Massive backfire in therapy - don't know what to do

[beaneeboo]

This thread is very interesting and I have a few thoughts to share based on my own personal experiences.

As someone also diagnosed with OSDD, the emailing has been a critically important aspect of my healing journey. Not only to help stabilize my-selves during times of crisis, but to share things with T I was unable to verbalize as well as giving parts the ability to communicate with T (since I have little control over my switching and parts are not always available in session to work through what’s going on for them). T may or may not respond to the emails, it’s always up to her and her discretion.

This is so helpful to hear for me because I get completely where you're coming from. T has (amazingly) now allowed me to email. Will see how it goes. Can I askwhat you do if the content of the emails you sent is something you don't feel ok to address in session (for the reasons mentioned). Do you discuss this with T? Does she ask if you want to go through them? Does that mean parts don't get heard?

We also utilize our journal daily and share writings, art, personal objects, etc. with T so all parts can be heard/seen/acknowledged and have an opportunity to unburden and grow…as well as to strengthen internal communication and collaboration.

I imagine these are all ideas your T brought to therapy? Up till now the thought of doing a journal has worried me because I know I may leave it around and my son may get his hands on it. I'm going to try the Joplin App that @Sideways mentioned to get around that... I'm still wondering how a journal will work out for me as it's not apparent to me who is talking... but maybe this will become more obvious through actually doing the journal...

As far as scheduling, we meet for 1-hour every other week, 2-hours on the alternating weeks, and have group session twice per month. If I am struggling, I can request additional sessions (which T grants if she has them available) and I have a back up T (another therapist in her same office) in case I need support if T is not available (if she’s sick, out of town, or I am in crisis). The 2-hour sessions were absolutely needed for successful EMDR sessions.

She sounds incredibly well experienced your T. I can see how you've received a multi-modal therapy approach...I know how intense and difficult it's been for you but also I can see how far you've come and the progress you've made since the beginning of the year...

T has been flexible with me and all these arrangements have kind of come into place organically. We have discussed boundaries and there are things I don’t do (like calling her on the phone) or only do very minimally (like texting).

Discussing the boundaries is so important. I think my T could possibly do a bit more on this. Though he may have done and I've forgotten. I feel I'm pretty good with boundaries.

T has said a few times (usually when I’m apologizing for emailing her because a lot of shame still lives there for me), that it’s actually been necessary for us to have that mode of communication between sessions because of how much is going on for all the parts.

Good to hear. I find this validating myself.

I suppose if emailing wasn’t an option I could arrange to have 2-3 sessions per week instead, but financially that’s not really an option for me.

I have to pay for my therapy- there isn't anything else on offer unless I apply through the NHS to attend a clinic 3 hours away (or do remote sessions). Neither of which I think is possible. Face to face is so important to me.

I agree with this. It took about 8 months before T started to really consider I may actually have a dissociative disorder and just over a year before she gave me the OSDD diagnosis. My trauma was well hidden from me (and T) until things started to just ooze and/or explode out. It took a long time before my parts were able to front in session.

I think for me, although parts have been present in session before, they've never taken over like they did (ironically) last session. I think this is a long process.

I believe I’ve been able to make significant progress pretty quickly because my parts have been acknowledged and connected with early on in treatment (even just starting with an IFS modality before my DD diagnosis).

Interesting IFS helped given the notion that it has the capability of derailing the system. But I guess your Ts have good trauma awareness.

I disagree with this to a certain extent…yes, we cannot always get validation and sometimes it’s more problematic for us to look for it where it’s not available or if it’s regarding something that should NOT actually be validated…but sometimes it is 100% absolutely necessary for our healing.

Invalidation of my thoughts and feelings has been a massive issue for me my whole life within my family. I shouldn't need others' validation but when I get it helps me heal alot. Like T's Acknowledgment of his part in last weeks session and apologizing.

Kids who have their feelings reflected back to them gain a confirmation of their perspective in the world. If you come from a family where this didn't happen, or you were told you were wrong in your perspective, your feelings, you can't develop that sense of self... self trust... hold true to yourself despite disagreements etc...

