Discussing different issues with t

[Eliza]

Hello,
I am in CBT at the moment for PTSD, but I also have OCD. They are sort of linked (intrusive thoughts etc), but they are also quite separate. I don't know whether to tell my therapist about the non-PTSD related thoughts, or whether focusing on recovering from PTSD will help the OCD as well.
I don't want to detract from the main focus of the sessions (a previous counsellor saw I had other issues, leapt on them and we never actually dealt with the trauma). But I also think they worsen one another.
Does anybody else have other mental health issues aside from PTSD? How do you approach them with therapists?

 

[Freida]

Personally I would tell my T about both and let her sort out which comes first. that's why she gets the big bucks. Maybe before you go forward with any treatment you can talk with her and set a plan?

 

[Eliza]

Thanks. We're currently laying out a plan and working with my thought cycles. I'm kind of letting the intrusive OCD thoughts out a little at a time rather than blurting it right out.

 

[Hopefully]

CBT often deals more in the here and now than in the past, it will recognises the causes but its focus can be on alleviating current problematic thought cycles. If you have a trauma that you feel needs solid attention be sure you tell them that, otherwise you are going to treating the edges without getting to the core of what is affecting you. Quite often however, this is where you need to start. If you have a trauma that has caused PTSD I would say there is often work to do in building tools, coping mechanisms and strength before you delve into the deeper work.

My T and I have starting looking at OCD patterns with regards to intrusive thoughts and my level of conviction in some beliefs. I definitely think there can be some cross over and agree that in treating one you can relive the other but I think it is important they know all of what is affecting you.

Even with CBT there are many different routes to take, the more the T knows of you the better informed they will be to decide what is right and what will help. I think this is especially true if you are in the NHS and could be time limited.

I wish you really well with it all.

 

[Eliza]

You're definitely right - that was part of the problem with counselling, he just tried to focus on the past and was so desperate to find a cause of my anxiety that I used to walk out of sessions feeling really angry because he tried to blame my incredibly supportive family for my anxiety/OCD (It's actually due to pressure I put on myself at school - my parents were always just happy if I was happy). But I was dealing with that. It's the trauma that's brought it all back up again (my trauma was quite recent), so I think CBT, dealing with the here and now and the thought cycles, will be much more helpful than counselling.

I'm finding that I can deal with the cycles by telling him some of the lesser worries and using them as examples, and keeping the super intrusive embarrassing thoughts to myself for now. Because I feel like once I've learnt the techniques, I can apply them to my darker thoughts. Or let him know some of the darker thoughts in later sessions. I have only had three so far, and I am down for 12 (NHS), so I think there's plenty of time to let him know the worst thoughts gradually.

 

[Hopefully]

It is hard because it is so individual, to the person receiving therapy and the therapist. Some T's have a physcodynamic style which believes that many of your processes now have developed out of patterns that have been learnt in childhood. A CBT approach is much more in dealing with the patters as they are now. One style is not better than the other but one can certainly benefit an individual more.

My thoughts (if you want that?), you don't have to deal with this on your own, it is going to be really difficult to apply what you are learning to bigger more complex issues. This is the point of therapy, to have someone by your side guiding you as you do this. If anything let him help you with the darker thoughts and then maybe you will be able to use those techniques on lesser issues on your own. I have had a fair amount of NHS treatment, 12 sessions will go by so quickly, if you are feeling there is an aspect of your trauma that is not being addressed and needs to be it is important that you say. That happened for me and I started becoming frustrated and disengaged with the process because I felt like saying 'what about this massive thing we are ignoring?'. Eventually we shifted the focus and I was encouraged to talk through the trauma. That felt like what I needed and it was a big help. I know it is hard, they are prematurely asking you to put faith and trust in a stranger before you have had time build that relationship, it is another big downside to short term treatment, it is hard to share these issues.

NHS treatment is though to navigate, it can be short term and due to that they sometimes seem to prefer to not dig to deep, to keep the focus on the now. It can be a fight to get more sessions or to be referred on, you have to be your own advocate sometimes but do it because the help is there.