Therapeutic Supervision

[sun seeker]

There is a lot of anxiety leading up to this phone call in a few minutes... can't think, afraid of not being heard, being humiliated, told there is nothing that can be done, left a wreck yet again... I hate being this vulnerable when the stakes are so high. If it goes badly I can't think what resources I have left. I hate feeling like this.

 

[Suzetig]

Try breathing exercises - seriously, I've watched you work out the kinks with this so carefully and your thinking is sound. You just need to get through it so breath in slowly for 4, hold for 2 and the slowly out for at least 4 clients. Keep doing it and make sure you're breathing from your tummy.

Don't worry about sounding upset - you have a right to decent therapy and he just sounds a bit out of his depth, which is fixable with support. I'm sending lots of empowering thoughts.

 

[Suzetig]

And he may have been right, other people may not be ready to hear all of your story - whatever they say and however much they say they want to hear it, you need to be able to keep yourself safe from people who just don't get it. But he needs to offer consistent care and needs to stop talking to you about his stuff entirely because it's stopping you using him the way you need to.

It's never your job to take care of your therapist and he needs to be clear about that and help you be clear about it. You're doing great, I'm so struck by your strength in this though I know you don't feel strong. You're awesome.

 

[sun seeker]

It went reasonably well. Not perfect, but pretty well. I'm drained. Just wanted to say thank you especially to @Suzetig for your support, and later today I will write out what exactly happened.

 

[sun seeker]

Well, let's see. What worked:

Transparency. I did bring up what he shared with me about his past that I think he is playing out in his relationship with me, and she didn't seem to think there was anything wrong with him having told me that, but agreed that was where the problem stemmed from and that he had brought that up himself and asked for help with it. That's the first step, that he owns the problem. Working on it will unfortunately take some time, and there is the question of what happens to me in the meantime. We agreed that it's unlikely I am going to make much progress while this is going on, but if I can at least stay where I am and not move backwards as I have been doing, that will be a success under the circumstances. Sucks.

Ongoing supervision. She brought this up herself, that it will be an ongoing process until resolved, and I requested and she agreed that she watch closely what is going on to make sure we are on track.

Reliability: This (or lack thereof) has been the biggest issue that brought this matter to a head. She said she had told him he needs to give me a realistic sense of what to expect, which may be new to him as he tends to live more moment-to-moment and has trouble getting his mind around other people's need to know what is going to happen. He will book sessions from now on with me in the room with him, so it's at least more likely that we're booking them when he is going to be available. She asked whether I would be happy with sessions less frequently but that I could rely on actually happening as opposed to the extreme degree of rescheduling that has been happening, and I had to say I wouldn't be happy with either, I do actually need regular weekly sessions. That is a point I am getting stuck on and am afraid of not being able to advocate for myself around.

What didn't get resolved: The issue of him wanting me to rely on him less and use "other resources." I pointed out that those don't really exist, not in the way I would need them to, and none take the place of regular therapy. ETA: Of course I know there are you guys, and you are awesome. Not to take away from that, but therapy is a whole other ball game, you know?

I did point out that when I have reliable weekly sessions I am more stable, have fewer crises, and am in better condition to reach out and connect with those "other resources" whereas when there is not that foundation, well, I can't. Other resources being, I guess, things like casual connections with friends that I can manage when I'm doing relatively well, but can't when in the midst of a trauma reactivation. I put this in writing so that important fact doesn't get lost. She didn't have any better ideas than I had when I asked her what other resources she could imagine me using. I think she got the point. At least sort of.

Timing: This is going to be a long process, and meanwhile, I'm not sure what to do to stabilize. She came up with a day she could meet with me and help me come up with some ideas, but it's not for close to another month. The month ahead feels like a mine field.

I feel pretty shaky and at a disadvantage, because I really don't have anywhere else to go so I feel at the mercy of someone who is immersed in their own stuff and not very able to be present for mine, however good his intentions may be. People keep telling me I've been doing a good job of working on this and am stronger than I think... but I feel pretty darned vulnerable. And very, very scared of my next session, because so many things have been said and done that are pretty anti-therapeutic and I don't know what I can trust and where I stand.

Thunderstorm starting. Really??

 

[sun seeker]

I could really use some advice here.

I don't know what to do. Anyone who has gotten this far won't need a rundown of the whole horrible situation. So there are three people now involved in this situation with me, not all of whom are communicating. I feel caught in the middle, trying to get quality therapy, but somehow in the process I feel like I must be manipulating people because of their reactions - only I really don't think I am.

There is the specialist I've been talking to, about my particular area of trauma. My therapist first enthusiastically agreed to consult with her to learn how to help me better, then backed out. I'm not quite sure why. She isn't taking new clients but is free with advice and has not asked me for any money. She just wants to help. She's been confused at the constantly changing plans and understands my frustration.