I started to believe I may have a DD before T was ready to give me the diagnosis, and sometimes I felt some unspoken resistance from her when I described my experiences (to be fair, some of my parts present as extremely high functioning and neither T nor I were aware that I was a survivor of trafficking/the extents of my traumas yet because I was not privy to those memories held by the other parts)…so T was being cautious because it’s not a label to throw out lightly…But sensing her resistance during this time period pushed me into huge feelings that I was actually insane and made me deny my parts/my experiences/what was really going on inside and caused more trouble for me. I was already struggling with massive feelings of denial and that contributed to it (hell, I still struggle with denial)…but it truly compounded my struggles.

Omg I get this so much @Renly is such a hard place to be in yourself... well done for getting through that awful part of it all...I'm not as far on as you... but I have definitely been affected by T's inability to look at my experience through the DD lens.. and I'll need to address with him - what he believes, how he can help according to what he believes... it's ironic that since learning more about his views, I've had a more natural internal communication with my parts to make sure adult me is present in this... it's almost kind of helped me to believe more in my system than before... which is quite telling for me...

For now I'll have to continue reaching out to other professionals who do know/understand more about it to guide myself... then bring this into therapy... though this will have to be addressed also with T

Denial underlies the nature of dissociative disorders, and until T openly and verbally validated my experiences and the presence of my parts, I struggled immensely to feel comfortable being 100% honest in expressing my experiences…the shame was overwhelming. And I denied my parts what they needed to start to heal. All parts need to be seen, heard, and validated.

I'm beginning to see this. Thank you for writing it so brilliantly. In black and white.

Yes, 100%. A few years in and it’s still immensely destabilizing. I’ve been connecting with 2 new parts across the last month or so (after establishing growing relationships with a handful of parts at this point) and although I know what to expect to some degree now, I’ve still be thrown into crisis. I still struggle with SI, SH, and out of control behaviors of the parts. It’s serious business and no joke.

It really isn't a joke. I know how much you've been through over the last year. You're very brave and incredibly strong to keep going.

This is a really complex question for me. Once I began actively practicing noticing myself and my inner experiences I (very slowly) started seeing what was really happening. I started noticing when I would switch and what those parts felt like in the front. Some parts talk to me verbally and we converse in my head, some parts it is a sense of “knowing”what they are saying (without words)….parts begin to feel other parts sensations/emotions/memories “oozing” onto them. Some parts only live inside (do not front) and the ones I hear inside have different voices. Usually, at the beginning of learning about a part, it’s just a sense of huge “overwhelm” and these scary feelings that I don’t know what’s happening. Then a lot of “automatic behaviors” are parts in action.

Thank you for sharing your experience.

The main thing for me was to notice with curiosity. And sit with the not knowing yet. And then a little at a time my brain opened things up. It’s been chaos, messy, scary… but an ultimately rewarding experience when I started to know who the parts were, why they are here, and when parts started to learn to work together as a team instead of being at war.

I'm really struggling with amnesia. The great thing about amnesia is forgetting all the hard stuff. I think that's one reason I could go back after last week's session. I knew more or less what had happened. But I couldn't access 2 (Sarah's) feelings.

Communication is foundational. And I’ve needed help (from more than just T, but her especially) to sort all this out. I (for the most part on most days) accept my diagnosis…the denial still exists sometimes. But…for the few people that know my diagnosis (my husband, siblings, a couple really close friends), they have said everything about me finally makes sense to them. They have words to explain what they have been seeing for years but didn’t understand. It’s harder for me to be in denial when others around me help me accept reality/my parts/my whole self.

I can see this... that's great you have that feedback and support.. you deserve it.

I haven't told anyone about my diagnosis. I don't know where to begin without people seeing me as crazy...

Ultimately @beaneeboo - things can be sorted out with T, you just have to figure out if you have enough support (for all parts) within the therapeutic framework he can provide.

I think I'm at this stage now... got to figure this out with him.. and be honest about my concerns that he doesn't seem to want to delve deeper into the diagnosis with me himself. Though after last session I think this may have changed.

The only way to figure that out is through communication (and vulnerability…so scary)! So maybe that means you can make it work with him as is. Or maybe it’s T plus additional supports (adding xyz), or maybe that means seeing someone who specializes in dissociative disorders.

yep thinking these are both possible options. But he can really only be my T. Help from the DD clinic would have to be on an adhoc consultation basis only.

