Sex With Therapist

[Biliwe]

I believe sometimes it is not very helpful to go back and go back and go back to the trauma in which one was essentially powerless. What for? To relive it and remember how powerless one was? It's only helpful to a point. So in that, I think it is totally acceptable to relate to your therapist that it is not helpful to you to go back and relive the trauma in detail.

There are approaches that entirely leave out the details of what has occurred and instead focus on what its effects are in the here and now.

Right. Let's just throw out trauma therapy entirely. After all what does TFCBT, EMDR, Prolonged Exposure Therapy, Somatic Experiencing, et al know about processing trauma? Instead? Let's ignore all that trauma therapy bullshit, and just do standard talk therapy. Which is soooooooo effective for PTSD.

 

[Aturur]

I said "sometimes" it is not helpful, and sometimes it is only helpful "to a point." Where did I say throw out the concept all together? Some types of personalities and some types of traumas are not treatable with the trauma therapies you have mentioned and sometimes it can even retraumatize them. So the operative word is "sometimes."

 

[Eko]

Let's ignore all that trauma therapy bullshit, and just do standard talk therapy. Which is soooooooo effective for PTSD.

There is a growing evidence base for talk therapy in treating PTSD, starting with Judith Herman's recognition that for some clients with experience of long term relational trauma, what she terms "old fashioned therapy" is the best and in some cases only way to go because the client needs to learn relational safety, possibly for the first time.

There's a place for revisiting trauma, a place for manualised, cognitive therapies, for emdr, for talking therapies etc etc it's not by any means an exact science and still research consistently points to the therapeutic relationship and the client's own internal resources as being the best predictor of therapy outcomes - with modality coming a distant third.

My issue with this therapy is that, while therapy should be hard work, it shouldn't feel like a year long argument, the client shouldn't leave constantly feeling like their being gaslit - that does sound like a recreation of an abuse dynamic which isn't helpful and at best is retraumatising. The therapist should be able to address transference in the relationship without recreating a trauma dynamic - not to do so is therapeutic error.

 

[Uge]

Some types of personalities and some types of traumas are not treatable with the trauma therapies you have mentioned and sometimes it can even retraumatize them. So the operative word is "sometimes."

I'm sorry; but you are a bit out of your depth with this. The statement is entirely too general.

It can't be said that some types of trauma are not treatable with, etc, because not enough is quantifiably understood about the science of PTSD. What we have to go on is the research as it stands.

Also: you keep saying 'trauma'. Yes - traumatic experiences in life can be very effectively dealt with in traditional talk therapy models. Some of those models encourage the level of hysteria and desperation the OP is manifesting right now - as well as providing the depth of insight she's experiencing.

But let's be very clear: this is not addressing PTSD. It's not even cognitive therapy. It's entirely based on re-experiencing in a very viscerally confusing way.

And you claim this is less damaging than trauma therapies that progress through the trauma events, and simply focus on getting the memories to re-integrate? They don't all use language. Some are quite gentle.

You're not a trauma therapist, you don't have PTSD...you might be in the wrong area of the board.

I appreciate that the OP has found your comments useful. But from my angle, as a PTSD sufferer who has worked through a number of capital-T Trauma modalities - your thinking is bullshit.

Sorry.

 

[Aturur]

My issue with this therapy is that, while therapy should be hard work, it shouldn't feel like a year long argument, the client shouldn't leave constantly feeling like their being gaslit - that does sound like a recreation of an abuse dynamic which isn't helpful and at best is retraumatising. The therapist should be able to address transference in the relationship without recreating a trauma dynamic - not to do so is therapeutic error.

I wholeheartedly agree with this statement.

 

[Aturur]

I appreciate that the OP has found your comments useful. But from my angle, as a PTSD sufferer who has worked through a number of capital-T Trauma modalities - your thinking is bullshit.

