News Is Face To Face Therapy Really The Best Method For Severe And Complex Ptsd?

[jock bubbleskin]

Each and every time I have met with a counsellor or clinical psychologist I spent a lot of time energy and effort monitoring and controlling myself and my responses to ensure I did not go into overwhelming red mist rage. I was so afraid of verbally, or god forbid, physically assaulting them.

Congruent expression of murderous hate and rage equals dead therapist. So went my thinking.

Text based therapy? Yes please.

 

[jeeps for now]

The problem I see with face to face situations is that the entire context of one's perspective never has the time to come out before someone is reacting to only pieces of it. The transmission needs to be completed in it's purposed form.

For example, if I am trying to 'paint a picture' with words, I may begin by describing spooky skies, strange scary people and hysteric reactions, before I get to the subject of feeling like warm rays of sunlight whenever I am alone in my room. If I am interrupted partly into this description, the therapist/etc., may never come to the realization that it is other people's erroneous/incomplete reactions that are bothering me.

However, if I am intermittently acting like a five year old when I am actually 60, a face to face situation could help point out the fact that I am regressing to a previous, unfinished state of affairs.

 

[Lucycat]

I have a combination of Text/E-mail and face to face. I think it works well.

There are some things that I just cannot say, but can text or e-mail. With these I can read and reread the replies. I find that very helpful.

However one of the main components of my difficulties is the shame I feel. For this ( I am told) I need to look into the face of my T. We have not started this yet, but it is to be the focus of my next round of therapy. I am decidedly uncomfortable with the idea, but logically can see the reasoning behind it.

Also I have been having EMDR. This can only be done in person.

So although I am so grateful for the Text based therapy for me this is not going to be enough.

 

[kimba]

How would text based help with leaving the house and dealing with the real world? Alot of us isolate as it is and going to the T means having to deal with the world to get there whether I want to or not.

The interaction, at least with my T, is helpful because she allows me to get the end point on my own and deals with the frustration when I can't get there fast enough for myself.

If everything was text based I believe I could become totally house-bound and just add to my problems. Am I wrong?

 

[Lucycat]

going to the T means having to deal with the world to get there whether I want to or not.

But my T comes to the house, so that aspect of it makes no difference to me!

 

[cat]

I seriously believed that if i hadnt had face to face therapy I wouldn't have made the recovery i have. As kimba said just having to leave the house to go to my T was a huge effort, i'd arrive feeling anxious & angry but then she'd be there to say 'well done' & it definitely helped. My T was the first person I had ever talked to about my feelings, after 50yrs i had a lot to get out! i think it was important for her to use other signals - body language etc to help me to understand where i was coming from, I'm not sure she could do that by text/email.

When i first started writing for her i would go over it time & time again before sending, checking to make sure it made sense, no grammatical errors, deleting the parts that i thought would tell her i was just going insane. When i got over this writing became very helpful especially after EMDR sessions, when i could just pour my heart out without feeling embarrassed about it. I also found that in between sessions if i couldnt cope with my thoughts writing them down & emailing them somehow relieved me of them.

For me, I think face to face therapy combined with email has been a good solution. I have to admit though that i have been extremely lucky with my T, she is very professional, tough but also compassionate & a great support.

Surely part of recovery & benefit from therapy comes from building a strong trusting relationship with your T, i know i couldn't have done that without being able to see her reactions & body language.

 

[Srain]

I think this is a very interesting thread. I am one of those who has been in and out of therapy most of their lives..guilty as charged! After reading all of this to honest one of the things that really spooked me was the feeling under this type of program I would only have so long to get it together and then be cut off. I get and like the progressive approach, however, once again it brings to mind that not everyone is the same and not every therapist would have the same abilities. That is a considerable worry.

I prefer to look my therapist in the eye and watch them. I don't trust right off the bat and can easily misread anything and then dismiss that person from my life.In person I am learning not to assume I know what they are thinking about me but to ask her what she thinks. I do text this current trauma specialist I have, I also bring journal entries and other writings I do, so I'm finding the combination working well for me.

I like the idea and think that it would work well if the therapist is a very good one working with people that are not agoraphobics like myself. My getting out is part of my therapy as well as sitting face to face with a woman and learning that she will not react like my mother in person, meaning she is who is each time, consistency.

I will bring this up to her as I find the study quite interesting. Thanks for posting.