Feeling misunderstood and not validated by T feels so yucky, but it absolutely can be worked out and that’s part of the process of therapy.

this is what's happening in real time for me...

And there is no one size fits all. You’ve got to figure out what works for you (all of yous).

Can't tell you how validating and helpful this comment is... thank you.

Wishing you the best as you sort through it all!

Thank you so much @Renly ... your wisdom, experience and compassion have been helpful to a degree you don't even know...


I wish you well too

 

[tofubreadcoriander]

I don't know man. If he's not willing to adapt to DD language to make you feel comfortable, there'll always be this gap between you and him. Your gut is trying to tell you something. Listen to it.

 

[beaneeboo]

I don't know man. If he's not willing to adapt to DD language to make you feel comfortable, there'll always be this gap between you and him. Your gut is trying to tell you something. Listen to it.

I do see where you're coming from. Thing is I don't think it's clear right now where he stands on it and it'sthis which needs clarification. He can see what I'm experiencing (he's acknowledged my parts and is working with this). And so despite not knowing maybe some of the diagnostic lingo he's still working with the issues coming up. But I know that's not necessarily enough. I guess that will become clear. Things like supporting me in journaling, communicating with parts and understanding what comes up would be really helpful. As well as maybe understanding 50 min sessions aren't conducive to working with parts...

That's the convo we next need to have. At some point, if what he offers doesn't work for me and he's s unwilling to learn/ train in DD (which I would understand for reasons people have stated here), I'll have to consider where that leaves me.

But for now he sees me, he's willing to be flexible and is already changing his therapy approach, apologises when he gets it wrong (which isn't often) and he's the only person in the world right now that knows this much about me. And supports all that he knows about. Even if I found a DD specialist it doesn't mean I'd click with them on a personal level - that's something no one can train in.

I think @Renly Is right...if we can find a way forward together with it and try to figure out together, this would be the best outcome. I just need to keep communicating with him about this so we can figure out what is realistic on both sides...

 

[tofubreadcoriander]

I do see where you're coming from. Thing is I don't think it's clear right now where he stands on it and it'sthis which needs clarification. He can see what I'm experiencing (he's acknowledged my parts and is working with this). And so despite not knowing maybe some of the diagnostic lingo he's still working with the issues coming up. But I know that's not necessarily enough. I guess that will become clear. Things like supporting me in journaling, communicating with parts and understanding what comes up would be really helpful. As well as maybe understanding 50 min sessions aren't conducive to working with parts...

That's the convo we next need to have. At some point, if what he offers doesn't work for me and he's s unwilling to learn/ train in DD (which I would understand for reasons people have stated here), I'll have to consider where that leaves me.

But for now he sees me, he's willing to be flexible and is already changing his therapy approach, apologises when he gets it wrong (which isn't often) and he's the only person in the world right now that knows this much about me. And supports all that he knows about. Even if I found a DD specialist it doesn't mean I'd click with them on a personal level - that's something no one can train in.

I think @Renly Is right...if we can find a way forward together with it and try to figure out together, this would be the best outcome. I just need to keep communicating with him about this so we can figure out what is realistic on both sides...

That makes sense to me! Fingers crossed it all goes well. Rooting for you.

 

[beaneeboo]

That makes sense to me! Fingers crossed it all goes well. Rooting for you.

Thank you @tofubreadcoriander

 

[DilemmaGal]

Went to T tonight. During the week, I sent him an email (which I'm not supposed to do) with info in it from another professional who writes/ does educational videos on dissociative disorders. (This person has a clinic which specialises in dissociative disorders and is well regarded). I told him about what I have found interesting about this information and that I think, as the videos suggest, that I should start trying to communicate with my parts.

I also wrote how I'm feeling stuck in therapy because so much happens during the week which i can't bring to the therapy room. Because I can't remember it, or, if I've made a log of different feelings / thoughts / states I experience, I then can't relate to what I've written and it feels too big to discuss in a 50 min session. So then I don't bring it. And the gap between therapy and what happens between sessions gets wider. I need more structure and options to manage this and him to help with this - didn't say that last bit. I hoped the videos would give us suggestions. Including working on my increasingly failing memory.

