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Questions about my therapist who sees no pathology in me & tells me i’m doing great

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TTC18

MyPTSD Pro
My therapist is super nice - but no matter what I tell her, she just supports me and reassures me and tells me I'm doing great. She says she sees no pathology in me, and I may have generalized anxiety - and only said that because I asked her directly.
I want to know what I need to be doing to be able to function better - she says meditate and breathe. Yes, breathing exercises help, and yes meditation does help me get to sleep (but not stay asleep) - but if I'm constantly screaming inside, living in fear (20+ years of being stalked) and using all my strength to maintain a calm and reasonable exterior... Only able to work a few hours a week, etc because I need so much energy to drown out the screaming/fear - and working doesn't drown it out, so I can't work much - I wonder if maybe this is more normal than I think it is, and I'm just expecting someone to tell me, 'Yes, you're badly broken and need a lot of help' - and then to tell me how to fix it, but that's never actually going to happen.
 
I don’t oftrn jump on the “need a new therapist” bandwagon but in this case I’d suggest you find someone else - do look for someone with experience and training in working with trauma (depending on where you are there may not be a “trauma therapist” specialty as such).
 
Craziness is you think something is not working for you and the therapist has the audacity to say ooh no you are fine (that just pisses me off but I need to get hold of myself here). Does this remind you of anything in your past or anyone?
I think you know you better than anyone and if you think you need help with something, you should ask and get it. This therapist is not giving you the help YOU WANT and how you want it so that itself is an issue but why and what about her side?

My take of why this therapist is like this is this: (too many this...)
My personal reading and understanding of your post sprinkled with my own past experience which can be similar or not.

  • She truly thinks you are not ready to face full therapy yet; hence the support phase. You need a lot of support because you are like an open wound and if she goes too fast, she may lose you to full psychosis and disintegration. and you do not see this or you are eager and keen to get going but your psyche is not ready (especially that you mentioned fear being your core issue here).
  • She is still assessing you fully to see how she may help you fully so the fact she says no pathology means that she is not sure where you are aside from this repeated incident. Same as the above reason.
  • Even though you seem to want the uncovering and therapy go, your transference says otherwise (you show you are still under seige)
  • She is not experienced in trauma and figuring herself out, giving herself time to learn and be confident to tackle your case.
  • It is also fair that you may not have pathology but you may have an intense experience that unravel you and that itself is not a pathology. If a kid is bullied is the bullied kid pathologized? NO! so maybe this about semantics.
  • Another thing that jumps at me is some therapists truly infantalize (intentionally or not) clients and maybe she thinks you cannot handle therapy or direct or indirect approach therapeutically.
About you it is possible you do not know what you do not know (about your reaction to your trauma) and maybe you created such a wall that is so impenetrable that no one can get through without a lot of support and that is what she is doing.
If your life is getting better since you met her (I am saying her cause it is easier), and your body is relaxing from all these breathing, and you are generally feeling better, then what exactly do you want more?
Fear/Abuse core issues are so freaking scary that any good therapist should make you laugh and relax before they attempt to risk you go into psychosis by remembering your story.

So maybe see another therapist to get assessment and second opinion and take that to this therapist to see if this changes the conversation but I think supportive and liking the therapist are prerequisite to a deep therapy work especially for someone like you who had such atrocity against in the past.

Please do not underestimate how frightened you must have been and still is inside.

Good luck in recovery.
 
I think a diagnosis is a big thing to not agree with your therapist about. Have you ever gotten a formal psychiatric evaluation? Even if you do not want to try medication, it can be very helpful to get their perspective about what your diagnosis may be.

I took a peak at your introduction post to get a bit more background, and I saw that you are seeing a therapist online. One concern is that your therapist might not be licensed to do therapy at all or in the state that you live in. If this is the case, she would not be able to legally diagnose you. I'm not against online therapy, but it is concerning to me that your assessment of your condition is so different from what your therapist is seeing.
 
Thank you, everyone for your responses, I really appreciate the time you've taken to give your perspective and thoughts.

@Nessa7, I brought it up directly - which was very difficult for me, since I am absolutely allergic to confrontation of any kind. She is licensed in my state and seems to just want to make sure I feel supported but not too freaked out by what's going on. She's emphasizing the positive to offset my focus on the negative, is how I interpret it.