Rain

 

[Reclusive]

I think the feedback you're going to receive here is going to be skewed towards text-oriented people. I, myself, communicate much better in type than I do in person. I also feel I convey a lot more as sometimes I like to ramble a bit before I get to the point. I, personally, would LOVE text-based therapy, especially since that's how I communicate with people primarily.

Regarding agoraphobes, I think that getting at the core issues will alleviate the fear of leaving the house. Since I've been without a T, I've really been concentrating on my own self-esteem, meeting my own needs, and realizing that I'm not such a bad person after all. Since doing this work on myself, I'm finding I want to leave the house more, I want to be more social, I feel lighter! Hell, I've even started using the voice function of my chat and am thinking I should do it more often. I really believe that agoraphobia is a symptom of PTSD, not a separate diagnosis.

Then again, I think it would take the right kind of t to do this effectively. I can definitely see the benefits, especially with someone like Anthony who communicates clearly and is extremely analytical/logical. That appeals to me. For other people, they made need that empathy and compassion to feel comfortable opening up and give them a feeling of validation. And then there are people who may get too reliant on their t for validation and may never find a way to be self-validating.

Also, I know of a company that makes a chat program where you can actually watch the other person type. So self-editing becomes much harder. I know though this program it becomes obvious when I become flustered because the typos show up more often and I care less about fixing them. People have typing habits that are deceptively expressive.

So, in short (I told you I ramble), I think it depends a lot on the client and the T. It's absolutely doable and anyone who isn't making progress through traditional methods should definitely give a go.

 

[Srain]

After speaking with my husband he thought this would be the future, Anthony, saving $$, gas, helping people like me that are not able to get out of the house, so colour me seriously old school! HA!! Okay, I am :p but staying open minded and can see the positives.

Rain

 

[AliveInside]

Very interesting thread Anthony, typing out issues I'm confronting creates a record I can review instead of the blah blah blahing from therapy where review is not possible.

 

[cherryblossom]

My T is lovely and helpful, and I do feel that I have come a long way with her. But I do often come home from therapy, and think I wish I'd said x,y,z, or I didn't really express what I meant properly, or how did we end up talking about a certain subject for so long, when there were other things I should have/ wanted to talk about.

Text therapy really focuses on what you need to say, but it is a more time-consuming process. Because, like cat, I find myself editing, and checking that it makes sense, and reads well etc. Mainly because, a bit like posting here, you need to get your point across correctly first time. Face to face, it's a lot easier to quickly reiterate what you want to say, if you feel you didn't say it right the first time. By text, that is a much more lengthy process - hence wanting to get it 'right' in the first place.

I think one of the things about text is that it does require absolute honesty in saying how you are feeling, because of the lack of face to face contact. For example during my face to face therapy my T might say, something like, I can see that this is causing some anxiety, because your demeanour has changed, you appear tense. Also she will help with grounding etc, if I was dissociating, where as that's not possible if exchanging text, where replies may not be made for several days. Other more obvious things such as tears or your general appearance (are you looking after yourself?), are going to be seen face to face, but not by text.

Anthony, I'm assuming that the people you have helped by text chat are people from this forum? If that is the case, then you have had a head start in helping these people, because they feel they already know you from reading your posts. And you 'know' them to a certain extent from their posts. They know your no-nonsense approach, and already trust you. Starting up a completely new text only therapy relationship could take a bit more time to get results, because the 'getting to know each other stage', by text alone could take quite a while.

I think both have their place, and could sometimes be a very individual choice. If I had to choose just one right now - I would take text, over face to face.

 

[Snuggy]

I've had about 10 years of face-to-face therapy, and still - after all that time - I struggled to make eye contact, had increased anxiety, body tightening, restricted breathing, and a racing confused mind. I also had dissociation and long periods of rumination after every appointment.

Typing allows me the time to think, but more importantly - typing from home doesn't remove me from my comfort zone and increase my anxiety. Changing my thought processes through CBT is actually possible in a private safe setting... but remained next to impossible when I tried going out to visit the therapist.

As for the relationship part of it.... This is where I am finding neurofeedback interesting. I still have to leave the house. I still have to go to their office, and I even have to allow them to touch me (install electrodes). But actually talking - it's almost completely in my control! Other than a general greeting, unless I initiate a face-to-face conversation - it doesn't happen. And my brain (through my subconscious mind, not my conscious mind!) is changed for the better.

So my choice would be text via internet for most information exchange, and neurofeedback for the relationship/agoraphobia stuff. And both would be combating my PTSD.