When I went in the room he was welcoming and asked me to tell him about it all which i felt relieved about because I thought I'd done something wrong by emailing. But he then quickly started questioning the material that I'd brought, in an consistent negative way. Didn't agree with alot of it. I felt he was gently challenging me on the other guy's view points. T's body language and eyes told me he wasn't interested in really hearing why I felt these videos struck a cord. He was waiting to prove they weren't as useful as I thought.

It then got more heated and he started saying he felt to blame (I think because I'd said I felt stuck in therapy?) and that we'd spent 9 months building trust and that I was now bringing this to session, and he didn't know what to do because he's not trained in those therapy approaches... and doesn't have access to this material (which is incorrect - all the videos are free on line)... I think he felt threatened that I was saying someone else knows how to do therapy and you don't. But that's not at all what I was saying.

At this point I dissociated really badly. For the whole session. A protector and young part came out (first time that's happened) and I couldn't speak hardly at all, move or say much during the whole session. I lost time. Couldn't make sense of my body.

I felt he was telling me that the trust was broken because of what I'd brought. I felt threatened and that he was angry and felt I'd done something really wrong. He told me I hadn't and he was my ally and that all my reactions were hard for me but really useful to share more with him so he can understand more about what happens and what triggers me/ how I react....I simultaneously felt gas lit because he said those things to me and pointed a finger which triggered that reaction, then the session was about me and my reaction - not how he had triggered it. He did say he realised he needs to be more careful and handle these things with more care. I don't think he said sorry but I felt he should have done.

We went over the session by 20 minutes because he made sure I was back in the room... and feeling OK enough to leave...

I don't know what to think now. I'm very confused. This is someone I've spent 10 months building a relationship with who I've told the most amount I have to anyone. And in 1 session I now don't know who he is to me, or whether I can trust him.

Do I go back? Or do I walk away from what feels like it was a breach of power and trust? Very confused and upset right now.

First off I am glad for you articulating into words your conception of the session as you did. I would highly recommend at least considering a new therapist. I recommend the website psychology today where you can filter therapist by type of therapy, gender, insurance, specialties they treat, religion, race and a lot of other factors. It took me a long time to find my DBT therapist and have now been seeing an EMDT therapist to address my trauma. I can only imagine what it is like for you to lose trust in someone you very vulnerable with. I can’t tell you what to do but I am willing to guide you in whatever direction you choose to DM me

 

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[Weemie]

Honestly, in my opinion the therapist did a bad job.

I agree with Tofu. It is fine that a therapist should specialize, but him telling you that you broke trust by bringing up a different modality is f*cking asinine. Is he that ego-fragile that he can't handle a patient with a complicated trauma history doing a YouTube search? Come on.

Now I can't say if this really did or didn't happen. If you're dysregulated and dealing with cognitive distortions it's possible he didn't actually say anything of the sort. But if he did, that's wildly unprofessional and borderline incompetent. I have a pretty major trauma history and I also have a personality disorder and a history of violent offenses. I need very specific therapy that most people here are not qualified to deliver.

With my most recent (and frankly most effective) therapist, a former practicing forensic psychologist, I have actually provided her the proprietary tools necessary to perform the therapy we are currently doing. I educated her on the modality and introduced a lot of how we actually conduct each session.

It is not something she was trained on because it's a very uncommon form of therapy used in specific circumstances, but she agreed to work with me on it because it fits with her education in violent offending and it uses tools that she is familiar with. We honestly don't have much of a choice. I can get shitty, half-effective therapy or no therapy. And no therapy? Is not an option for me.

There is absolutely a time and a place for patients to bring their own education to the table and therapy should be one of those places. This is a collaboration and you should feel comfortable to work with a therapist and not fight their ego every time you have a slightly different suggestion. If it were me, he would need to do a lot of work to repair the damage his countertransference here may have caused.

I certainly don't want to project my intolerance for bad therapy onto you (I've had plenty of therapists lash out when I explain that they don't possess the training necessary to work with me - which is absolutely a sign that they don't have the training, since they can't even keep emotional composure when slightly challenged - and I've walked out of the room for much less than this.)

As you've made it apparent that he is effective in other ways and that you intend to keep seeing him, but I do encourage you to lay the responsibility where it belongs. You did nothing wrong and he had a very evident ego meltdown because he didn't understand something and wasn't willing to learn about it in the moment.

 

[beaneeboo]

Thanks @Weemie and @DilemmaGal for you thoughts and in put...

