Making The Most Of A Crap Therapist

[Abstract]

I'm probably not the best person to reply to you. I have come to the conclusion that is way better for me to have no therapy than bad (FOR ME) therapy. Partly because of the reason @coco9 mentioned. I've also more and more come to believe that a lot of what is good is not just about the t's skill but about an approach, diagnoses and personality match. Personally, generally. I think one of the things that spells the most doom for us with PTSD is "the past is the past" camp. Lots of them in general therapy and honestly this can work really well for those who are not traumatised.

I would start with the whole I'm diagnosed with PTSD - what are your thoughts on whether to talk about the past or not? And their thoughts on ptsd. Then you can clearly state that it is a deal breaker for you if they come back with a get over it track.

Have you looked at what approach and interests the different t's have? Im assuming you still get to choose? Do you have a list of screening questions to ask them before deciding? Good luck!

 

[Dana1010]

Im assuming you still get to choose?

I'm told that I won't get to choose my therapist, so I'll have to stress what my needs are at the intake appointment.

 

[Friday]

IMO better no therapy than bad therapy. There are acres and acres of things that I can research and work on, on my own, in the meanwhile. :D

***

The last time I went on the therapy mission it took me about 6mo to whittle down a list of a few thousand therapists who listed PTSD in their skill set in my city/state, down to about 200 actual trauma therapists, down to a couple dozen who might work / set up interview appointments with. (Fortunately, of that 200, many were very up front about what traumas they treated and/or modalities they used; so I didn't have to call all of them, but I had to call a whole helluva lot of them to get to the 20 some odd finalists. :wtf: ). Of that 20 only 2 or 3 were maybes, & 1 was really good. The rest? Were no f*cking way.

I've been in ADHD-therapy-land for 25 years. ADHD therapists are waaaaaay easier to find, and find really good ones. That said, it took several years of moving every 6-24 months, and a lot of bad therapists, to work out both how to find good ones & how worse than pointless (aka straight up harmful) bad ones are. And that's with a disorder that is mostly good stuff.

PTSD? Is mostly bad stuff. The stakes are much much higher.

There is no way in hell I would voluntarily deal with a bad therapist. Period.

...

While I deeply appreciate wanting to make the best of a bad situation? Where my positive outlook goes to in dealing with therapists who suck? The ways and means that I can work on things, on my own, until I can find someone who is damn good at what they do.

 

[Abstract]

@Dana1010 if I was you then I would have a list of things you need and cant have and i would word it as being about you rather than generalising too much. Unless the evaluator starts speaking rubbish about ptsd.

For example: I need someone who understands that PTSD means the past is present and cant jut be dismissed. I need someone who therefore isn't primarily invested in dismissing what happened to me. etc or whatever you decide is most important. Good luck.

 

[Dana1010]

There are acres and acres of things that I can research and work on, on my own, in the meanwhile.

So what do you do when you have a flashback that shuts down your whole body/brain except for a voice in your head screaming, "I need to talk about this! I need to talk about this! I need to talk about this!?" What can you do about that except...talk about it?

of that 200, many were very up front about what traumas they treated and/or modalities they used; so I didn't have to call all of them, but I had to call a whole helluva lot of them to get to the 20 some odd finalists. :wtf: ). Of that 20 only 2 or 3 were maybes, & 1 was really good. The rest? Were no f*cking way.

I could see myself being this choosy if paying wasn't an issue, but most people are limited by funds or insurance type.

There is no way in hell I would voluntarily deal with a bad therapist. Period.

I get this, but things are getting desperate. All I really want is someone to shut up and listen, don't try to change the subject, and maybe ask an apposite question once in a while. I feel like even an idiot should be able to follow those directions.

 

[Friday]

So what do you do when you have a flashback that shuts down your whole body/brain except for a voice in your head screaming, "I need to talk about this! I need to talk about this! I need to talk about this!?" What can you do about that except...talk about it?

That's not my reaction to flashbacks, so I can't really speak to it, sorry.

I could see myself being this choosy if paying wasn't an issue, but most people are limited by funds or insurance type.

