Support Outside Of Session

[aria]

What kind of agreement do most of you have with your therapists in terms of outside session support? And what works best for you whilst doing trauma work? What kind of support if any do they offer you?

Are you allowed email, texting, phone calls? Or do you have no contact outside of sessions at all? How do you feel about the current agreement you have about access or lack of access to your therapist outside sessions?

 

[Suzetig]

I have no contact between sessions other than for scheduling, this works for me because I've had to learn how to cope, use other supports around me and generally keep my therapy stuff contained in therapy. It's not easy and there have been times I was very tempted to contact her in between sessions but I know I could quickly have become very dependent on my therapist, which wouldn't have been helpful. We're doing very deep work just now and I'm managing fine, that wouldn't be the case if I had access to her outside of session because I know I would have kept myself in permanent crisis to give an excuse for more contact, if that makes sense.

Amongst other things, therapy should help you develop coping strategies, it's harder to do that if you have too much support from your therapist. That's purely my experience and view, others here will have different opinions.

 

[sun seeker]

I've worked with several therapists and none of them ever brought up the possibility of contact outside of sessions, so it never occurred to me that this was common until reading about it on the forum. The therapist I have just started working with mentioned that it was okay to call between sessions, but I can't imagine that I would. For me it's because I know I can come to depend on one person way too much and for me being that vulnerable has meant getting hurt. Actually what concerns me most about the therapeutic process is how to allow myself to be vulnerable and dependent and resolve the fear that brings up, more than how to learn my own coping strategies. It's when things are going relatively well that I ask for help, because if it goes badly I won't be hurt so much. When in crisis I shut down and don't tell anyone except maybe one friend who has shown over the years that she knows how to respond.

 

[digger]

I don't have any contact with my T outside of sessions other than for changes to arrangements.

While there are times when I feel like I need extra support between sessions, I actually think, for me, it is good for me to develop my own coping skills and look at the other options I have instead.

I'm not sure I'd have the confidence to use the option anyway. I have a hard time working out whether things are important enough and the anxiety about that I think would make an arrangement like that difficult for me.

Reading on this site though, it does seem like a beneficial arrangement to some people.

@aria what are your thoughts on it? Is it something you are wanting from your therapist?

 

[Lucycat]

I am 'allowed' as much contact as I need. I have my T's office number and mobile number. I can phone, email or text between sessions - although I should point out my sessions are usually a few weeks apart not every week.

I have found this level of support absolutely brilliant. At first ( 5 years ago) I was having very frequent contact but it has naturally reduced as I need it less. Currently the only contact between sessions tends to be arranging another session. I have never abused the arrangement and only make contact when I have run out of options. I don't think it has in any way made me dependent on T but felt more of a safety net enabling me to push boundaries and face challenges

 

[scout86]

My T encourages me to email between sessions. Sometimes I get a reply, sometimes not. I know he reads the emails. I'm not a person who's comfortable asking for help. It's possible he handles different people differently and this is part of the process of getting me more comfortable with the idea of "talking" about stuff. I have his phone numbers. He has flat out told me to call him before I ever decide to commit suicide. I flat out told HIM that's one time I WON'T call him. :wideeyed:

This system works for me. It's pretty common for him to say "Haven't heard from you in awhile." because I didn't check in at all between sessions. Because he's made comments about other areas where he handles different people differently, I suspect he's open to hearing from all of his clients, but he's encouraging people to move in what ever direction it is they need to move to live a more balanced life. And, this works for HIM. Different T's probably have different boundaries that work for them. It doesn't seem like it needs to be a one size fits all kind of thing.

 

[Hope4future]

I can call my therapist any time between sessions. Usually I get his service, so I can leave a message for a call back. If it's urgent they'll get him on the line. Usually either of these results in another session. We don't process much on the phone.

It's hard for me to call even if it's to schedule an additional session, but usually these are the most productive times because something is working itself out.
I've learned to trust that I know when extra support will be helpful and when I can and need to cope on my own.
Having the support there is powerful, even when I don't use it directly. It's something I've never experienced in my life before and it's healing to know it can exist.

Overtime, I'm learning to accept similar, although not therapeutic, support from the people I care about and who care about me. It's such a novel idea.

 

[joeylittle]

Over time, we evolved into my therapist essentially functioning as my crisis line. But that came from need, it wasn't an assumption from the outset. When we started working together I was very scant on coping skills; I was also in a PHP and developing them, slowly, but sometimes just couldn't cope. I started trying to use the proper crisis lines, but after a few very unhelpful experiences there my therapist told me I should call him instead.

