Dilemma about therapy – to stay or leave

barefoot

MyPTSD Pro
I've been seeing my therapist for about six years. I really like her, we get on well, we've had a few significant ruptures over the years but have always been able to talk about those and somehow come through them stronger. I have got to the point where I (largely) feel safe with her. Or as safe as I think I am able to feel.

I am in a very different place now than when we first started working together. Back then I was in the middle of breakdown, I hadn't even considered the possibility of having PTSD because I had never thought of any of my experiences as being traumatic (after all, they weren't 'that bad') and then I lost my job while I was signed off sick. I spent the best part of the first three years of sessions hiding behind my glass of water and then dissociating to the point where I couldn't speak or stand. It was pretty full-on.

Now – I'm not in crisis. Things (me!) feel much more stable. I'm now self-employed, which I really enjoy though it's hard to relax during tough Covid times. I haven't full-on dissociated for probably two years or so – a big achievement. I've not been in very good physical health these last six months and I've been feeling a bit low lately due to illness and feeling a bit disconnected.

But I feel like I don't really know what I'm doing in therapy now. I'm not in crisis so I don't really need her support or her tendency to get really directive and solutions-focused. I feel like there are still some things I would be interested to explore but we just never really seem to gain any traction on them and, even when we have a good session about one of those topics (eg my getting triggered by my teenaged niece) we then don't manage to build any momentum. I just feel a bit lost and am having a hard time focusing. I know I can talk to her about refocusing our work and try to get clearer on what I want from it. But I don't know that I know. Plus, we've had conversations like that before and things pick up but then we get distracted and lose traction again. I don't think I'm very good at this!

I do still have sessions with her that feel really juicy and...therapeutic. Often though, I think we get caught up being more 'chatty'. I don't know that she would describe those times as us just chatting. I think she would say that there is more going on. But that's how it sometimes (often?) feels to me.

I still have some anxiety. I still experience periods of depression, but I think it's quite mild. I still get triggered. I still have sleep disturbances. And I'm really starting to think – maybe this is just as good as I'm going to get? And maybe I should just appreciate that things are going pretty ok and that I don't therefore need to still be in therapy.

She is quite expensive – I spend £600 per month. I don't know whether I am now wasting my time and money. Am I really mainly paying someone because I feel safe with them and like talking to them? I definitely don't have any sense of us being friends/wanting to be her friend etc. This isn't a blurred boundary, trying to be friends with my therapist type situation. But maybe things have become too easy with us, if that makes sense, after all this time. I am very attached to her. Having spent all this time and tried so hard trying to feel safe with her and opening up to her, the thought of then losing that and never seeing her again is incredibly painful.

But there has to be a time when I stop. And I don't know whether this is now?

I feel trapped in the relationship. Not because she is doing anything to trap me. But because I feel so attached. A lot of people say you just know when it's time to stop therapy. I don't know. With painful attachment stuff, does it ever get to feeling ok to make a decision not to have your therapist in your life anymore?! Does that pain ever go – or at least reduce so that it feels more bearable and do-able? Or does it stay like this always, so you just have to pick a moment and rip the band aid off?!

I emailed her earlier and basically told her some of this. I said I think maybe it's time I started thinking about stopping. Not really sure why I did that so suddenly. We had a session yesterday and it was fine. I suspect she was surprised to then receive this from me today. I don't even know what the point of the email was. It wasn't really an 'I'm done' email – and we already have an appointment booked in next week. It felt both anxiety-making and a relief sending the email. I feel so conflicted.

I just don't really know what I'm trying to do there anymore. And keep going and keep spending that money because the thought of not seeing her again is very painful....that doesn't sound like a good enough reason to continue, does it?

I don't even know what I want any of you to say. Perhaps I'm just hoping I might be able to think things through with people here? Sorry if this is not expressed very clearly – brain feels like a pinball machine at the moment!
 

