Higher level of care unavailable. How do I start processing trauma in therapy?

eroday1

New Here
Hi all. I've been working with my current therapist for about 2.5 years and she is amazing. However, I'm in a bit of a conundrum.

I have schizoaffective disorder and PTSD. For about the past year, I was in a major psychotic episode most of the time. I think I've been doing better, functioning and communicating better, for the past 2-3 weeks.

My therapist says I need more intensive treatment. However, I'm on medi-cal and very limited on my options. The only IOP/PHP program available to me are at a local hospital that I've had very bad experiences at and I know is poor treatment. Additionally, it's not even trauma informed. I've asked my psychiatrist, people in my support group, etc. if they know of any intensive trauma groups nearby, or even just weekly support groups. They don't. Many said they have actively looked and can't find anything. I have searched the internet high and low. Also, I don't really want to do trauma processing in a group setting. I really don't think that would be helpful for me. For some reason, she doesn't seem to quite believe me that there is nothing available. Maybe she's just frustrated. To make matters worse, I have no friends or family I can go to. When I did have friends, they'd just say something like, "you should really talk to your therapist about that." Eventually they ditched me because, well, I have nothing to offer so I'm not worth the trouble.

Basically my only option is once a week therapy (that's all my insurance will cover, and that's all she can provide). That's my option, along with bi-weekly psychiatry. Also, I've spent a long time learning to trust her and slowly opening up. She says she wishes she had a full week she could just work with me, but of course that's not a possibility. I'm ready to start processing my trauma because it is extremely debilitating and leaves me feeling constantly like I want to die. An intensive program is NOT an option and also not something I am super interested in. Her website says she treats trauma/PTSD, and she's even said she does. In the past, she's said that she wants to process my trauma with me. Then, she said something along the lines of that she couldn't push me because of how constantly stressed out and unstable I was, but that there was "so much work I want to do therapeutically with you" or something like that.

Then, last week, she says how I need more intensive treatment, and then she says "because this is just a once a week check-in." So it's not therapy?? I'm just so, so confused. I am ready to start slowly processing my trauma and I actually trust her, but I'm feeling hurt by this. I can only do so much work on my own, but I am doing what I can in between sessions. I need to try to heal my PTSD. I feel emotionally paralyzed. I'm also worried she's just gonna terminate me or insurance will stop covering it. I got a DBT workbook for psychosis I've been working on, and she says it can also help for PTSD, but I know that DBT skills are not the answer- only some helpful tools to try to help lessen symptoms, but at the end of the day, I still feel the same, and the skills are effective maybe 20% of the time, only if my symptoms are mild. I can't be expected to heal my disorders completely on my own, especailly when I'm in therapy and have been led to think that it would be ok to process my trauma when I'm ready. I really, really don't want to change therapists. It is SO hard to find a good therapist who keeps it real, 10x more so with medi-cal.

Does anyone have any insight as to what could be going on here? Or any advice?

Please help.
 
Solution
If you only have 3 weeks of stability under your belt, you’re nowhere near ready to start processing your trauma. IMHO.

The stabilization portion of healing can honestly last years for those of us who are very destabilized.

The reason that stabilization is so important is that talking about trauma can be incredibly de-stabilizing, and thus you need to have a number of coping skills that work well for you. Your therapist doesn’t want to dig into the worst things you’ve ever experienced only to have you go home and spiral out of control

Are you aware that DBT is typically a 6 month program, and therapists recommend that you go through the program twice? This is so you can have the skills down pat.

I know you say that coping skills...

Cypress

Confident
You haven't mentioned this yet, but what is your relationship with your psychiatrist and do they know you want to start processing your trauma on your own while free living in the community? If you've had psychotic episodes while attempting to work on this in the past, you may need to have a medication plan in place that will help prevent you from full-blown psychosis and another "danger to self or others" psychiatric hold. I know the medications really suck and are only somewhat effective but I really think you will need to take them regularly while you go through this process. As you know psychosis begets psychosis and keeping the spark from the kindling is really important.

On another note, I also checked out the WRAP website, WRAP is . . . | Mental Health Recovery , and I am going to do it myself too. Very practical stuff, I particularly like the early warning signs part. Maybe a plan like this that you could share with your therapist and your psychiatrist would help?
 
