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

[Girl3]

Some of the things I learned both from reading and from dialogues with my psychiatrist is that because my abuse started when I was very small, I am mostly mute when I try to discuss my traumas. As I grew and more traumas happened, I was muted by society, authority, family - you must appear and act a certain way or you must shut up.
My psychiatrist works with me via email, phone, and periodic face to face sessions. I express myself most cogently when writing because I have time to think/reflect on what I am saying. By improving my precision, Dr. N can be more focused when we talk. Over the phone, I can be as ugly, weepy, intense, and angry as I want (girl number two, the angry teen) - because he can't see me. I cannot be seen unless I appear perfect and in control - residue of my upbringing and basis of sucess of girl number three. Face to face - I often dissolve into girl number one, the 6 year old who is very sad but very trusting. So we work in several modalities to get the most out of our work.
Not having to be face to face all the time definitely has helped me - allowing me to say things I couldn't in a face to face setting. But there are times when I like to see my psychiatrist - so that I know he's real.

 

[Girl3]

People must "own" their healing whether it be high blood pressure, diabetes, PTSD, or total knee replacement - no one else can magically make you better. However - now that we know the limbic system is structurally changed by chronic stress/trauma - current experiments of remodelling the hippocampus/amygdala/cortex/habenula interaction will determine in the future exactly how to treat. We do know for instance that cognitive therapies can achieve some limbic system changes but it takes a longer time and it must be done precisely rather than just "let's talk" about what is bothering you. Some of the experimental studies in which I have participated are looking at using known drugs or experimental drugs to speed up the process of fear extinction, dampening anxiety response, etc. A study I am to begin later in the year combines yoga with cognitive therapy and uses no meds - based on experimental data that suggests it is a very useful adjunct to medical therapy.

On the other hand, comorbid (and I hate the term) personality disorders with PTSD typically don't respond to 'pure' PTSD treatments which make the patients more difficult to treat because of the underlying schemas. Maladaptive schemas arise because of dysfunctional family dynamics and teach a person to experience/react in a dysfunctional way that gets perpetuated over a lifetime - and that is where confronting people with their maladaptive schemas gets hairy. It redefines the way you have always experienced the world - it's very unsettling. That is where alot of people drop out of therapy or fail to make progress. I know last year when I finally got into appropriate treatment, having to give up my 50 years of seeing the world a certain way made me feel like a ghost. Suddenly, I didn't know who I was. Or who I might become. But I love the idea now that I don't have a personality disorder: I have a warped way of dealing with everything because I grew up in a very warped household. So my job isn't to change my personality, it is to change my way of perceiving/reacting.

 

[who am i kim]

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

I believe that we need a number of different methods combined. What these are i do not know?? Are there any guidelines for thearpists to follow for people with severe and complex ptsd?

I am at a stage where i am getting nowhere with thearpy so what hope is there for me. I need help but no one understands me enough to be able to help me, it is like being put into the too hard basket. It like reliving the past again. What am i doing wrong here. I want out of this darkness called depression.

People with CPTSD need a hell of a lot of help due to the complexities of there PTSD. I am sorry Anthony but i do not believe that you can cure a person in 6-12 months, pure straight forward PTSD maybe but not the other types.

I like what girl 3 said and also agree with Jacquie views too.

<Heading edited as there is no need for it to be so enlarged. Amethist>

 

[cat]

From my experience I would say yes it is.

When i first spoke to my psychologist she gave me a time scale of around 6 mths of therapy, but then went on to look into my childhood & diagnosed me with cptsd, which as she told me takes longer to work through & understand, small steps are needed to create changes.

I finished therapy in July after 2 1/2 yrs, the last year i had appointments as & when i felt i needed them, i didnt want to finish until I felt human & stable again. I'm now in recovery -I can't say i'm healed yet as anger still raises its head from time to time, but life is a whole lot easier than it was 3yrs ago. At long last I can say 'I like who I am now' therapy has taught me to forgive, understand & move on.

And so I wanted to say, there is hope for those of you who feel you are beyond help, as Anthony says we can either fight our way out or roll over & go into despair, neither option is easy, but hey, who ever said life was going to be easy!

Keep up your strength, have faith in yourself & challenge every single negative thought you have, eventually they will give up the fight!

