How To Tell If Your Therapist Is Working For You.

[AlmostFellForIt]

Text my T today and said I had concerns and wanted to speak over the phone so I could affirm to myself the treatment plan and direction were heading in... Explained I'm 10 sessions in and still don't know the type of therapy I'm actually undergoing... Also explained I didn't understand the basis for my diagnosis and how after one questionnaire we never revisited the clinical assessment that was made....

Well....My T refused to talk on the phone but insisted I come in for a session to discuss (at a cost of course) all I wanted was a 10-15 minute call...so after numerous texts he called anyway.... It didn't go well... On this phone call I was made to feel guilty on seeking advice outside of sessions.... Must be done inside (paid) sessions. I was also made to feel wrong for the amount of 'control' I try and exercise over my own destiny.... Aren't I supposed to be the one in control?... Was made to feel like I've tried to steer the therapy... Even got told I wasn't the qualified one that knows best! Really, WTF!! Anyway, I think this is ridiculous so I'm done... Not to mention in never saw a treatment plan, with a timeline or goals... Feedback was minimal... I explained that I had no idea of where I sat in the process... It didn't seem to matter though, "just come back next week"

I hope the next one is different and more structured.

 

[JEKBreatheandBelieve]

I hope the next one is different and more structured.

By "next one" do you mean next therapist? I am assuming after that conversation you do not want to go back to that therapist. You are supposed to be in control with the therapist guiding you through whatever methods he/she uses/will work to help you and you have every right to understand your diagnosis. When you look for a new therapist, you can interview them without committing. I would ask questions such as, how will you arrive at a diagnosis and treatment plan; do you set up specific goals and a timeline; etc. I would think a timeline might be hard, but goals are important both short and long term ones. Wishing you the best.

 

[barefoot]

Sorry this therapist didn't work out for you. On the flip side, it looks like you now have a clearer idea of the kind of therapy/therapist you do want ie you want a clear road map of where the therapy is going, sounds like clear structure/goals are important to you and also the need to have open, clear discussions with your therapist about your treatment and progress. So, you have some things to look for if you want to find a new therapist - which will make it easier to find someone who's style/approach/methods are a good fit.

 

[barefoot]

Also, I just wanted to throw this out there...

I think there is a difference between "being in control" of your own therapy/treatment and "being controlling" with regards to your therapy/treatment/the therapeutic relationship etc.

I'm not saying I think you are "being controlling". But it's something that has come up for me and it took me quite by surprise. My therapist mentioned some kind of power struggle that she picks up on in the dynamic of our relationship and said (in a way that didn't actually sound critical or judgemental) that she didn't think it was her putting that into the relationship. And she said that sometimes she feels like I'm trying to control or undermine her. It was quite a shock to hear that and it didn't feel very nice...but, after we discussed it, I realised that she had a fair point and that I was doing those things, though not intentionally. It was a defensive thing, trying to protect myself...

So, yes, feel in control of your therapy and your healing. For sure.

But trying to control the process/space/relationship/your therapist - probably isn't going to be that useful! :-)

Though, as I said - I'm only sharing this as it came up for me. I'm really not implying that this is what I think you do!

 

[Born to Run]

I don't like the phone call at all. Especially in trauma therapy it is very important that it is a fair relationship, and you have every right to ask the type of questions you have.
A treatment plan and timeline is not per definition something you can or need to have. With complex trauma it may be impossible to calculate any timeline. I thought I would be done two years ago, but it was impossible to foresee what I did not remember of the trauma. The only thing you can count on is that it will take a few years to a many few years.

 

[AlmostFellForIt]

Also, I just wanted to throw this out there...I think there is a difference between "being in control...

This is a good point, something I've been critically aware of because It's not something I want to be nor appreciate in others. The behaviours that have been cited as "controlling" are as follows....Self Research: gathering information and background including insight on PTSD including discussions from this forum (this was seen as me unnecessarily arming myself with insight that I'd supposedly then run off with and do something with).Self healing: reading various books and at times discussing some of what I'd learnt in therapy (I wasn't sure why this was bad, it was never outwardly stated as bad but for some reason I was made to feel like me "reading up" was trying to short circuit the process).

There is a real danger in therapy in that slights such as these have the potential to undermine your confidence. Because of this, This T actually succeeded in making me feel like my strengths were a weakness, and the only resolution was to trust them and go with their process... And mine was faulty because of my "condition".. And any attempts made on my part were not only wrong but ultimately ineffective because they were faulty as they were "coming from Trauma".... This for me was the deal breaker....effectively, it creates self doubt and destroys your confidence.

 

[AlmostFellForIt]

By "next one" do you mean next therapist? I am assuming after that conversation you do not...

Yes, next T not session!

