Switch From Psychotherapy To Cbt?

[EvenStrongerNow]

Anytime I ask my T what to do in between sessions, she says the same thing each time. "You're doing so well. You're working so hard. This isn't going to be like this forever. Make sure you're eating and getting good rest."

Then I say, "What do I tell my husband?" She responds, "Tell him you love him and that you are trying really hard."

I told her about my experiences with depression and anxiety today, and how a lot of the time, I don't brush my teeth, etc. And about how I can't sleep at night, how I only eat at night, etc. We talked about my fears around sleeping being related to my trauma, but not about any steps that I can take to resolve any of these unbearable things that keep me from functioning on a day to day basis.

So basically, I leave my T session every week thinking that if I just keep going, then eventually this will all end?

 

[Hashi]

I'm a bit confused. I don't mean general self care, but what sort of grounding skills you have. What specific strategies do you have to remain strong and present when you go out and when you are out? What specific strategies do you have to ground in the moment, in reaction to something upsetting you or feeling too much? Even if you might forget to use them. Things like reminding yourself of the date, looking for things of a particular colour, touching things, counting things, focussing on your breath, focussing on the feeling of your feet on the ground, making yourself say something to someone?

 

[EvenStrongerNow]

The answer to that would be that I have none. I only have some for at home, but not really.

Also, I don't know when something is upsetting me or feeling too much. I wonder if that's because I'm dissociating the entire time?

 

[EvenStrongerNow]

What I mean is, once that war starts in my head, I feel as though I have no control over it because I don't even know that it is occurring until it's too late and I've already responded somehow completely out of proportion to the situation. Or, I will just dissociate because I am at a place of work and have no option to escape.

 

[Abstract]

I am glad you answered more as I too was confused as to whether you have ever had any skills training at all. I am guessing from what you said now that you have not. You were answering by discussing the problems you are having but no information about what you have and have not done in therapy skills wise.

One of the problems with pure psychodynamic therapists is that they will not train you in anything or advise you about anything. There is a lot of good in that as you gain more of a sense of personal power but the negative with trauma and if you have never done any other type of therapy is that you won't be getting some things that you need. That is fine as long as you are willing to get the rest yourself. If not then I think that can be a problem.

Remembering to do things in the moment is obviously very important and a common problem. There are ways to help us train ourselves to start thinking that way such as having a coping tool box (you can put an equivalent on your phone too). That only works if you first have the skills or concepts to start though.

CBT wasn't that important for me as I always had the ability to look at my thought processes and examine them from the outside in. My problems were more related to trusting and connecting to my inner world and building emotion tolerance which DBT is excellent for and the way CBT was done with me made that worse. However, it seems most people really struggle to identify cognitive distortions and so I think for most people doing some CBT is a good idea. My thoughts are that everyone should try it and then if it doesn't help then it is easy to move on anyway. DBT is too as it helps with emotional regulation amongst other things. I find it life changing for me.

I am also of the opinion that a wide range of grounding skills is absolutely imperative for managing PTSD. A lot of the problems you mention will be made much worse if you don't have grounding and safety skills and have not found something that helps you.

Is this t a trauma t? I have some concerns about someone who is purely strict psychodynamic when it comes to trauma for a few reasons. Along with other approaches is wonderful but formal psychodynamic with nothing else is inevitably going to cause some problems to my mind.

 

[Abstract]

I don't even know that it is occurring until it's too late and I've already responded somehow completely out of proportion to the situation.

Trauma focused CBT deals with situations such as this and many find it helpful. Not me but most people do.

One more thought here. I was thinking about your style of posting and wondering about impulsiveness for you. I hope you know this isn't a judgement at all and like hearing what you have to say. I have just noticed that sometimes people who follow with multiple posts that run on from each other think in that way too and find it difficult to take a moment, slow down, consider before then taking the next step thought wise. They can also get lost and loose touch with the original thought. Do you think that could be part of the story for you?

 

[EvenStrongerNow]

My T just got her license MFT last year. She must know a lot about it because she was the first one to suggest PTSD. I always thought that was just for veterans. It was her suggesting of it that led to the diagnosis.

So, then, I must know that I've been needing more. I thought I was just resisting when thinking about needing more. Obviously, that isn't logical.