You seem quite hellbent on proving me wrong here, mostly based on things I did not say. You took a purposefully general statement and quite specifically pointed out what is wrong with it, that's quite a feat.

But, so, if I understand you correctly, you believe: all PTSD (sure, let's move away from the more general "trauma") is equal, can be treated equally by the trauma therapy modalities you have listed, that none of them can retraumatize, and that some patients aren't better treated with a CBT approach due to the specific nature of their complex illness. Ok. That's your opinion. I disagree.

I respect the fact that you have done the hard work, and that you have amassed great knowledge about the nature of PTSD and its treatment. However, I think it is ill-advised to turn your experience into dogma about what does and does not work for other patients.

 

[Niwubo]

ll PTSD (sure, let's move away from the more general "trauma") is equal, can be treated equally by the trauma therapy modalities you have listed, that none of them can retraumatize, and that some patients aren't better treated with a CBT approach due to the specific nature of their complex illness. Ok. That's your opinion. I disagree.

No - I don't believe all PTSD is equal.

Let's review the list of trauma therapies:
PROLONGED EXPOSURE - can be difficult and retraumatizing, yes. Not for everyone. Proven effective for those who do use it.
EMDR - also not right for everyone, depends on the scope of trauma. Is exhausting, by all reports. Is also proven to be effective for those who can tolerate it.
CBT and TF- CBT: low likelihood of re-traumatization. Not necessarily right for everyone for trauma processing specifically; but a CBT foundation is pretty essential in grappling with any mental illness.

(CBT, by the way, is awesome. What this therapist is doing isn't anywhere in the neighborhood of CBT. It sounds like psychodynamic--jungian-reenactment)

BRAINSPOTTING - a different approach to essentially an EMDR structure. Not as difficult, also not always as effective.
SOMATIC EXPERIENCING: the preferred therapy for people who have complex trauma and years and years of layered abuse. Very gentle; incredibly low risk of re-traumatization; very slow moving, but an excellent option for those who need to take extra special care. Unique in that it does not depend on a spoken narrative (which is the usual cause of re-traumatization).
EFT: EMDR-lite. Same principals plus some woo-woo energy psychology stuff. But it works for many people. Very gentle, very low risk. Like SE, affected by the skill level and training of the therapist.

And then there's whatever the OPs therapist is doing.

I'm sorry; I have been a little hell-bent. But you seem to have a lack of working knowledge about the various PTSD treatments that do exist.

No - I can't categorically say that a psychodynamic approach wouldn't work...but the technique that therapist is using has SO much re-enactment - IF he actually knows what he's doing.

So when you say it's necessary for people to use psychodynamic alone sometimes because actual trauma therapy is damaging - it's bizarre, when what we are looking at is a technique that depends on manipulating the client into a deep transference where the therapist becomes the predator.

Like I said - that could definitely be effective and cathartic for someone who was victimized, traumatized, and doesn't have PTSD.

Ok? Can you at least see how that's possible, even if you disagree?

 

[Zote]

But you seem to have a lack of working knowledge about the various PTSD treatments that do exist.

I don't understand, how would you know what working knowledge I do or don't have? Because I said that sometimes trauma therapy does not work for a particular brand of PTSD? I'm legitimately confused.

So when you say it's necessary for people to use psychodynamic alone sometimes because actual trauma therapy is damaging

I merely stated that SOME patients are retraumatized by the trauma therapies available and that simple talking therapy might be more helpful in THEIR case, but not others. You seem to have in your mind that I dismiss trauma therapy ad hoc. I do not. But there are many patients for whom they do not work.

Two issues are being conflated here: 1. The OP therapist's approach, which, to the best of my knowledge, seems to be failing for multiple reasons, including but not limited to verbally reentering the traumatic scenario. And 2. The psychodynamic approach in general, which does not any in case prescribe verbal rehashing of the traumatic event or some sort of predatory role playing as you suggest. (Also, I cannot see how, from the information provided, you could judge what kind of approach the OP therapist is choosing. Least of all, some sort of Jungian reenactment. Just because the OP feels persecuted by him does not mean it is his approach.)