 

[Mercy]

Ultimately, it is each person's choice or best guess at which kind of therapy is good for them. I should think six months of face to face would get the trust set up and the history collected. At that point, you will be in a much better position to make an informed choice. What is missing from nonface-to-face therapy is the significance of the presence of the 'compassionate witness'. I believe that we can learn from our reactions to things and symptoms by being with a real person.

 

[Girl3]

Everyone moves at a different pace.
Trust is part of the face-to-face.
There is no benefit without the trust.
Trust is the need, the mend, the must.
bless you

 

[Girl3]

If the T were turned around it might help.
This is actually a totally OK request BTW.

 

[PhilipH]

I am only beginning my training as a Counselling Psychologist, but I do have experience now as both a practicioner and a client. I personally prefer the face-to-face approach both as a therapist and as a client, however the research does show that computer based CBT, and therapy coducted via Skype-like technologies, can be just as effective as face-to-face therapy. It is a fantastic resource to have available for those who are unable to leave their homes or travel the sometimes very long distances to receive top quality treatment.

 

[MyStarryNight]

I've only been in face to face therapy for about two months but it has already really helped me. Then again I have attachment problems on top of my PTSD so that may be why. For me learning to trust someone who is real and physically present is a very big deal. Also, I dissociate a lot, even in therapy, and my therapist catches it and helps me learn to ground myself. I'm not sure this could be achieved outside of a face to face encounter. However, I can see the many benefits of being able to reread what is being said for both the client and the therapist.

 

[Meadowsweet]

From my personal point of view, I have a lot of concerns about face less communication. To be honest the very suggestion of text therapy raises my anxiety considerably because my trauma is connected with an internet site that encouraged self-help, but had it's own self styled therapist (not trained or professional) who incorporated sex into text therapy. He was not involved directly in any abuse, but his style of 'help' and the way he handled it when I rejected it, was certainly detrimental to my recovery. It concerns me greatly, that the manager of that forum runs a project for vulnerable young women and is pro text talk as a means of helping those girls open up and I don't know if she even knows what that man was doing when he 'helped' people. It's an area with too many questions and unresolved fears for me.

But, trying to be objective about it. The pro's I can see are:

a) It can be easier to write about an experience than to verbalise it.
b) When I speak with high anxiety levels, I regurgitate racing thoughts and images, that make little sense. Through journaling (but not live text chat) I can go back to it when I'm calmer, and sort out the significant points.
c) There is a feeling of anonymity which might help to tell things that feel very personal.
d) I am in safe, familiar surroundings and I don't have to make my way home afterwards (something that concerns me about going to a therapist)
e) If I'm typing something difficult, I often have to leave the room just to get away from it for a minute, before going back. This is something I can do at home.

And the cons:

a) A real voice can snap me out of a dissociative state. Also, if I'm going into a trance like state, I get scared I won't come out of it. So I would feel safer having somebody there in person.
b) When typing text on a screen, it's too easy for focus and concentration to drift. This applies to the therapist too.
c) Tone of voice and physical body language is a huge part of communication. When something feels huge emotionally, my words tend to vastly under-exaggerate the impact it has on me. But I don't think I could hide the physical signs.
d) Without being able to see the effect the conversation is having on the other person, there is too much scope for misunderstanding and for missing signals that would help the therapist to monitor the pace of therapy.
e) Without tone of voice, it is much easier for the mind to fill in the gaps. When fear is already a big factor, the simplest remark can take on a great deal more imagined meaning.
f) For the same reason, there is greater risk online of developing fantasised closeness.
g) It avoids bringing the traumatic memory into a real face to face social situation. I keep my life in seperate parts, and it is a constant struggle. I think bringing those realities together will be difficult, but will help me accept the reality of the trauma and the present.

In some cases, I think being given the opportunity to talk is a priority, and if a person can only do that in text, then it is a great benefit. But, I think there are many dangers with text therapy too. Perhaps ideally, therapy should combine face to face and written communication.

 

[olaja]

I just wanted to report that I have a combination of face-to-face and phone therapy sessions. Face-to-face is important so I can experience being in a truly safe environment with another human being. Phone sessions sometimes allow me to access stuff that would be too close for comfort up in a face-to-face session. Plus, if it is extra tough stuff, I have the benefit of being at home, surrounded by security animals (real one and also stuffed plushies :)), as well as not having to drive while regulating after a tough session.

 

[VDWngr1355]

Olaja-- do you do the phone sessions with the same T?

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