How can you tell when you need to ask your T for an extra session?

goosegoose

Learning
Hey again besties,

Basically as the title suggests. I had a session today with my therapist and my SO for a 3 month treatment plan review. I've been bottling so much up with this therapist, scared to talk about anything, and I think I'm starting to hit my limit. The "bottle" is about to explode into a million pieces. I've been basically only laying in bed the past week or more because I'm so stressed and weighed down with keeping so much inside. I'm overall very intimidated by her energy, even though she's the nicest person.

I feel like I should request an extra appointment this week, but then I start self shaming and feeling so stupid and embarrassed/guilty for even thinking about asking. I'm under the impression that if I ask for an extra session, I have to be talking and open the whole time otherwise - why am I wasting her time? (Personal belief, not her words). I'm also worried about crossing her boundaries because I make consistent social faux paus (sp?) from potentially being on the spectrum/not being socialized properly at all as a child.

She told me today that she strongly feels that I need more intensive care (EMDR, which I've tried and don't understand). So I'm anxious that she'll think I wasn't listening or something. She asked me to reflect on some pretty intense questions, so I'm also nervous about seeing her again before I've had time to sit and think. I can act emotionally impulsive, re: reaching out during periods of splitting (borderline), so I keep feeling like "well no maybe I'm just splitting, don't waste her time." I don't want her to get overwhelmed or frustrated or disappointed with me. I don't want to make her think I'm in full crisis either because being redirected to a hospital or something is not the solution I'm looking for. But I'm realizing that I don't even know what kind of signs or red flags to look for when considering reaching out.

Tl;dr: what are some red flags or warning signs you've recognized in yourself that indicates that you need an extra session?

Thanks for reading and checking this out
 

Movingforward10

MyPTSD Pro
I can't answer the extra session thing as I haven't asked, even though I probably should have at various points. What I did do was contact T between sessions and we had agreements at times about that.

What lept out to me from your post was this fear of you letting her down or doing it wrong.
I just wanted to leave these statements here:
She is there to support you, not for you to please her.
It's totally ok not to have thought of answers to her questions yet. Take your time. She has suggested them as she thinks they help. She won't want it to stress you out.
You don't need to bottle things up with her.
Take a leap of faith and let out what you need to.
This shame hurts you.
Can you imagine telling her what you need to and her responding in a way that helps?

I think saying everything you said in your post to her, either verbally or via email, would really help.
 

Friday

Moderator
If it would be useful to me? I ask. That easy.

They can always say no.

Ditto for arranging a therapy schedule to my liking. What works best for me is a 2-3 hour session, rather than an hour session; and If we’re doing a lot, twice a week. Since I know that about myself, it’s one of my interview Q’s. Since most of the trauma therapists I interview do EMDR in 120 or 180 min sessions, anyway? It’s almost always something they’re cheerfully on board, with. The ones who aren’t, aren’t people I work with. Unless it’s a freebie, like kicking it with the vetCenter T for an hour once a month. Freebies have wildly different rules, in my universe. But if I’m paying for someone to help me with something? It’s only common sense to pay the person who can help me best. Which means 2-3 hour block of time.
 

Sues

MyPTSD Pro
I've asked for extra sessions quite a few times over the past 2 years. Since I always wait until I'm struggling horribly, my therapist knows me well and understands that I really need the support. He always tells me that I don't have to "white knuckle it" and to call sooner or more often. He is always supportive and wants to help.

If you're thinking that you need an extra session, then I'd say you do and you should just ask for one. I know it's not that easy, but it's the truth. I often shame myself, put myself down and tell myself that I'm over reacting, not deserving of help, etc. But we all are.
 

goosegoose

Learning
I can't answer the extra session thing as I haven't asked, even though I probably should have at various points. What I did do was contact T between sessions and we had agreements at times about that.

What lept out to me from your post was this fear of you letting her down or doing it wrong.
I just wanted to leave these statements here:
She is there to support you, not for you to please her.
It's totally ok not to have thought of answers to her questions yet. Take your time. She has suggested them as she thinks they help. She won't want it to stress you out.
You don't need to bottle things up with her.
Take a leap of faith and let out what you need to.
This shame hurts you.
Can you imagine telling her what you need to and her responding in a way that helps?

I think saying everything you said in your post to her, either verbally or via email, would really help.
It's totally okay that you haven't personally experienced it, I'm still grateful for responses. Thank you for all the statements, I beat myself up so hardcore and always on edge about failing or doing it wrong, so you're not wrong with that. I guess I should look into people pleasing because it seems like that's a bigger issue than I gave it credit.

Leaps of faith, my worst nightmare, we meet again lol

If it would be useful to me? I ask. That easy.

They can always say no.

