Is Talk Therapy The Answer?

[RuthieJujube]

Hi everyone. I hope you are having a wonderful start to the week!

I've quickly gathered that many PTSD sufferers out there are dissatisfied with their therapist. I am one of them, but I am feeling doubts about what to do, or if I should return at all.

In March, I started taking Paxil and visiting a therapist weekly, following a visit to the psychiatrist who diagnosed me with PTSD. At this time, I was at a low point with my symptoms (my father suddenly passed away in October and I fell into a deep depression, then a very angry depression that brought impulses to self harm.) I have been following the psychiatrist's original orders since March but I can't help feeling that I am spinning my wheels.

My therapist is new to the profession and I just don't think she "gets it." I have been making what I feel is progress (but gosh, does PTSD really make you question what that even means!) but this progress feels like a combination of my own efforts and the medication hiding my symptoms. I have been pushing her for an action plan and she has said this is up to me without providing much detail about where we are going with things. So what does therapy offer me that I cannot do for myself?

My temptation now is to not go back to therapy at all and to continue following my own action plan (eating healthy, exercising, journaling,) but I wonder if this is safe or if anyone has found success on this route.

I am at a point where I seriously doubt what therapy can offer, but on the same note, I have never visited someone who really knew PTSD. I honestly just what to do what is healthy and will help me be well.

My other doubt (and perhaps this is for a separate thread entirely) is how to know I am working on my symptoms effectively in therapy when I am medicated. My worst PTSD symptoms feel hidden by Paxil, so when I discuss sensative topics in therapy, they often feel detached from me. I know they are not provoking the debilitating reactions they were before, so how do I know if I am dealing with them? Is Paxil hiding them away for later, only to knock me out later?

 

[Changing4Best]

My therapist tells me about times in her life when she has faced something similar and what she has done about it that helped. I like it when she does that. I guess you could call that some kind of action plan.

 

[Anarchy]

Hi Ruth,
I've asked a retired psychiatrist the question about going it alone, and their advice was to find a well grounded person you trust to act as a reality anchor.

They don't have to be super intelligent, their job is to spot and alert you to any self perpetuating spirals of distorted thinking.

This place is very good for getting that, if you don't have anyone you trust face to face to do it.

Regarding SSRIs, you are not alone in thinking they just numb you.

I was chatting to another tricpsychalist about that and pointed out that in most trials there is a response to the placebo in the mid to high thirties percent, and the SSRI variously comes within about 3 to 5% of the placebo.

The response was, that the interest taken in the trial participants works as a kind of psychotherapy- Someone actually interested in them and listening to them... Hence massive placebo effect.

If that is the answer, then the drugs companies can't have it both ways, either that benefit works for both the placebo and the SSRI (its the rising tide that has brought the duck to its new elevated position in the world) or it works for neither

Either way, SSRI s don't come out much different to a sugar pill, and a sugar pill doesn't have side effects.

Regarding the psychotherapy effect, the psychiatrist said that if the patients like the therapist, it doesn't matter what treatment mthod the therapist follows, the relationship will do the work...

Three people s opinions. There's no such thing as unbiased information in this universe.

 

[Truthful_Whispers]

Cognitive therapy has very little effect on me. Specialized therapy, such as EMDR, have been moderately effective.

 

[falling_wave]

My T does a mix of approaches. She does a lot of psychodynamic and relational work and throws in cbt here and there as needed. It's just talk therapy but my T knows trauma and has been practicing licensed for 30 years. She knows her stuff and I saw that quickly and it made me trust her along with us just having that natural connection. I've been seeing her for two years and I still struggle at times but have made tremendous progress. Because it's long term my T doesn't really do goals or an action plan but that doesn't mean we don't have them. I think before therapy about everything that I've responded to emotionally in any way that week and write it down. I review the list before I go in so I don't forget. We then explore those things and she brings in links to the past from those things and we process bits and pieces of trauma that way. It helps me understand why I respond to situations now and develop insight so I can work on change. Often seeing things differently changes my responses. She also works a lot on noticing how the two of us interact and she will call me out on stuff I don't even notice. Again it's building that awareness to behaviors and reaction and checking to see what keeps them going. I was on SSRIs for a while and I had the same fear you did. I wanted to see if progress was real so I made a pact with her that she would honestly tell me if she thinks I need to get back on and I would but wean off until then. I did (the weaning off process was tough) and I realized I had made all the progress on my own and I felt better. I just took ativan when I needed it. I do think you have to be 100% comitted to real work to get better including therapy exercise or whatever if you get off. In my opinion medication is only necessary in active therapy if there is a crisis making it hard to do actual work. If you can do the work without meds and are getting somewhere maybe something on an as needed basis? Just my personal take.

