How Is "urgent" Defined In Therapy?

[joeylittle]

I think this will be a good conversation to have with your therapist, when you are back in session.

I would never call my needs "urgent", so I had to talk this out with my T when the concept came up. It is now defined as "if it would be helpful" - as in, I'm not to call him unless it's "urgent", but really what that means is if I think it would be good to have his help managing what is going on with me, and (conversely) know that without his help I will have a very very hard time of it.

I think this is beyond generous of him, but it relates to the work we are doing - he would rather have a 15 minute phone call with me than have me come in the next week having lost ground that we've been gaining, if that makes sense.

Instead of answering your T with "yes" or "no", you might just describe back to her what your state is. So: "is it urgent" can be met with "I am more numb than when I saw you last; I am still making it out of the house, my sleep is irregular, and I'm doing a lot of ruminating. I am not in crisis"

(I'm just making that up - whatever your state is should be what you answer)

And let her decide if it's urgent or not, based on her assessment of your current state.

 

[Hashi]

This isn't the question you're asking, but I'm wondering how you feel about your relatively new therapist? Do you think she's reliable and professional?

To cancel a session a week in advance but say she could still honour the appointment if it's "urgent" is, to me, not a good sign. If she has a true emergency such that she can't see you, then she can't see you. In giving you the option of saying it's urgent and then fitting you in, she's effectively asking you to decide how important your session is. I think that's unprofessional and unfair.

In my view, a therapist has a responsibility to not let their clients down. Childcare issues on the same day is understandable, but childcare issues the following week? If they have children, I think they should have some sort of backup arrangements they can put in place. Otherwise, how can they be reliable with appointments? When being reliable with appointments is a cornerstone of trauma therapy. Every session is important. Consistency and trust are important.

Childcare problems mess up parent's schedules all the time. Therapists should not be messing up their appointment schedules as a result - they need to organise things so they have alternatives or they should be doing a job that doesn't involve someone depending on them being there when they said they would, A childcare problem causing problems on the same day isn't great but it's understandable. Bumping clients the following week for a childcare problems - to me that's a concern.

I would be more interested in whether she's justified in cancelling your appointment, more than whether you're justified in asking her to keep it,

 

[greenleaf]

Thanks for your replies, all, much appreciated and I hadn't thought of the implications of a therapist with a child, and perspectives on how they could be handling that...

I did get an appointment next week (she has an online page for that) but am seriously wondering what to do.

It feels like I got majorly pushed (or let myself go? hard to tell but I wasn't aware of a choice) down a hole of old reacting and "coping". Recent negative events have been bringing up old stuff, and I'd been having to deal with life time periods popping up (surprise! you won another lottery!!!) that I guess I hadn't really integrated at least emotionally. Ugh...that one little sentence about cancelling. (She had said we could wait a week unless it was "urgent", as she had a child care problem.)

Her tone of voice sounded happy, I think she loves her kid and was maybe looking forward to the together time. I have this totally split reaction. One side is more in "now" and my current life; it's great she is happy with her kid, and she'd seemed a neat person with good insight on dissociation etc.

The other side is very separate and feels something really negative about all these events; it's hard to get across how separate these parts are -- it's like superimposed vision almost. That older side feels strongly and isn't great at hearing logic or even taking anything new in it seems, except that this recent event shows that yes I shouldn't have trusted, I should keep myself from trusting, I'm just totally different and not innately deserving of loving family. (I guess the thing about it being for her kid reinforced my not having family that would stand up for me, I'm just not that valuable to others.)

I read all this and it sounds like "attention-seeking" like folks replied earlier they'd feel, in this thread... the problem is that it's not coming from a level where that feels like it would be true -- the level that's mostly doing this writing here is not where it's from. (I'm not DID, though, I know this is all "me", but jeez.) I think an isolated "me" way back felt these things very strongly; it feels like a somewhat contained cloud of emotional mess, like I'm multitasking with it at the moment.

So, I feel kind of sick to my stomach about talking to her now. I hadn't self-harmed in many years, it seems connected to keeping myself from trusting and was designed to protect myself what also feels like a twisted way. It feels like this interaction got through some really weak points that I guess I still have... feeling pretty scared about even talking to her now.

 

[Hashi]

Her tone of voice sounded happy, I think she loves her kid and was maybe looking forward to the together time.

I would gently suggest you don't decide her feelings and motivations. Really, you can't know from your perceptions what the situation is. The only way to find out is to ask her directly. Other than that - you don't know. Most of us will project onto our therapists at the drop of a hat - I've certainly done that. Meaning that we project what's going on with us/our history/our fears/our wishes/our experiences with other people and we start seeing them in our therapist when they're not actually there. This isn't bad, it's actually very helpful if you can look at it for what it is.

If she really was happy to bump your scheduled session to spend more time with her child - run in the opposite direction and don't look back! ... if she clearly tells you this herself, not because you've guessed about what she might be thinking and feeling.

But I think there might be more going on.

I have this totally split reaction. One side is more in "now" and my current life; it's great she is happy with her kid, and she'd seemed a neat person with good insight on dissociation etc.
The other side is very separate and feels something really negative about all these events; it's hard to get across how separate these parts are -- it's like superimposed vision almost. That older side feels strongly and isn't great at hearing logic or even taking anything new in it seems, except that this recent event shows that yes I shouldn't have trusted, I should keep myself from trusting, I'm just totally different and not innately deserving of loving family. (I guess the thing about it being for her kid reinforced my not having family that would stand up for me, I'm just not that valuable to others.)

And this is exactly why therapists should be reliable, professional and stick to their commitments.

I'm not going to go back more to what I said before, except to say that you need a reliable, professional therapist who understands trauma and acts responsibly towards her clients. If you have that, great. If you're not sure... I'm afraid you need to make sure or find someone else. Please don't turn this on you, or let your therapist do that either. Your therapist wanted to cancel a scheduled appointment. She needs to have a really, really good reason to do something like that.

 

[Changing4Best]

I'm farther along in therapy, I'm guessing, than you are, but I could be wrong with that. I am up to seeing her once per month and I am OK with that. If she cancelled an appointment on me, I would expect her to make it up the next week though (or sooner), surely not a month later! None the less, when I am trouble between appointments, if I call her she calls me right back, and I am pleased with this. She even gave me her home number, which I felt totally blessed to be given. I have only had to call her once between sessions, but I sure am glad that she called me right back, as I was truly in crisis. She talked me through it and all was OK after that. I think we discussed it further at the next appointment, which was not too far off thankfully. She's never missed an appointment on me.

I trust her and she is one of the best therapists I have ever had. One other one I had for 5 years didn't ever miss an appointment and was really good too. It is hard to say which one of them serves or served me better, so I will just say that they both hold the position of best in my eyes like they are tied for first place or something.

 

[greenleaf]

:O_o: "Farther along in therapy" seems to be a moving target sometimes, I was doing monthly for years and worked on having a "real life" but the PTSD onion had another layer, turns out.

 

[Changing4Best]

Oh good grief! Thanks for the warning @greenleaf.

 

[greenleaf]

@SheilaKathy -- I didn't mean to imply that it would happen for everyone! I really hope your onion has no more layers and is happily growing into a nice strong plant!