.

what they think about how to approach that, and even whether or not they think they are right for you, going forward. It sounds like you have built a strong therapeutic alliance with T1, and that would make such a conversation very possible and potentially helpful

I did some reading about CBT last night when I couldn't sleep and I can see some aspects of it that he incorporates into our therapy sessions. I say that he is "insight based" but honestly I don't truly know what that means. He's never said, "and now we are on step 1 of...)." but he doesn't just sit and let me ramble. It seems, now, more like he's eclectic.

After seeing both in the same week, comparing, and looking back, I'm sticking with T1 for sure. It's not just about the fear and time of having to eventually tell someone else about the csa I've recently remembered. I trust him, and he has helped me. He never told me "You can't talk about trauma now because you're not stable" he just directed the appointments that way without making me feel bad. The only thing I've ever really felt like was missing was working on coping or grounding, but I also don't think he knew I needed it as much as I did. And my friends here have taught me a lot of that already.

He told me in our appointment this week that I tend to avoid telling people how I feel or what I need and get upset that they don't fulfill my needs. He wasn't talking about therapy, but about my husband. It applies to him too though.

When it came up that there was some trauma from my younger years he realized that there was a lot in my past I never told him. He did the most excruciating social history ever. I told him I was worried that my trauma would be too much for him. Afterwards he said that it wasn't. He told me a little about how he works with trauma and that he would pace it so I didn't get retraumatized. Of course then I quit telling him how much was still bothering me lol. He knew I was stuggling but not why. I guess he really hit the nail on the head with his insights.

I'm voting with T1, at least to get more clarity on what you might do next.

At the end of my appointment this week he suggested I write a letter to my mom to start trying to get out some of my feelings and also to redefine the relationship her and I have. He said I could share it with him if I was comfortable. I needed to get out some feelings last night, so I wrote it and emailed it to him. I also used that opportunity to share with him what I need from therapy and how I want to redefine our goals, since I'm sure I will forget to have that discussion at our next appointment. Now I know we'll finish that discussion next time.

Thanks for the help everyone :)