When we got into the trauma work, I no longer needed to call him for crisis help, I was good at that - but I started having very aggravated intrusive memory/flashback experiences, and he instructed me to call him for those when I couldn't handle them myself. Now, that's essentially how we operate - but my need to call because of PTSD is very infrequent.

We also have a safety contract, because I am chronically suicidal. I have to call him before I take any action to harm myself; every once in awhile I get clarification on what "take action" means...so it's a very specific sort of arrangement. Having it in place really helps me, actually. The few times I've had to call because I was very on the edge, he was just so good at handling it; now, I have a pretty clear sense of what we would talk about, if I called when I was that bad. So when I feel that bad, I can almost talk myself through it that way, without needing to call on his help. If that makes sense.

I don't like calling him in-between sessions; I don't like the feeling of dependency, and I just don't like (frankly) waking him up in the middle of the night. I don't like how it feels after I've called ready to end my life and he's talked me down; it is a rough conversation to put someone through, and while I know its his area of expertise, I'm also certain its not pleasant.

He is clear that he considers all the calls part of the work we do together, and that I am always welcome to use him as a resource. I periodically ask whether I am over-stepping any boundaries or leaning on him too much; he explains to me why I'm not, and reminds me that he is capable of setting his own limits and I don't need to do it for him.

Something else that is true: because I don't want to need to call him, it's built-in that I won't abuse the resource. He points this out to me often, and it does make sense. So altogether, I am exceedingly grateful for the support, and am glad I have a therapist who is willing to be on call for me.

Probably relevant: I live alone, often am working in strange cities for periods of time, and have no friends that I could call on in a crisis, because a)they aren't trained for it, and b)they don't know enough. Most of them only know I have depression, and the few that know I have PTSD do not know any detail.

 

[darrenS]

i have no contact either between sessions , i had one therapist that offered it . and when ever i sent an email she would charge for a session. I have learnt as hard as it is ...the contact outside of therapy with a therapist tends to remove your own want and ability to deal with it, dont get me wrong , i know at times it can be dangerous , but i have also learnt that everything comes to pass , just have to persevere.

And once i started working through things between sessions , i found yes it was damn hard, but each time i done it ...i learnt a new skill or became aware of my inner strength. It dosent mean i dont flashback , etc etc and get a bit crazy at times...i do...but i honestly dont think extra contact with a therapists would actually make much difference, i tend to believe you need to have some space from continually addressing problems otherwise it just becomes and endless cycle of problems and addressing them.

 

[aria]

@aria what are your thoughts on it? Is it something you are wanting from your therapist?

I am conflicted in my thoughts.

I can see the argument for having no outside contact with a therapist helps with containment in terms of not letting the therapy spill too much into the rest of you week and basically making you find your own strength and coping skills.
I don't agree with this fear therapists have and a lot of clients have too that dependence on a therapist is a bad thing. From an attachment and developmental point of view, I think people with complex ptsd and or attachment problems often haven't had the experience of being allowed to be dependent in childhood. I think that's a really important thing to learn, I think to be dependent on someone and that someone meeting your need is a great way to learn about trust.

I don't think being dependent or needing outside help from your therapist makes you over-dependent. Not at all. I think it's about learning to ask for help, learning that someone will want to meet your needs, that having needs is ok. I think being dependent on your therapist is a developmental stage, and as you become more secure in the relationship, you learn to explore what you can do for yourself in terms of self-soothing and coping strategies.

I think like a lot of people here, there's a lot of shame surrounding needing to ask for help, of being needy. I have had a lifetime of being "independent", not asking for help, never being seen as weak or vulnerable or in need of comfort. I really struggle with the healthy concept of interdependence. I find it hard to recognise whether I am being "too" needy and over-dependent ( although I don't think i've ever been over-dependent on anyone) and if by asking for help I am practicing being "inter-dependent" which is good.

I feel like I don't need to learn how to be on my own or to cope on my own. I need to learn how to tolerate someone supporting me, being available to me and allowing someone to soothe me in an appropriate manner and teach me about emotional self-regulation.

Having no outside support feels really cold and abandoning and frightening to me. But I can also get overwhelmed with the trauma stuff, so I can see the argument that having contact with a therapist outside of sessions can make it all spill out of that 1 hour per week.

So I feel confused about what I need versus what I want.