Ditto for arranging a therapy schedule to my liking. What works best for me is a 2-3 hour session, rather than an hour session; and If we’re doing a lot, twice a week. Since I know that about myself, it’s one of my interview Q’s. Since most of the trauma therapists I interview do EMDR in 120 or 180 min sessions, anyway? It’s almost always something they’re cheerfully on board, with. The ones who aren’t, aren’t people I work with. Unless it’s a freebie, like kicking it with the vetCenter T for an hour once a month. Freebies have wildly different rules, in my universe. But if I’m paying for someone to help me with something? It’s only common sense to pay the person who can help me best. Which means 2-3 hour block of time.
You inspired me - I ended up asking her through email "How do I know if/when I need an extra session?" because I'm still on the fence as the whether or not meeting again this week would really be what I need and also still like "???" about how to really tell. I felt weird flat out stating "I need this extra help." I hope that makes sense. She hasn't responded but I get the feeling that she can sense me feeling unsure.

I totally get what you mean about extending the session time block for EMDR. I've only ever been able to try it under the typical 50-minute block and it felt so rushed and inaccessible.

I've asked for extra sessions quite a few times over the past 2 years. Since I always wait until I'm struggling horribly, my therapist knows me well and understands that I really need the support. He always tells me that I don't have to "white knuckle it" and to call sooner or more often. He is always supportive and wants to help.

If you're thinking that you need an extra session, then I'd say you do and you should just ask for one. I know it's not that easy, but it's the truth. I often shame myself, put myself down and tell myself that I'm over reacting, not deserving of help, etc. But we all are.
I really like your use of "white knuckling" it because that's exactly what I do. You explained it spot on, I always wait until I'm struggling and trying not to drown. I did end up reaching out but I couldn't make myself say directly "SOS" so I'm unsure of the results, but I'm glad I at least tried. I wish so much to not be my own worst enemy anymore
 

Movingforward10

MyPTSD Pro
I understand. It's so tough all this. I would feel unimportant too.
But, I think that is a trauma response.

Because what I hear her meaning is: she hears you, she has acknowledged what you said, she took the time to respond, and she wants to explore it with you in the session.

My t does similar things. If I don't ask a direct question, she doesn't respond to a direct question. But if I say I don't know if I need this or that, she will explore that with me. Which is what I think your T is doing?

In the meantime, can you hold on till then?
Or do you want an additional session now and not wait?
 

goosegoose

Learning
I understand. It's so tough all this. I would feel unimportant too.
But, I think that is a trauma response.

Because what I hear her meaning is: she hears you, she has acknowledged what you said, she took the time to respond, and she wants to explore it with you in the session.

My t does similar things. If I don't ask a direct question, she doesn't respond to a direct question. But if I say I don't know if I need this or that, she will explore that with me. Which is what I think your T is doing?

In the meantime, can you hold on till then?
Or do you want an additional session now and not wait?
Thank you for replying again! I think it definitely is a trauma response - feeling ignored and brushed to the side.

It's really damn hard for me to see beyond my fog of self hatred, so hearing other people confirm that she did acknowledge me/hear me/take interest is helpful. It's kind of like evidence for myself when I mentally go places.

I think our Ts are probably very similar in that respect, in that if I don't ask a direct question, she won't respond directly. It's a new dynamic and concept for me and I've really been struggling to communicate. And yeah, I didn't explicitly say "I need this," I said "I don't know if I need this" and I still honestly don't know but tomorrow's Friday and then I see her on Tuesday so I feel like I need to just sit and process but it truly sucks. We've been in a bit of a rocky place (new therapeutic relationship, plus communication struggles, plus me throwing roadblocks constantly, etc) so I really want to give her space. I'm terrified of putting my foot in my mouth and saying the wrong thing and having her respond with "are you really ready for this?" aka threat of termination.

Idk, my mind has been in an absolute vortex the past two weeks. I've barely been able to get out of bed, like I'm past drowning - I'm dead man floating on the water
 

Renly

MyPTSD Pro
I emailed her and she said "let's talk about it next week" and that's fair, I didn't explicitly say "I need help stat" but now I'm trying to push away feelings of being unimportant haha

@goosegoose I just want to give you major props for taking steps in the right direction. It’s so hard. I actually texted my T today to see if I could change my appointment to come see her a few days early (because I’m truly having a bit of a mental break today and the last few days have been hell)…but alas she said she will be out of town. It’s seriously so hard for me to ask her for extra help…But I am learning it’s okay when I really need it. I was able to share a little of my struggle at the moment with her and she texted me back some insights that helped a lot and now I feel like I can hang in there until my scheduled appointment time.

For me, I have been trying to ask for extra help when I’m feeling overwhelming hypervigilence, my parts internal battle is going crazy, and when my depression/SI become overwhelming.

