I Dont Need You, So Get Off My Case!

[BloomInWinter]

Therapists are obligated to avoid allowing clients to determine their own treatment frame parameters.

There is a treatment frame set up for our own safety. Just because we want to receive special treatment (that which differs from the treatment frame) does not mean it is healthy for us, nor ethical for our therapist to do so.

"Counselors should develop and maintain a treatment frame--those conditions necessary to support a professional relationship. Setting and maintaining boundaries is especially critical in treating survivors of childhood abuse and neglect. Several parameters of the treatment frame are discussed below, as well as special issues that may arise. Because childhood abuse is a profound violation of personal boundaries, adult survivors of abuse or neglect may never have developed healthy and appropriate boundaries, either for themselves or in their expectations of others. They often need a great deal of affection and approval, and counselors must make clear that they are not responsible for directly meeting all of those needs. Boundaries help the counselor as well as the client because counselors tend to be nurturing healers, which may lead them to fall unwittingly into inappropriate roles in response to their clients' stories.

For example, a counselor may react to strong countertransference feelings by trying to respond to a client's wishes and expectations. The counselor should guide clients in doing difficult interpersonal tasks themselves, not only to strengthen the clients' ability to take responsibility for their lives but also to maintain important adult boundaries. The counselor must maintain a calm, optimistic interest in his clients, recognizing that getting overly involved will rob clients of the opportunity to identify and build upon their own inner resources.

Other parameters of the counseling relationship, or treatment frame, set by many mental health professionals (Briere, 1989) include

- Making regular appointment times, specified in advance
- Enforcing set starting and ending times for each session
- Declining to give out a home phone number or address
- Canceling sessions if the client arrives under the influence of alcohol or psychoactive drugs
- Not having contact outside the therapy session
- Having no sexual contact or interactions that could reasonably be interpreted as sexual
- Terminating counseling if threats are made or acts of violence are committed against the counselor"
Source: http://www.ncbi.nlm.nih.gov/books/NBK64902/​

We may not like it, but a therapist's adherance to the treatment frame isn't a negative behavior directed at us to intentionally make us upset. It's there because it needs to be.

 

[tphillips117]

I think you are all right about his position. I'm just not comfortable there at this point and I think it makes sense to move on. I will not be accepting a referral for him. Since I've only seen two males therapists to date, I think a woman might be in order. A change of pace in gender, might be just what the doctor ordered. I think it's worth a shot.

 

[Tinyflame]

Dear tphillips, I hope you don't mind me interjecting in a tiny way here, I mean it respectfully and gently, and can only put forward what I have observed (and come to learn) about myself and ptsd.

I believe I recall you mentioning in other areas (please forgive me if I've misinterpreted the posts), that for all intents and purposes you have a good life, one wherein you have much to be thankful for, and also that feel you may not 'appear' you need therapy. And similarly, that the excrutiating response (feeling) when speaking of some things within your mind is the scream of "Don't talk, don't tell!". That being said, I believe you have the right to choose, and invest, in whatever form of therapy that fits where you are at.

However, I agree wholeheartedly especially with Bloom, and Pencil. I wish I had Bloom's words through my life, she would have spared me much heartache and self-recriminations. After 30 years of ptsd, I can say it's extremely valuable advice. Sometimes, it takes me months to realize what triggered me months earlier, and God only knows I'm still learning. I may be the least person qualified to give advice over choosing a therapist, but I am a long-time member of the "PTSD Club" (sic). :rolleyes: I have been a master at avoidance, minimization, "carrying on", and independence. I have also learned however, that perhaps the key to progressing away from the symptology (and control) of ptsd over my life relies greatly on doing what I precisely don't want to do, am afraid of doing, or cognitively rationalize to myself is the 'best' thing to do. I say this because, if it were me, I would ask myself, why does this upset me, why do I (in retrospect) post a thread saying ".. get off my back", but conversely want my therapist to contact me. I say this not in judgment, only as I think dealing with the ptsd I have come to realize that would (could) be a prominent 'roadsign' as it were, for me, to think the ptsd is exerting an effect here, (perhaps a big one).

I think your greatest therapy would be to go wednesday and discuss this rationally, and to really put it out in the open. To me, THAT'S telling 'ptsd' to 'scr*w it', that action and new way of dealing with this situation, I think you would find most healing of all.

JMHO, of course. Best wishes and good luck.

(And you have more than 3 options, because the key here is everything can't be planned in advance. That is a ptsd-controlled thought, a way to deal with the effects of how it felt to survive trauma. Self-limiting now).

 

[tphillips117]

Hi Junebug,

I totally understand what you are saying. I think I've taken to heart what everyone has said. Therapy is tricky business for both the client and the therapist. I do not see this one sided. I know that by walking away from therapy, I am disappointing both myself and my therapist in the sense that he has 4 months invested in this too.

I think I could make it be a good enough fit, if he was willing to meet me in the middle somehow. We have talked about the relationship together a lot. He will often say, this is not about "Us", this is about "you". While that is true to a large degree, there is no "us" without his guidance and insight.

He makes me uncomfortable. And yes, I agree that therapy is supposed to hurt a little sometimes, but for me, I dread it. My stomach hurts, my head hurts, I feel physically sick with stress and anxiety. I often think to myself "Good God, why am I doing this to myself when I have enough problems already". The truth is, I dont know my therapist. Hes as much a stranger to me today, as he was 4 months ago.

I walk in the office, he welcomes me to the appointment and then he proceeds to stare at me, until I say something. I don't know about you, but when that happens, my mind turns into a barron waste land. I can think of absolutely nothing. I start looking at the ceiling, the windows, the clock, ANYTHING! The discomfort much be insanely obvious, because I certianly feel it all over my body. I have told him repeated times, to please not stare at me, and he will coyly say "Well, what do you want me to say?". Ugh, wait, aren't you the therapist? Maybe this method works for others, but for someone who has serious trust and bond issues, is hurts way more than it helps.

I need a warm-up period. That is what I meant in my earlier post when I talked about discussing "snot". Just as two new friends have a dialog that runs smooth with both participating in the conversation, I expected that in this case as well. You talk, I talk, back and forth. At this point, I wasnt looking for a break though, or for real work to happen. I was still in the process of forming the bond. A bond that never took place, at least for me it didnt. I wont speak for him.

The title of this post was off base. I did want a reply from him, becuase I felt like it was common courtsey to get it. It took more than a week to get one, and when you're trying to rely on someone (and again, trust and bond), that delay feels inexcusable. It angers me, because I don't think it would be fair to reply to him a week late, or to pay my bill a week late, etc.

You are right about his judgement call when it comes to what he thinks is in my best interest. However, he's not the be all end all of opinions. I have a stake in this as well. I should have discussed this with him at our last session, but I hadnt decided that was what I wanted to do at that point. What I really needed, was to walk away, clear my mind and really figure out what I wanted and needed from therapy and if this man was the right person to walk along with me on my journey. I needed that.

I dont think his intention is to refer me, but in my head, the damage has been done and I don't think there is any going back. I think he is a wonderful, competent therapist for someone else--just not for me. I need to feel compassion, I need to feel like I'm not boring him, I need to feel confident that he can help me, I need to feel like he's understanding what I say...but MORE importantly, I NEED him to hear what I dont say. Watching me squirm in my seat week after week feels like torture to me, and even if I'm making it out to be a lot more than it actually is, it shouldnt matter. What matters is that I need to feel safe, and I just don't. :(