Gotcha. This all makes sense. I really don't find joy in anything. I've been trying but I have absolutely no desires and everything feels draining. Everything. It's really tough. I hope maybe the chemicals will shift in my head enough sometime to where I can feel a small amount of joy at least, but so far the meds don't help my depression and "negative symptoms" (of psychosis) like anhedonia and avolition, and I've tried all the meds my insurance will cover and my psychiatrist will prescribe. I also agree this all makes sense, I'm just confused on if my therapist is actually willing to/trying to do that. Her saying "this is just a once a week check in" really threw me off. Like what does that mean? It's supposed to be therapy, right? I'm so confused. She's tried to start light trauma processing in the past, then I destabilized more, and she said she thought she pushed me too hard, but I really don't think she did. I hope she's not just giving up and feels completely helpless/hopeless toward my situation and thus is pressing the brakes on any deeper work. I don't know. I was just really disheartened by that. Hopefully I took it the wrong way or she meant something else?
Omg!! I’m in ur exact situation. With a therapist for a few years, she said I needed higher care, went to multiple higher cares and they couldn’t/didn’t help me. They kept saying that this is stuff I need to work on with my therapist but my therapist wouldn’t work with me cuz she couldn’t help me. I kept saying I need to work on my trauma because that’s what’s causing this. I’ve also been told I’m not stable enough or in the right mental state to work in trauma but I’m only getting worse by not working on it. Trust me I FEEL your frustration and helplessness. And I still haven’t found good care. Trust your gut. Hopefully they are people that can help us and actually know how to help. Thank you for sharing your story, I relate so much and I thought I was just crazy and unhelpable and alone.

Hi all. I've been working with my current therapist for about 2.5 years and she is amazing. However, I'm in a bit of a conundrum.

I have schizoaffective disorder and PTSD. For about the past year, I was in a major psychotic episode most of the time. I think I've been doing better, functioning and communicating better, for the past 2-3 weeks.

My therapist says I need more intensive treatment. However, I'm on medi-cal and very limited on my options. The only IOP/PHP program available to me are at a local hospital that I've had very bad experiences at and I know is poor treatment. Additionally, it's not even trauma informed. I've asked my psychiatrist, people in my support group, etc. if they know of any intensive trauma groups nearby, or even just weekly support groups. They don't. Many said they have actively looked and can't find anything. I have searched the internet high and low. Also, I don't really want to do trauma processing in a group setting. I really don't think that would be helpful for me. For some reason, she doesn't seem to quite believe me that there is nothing available. Maybe she's just frustrated. To make matters worse, I have no friends or family I can go to. When I did have friends, they'd just say something like, "you should really talk to your therapist about that." Eventually they ditched me because, well, I have nothing to offer so I'm not worth the trouble.

Basically my only option is once a week therapy (that's all my insurance will cover, and that's all she can provide). That's my option, along with bi-weekly psychiatry. Also, I've spent a long time learning to trust her and slowly opening up. She says she wishes she had a full week she could just work with me, but of course that's not a possibility. I'm ready to start processing my trauma because it is extremely debilitating and leaves me feeling constantly like I want to die. An intensive program is NOT an option and also not something I am super interested in. Her website says she treats trauma/PTSD, and she's even said she does. In the past, she's said that she wants to process my trauma with me. Then, she said something along the lines of that she couldn't push me because of how constantly stressed out and unstable I was, but that there was "so much work I want to do therapeutically with you" or something like that.

Then, last week, she says how I need more intensive treatment, and then she says "because this is just a once a week check-in." So it's not therapy?? I'm just so, so confused. I am ready to start slowly processing my trauma and I actually trust her, but I'm feeling hurt by this. I can only do so much work on my own, but I am doing what I can in between sessions. I need to try to heal my PTSD. I feel emotionally paralyzed. I'm also worried she's just gonna terminate me or insurance will stop covering it. I got a DBT workbook for psychosis I've been working on, and she says it can also help for PTSD, but I know that DBT skills are not the answer- only some helpful tools to try to help lessen symptoms, but at the end of the day, I still feel the same, and the skills are effective maybe 20% of the time, only if my symptoms are mild. I can't be expected to heal my disorders completely on my own, especailly when I'm in therapy and have been led to think that it would be ok to process my trauma when I'm ready. I really, really don't want to change therapists. It is SO hard to find a good therapist who keeps it real, 10x more so with medi-cal.