I agree with Tofu. It is fine that a therapist should specialize, but him telling you that you broke trust by bringing up a different modality is f*cking asinine. Is he that ego-fragile that he can't handle a patient with a complicated trauma history doing a YouTube search? Come on.

So this is the main part of my original posts about what happened that session I perceived incorrectly. (I did write a post about my follow up session with T - about 1 page back! - but this is such a long thread it's hard to navigate to find all the info).

Essentially, T let me know my perception of that session was mostly correct. But that he had never meant to imply that I had broken trust but bringing in that material. Rather that he was berating HIMSELF for not having been able to build enough trust in 10 months of therapy with me that I would need to go away and bring back research on a different approach. So I did perceive the issue incorrectly and that was down to cognitive dissonance. Because I thought he was gas lighting me, getting angry at me etc (all my past) when actually he wasn't. T did apologise pretty profusely for his mistakes and did acknowledge he'd let his ego get in the way and that now that's been highlighted he knows what he has to work on to make sure it won't happen again. So that was good.

With my most recent (and frankly most effective) therapist, a former practicing forensic psychologist, I have actually provided her the proprietary tools necessary to perform the therapy we are currently doing. I educated her on the modality and introduced a lot of how we actually conduct each session.

This is interesting for me to hear you've done this. And encouraging to know a professional is open to this. Happy that's worked out for you. It took me a long time to build the courage to introduce what I found to him. I guess I was scared (ironically) of his reaction - that he'd think I don't rate him as a therapist.

We repaired alot of the rupture the session after. However the one thing we didn't cover (due to lack of time) was his exact opinions on dissociative disorders and approaches to work on them. And here lays alot of my problems.

He's intimated that there isn't good evidence backing DDs - which is worrying for me ...but its also confusing because this is at odds with some of his actual approach in sessions e.g talking about parts / handling a part coming out in session etc. I know from other comments though that he just doesn't know much about DDs. For example, i pointed out that i felt it necessary to do more research on them because there's a difference between experiencing episodes of dissociation (e.g depersonalisation) and experiencing dissociation in a way which effects your identity (i.e having a DD). T's comment in relation to that was 'Why make the distinction?'. Well because THEY ARE 2 COMPLETELY DIFFERENT THINGS!

This worries me because it shows ignorance about what having a DD actually means. About the effects. About the experience of someone who has a DD. So my logic was therefore, 'How are you going to provide an appropriate therapy approach if you don't understand what my experience is?'

It also baffled me how he only offers 50 mins for therapy sessions. Doing parts work with someone who may undergo full switches can be really time consuming. 50 mins is not enough imo for any trauma work. 60 mins min and really 75 would be ideal. More time allows dissociation to happen in session and to come back to the room in good time. I was also surprised that he wouldn't allow me to email between sessions. I don't think there is a guideline about emailing between sessions for DDs - certainly in the UK- but it seems pretty obvious to me that dealing with parts between session is a really tricky juggling act and being able to email is a key tool to ensuring communication from all parts. However T HAS listened to this and has now allowed me to email him. So I'll see how that goes. Guess he's learning also.

There is absolutely a time and a place for patients to bring their own education to the table and therapy should be one of those places. This is a collaboration and you should feel comfortable to work with a therapist and not fight their ego every time you have a slightly different suggestion.

I agree with this. And I think this is where the work is for me now. I have to keep using my voice because I still have concerns about his level of knowledge on DDs and I don't know whether he's willing to find out more about them and therapy approaches for them. He may or may not be willing to broaden his education. And if he's not that's fine and maybe it's the end of the line.

But I have very little choice for therapists who specialise in DDs. There may be funding for me to receive long term therapy with a specialist but this would be online because geographically they live so far. This really isn't conducive to trauma therapy either. I feel I need a human in the room when opening up about my biggest and darkest fears/experiences. My current T - despite his mistakes that session - has shown great compassion and support. More than any other T I've had. I know he genuinely cares because I can feel it. And the fact I'm going back to him after that awful session says alot. My main issue with the situation is that he's a bit ignorant to some things and hasn't looked outside of his own knowledge to see how we could guide therapy together. If I know he's open to learning more ìt would be really helpful.