 

[Hashi]

You do sound like you're dissociating a lot. The forgetting sounds like dissociation. That's what grounding techniques are for, to keep us from dissociating as well as to keep us from getting overwhelmed. They're also to keep us anchored so we don't get hit by something without realising it. They give us some control over things.

Grounding/coping doesn't just happen, though. It doesn't just happen even when you know about these skills. You have to seriously rehearse them, practise them and keep bringing yourself back to them in various ways.

I've got to be honest and say that you seem very vague when you talk about any kind of coping. I think that's probably dissociation too, but I can't help feeling that you need to push yourself to be more involved with your own recovery. For example:

I'm not sure I understand what CBT skills are. I have been told over and over by people here to read about it and get the work books and I forgot about it.

I'd like to gently challenge you for writing in two threads about possibly switching to CBT when you're not all that clear about what it is. It feels like you're asking others on the forum to do some quite basic research and thinking on your behalf, that you need to be taking responsibility for yourself.

Also, there are loads of discussions here on the forum about grounding, as there are in any book about trauma. I'm puzzled how the idea of grounding techniques seems to be so foreign to you.

This is more than dissociation. There are moments when you haven't forgotten and you don't act in those moments. For example, when you wrote this or wrote about getting a CBT book before, it was in your mind. Why didn't you pause, go over to Amazon and order a book?

I've experienced a lot of dissociation and I know that it's actually comfortable for me to let the vagueness take over. I also know that there are times of more awareness and energy when I'm un-vague enough to take a little more action if I choose to do that.

This may sound tough, but you did start the thread by saying you wanted to get out of your comfort zone. I would suggest that your comfort zone is exploring your feelings of being triggered, anxious and vulnerable but not exploring what you can do about it. It feels like your comfort zone is staying vague about the steps you have to take for recovery. Steps like taking responsibility for having therapy that's appropriate for you.

I think I'm in Psychodynamic now, or depth. It's based on Jung and Freud I believe.

My T just got her license MFT last year. She must know a lot about it

I don't know what MFT is, and I don't know if that means it was her first trauma qualification/license. Whatever it is, it sounds like that's what you see as relevant and that she had only just got it when you started seeing her?

A therapist who has only just got licensed in something is likely to have a high awareness and alertness to seeing it. That doesn't mean she knows how to treat it, a lot of which comes from experience.

If your therapist is letting you wander around with no grounding skills, and telling you to eat well, rest and things will get better, then I have to question how much she knows about. I also have to question why you're not questioning it. Why you aren't clear about what kind of therapy you're having, and working in partnership with your therapist on the approaches you use? This is your therapy, probably one of the most important things you'll ever do in your whole life.

If you think I'm harsh, then you would probably find CBT very harsh if you engaged with it. It's all about challenging, pushing and questioning ourselves. As I've said before, I personally feel that it's too harsh and lacks aspects of understanding and validation. Just as you probably think I am too harsh and lacking understanding and validation right now. Sorry. But I feel I have to say it.

 

[Abstract]

I both agree and disagree with what Hashi said here. It's probably just the context and one or two technicalities that I disagree with.

I am guessing that you have had one years therapy and its your first lot of therapy. I think it is usual for a client to expect that if there are fundamental things they should be doing that the therapist would tell them about it. After all they are the expert and those going into therapy usually have problems with self doubt and tend to know nothing about the road to wellness. Just as they wouldn't know the actual process of what it takes if they were starting to learn dancing even though all the practising and hard work after would be up to them. Many also have been trained to do what authority figures tell them to do. The amount of people that would be aware of the approach their therapist does the first time they have therapy would be extremely low. I did but I know I am not usual.

It therefore makes total sense to me that you would be confused if you should or shouldn't do more or if doing anything different is or is not relevant for you.

I do think we need to take responsibility for our own healing (with the help and support we can get from T and places like here). That knowledge usually comes with experience. Some of us have always thought that way and in my opinion there are another set of important problems that come with that too. Either natural tendencies come with problems and advantages.

So what I am saying is that I think you have reacted in a very understandable way. That many would have reacted similarly. You are now clearer about what is meant by skills training and the important part is that you now follow through. It is important to take an active role in your healing. It's sad that the information on what healing should look like doesn't always come from the professionals. I think that is a failing in the system when it comes to trauma. You can however take the reigns and make sure you get what you need and regardless taking the reigns is something we all have to do to get well.