Survivor3

MyPTSD Pro
Hiya @barefoot, I think what your going through can be a common predicament. £600 a month does seem like alot of money! Really quite alot. If you don't really feel like you have any major issues at the moment then how about just taking a break for a while...? It doesn't have to be a 'Big' thing. Attachment can be difficult but by taking a break you can take time to process the situation and maybe use the money for something else that you would benefit from. All the best to you. S3. 😊
 

Teamwork

MyPTSD Pro
You sound like you realize you are at a crossroads, so which road do you want to explore and could they converge? What I mean by that is if you reduce the number of visits to 2 times a month with a focus goal per month that can carry on to next month if not accomplished then you are becoming more goal focused that doesn’t lose traction while at the same time seeing what reduced in session feels like so that you could head off on your own in a years time? This puts you in charge which is where you want to be in a years time. You could also have a goal in six months or longer that you go to once a month. If any of it seems frightening then it tells you you are not ready-take it easy no hurry. In the world of therapy 6 years is nothing and having a great relationship is something you have achieved in that time. I’m longer than 6 years and I’m not sure if I’ve formed an attachment yet.
 

barefoot

MyPTSD Pro
Thanks @Survivor3 Yes, it is a lot of money. Possibly a downside of seeing a central London private therapist! To be fair, that's for weekly 90 min sessions. I did 90 min sessions early on as I needed time to kind of settle down, check how safe the room/she felt, chat for a little while to warm up a bit and feel more present...at that point and for about 18 months, someone else paid for my sessions. By the time I had to pay for myself, I had lost my job but I was desperate to continue with her. So I moved to 1 x 60 min session per fortnight and did that for about 18 months or maybe longer. Then, two years ago, my mum died very suddenly and unexpectedly. It was a huge shock. And I moved back to weekly and longer sessions because...I think I just wanted to sit with someone who felt warm and grounded and calm for some time every week.

And it's just stayed a habit – the weekly and the 90 mins. And part of me really likes it – because, in all honesty, part of me would probably sit with her every day if I could! But maybe that makes things more flabby and meandering and encourages us both to be more chatty....perhaps the chattiness at the start is still a habit of when I needed to do it to safety check, which I don't really need to do these days. Perhaps going back to 60 mins and possibly to fortnightly as well would help me stay more focused and productive.

Yes @Teamwork it does feel like a crossroads...perhaps you are right and the paths could converge. And maybe changing frequency/session length is worth a try to see what that's like and whether it changes how lost I feel. We don't really do goals?! Thanks for the encouragement....I always think I should be done and out of there by now! I am attached to her...but I wouldn't say securely attached! So, while it can feel lovely at times, at other times it can feel very confusing and painful ☹️
 

Sadielady3

Confident
I've been contemplating what the end of therapy would look like for me. I'm nowhere near the point where I should stop going but when will I know when to stop. What am I trying to accomplish? What am I willing to settle for?

If my current situation continues, it will never be a question of money for me. I only pay a 5 dollar (US currency) co-pay for therapy. I spend more than that on impulse purchases at coffee shops. But, in your case, that's a substantial amount of money. I once heard a therapist say that the money you pay them is so that they don't have to work another job so that they can sit with you, which they want to be doing. I don't begrudge mental health professionals making a living and I doubt you do either. But that is a lot of money. Are you getting enough out of your sessions to justify it?

I think I agree with the people above who said to refocus your therapy on whatever it is your trying to accomplish. Maybe also try to build some more secure relationships around you. It might sting less to lose her if you're able to build more relationships in your life. I personally don't have a lot of friends but the ones that I do have are rock solid. Losing my T would be hard (and I've only been seeing him for nine months!) but I know I could bounce back. Most of that is because of my awesome support system.
 

Mogz

New Here
I’m discovering slowly that there are many avenues of self help which cost £$€ nothing but hard work, which I totally understand how hard it can be to self motivate, in fact I find the loss of motivation and self isolating are one of my worst foes, A lot of the group therapy’s I have found available are based initially on substance misuse or addiction however the fundamentals of many platform for which these groups use are based on CBT, i initially went into rehab due to alcoholism, my detox was pretty much nil and the time they allocated for this was reduced and was able to start therapy sooner.
Although rehab was not a solution it did give me an insight into how therapy was and the platforms they use.
CBT saved my life and has ingrained understanding about emotion and that control of these emotions is possible, I’m in the early days and start another CBT program next week another thing I’ve understood is that it’s not what happens in they 60 minute session it’s taking away the ideology and bring it into you’re day to day life.

“practise makes perfect”
 

barefoot

MyPTSD Pro
What am I trying to accomplish? What am I willing to settle for?

This is a key part of my dilemma really - trying to get clear on these two questions.