Most of the past few years I've spent broke &/or homeless. Which has been something of a good thing in searching, it meant I didn't have to limit my search by who I could afford to pay. I couldn't afford to pay anyone, I could just as easily look at everyone. Find the right person, then include whatever their pay scale was in my baseline of setting my life up.

I get this, but things are getting desperate. All I really want is someone to shut up and listen, don't try to change the subject, and maybe ask an apposite question once in a while. I feel like even an idiot should be able to follow those directions.

That's not what I want out of therapy; I want solutions / someone who knows more than I do working with me towards them.

If what you want is a confidant? It doesn't really matter what they say/do, so long as you can talk about the stuff you need/want to? Then, yes, I'd have to agree... They don't actually need to be skilled at their job, per se, just skilled at listening.

 

[Dana1010]

That's not what I want out of therapy; I want solutions / someone who knows more than I do working with me towards them.

Of course this would be ideal for me as well. It's just incredibly hard to find someone that competent even when you do have wide open options. When you're under-insured? It's a pipe dream.

If what you want is a confidant? It doesn't really matter what they say/do, so long as you can talk about the stuff you need/want to? Then, yes, I'd have to agree... They don't actually need to be skilled at their job, per se, just skilled at listening.

The thing is I've found that the best therapist I've had was the most like a friend who simply listened and expressed genuine interest. It's the ones who think they need to take what you tell them and serve it back to you in some manner that drive me nuts. I think what I have to do this time is keep stressing that that isn't helpful to me.

Also what sort of "solutions" have therapists provided you with besides allowing you to process, i.e. listening?

 

[joeylittle]

The kind of solutions I've gotten in-session have to do with detailed CBT/DBT work. It's the sort of thing where you do most of it on your own, but it's incredibly helpful to have someone there to push you harder in it.

Structure for developing a doable meditation practice (from someone super-into mindfulness), breathing techniques and how/when to apply them (also mindfulness)....kind of all the cognitive and physiological stuff that goes into managing PTSD day-to-day.

Lots of therapists have skill specializations.

 

[shimmerz]

The thing is I've found that the best therapist I've had was the most like a friend who simply listened and expressed genuine interest.

@dana1010, just a thought on this.

Are you wanting the therapist to listen to 'what happened'? What is it specifically that you want them to listen to?

I had a couple of therapists, back when I was in the 'tell the story of my trauma' mode who absolutely would NOT let me continue with retelling of them. I was pissed at the time, but in retrospect, it was actually a good thing. The more times you tell it, the more ingrained it gets.

No therapist is doing you any good if they are allowing you to continually get into the trauma without helping you to reframe it.

I am sorry if I am not understanding correctly what you are saying with this.... but please be careful not to fall into the re-enactment hole. A good therapists job is to hold their hand out to you so you can climb your way out.

 

[theshadowoftheliving]

To echo what @shimmerz says - therapists are ethically required to not cause harm. Current ideology about PTSD stipulates that phase one of treatment is stabilization. Trauma processing comes after that. If they let you process, ie talk about the trauma, without doing phase one work, they're setting you up for harm.

 

[Ronin]

I'd reevaluate how helpless / desperate you feel, honestly.

Money is secondary. I know, it probably doesn't seem that way, though is.

That drive beyond searching for a therapist, better bad than none, seems to me to be stemming from something else, and that something is better reevaluated before committing yourself to another relationship, one with so huge power difference as a therapist and their client are.

 

[Dana1010]

I had a couple of therapists, back when I was in the 'tell the story of my trauma' mode who absolutely would NOT let me continue with retelling of them. I was pissed at the time, but in retrospect, it was actually a good thing. The more times you tell it, the more ingrained it gets.

Interesting. Well, my experience has been that allowing me to retell the trauma is the only really helpful thing I've gotten from therapy. It doesn't seem to become more ingrained for me. It feels like an expulsion and a cleansing. I've never had a therapy session where I was allowed to retell where I wound up feeling worse for it -- it's always better for me. Maybe different people react differently to retelling, and it actually is harmful to some. I don't know.

I have no friends or family to talk to, so maybe that is why, for me, being able to simply talk about it in therapy is important.

and that something is better reevaluated before committing yourself to another relationship, one with so huge power difference as a therapist and their client are.

Well, this post is about changing that power dynamic so that I'm the one driving therapy and they can't screw me.