 

[sun seeker]

@aria, I love the points you make about dependency being a needed stage and a positive thing for some of us who never had the experience of trusting someone. I agree with all you are saying, which was more eloquently put than I could have done. Now, maybe not everyone has this same issue, and a kind of therapy that is more focused on developing inner resources is what they need. From what you write it actually sounds like you are clearer on what you need than you think you are. :) Learning to depend on another person in a safe way is a stage, not an end in itself. The idea is eventually we internalize the demonstrations of healthy caring and learn to give that to ourselves, but it has seemed to me, too, that the school of therapy that expects us to do that before we have the raw materials to do it with is putting the cart before the horse.

Having said that, I know that for me to get to the point where I could trust another person enough to let them meet my needs that way - even to communicate what my needs are - would be such a huge step, I would be a long way towards being healed already. I can be with someone who obviously wants to help and is asking me what they can do to help, and all I can do is go into what I now realize is an emotional flashback, sobbing helplessly, because what I need is wrong or shameful or too much and to be vulnerable means I'll get hurt. So it's hard even to imagine a situation where I would overuse an offer to call for help. My last therapist was big on teaching me to develop my own resources, but I realize now that was a long way away from what I needed. My new therapist actually asked in the first session how good I am at asking for help when I need it, and seemed to think it was noteworthy that I don't do so.

I do have this one friend who is very good at being supportive in crises, and who has offered that if I ever really need to, I can call her at any time, even in the middle of the night. This feels like something of a safety net, but not entirely because again, at my worst it feels too risky to ask for help. Say there is a scale of distress from one to ten, one being neutral and 10 being seriously suicidal. With most people, if I get any higher than about a four, I don't want to talk. With this friend, I can call up to about a seven. Any higher than that, I don't reach out to anyone. The thing is, my scale of distress has so much to do with feeling safe and trusting (or not) around other people, that if I felt able to call and ask for help, and receive it, when I got close to a ten, then I wouldn't get there in the first place.

Supposing your therapist did agree that it was all right to call outside of sessions, would you feel comfortable doing so? How often? Would you feel able to talk with her about where she stands on the issue of dependency as a part of the therapeutic process? It sounds like an important thing to know since this is such a big part of what you are looking for.

 

[Chava]

I think like a lot of people here, there's a lot of shame surrounding needing to ask for help, of being needy. I have had a lifetime of being "independent", not asking for help, never being seen as weak or vulnerable or in need of comfort.

Yes!! I hate needing anyone or anything...my most "powerful" feelings came from total denial of needs, starving, having no feeling, just going vacant. I am able to e-mail my therapist. It's been hard for me that she hasn't responded so quickly, probably trying to not reinforce constant emergencies but also let me know that she still supports me, but doesn't live at her computer.

I agree about the learning how to ask for help. It's SO SO SO scary. E-mail actually feels safer...so if I was able to practice that first, I got better talking about some of it, or things that helped, face to face. It's been very helpful because I really clam up around people, doesn't matter if it's a nice therapist. I just have a really thick protective bubble. BUT, I agree with others and the need to find outside support (and major growth challenge in itself), but for some of my stuff I knew I couldn't trust ANYONE. I've also been through periods of feeling too impulsive about contact between sessions and dependent upon some kind of response, so sort of crazy and triggered if I didn't get it within a day...like back into feelings of non-existence and certain my therapist hated me. It sort of played into my I CAN'T TRUST ANYONE IN THE WORLD stuff because she sometimes replied minimally or in confusing ways when I thought I was screaming for help...it felt like I was, but my e-mail probably didn't show that (still me being very careful to not ask too directly or seem like I really need anything, but sort of expecting her to "get it" or read my mind or whatever).

Anyway, I have complex trauma and definitely some attachment stuff. I'm very avoidant and easily overwhelmed too, since I've never trusted feelings...can't trust others to help me cope, can't survive them on my own. But my therapist is private practice and maybe just decided what kind of time and/or boundaries are possible for her, and what works best for her clients. In a clinical setting, like a hospital or clinic psychologist, this seems less common (although I had one psychologist encourage me to e-mail her because I never talked about anything). I think they get just plain over-scheduled, too many clients. In my opinion, trauma therapists shouldn't be loaded up with a whole bunch of clients every day, but probably smaller numbers and some built-in response or emergency time, and certainly time to take care of themselves and not burn out.

If it doesn't feel right or supportive, is it something you can ask your therapist about? Or have you already done that? Maybe there is a helpful explanation to the "rules" or support between sessions. Or maybe your therapist has ideas. It's at least important that you share it's hard, which I think is normal, but there is a point where it makes the work really hard and I know it can even feel hard to trust the therapist because you sort of have to relieve feeling alone with terrible feelings, abandoned somehow. Sorry to get pretty long-winded. I think it's a really good topic here!