I don't like the phone call at all. Especially in trauma therapy it is very important that it is a fair relationship, and you have every right to ask the type of questions you have.
A treatment plan and timeline is not per definition something you can or need to have. With complex trauma it may be impossible to calculate any timeline. I thought I would be done two years ago, but it was impossible to foresee what I did not remember of the trauma. The only thing you can count on is that it will take a few years to a many few years.

Yeah what got me was the completely commercial attitude that I was now indebted because of a 15 minute phone call. I understand a treatment plan per se may not be applicable, I'm going to need more though next time starting with at least the outline of the approach being used... I can't believe after 10 sessions this was still unclear...your comment on I need to count in it taking years is interesting, something maybe I'm naive to but wouldn't thus be dependant on the trauma......... Every one would be different, thus it may not be years.

The worst part about this all is I'm actually doubting the diagnosis of PTSD, I'm assuming this is something I can get a second opinion on... As in literally go to another T and be re-assessed?

 

[Kintsugi]

feel like my strengths were a weakness, and the only resolution was to trust them and go with their process... And mine was faulty because of my "condition".. And any attempts made on my part were not only wrong but ultimately ineffective because they were faulty as they were "coming from Trauma"....

I haven't been following this thread closely, but I just wanted to say that I feel utterly mortified reading the above passage and hope Ts such as this one lose their licenses for affecting traumatized patients in such an insidiously horrible way.

 

[AlmostFellForIt]

I haven't been following this thread closely, but I just wanted to say that I feel utterly mortified...

Thanks for your support. The problem with this is that when in this position, you're never actually sure if your judgement can be trusted... And even more so if you're made to feel that you're wrong. In this case something was telling me to move away from this person so I did.

I'm keen to know the opinion from forum members on something said in about my 5th session. I raised that I wasn't even sure if we'd started therapy and wanted to known when we'd be touching on things. The comment made back to me was as follows (perhaps not verbatim but close)

Me: "When we be touching on trauma and processing it?"
T : "First we will build coping mechanism and then slowly we will begin to process, this isn't something you want to rush, or rip the covers off, especially with a trauma like yours....I could let the shutters fly open now and could really hurt you"

I don't know what the opinion of others is but what therapist lets another know they could hurt them. This is where my doubt crept in, it was as if to say 'I could do things to you, respect that' lol.. What the hell.

 

[Born to Run]

Me: "When we be touching on trauma and processing it?"
T : "First we will build coping mechanism and then slowly we will begin to process, this isn't something you want to rush, or rip the covers off, especially with a trauma like yours....I could let the shutters fly open now and could really hurt you"

Basically in theory, he is correct. This is how you start off trauma therapy. The way it is delivered, I don't like. It feels to me that he is the one that has control issues, by saying "I could let the shutters fly open now". He should have explained much more about the mechanism/theory on a level understandable to you. I feel it is a bit intimidating to you to say "especially with a trauma like yours".
I would run from this guy too.

The worst part about this all is I'm actually doubting the diagnosis of PTSD, I'm assuming this is something I can get a second opinion on... As in literally go to another T and be re-assessed?

Yes, definitively you should and have every right to do so. I like your critical attitude, and am sure you will find someone that you deserve.

 

[AlmostFellForIt]

I feel it is a bit intimidating to you to say "especially with a trauma like yours".

Especially given we hadn't even gone into my past much at all... Think about it, we were at the skills building stage. It felt like a hell of a lot if assumptions were being made.

Going further on this (and this is the other big doubt) I don't get flashbacks, painful memories, trauma memories, nightmares, day/night terrors ... I simply just don't get them and never have. When I did the PTSD Questionnaire I actually had to state that I didn't get these to which I was told "you don't necessarily need to in order to qualify" ....I pressed on this for a session or two because it didn't seem to fit what the questionnaire was getting at nor fit tightly with my interpretation of the DSM diagnostics (another example of me again trying to "control" things).....You go to a specialist because that specialist has the knowledge, insight , experience to rule in but also rule out. I really hope this wasn't a case of a man with a hammer thinking every problem is a nail......Without opening up the whole affair I think I'll be seeking to be re-assessed. It's almost iatrogenic in that if this diagnosis is incorrect, it probably made me worse!!

I like your critical attitude, and am sure you will find someone that you deserve.

Thanks, a silver lining I guess.

 

[Kintsugi]

I think that rhetoric was highly manipulative. @Born to Run is right in that he was using a solid kernel of truth (saying that building coping mechanisms before diving headlong into trauma is a sound therapeutic approach), but he then laced that kernel with a sinister powerplay that--to me--was thinly veiled as a contextually appropriate thing to say rather than a suggestion of power. Y'dig? ;)

Good on you for thinking critically, as Born said, and I hope you can move forward productively with someone who is more supportive and deserving of the responsibility with which mental health professionals are tasked.