I once heard a therapist say that the money you pay them is so that they don't have to work another job so that they can sit with you, which they want to be doing.
Hmm...not really sure I understand this... As a therapist, they are doing a job and charging a fee for it. It’s not like it’s a hobby that they can charge for and then not have to get a job they don’t like? And they are not just getting paid to sit with someone. They’ve invested a lot in their training and continued professional development and (should be!) highly skilled professionals. Maybe I’m missing the point whoever said this is trying to make?
Maybe also try to build some more secure relationships around you. It might sting less to lose her if you're able to build more relationships in your life.
I have a great partner and a few core good friends who I love dearly and enjoy being around. So, it’s not that I don’t have anyone. But I’ve been unwell with Covid-related problems for the past six months and that coupled with the general current guidelines restrictions has just left me feeling a bit cut off. Not a big problem - it’s just not that easy seeing people at the moment. And I’m trying to stay at home much of the time so I don’t catch anything else. Plus, the therapeutic relationship isn’t the same as a personal/social relationship. I wouldn’t talk to friends about what I share with my therapist. So I don’t think making new friends is the answer. I have enough!
I know I could bounce back.

Yes, I would bounce back too. I’d have bounced back without her at any time - even when I was in the middle of a breakdown.

I’m discovering slowly that there are many avenues of self help which cost £$€ nothing but hard work

A lot of the group therapy’s I have found available are based initially on substance misuse or addiction

Do you mean you had free group therapy? Wow!

insight into how therapy was and the platforms they use.
CBT saved my life

Glad to hear CBT has been amazing for you. It’s not something I’ve ever found very helpful - but it’s horses for courses, right?!

it’s not what happens in they 60 minute session it’s taking away the ideology and bring it into you’re day to day life.

Yes, of course.

Thanks @Teasel - it’s difficult to know what to do! The lack of certainty makes me feel quite panicky for some reason. I’d like to be clear either way. feeling so conflicted.

She hasn’t replied to my email and I suspect she won’t. So, I guess I’ll just see where we get to when we next have a session.

A break could be worth a try. Though I worry that that may be harder that a totally clean break in a way...
 

Mogz

New Here
There are walk in group therapy’s out there for free, like I mentioned most seem to be aimed at addictions but when you you look are actually based on a rounded outlook that can benefit many people
 

grit

MyPTSD Pro
Hi Barefoot,
what a thoughtful and really exploration post you have here. You were describing a great ambivalence and uncertainty which sometimes are the flagstone of life as well.

This is my take and I know you are not looking for advice so I wont say what you need to do but I will say how it landed on me and point few things to give you different prespective.

The most telling statement I notice was this:
But I don't know that I know

That really landed on me heavily. I do not know that I know. I still cannt get my head around it.

IMHO, therapy is a process of making sense, meaning, symbolizing a painful experience. It is akin to (simplifying here for lack of vocabulary) when a child has a nightmare, and the mother/father tells a story of far far away blahhh to give the child some imagination and understanding that though the child felt a monster, the child is empowered, has options and the monster is just a fantasy, a memory of something else or imagination...which ever it is. somewhat at some point, the child learns there is no monster but imagination. and in therapy as adult, we learn eventually, yes we had horrific experiences, traumas and childhood or events but we can process it now that we are safe even though our bodies and minds are still there, here we can use our imagination and symbolization to make sense out of it without forgetting fully what happened. This is so much easier saying than done.

A good therapy sort of recycles this bringing the experience from the body to the mind to here and now to past and again back and forth. Until the person, gets to hold the centre (the here and now where the therapist is holding), the therapy continues. When you take the function of the therapist to hold the here and now and can go back to the past and come back to here and now without major (minor is OK and even healthy for trauma) coping or breaking down, then it is suffice to say, one is ready to practice this outside of therapy.IMHo therapy is mindbody and past/present surgery and no one can forever be in surgery unless the surgery changes to palliative/support/managing pain because all core issues have been worked and understood but the pain remains for some reason. Now the question is where are you?

Also it is fair, if you feel the pinch of the therapy fee after 6 yrs continuously. It may be worth to see if you can lower the fee/time etc and keep the same sessions, or if you can see her less because now it may be supportive rather than surgical.

The fee of therapy is usually the time they are seeing you not for their love, care, and concern. One cannot really put monetary value on that. that is why even a bad therapist is expensive because of the time. Therapists can only physically see so many people and need a lot of training, self care, sometimes their own therapists (if they are smart), and all these have cost. So the client is truly paying for the time, the training and maintaining the holding space safe...not for the therapist love and affection and sincerity. This is my understanding.

I think leaving therapy is like letting go of the training wheels of a bike for the first time, very scary but yet, once you learn how to ride a bike, that is it.