I certainly don't want to project my intolerance for bad therapy onto you (I've had plenty of therapists lash out when I explain that they don't possess the training necessary to work with me - which is absolutely a sign that they don't have the training, since they can't even keep emotional composure when slightly challenged - and I've walked out of the room for much less than this.)

Sorry you've had these experiences. Therapy ruptures are so difficult and painful. I think you're incredible @Weemie to keep forging on despite all this... that takes great strength. You're very strong. And that's inspiring given you've been through so much.

Don't worry - your opinion is your opinion. I don't think you're forcing any projections on me or anything.

As you've made it apparent that he is effective in other ways and that you intend to keep seeing him, but I do encourage you to lay the responsibility where it belongs. You did nothing wrong and he had a very evident ego meltdown because he didn't understand something and wasn't willing to learn about it in the moment.

Thank you. I agree and it's work in progress.

 

[Weemie]

he was berating HIMSELF for not having been able to build enough trust in 10 months of therapy with me that I would need to go away and bring back research on a different approach.

This is something that would definitely continue to concern me. If he feels you doing research is somehow undermining his capacity as a therapist, I would say it actually does undermine his capacity as a therapist. It gives the impression that you're not allowed to go and do research on your own condition, or else you "don't trust him." That's not even going into the fact that he quite frankly doesn't even seem to believe your condition exists, which is a pretty untrustworthy quality in the clinician supposedly attempting to treat it.

He definitely has a long way to go. I'd encourage him to examine why he is uncomfortable with patients educating themselves on their disorders, and why he feels like that has anything to do with the trust a patient has in him (or why he believes that response would engender trust in the first place? Truly baffling.) A big part of why I trust in my therapist's competence is that she has never once disregarded my input, and treats me like the well-educated person that I am.

You should be able to share information about your disorder without him immediately latching onto guilt-trippy and emotionally manipulative language about trust.

To give you some insight into a more healthy approach to this kind of thing, I was recently diagnosed with SZPD because of research and data that I brought to the room. The first thing my therapist did was go to the DSM and walk through it with me, and then she broke down her opinion based on our two years of working together - that I'd definitely hit onto something legitimate. There was never an option for her to refer me to an SZPD specialist as there is very much a void where treatment should be, when it comes to this disorder.

The general consensus from therapists is that SZPD patients almost never seek out treatment (as that's quite literally one of the defining features of the disorder), so most of them don't learn a thing about it and never encounter a patient that qualifies for it. So we had to muddle through on our own! Which has been the running theme for my entire therapeutic journey, since I can't just be run-of-the-mill in any aspect of my life, evidently.

We went through some diagnostic assessments in our following sessions and she scored them in front of me, coming to the conclusion that my suspicion was correct, and thus I was diagnosed formally. I've since shared a lot of the research I've been able to cobble together as SZPD is one of the most under-researched disorders in the DSM, so what information is available is quite scattered and difficult to find. Rather than berate me for "failing to trust her," she works with me using the information I provide, and that actually results in the opposite: it increases my trust in her.

If your therapist really is reaching the limit of his capability to treat you, then it is incumbent upon him to connect you with a clinician that is appropriately trained to do so. That is one of the foundational standards of professional conduct for therapists, but instead he has taken your desire for correct treatment personally (by blaming you for claiming he is essentially not treating you correctly, which he isn't, while simultaneously implying that your disorder may not even be legitimate)

- the whole thing is just baffling to me. I don't have any real advice as I do absolutely understand your limitations in seeking additional assistance. It's certainly a regrettable situation, but there is nothing lamentable about your actions. It is completely ordinary, and normal, for a patient to do research into their disease and to study the different treatments to deduce what will work best for them.

This is just basic, normal stuff.

 

[Sideways]

If he feels you doing research is somehow undermining his capacity as a therapist, I would say it actually does undermine his capacity as a therapist.

The impression I have from what @beaneeboo is saying is that he was berating himself over the state of trust in the relationship. That’s a reflection of how much trust he felt he should have earned by now, rather an issue with his patient doing their own research.

 

[Weemie]

That’s a reflection of how much trust he felt he should have earned by now

It may very well be more relative to this, but I still don't think that's much better, since at no point was he ever entitled to trust in the first place. It is not fair to put that on the client. If you want to be trusted, you need to be trustworthy, and this response was not trustworthy.