I'm a bit confused about what you're getting at, other than wanting to explain to me what trauma therapy is.

 

[Tihet]

I'm a bit confused about what you're getting at, other than wanting to explain to me what trauma therapy is.

Well, that's sort of it. I'd like you to be more respectful of the specifics, in regard to trauma therapy. The OP is their own person, and they can and will take what resonates for them - and I also know that my wish for your respect of the treatments available isn't anything to do with you, it's really just me.

But I'll tell you how I got to the assumptions I did. You asked -

I don't understand, how would you know what working knowledge I do or don't have?

Your first post was really definitive - trauma therapy can and should include transference synthesis; that is the key to resolving their issues in the present. You're clearly a big believer in transference -

trauma therapy, especially with clients as "advanced" and aware of their relational issues as the OP, can and should include transference synthesis in the roundabout way that has been described, as the client's own interpretation of the relationship and therapeutic approach is key to revealing larger relational issues in the here and now. The issue at hand seems to be that, even thought the OP was up front on the topic, she projected her desires onto the therapist, which left him no other option than to inquire into its nature.

The therapist had no other option - the client forced the therapy in this direction.

The sheer number of schools of thought on trauma therapy specifically would indicate that no, the therapist had many different avenues. He chose to go with what he did.

I asked you for a citation, anything, on the "trauma therapy...can and should include transference synthesis" Here was your reply:

I'm afraid I will have to do go back and research the proper sources. If you're interested, I will do my best and find the citations - it's been a while since I have consulted the literature. As such this just stands as my opinion based on my own training in the field, which I don't like to divulge on this forum, but alas, it's anonymous

That's fine - we all have opinions, and they are a melange of things we've learned, remembered, experienced...

I didn't jump to any conclusions. I just believed what you said - you've not looked at the stuff in awhile, these are your beliefs based on your training.

Another poster responded with this (meant sarcastically, that's kind of obvious)

After all what does TFCBT, EMDR, Prolonged Exposure therapy, Somatic Experiencing, et al know about processing trauma?

And you said:

Some types of personalities and some types of traumas are not treatable with the trauma therapies you have mentioned and sometimes it can even retraumatize them.

To me, it's really just ignoring the fact that there are multiple options. Yes. Some people cannot do EMDR, PE, CBT...but they usually get a lot of relief out of SE - that's just one example. I actually would say that trying a few of the evidence based approaches to treating PTSD trauma would be the right way for most people to begin. And, statistically, re-traumatization is not likely for about half the things on that list.

You didn't say the opposite of that - I know. But you generalized the hell out of it, and it bugs me, if you're going to be claiming that transference is a necessary part of therapy, period, trauma therapy included.

I merely stated that SOME patients are retraumatized by the trauma therapies available and that simple talking therapy might be more helpful in THEIR case, but not others. You seem to have in your mind that I dismiss trauma therapy ad hoc. I do not. But there are many patients for whom they do not work.

Just based on what you've posted - you say you don't dismiss trauma therapies - but "many patients for whom they do not work" is not the data.

And of course - the data is extremely sketchy. I know. And anecdotally, I agree that there are people who struggle to find the right way to process their trauma. They are all over these boards.

But I've read more horror stories of people ending up with incompetent therapists who try and psychodynamic the trauma away...but transference as a core principle has not gained traction (as far as I am aware) in the thirty years or so that these PTSD therapies have been developing.

So, you led with saying it was necessary. And the fact is, that's not true. It's no more true than my insistence that trauma therapy depends on memory integration. But the neurology and psychology of it all come together to indicate that breaking down the memory is pretty key to our understanding of how to treat PTSD right now. It may be proven wrong. And yes, there are people for whom it is not necessary, and a different approach is better. I would wonder, though, if we could empirically diagnose PTSD - if those people actually would have it. The majority of people who suffer and survive trauma do not end up with PTSD, specifically. You can end up with extreme attachment issues, depression, dissociation - and not have PTSD.