I am personally of course still in therapy and group therapy but I also changed therapists few times and every time, I learned a lot. The attachment stuff is real but it is also OK to be attached and not be with that person. We all have parents we were attached but we do not see them everyday or week. This is where symbolization of the attachment helps. You will always remember her when you need her just like everybody in your past who touched you positive ways. Maybe it is worth to bring this attachment and letting go into the surface with her.

The only other dark side of therapy is this: unfortunately we are all human and sometimes a therapist, unconsciously can keep us in therapy for various reasons and not always good for us. It is beyond me and you to know, what your therapist feels or thinks but this is the downside of therapy is what if the therapist does not feel or want you to go? The only way to get this monkey in the room is to bring up the possibility of changing the parameters of therapy and see where that takes you. One thing for sure, it will increase your own competence, non-compliance and confidence to say what you want in a safe relationship and this may open the door for your strength to say what you want to say when you want to say it.

All in all, not easy. So much easier to say sitting in my own house than done in person, in body and mind.
I wish you well and strength to water through this.
good luck
 

Friday

Moderator
I’m a big fan of having my cake and eating it, too...

What about monthly 90min appointments (instead of fortnightly 60min) as the “break” for a few months?

That way you
- maintain the relationship/touchstone/counsel
- have a significant break to evaluate what you & your life need right now & in the near future
- can better evaluate therapy goals,
- & keeping the longer slot gives you time to both do your thing & keep in practice if you decide to ramp things back up again in a few months, & cover a much longer time period in your life between sessions.

(optional, not knowing your finances ;) stick the weekly 90min money in the bank, for either once/twice weekly deep dives later, or a nice little post-Covid-holiday to celebrate greater independence; depending on where you want to take things after 3 or 6mo?
 

barefoot

MyPTSD Pro
We talked last week. It felt like a bit of a relief to share my frustrations with therapy and to talk through how conflicted I feel re: continuing or not. Though it did also feel quite excruciating.

It really feels like there's a part of me that would spend time with her every day if I could. And another part that doesn't want anything to do with it and never wanted to go to therapy in the first place. And then there's me. And those two parts are in conflict with each other a lot of the time (not only about my therapist) And it sort of feels like actual me is always third place in the pecking order. Not sure if that makes sense? But it can be hard to tune into what I really want/need when these two aspects are loud and convincing and both polar opposites of each other! It's frustrating and tiring.

Anyway...she seemed to have reflected on our previous conversation a lot. We have now agreed a key context for us to work on (to help to increase focus and momentum rather than darting around different topics every session) and she made suggestions for how she could help hold the focus/accountability to help to keep us on track, which sounded good. She said she's going to write stuff down and keep the notes next to her when we speak and that she'll use that to flag when we go off track so that I can then decide what to pursue. It sounds helpful. I'm just not sure she will stick to it! But I would like to try. Because if we have a clearer focus and can build momentum I feel like sessions will be more productive and I will get more value, more consistently from our work.

I'm thinking I want to have a good run at it to see where we get to with digging in to that. So, I'm planning on doing weekly 60 min sessions until the end of the year and to then review. If the things we agreed last week aren't really happening or if I still feel like it's not really working for me, I guess that'll be my clear answer.

If it is working better and I am getting a lot out of every session (in terms of what we're working on – not just that part of me wants to see her every week!) then I guess we can either continue as we are or drop to fortnightly. I just want to give it a good try seeing as we have had a very open discussion around what isn't working for me and agreed some things to try.

I don't know whether this is a good thing (it feels like it, largely?) because I managed to express that things weren't working for me and we're now going to change things up so I get what I need – and that we will now be more consistently productive and build more momentum/make more progress around what we're working on.

Or whether I have wimped out by not leaving and by keeping to weekly sessions – albeit shorter ones.

But hopefully I'll have more clarity after I've seen how the next few sessions go.

On the money front – it's not that I begrudge her her fee. I am paying for her time and also her training and expertise and on-going CPD (and, outside the pandemic, for her Central London location) . I'm not a therapist but I do 1:1 work with people and I charge the same way. But I do want to feel that I'm getting the most value I can. I think our 90-min sessions had just got a bit flabby and we'd got into a habit of being quite chatty with each other for a chunk of time before we actually then got focused and got into the work. So, I'm hoping that, with this renewed focus and shorter session length, I can go back to getting what I need.

But the push-pull around attachment, my challenge with intimacy and vulnerability/feeling exposed and the two conflicting parts I mentioned above aren't going to be resolved by our refocusing, I suspect...
 
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