Does anyone have any insight as to what could be going on here? Or any advice?

Please help.
I relate to this in every aspect. Just being pushed around in the system. No one knows what to do with me. I’m so thankful you shared ur story, I feel less alone and less crazy and less helpless knowing it’s not just me.
 

hithere

MyPTSD Pro
Processing trauma isnt all its cracked up to be. It can make symptoms so so much worse. Doing weekly check in is indeed therapy. There is a lot that happens unspoken between therapist and patient/client. Getting stable is wonderful, and I hope it co continues for you for a long period. I personally think processing g trauma can stress the brain so much as to cause some serious harm. Be patient and rest in the relationship a little bit. That's my opinion with what very little I know about your situation.
 

TruthSeeker

MyPTSD Pro
Processing trauma isnt all its cracked up to be. It can make symptoms so so much worse. Doing weekly check in is indeed therapy. There is a lot that happens unspoken between therapist and patient/client. Getting stable is wonderful, and I hope it co continues for you for a long period. I personally think processing g trauma can stress the brain so much as to cause some serious harm. Be patient and rest in the relationship a little bit. That's my opinion with what very little I know about your situation.
The "time one is processing trauma" isn't meant to be a picnic, but each time I've worked on it-processed stuff....I felt a little bit "lighter" and less angry or hurt. After 3 years, I have many happy moments, and in comparison to where I was before.......I'd say that the time was well spent. Now, I think I'm able to move through issues, and while I know I sometimes circle back around to the same issue again, it is easier to talk about the next time. I have become more able to think traumatic things through, identify a resolution to be able to put it in the past, and then follow through.. My T always makes sure I stayed grounded.....and would stop therapy and move to grounding exercises.......and not let me dissociate into the wall. I think pacing in therapy, and having the T take responsibility for pacing and being active in helping me to stay grounded has been helpful, and that has helped the phase 2 processing a lot.
 
I agree with @TruthSeeker, processing trauma is hard work and often painful. Personally I am currently making the most progress I have ever made, since my therapist has added IFS (internal family systems) or parts therapy and play therapy to CBT and groups. Enough progress that I have begun to get "gut" feelings again (alexithymia) after 40 years of not being able to experience them due to trauma. Being able to experience emotions physically and not just in my head has given me more hope that my quality of life will improve.
 

TruthSeeker

MyPTSD Pro
That's totally awesome! Are you still falling? I know that I fell much more frequently when my dissociation was high....and that means when my feelings were high. As a multi time TBI recepient (sounds like an accomplishment LOL) I have practiced falling. There are right ways to land when you are going down....and have but seconds to make it so you don't land on your face or break a hip.......before "the lights go out" in my case. You can train your brain when you are standing to bend your knees and not have the auto reaction of straightening your arms, but instead.....focus on protecting your head so that when "that happens" you fall more safely. I don't know if this makes any sense. But now, when I'm starting to feel light headed......I intentionally go down safely and get to the floor as quick as possible rather than trying to make it to the bed or wherever.....rather than fighting it and chancing breaking something....I've had blood pressure issues before where when I stand I get dizzy and am not safe, but I also have hypoglycemia which creates dizziness and passing out, and a seizure disorder (which is usually under control unless there's some crazy stressors).. Dissociation made me have vestibular issues too, dizziness, so.....I had to devise a plan of attack to stop breaking and bruising bones my bones......you can use IFS to make a safety plan......find out what part has the most knowledge about your condition and awareness of when you fall.....and give that part a job to help protect you and get your attention to take immediate safety precautions. Is there a part of you that wants you out of commission.....is your falling attached to disssociation (fear response) or emotional triggers? You don't have to answer if you don't want to, but an internal fall plan could help you stay safer whilst you are getting in touch with your feelings. You take care, and I'm so glad to hear you are doing better now!
 
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