It’s so so hard to ask for help. And sometimes we feel like we are too much or too crazy and going to push out T away…but a good one truly does want to help and is trained to meet us where we are at.
 

goosegoose

Learning
@goosegoose I just want to give you major props for taking steps in the right direction. It’s so hard. I actually texted my T today to see if I could change my appointment to come see her a few days early (because I’m truly having a bit of a mental break today and the last few days have been hell)…but alas she said she will be out of town. It’s seriously so hard for me to ask her for extra help…But I am learning it’s okay when I really need it. I was able to share a little of my struggle at the moment with her and she texted me back some insights that helped a lot and now I feel like I can hang in there until my scheduled appointment time.

For me, I have been trying to ask for extra help when I’m feeling overwhelming hypervigilence, my parts internal battle is going crazy, and when my depression/SI become overwhelming.

It’s so so hard to ask for help. And sometimes we feel like we are too much or too crazy and going to push out T away…but a good one truly does want to help and is trained to meet us where we are at.
Thank you, it really means a lot. I actually felt like I had failed by reaching out, like I couldn't access enough coping skills or do them "well enough" but I'm really trying to reframe it as something positive, it's just so incredibly hard like you said. Major props to you too for facing that challenge.

I definitely was/am at my limit with the depression/SI/etc. I think one of my biggest anxieties with reaching out is the threat of being perceived as lazy or not trying hard enough. I do feel like I'm too much
 

Friday

Moderator
I'm terrified of putting my foot in my mouth and saying the wrong thing and having her respond with "are you really ready for this?" aka threat of termination.
Is that how you always read “are you really ready for this?”… instead of as a direct Q?

I ask… because I’ve been asked variations of that Q by therapists, and my response is usually somewhere along the lines of “f*ck NO. But…”
- I need to accomplish ABC & XYZ isn’t letting me do that. So the solution would be to sort out XYZ so I can do ABC, yes?
- What does being ready have to do with it?
- I don’t know how to get ready, and need someone to break that shit down for me, Barney-Style.
- I’m stubborn. If I waited until I was ready to do something, I’d never do anything.
- I’m here.

As well as…
- That depends on what you mean by “ready”. Lay it out for me, and we can figure out where I am, and what needs shoring up.
- I’ve been living on the edge for so long, I don’t know what’s ready, and what’s just sick & damn tired.
- Ready? Or willing? Are we talking stabilization & coping skills, or determination & grit?

Never had a T terminate, or threaten/propose termination, for not knowing WTF is going on with me/my life. That’s why I’m there, after all. For some expert direction.

But I also pick a certain kind of Therapist, both in personality & education/experience. I don’t do passive aggressive say one thing, but mean another, if I have any choice in the matter.
 

goosegoose

Learning
Is that how you always read “are you really ready for this?”… instead of as a direct Q?

I ask… because I’ve been asked variations of that Q by therapists, and my response is usually somewhere along the lines of “f*ck NO. But…”
- I need to accomplish ABC & XYZ isn’t letting me do that. So the solution would be to sort out XYZ so I can do ABC, yes?
- What does being ready have to do with it?
- I don’t know how to get ready, and need someone to break that shit down for me, Barney-Style.
- I’m stubborn. If I waited until I was ready to do something, I’d never do anything.
- I’m here.

As well as…
- That depends on what you mean by “ready”. Lay it out for me, and we can figure out where I am, and what needs shoring up.
- I’ve been living on the edge for so long, I don’t know what’s ready, and what’s just sick & damn tired.
- Ready? Or willing? Are we talking stabilization & coping skills, or determination & grit?

Never had a T terminate, or threaten/propose termination, for not knowing WTF is going on with me/my life. That’s why I’m there, after all. For some expert direction.

But I also pick a certain kind of Therapist, both in personality & education/experience. I don’t do passive aggressive say one thing, but mean another, if I have any choice in the matter.
To answer your first question - yes, I always hear "are you ready for this?" as a threat of termination. It feels like I'm being asked as a confrontation or a threat that if I don't "get it together" that she'll pass me on to someone else. She's tried to reassure me that this is not the case, that she wants to make sure that I'm ready to actually do DBT and apply the taught skills. I try so hard to hear her but my anxious brain tells me that she's tired of me, she doesn't want to waste her time anymore, she doesn't think I'm capable, etc. She told me a couple days ago that she wasn't sure we could make progress until I did heavy EMDR work to process all my "surface" traumas. All of my traumas are surface, it would take so so many years for me to get through them. I really tried not to take it personally (did not work) because it felt, again, like she thought I was too much and couldn't work with me until I "fixed" myself more.

I agree with all your listed questions and thoughts, I feel like if I waited until I was ready I would never do anything therapeutic. Your list is actually extremely helpful, because she just asked me to consider "what do you want to get out of therapy" and I feel like you hit some nails on the head for me. I've really been struggling to put it into words. She is definitely in a place of WTF with trying to figure me out, I feel so guilty for putting her through the ringer so hard.

I also wanna add that she's never been passive aggressive or condescending/etc, so that's not an issue. I'm very grateful, she's actually very level headed and professional
 
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