When I asked directly, she said I do fit the criteria of PTSD. I don't know whether there's a thing about online diagnosis, she does seem really reluctant to come to any concrete conclusions - possibly because it is online, and she's just working off of e-communication. I've never been formally psychiatrically evaluated, but am going to a dr checkup in the next few weeks, and am planning to ask to be referred for mental health services.

@grit Thanks for all of that - yes, I do have people in my life now who downplay my concerns, but mostly because they're optimists and have never experienced trauma. Yes, I can get to sleep now, and am using breathing to try and cope, but holy cow I'm in rough shape, and really need more tools than breathing... And although I get to sleep right away, I'm awake again an hour later and pretty much all night long. I promise I don't underestimate the fear, lol - my goal is to try not to feel so stinking afraid all the time, without losing focus on the fact that I do need to be careful given the fact that I live under threat. Being aware and watchful without being paranoid and too scared to sleep, that's the goal.

I have a tendency to downplay anything that's wrong. I grew up in a very abusive situation, and I dealt with it by cracking jokes about it. "Oh my mom is so crazy - she threw a clipboard at me last night, and it stuck in my arm, and the metal part went in so deep that it hung there for a while before falling! Isn't that hilarious!!?" And I'd show the latest wound on my arm, (My right arm is scarred because I always put it up to protect my face/head. I only actually have one scar on my face, from a time when I wasn't paying attention) and make sure everyone knew I was laughing about it, so no one would worry about me or feel sorry for me.

Because I have never been able to lie - if someone asked me what happened, I had to tell the truth, but I told it in a way that took the pressure off of everyone. If I had cried and made a big deal about it, people would have had to feel bad for me, and think they needed to do something - which wasn't going to help anyway, I'd just get in trouble from my mom for telling, so I just made jokes out of everything.

Because of this, no counselor/therapist has ever really taken me seriously or been concerned about me. Because I'm clearly fine if I'm laughing, and coherent and able to talk about everything. Sure, I have huge blocks of time in my childhood that I don't even remember - but I can laugh about it, and talk about what I do remember without getting upset, so I must not be in that bad of shape. *shrug*

I have explained this to my therapist, and I think it's helped her see that if something is bad enough for me to bring it up or remark on it, it's really bad, even if I am not able to edit out the comforting language/jokes/etc.
 
I've never been formally psychiatrically evaluated, but am going to a dr checkup in the next few weeks, and am planning to ask to be referred for mental health services.
Just validating this, and encouraging you to go through with it.
I don't know whether there's a thing about online diagnosis, she does seem really reluctant to come to any concrete conclusions - possibly because it is online, and she's just working off of e-communication.
Technically - if you are in the US - she may not be licensed to diagnose. It varies state-by-state. I don't think it's a bad thing for her to take her time with it, in any case - online is not quite the same as being in the room with someone. It does sound like her phrasing of seeing no pathology in you was poor - it's easy to hear that as, "there's nothing wrong with you". It doesn't sound like that's entirely what she meant...hard to know for certain.

But seeing someone locally for an evaluation, and getting some kind of 3-D support, will be a good thing. If you have a good relationship with your general physician, do try and ask them if they can refer you to someone they personally know and trust. It can make a huge difference.
 
Because of this, no counselor/therapist has ever really taken me seriously or been concerned about me. Because I'm clearly fine if I'm laughing, and coherent and able to talk about everything
Any decent therapist would see through this - humour and laughter are very common defences to difficult emotions and I’d expect a T to at very least notice the gap between what you’re talking about and the way you’re talking about it. I think it’s a good idea to get a formal assessment in a face to face setting, online communication can be remarkably hit or miss but physically being with someone allows a fuller assessment of how you’re doing.
 
I'll hope that seeing someone in person will be better. I think the problem is, really, I'm asking for help calming myself down, etc while I'm still in the stressing situation. What I really need to do is get out of the stressing situation, lol - but I have no way to do that, so I am just struggling.
 
Regular therapists don't get it. It's almost like you have to tell them you have PTSD. I was so relived when I finally got in front of a trauma therapist and felt like I didn't have to keep trying to explain it? Especially CSA? I couldn't say "hey I think this is CSA!" All I could do was like hint around at it? I'd say stuff like "some weird things happened with me and some of the other kids." They'd say " oh that kind of stuff is normal" or "children experiment," and another few years would go by, wasting time, talking about nothing. I couldn't get it out or get anyone to see it. It reminds me of Daffy Duck saying "you have to practically kill yourself to sell script around here." Once I started trying to kill myself someone listened finally. It shouldn't have had to go that far, I almost did it.
 
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