The other thing that I think is usual is that the therapist has not discussed any grounding or other skills if she is a psychodynamic therapist who only works with this approach. They don't. They believe it is all up to the client. With trauma that is fine if the person is naturally used to doing things for themselves and does the rest themselves. Most people aren't like that. It is one of the reasons I think it can be unhelpful for trauma.

When you said she got her MFT a year ago I assumed she got her license a year ago. In that case she would definitely not have done any other approach if she trained in psychodynamic and is unlikely to have done any specific trauma training.

That doesn't mean you need to leave her. If you decide you can do the rest on your own and you like her you could stay. If you are realistic and you think you will get distracted then I would think of changing. As an alternative if you find it difficult to keep on track there are online or in person CBT courses you could do and there are in person DBT courses.

Hashi is right that it takes a lot of hard work and perseverance to actually make these work for us and get to a point where it starts being automatic. We have to work hard and be motivated to make those changes. I also agree that it is probable that part of the reason you get distracted is dissociation (I know that feeling where I don't know what day it is let alone anything else) and that part of it is focus for you. I would add the possibility that you may be impulsive and not be used to taking a moment out to evaluate before skipping to the next thing.

And yes, CBT is tough on the ego if we have a fragile ego. Even DBT can be actually. It is tough love when done formally. For me teaching myself helps with that.

So to summarise all - I hope you don't feel badly about this. You don't deserve to. I think you should feel encouraged as there is opportunity for you to make good changes in your life. It is important now to think through what you are going to do. Do a couple of threads if you need to. Buy some books. Look at the DBT support site. http://www.dbtselfhelp.com/ Keep practising skills. Maybe a thread to keep you on track would work or use the accountability thread on the site so that you cut through the forgetting.

I must know that I've been needing more. I thought I was just resisting when thinking about needing more

It's so awful if we distrust our intuition. I know many of us have been trained to do so. Well done for listening to yourself and asking the right questions.

 

[Abstract]

There are some things in this that really don't fit with my experience or what works for me at all but I think it is worth a read. https://www.myptsd.com/threads/what-is-a-trauma-therapist.16495/

 

[Deleted member 1860]

@StrongerNow,
I, too, am questioning the effectiveness of this therapist. Honestly I think it's time for a change if she's only suggesting that you take care of yourself between sessions. Yes, self care is important, but it won't push your healing forward very much, in my experience.

I think that what @Abstract says is quite valid. She does better with DBT, but I personally do better with CBT. They are similar in that DBT is an offshoot of CBT. I think it may help you to research both to get an idea of what may help you more at this point.

I've done DBT at home in a workbook and in therapy. The skills themselves have been useful, but my obsessive mind does better with CBT. I think it would help you to do a self assessment of your symptoms as that may guide you to which approach is better for you.

Please go to Amazon and look up those dummies books I mentioned. You can look at quite a few pages inside. While you're there, look up the DBT workbook and Marsha Linehan's DBT guide to get an idea what those skills are like.

Neither approach is necessarily better, rather one is likely more suited to your particular symptoms. And if you learn both sets of skills, you'll be even better off!

 

[Hashi]

I've been in talk therapy for 3 years.

@Abstract, I'm getting confused about timelines myself because this thread started over a year ago.

StrongerNow, I felt like coping skills had come up in one of your threads before. I just searched to check, and they have, in two threads actually. Some time ago, talking about wanting them.

I do feel it's about taking more responsibility for your own healing- at the very least ensuring that your therapist is working with you adequately on skills, once you became aware of them and that you needed them.

I feel like you're just shrugging and saying, well I don't have any skills, and leaving it at that. As if you're powerless over it. Here in this thread, you immediately left the topic and switched back to talking about dissociation, being upset and then your therapist's qualifications and knowledge. Which neatly shifts you back into helplessness and shifts issues of responsibility onto your therapist.

What do you think about the fact that you don't have any grounding skills? What do you think about the way you and your therapist have been working, given this? What do you think about continuing to work with her? I honestly think you need to stay with this and address it, Before you have a chance to forget it again.