 

[Chincho]

Talk therapy has worked for me, although at the beginning it seemed like it didn´t. My therapist has experience in trauma and that probably helps.

I stopped taking Effexor about 2 months ago. When I was on it, I thought I was doing great and had almost beaten PTSD. As soon as I started tapering off I realized the meds were hiding or managing my symptoms. That really made me angry. I'm taking Brintellix now and although it helps, the symptoms are still here.

Hope it helps.

 

[seedling]

I could feel numb in therapy without taking meds. Sometimes it's just hard to feel it anyway.

I never tried SSRI's but came close. My therapist recommended them as a way to get some space from the symptoms so I would have the strength to do the work in therapy. I was afraid of being number than I was already.

 

[greenleaf]

Everyone's chemistry and trauma is different, so there will be lots of different responses here. I have been on Paxil for a long time... when things in life were going ok I could do without it, but if something triggered old stuff (or if my abuser surfaced again in reality, which happened periodically) -- fear, unsafeness -- I would get into a sort of spiraling up pattern of inability to sleep, feeling more and more unsafe, fear of fear... really bad place. That has made me glad that the stuff exists. I also exercise really regularly, which keeps those stress hormones down too.

I think that a combination of dissociated away traumas and many years of therapy where structural dissociation was not part of the extant understanding of childhood trauma, made the SSRI really necessary. I didn't have any effective way to deal with the trauma feelings other than dissociation; they would come and go, and during normal talk therapy (1990s style) they would generally vanish... (into my tense muscles, slowly causing trouble there...)

The SSRI seems to keep the spiral of unsafeness from escalating, for me. I can feel unsafe, try to work on it, am making some progress finally with a trauma therapist, but I can also SLEEP. Yay!!!

 

[qwyoey]

I'm actually extremely please with my therapist, and therapy in general. And I started in April/May. One thing is that I see a prominent psychiatrist and PTSD researcher and we have an excellent, goal driven relationship in therapy.

My therapist is new to the profession and I just don't think she "gets it."

I think that with trauma it really helps to see someone who is dedicated to this and has a lot of experience. The relationship you have with your therapist is important.

but this progress feels like a combination of my own efforts

That's how it should be. A lot depends on the type of therapy you are engaged in, but good therapists should make it clear that it's your effort that is key. They are there to guide you through the process, so in this way it sounds like you are doing a good job!

I am at a point where I seriously doubt what therapy can offer, but on the same note, I have never visited someone who really knew PTSD. I honestly just what to do what is healthy and will help me be well.

Perhaps it's time to get another opinion? See a dedicated trauma specialist to figure out if there is something else you can be doing? There are a ton of people who do it themselves. A trauma doc can make it easier.

 

[void]

the quality level of T.'s is inconsistent.
there are outstanding ones who have mastered their craft and
there are dullards who have an easy job making great money who are so busy that they don't have to be good at therapy because people just keep coming.

these facts are compounded by the reality that the T. that works well with you may be useless for me and vice versa.

Ergo, it is an expensive crap shoot.

BUT when you click with a master it is EPICALLY GREAT!!!!!

 

[Chava]

A lot of good points and questions. I know my chaotic feelings can get masked by meds. I even noticed this with a very small dose of tramadol for chronic pain....feeling more real and connected with a switch from that to a different med.

I think the important thing is finding a therapist who is trained in working with trauma....and not even just a counselor type who has done a little EMDR training. A trauma-specialized therapist is ideal. Then, working with those tools, maybe one could trim back on some of the meds and continue to address symptoms underlying the meds as they feel more safe to do so.

I quit talk therapy because the real trauma stuff makes me quite mute. It also has almost nothing to do with cognitive stuff for me, such as the focus of so much CBT. I'm working with a therapist who uses body/somatic methods of working with trauma (Somatic Experiencing, among other approaches she's trained in). It's been very different for me. We do talk, but it's not the focus. I'm constantly working on keeping safely connected to my body and working out the nervous system regulations stuff. I've actually found it much easier to talk with her about the harder stuff because I feel like there is space for me to do that and not the pressure to sit neatly in a chair and have a sort of mentalized conversation about it. So no, talk therapy was not the answer for me. But I'd say, through sticking with it, the therapy I've been doing has been more helpful than medications. The things I'm doing on my own at home are also important but I feel like I've gotten good support from my therapist in testing out and finding what helps me.

 

[Truthful_Whispers]

Talk therapy has very little effect on me. Also, I get tired of re-hashing my life story over and over to different therapists. I feel specialized or experimental/cutting edge therapies would work best for me, but they aren't really available in my area.