Now, that's me really stepping out into the theoretical - there's no evidence yet. They don't totally know what PTSD is. Just, there's a lot of evidence that points at how to treat it. I would think that someone in the field wouldn't blow that off as much as you seemed to. Maybe you didn't mean to, or didn't realize that's how the posts were building. Maybe I over-read it. Probably, some of both.

I don't know that I did a great job of laying all this out cogently - in fact, I'm confident I didn't. But I'm hoping you can at least understand where I was coming from, even if you absolutely disagree. Disagreeing is cool, it's what makes discussion happen.

 

[Tuhoh]

1. The OP therapist's approach, which, to the best of my knowledge, seems to be failing for multiple reasons, including but not limited to verbally reentering the traumatic scenario.

I get lost in the anonymous forum so I may have you confused now with a previous poster but were you not previously advocating the therapy was actually going well, that the OP was close to breakthrough, an "aha moment" if you will?

 

[Kobovu]

I haven't commented here before - just reading. But in my opinion this discussion is getting really over complicated.
One of the best things I've learned in therapy is to trust my own intuition, not my therapist's. I've suffered sexual abuse and it would totally do my head in and not be at all useful for me to talk about the actual abuse. That in itself would make me feel mistrustful, esp if it was to a man.
All this talk of therapy processes and modalities is very interesting intellectually, but if this therapy is leading to feelings of disempowerment and confusion in the op that can't be a good thing!!!
I agree with others who say find a female therapist where these power games can't be played out.
There isn't really a magic solution. Just the building of a trustful and healing relationship with another who knows how to listen and assist.
if you don't feel safe, you don't feel safe. And that's not helpful - in real life or in therapy

 

[Miva]

I'm getting very confused about these anonymous avatars too, so I'll just say, it's me!

Okay, I think there has been some misunderstanding here. And yes, I can see that my posts seem to have been building toward a dismissal of trauma therapy in general. I should have expressed myself in a more nuanced way. I do not dismiss trauma therapy. I can only repeat that I think it works well for some, and less well for others. As you say yourself, the data is sketchy. We don't even know just what PTSD is - it's not unusual that some patients with specific symptom clusters will not react well to it.

Just to come all out, I am a psychiatrist, albeit NOT specialized in trauma treatment. I do, however, encounter patients who could be diagnosed with PTSD (symptomatic), yet whose treatment specifically entails an avoidance of trauma work. It just would not do them any good. The reasons for such would take too long to hash out here, but just as with any disorder, physical or mental, PTSD treatment cannot be painted with one brush.

That said, I believe there is a skewed judgement of what transference analysis within therapy entails. It is not a reenactment of the perpetrator dynamic. It is not a reenactment at all. Just as you're miffed that I seem to be generalizing in your eyes, I get miffed when people take concepts out of context, dismiss all of Freud's work, and deem it outdated. I am not a Freudian, but we would still be clubbing patients over the heads if it weren't for his work, so, transference:

To use a simple analogy: say I had a bad experience with an ex-boyfriend who always wore green tshirts. Next boyfriend always wears blue tshirts, but suddenly he appears in a green tshirt. I start having a fear reaction to him due to my experience with green tshirt ex boyfriend. That is transference. In very simple terms, applying my experience and judgement to a similar experience that may be quite different. The analysis of this transference would be my boyfriend and I discussing my fear reaction to him, wherein I can understand that not all men with green tshirts will do me harm. Ideally I would start losing my fear of guys in green tshirts. That is all transference analysis in psychotherapy entails.

Transference in psychotherapy and the analysis of such is no different. Just because its title came out of an outdated Freudian model, it does not mean it has its rightful and helpful place in therapy, including trauma therapy.