There is my therapist's teacher, who is doing supervision and working with him on his countertransference. She has talked to me on the phone once to get my side of the story. She agreed to meet with me later in the month.

When we talked, I felt she was already somewhat prejudiced against what I was trying to express, and kept telling me that I need to be more understanding that my therapist has human limitations. This phrase came up because of my reactions to his repeated cancelling/rescheduling and everything else I've been anguishing over in the past month or so - and also that I need to find "other resources" although she could not name what they might be.

There was no particular response to my grave concerns about some pretty serious therapeutic mistakes he has been making. She tended to interrupt, and often left my concerns unanswered. She takes a long time to answer e-mails.

After my last session, I wrote the supervisor an account of what happened in it, and forwarded it to my therapist for the sake of transparency. It was mainly not a happy account, because it was not a happy session. I began it by telling him how important it is for me not to go home in a crisis state (a state I can't get out of on my own) especially since he is no longer available in crises. He forgot all about this until the last minute when I was lying in the floor in close to a catatonic state. There were a number of other things that were extremely anti-therapeutic, and I was honest about them.

She wrote me back today, in a very curt e-mail, saying she would read what I wrote but if she were to show it to her own supervisor, she would probably say to terminate the therapeutic relationship based on what I said. She said not to expect answers from her because she has already given a lot of her time to this (she talked to me for an hour on the phone) and that I should send her a balanced account including what my therapist did that was good, or, like she said, her supervisor (I don't know where she is involved, if she is) would tell her to terminate.

I feel like I am being threatened. Like unless I say enough good things, my therapist will be taken away from me. I feel just exactly like a child being threatened not to tell the truth about an abusive parent for fear of being taken out of the home or abandoned. I'm not saying my therapist is abusive, but there have been some things going on that are decidedly not what a therapist should be doing, and I've had to insist over and over so he, and now his supervisor, will hear me. Now I've apparently done that too well. My intent has been to have my concerns addressed, not to end the relationship.

Yes, I definitely feel like I am being threatened. He'll be taken from me if I say how bad it is. So do I write about how good it was before it got so bad? And how will I even know what she thinks or what she is doing with what I write if I can't expect an answer? Oh, and she wants to know more about the specialist - why, if my therapist says he won't talk to her?

Meanwhile, my therapist hasn't gotten back to me since Sunday when I wrote him back about some scheduling questions. I don't know whether the two of them have talked and what he is thinking.

And I cannot stand to be abandoned again. Abandoned for trying to get my needs met?

What am I supposed to do now?? How do I get some of my power back in this situation?

 

[joeylittle]

So do I write about how good it was before it got so bad

Actually, this would be helpful in a certain format.

Can you make a list of tangible things - actions - that have been present in the relationship as positives, and a list of actions that caused confusion (negatives), and a list of specific issues that you have questions on.

I think you've done the latter two already, but it would likely be good to put them altogether.

How do I get some of my power back in this situation?

I don't think it's so much about power as it is about stability. Re-forming a therapeutic alliance doesn't just happen because it needs to; it's a process. In many ways, you are starting over. Which means you do have an equal stake in this. What will be hard is really understanding how to re-address the gaps that are being left as a result of these new boundaries.

Like, not written back since Sunday might be the new reality; the question is, "what is your new time-frame for responding about scheduling; or, is there a way we can make it easier?" You also need to brainstorm what the 'other' support options are. Will he be able to speak with the specialist, or does he now believe it's a bad idea? You're looking for an update.

These are reasonable things - but they also take some time to be answered and implemented. It's a new relationship - that's probably the most useful thing to keep in mind.

(Another way of thinking about the positives is, what would you like to keep, and what do you need more guidance on in terms of how to handle what's going away. Is there anything going away that you are sad to lose?)

Yes, I definitely feel like I am being threatened.

I can understand why. Do you think it's possible you aren't being threatened, but rather, are having a catastrophized reaction to a new boundary?

I can tell you that I also understand where the supervisor is coming from - if you are making demands that exceed the scope of these new interpersonal boundary lines, then it would be inappropriate to mislead you into thinking those demands would be met.

On the other hand, if you can speak in terms of the things worth saving, and the gaps that need addressing - it will shift the locus of pressure away from your therapists shoulders and place it instead in the space between the two of you - which helps it become a clearer problem to solve.

I hate that this sounds like 'don't get what you need' - because that's not what I mean. It sucks that this is all happening. But it is to the good, right?

That's a fair question too though. Is it still worth it? Making the lists might help figure that out.

And don't underestimate the sheer amount of re-building, from zero, that goes into making the therapeutic alliance work again in a situation like yours. It's effort that both you and your therapist will need to make. (I think that's why she's pointing out that he's human - she's just making the point poorly)

Sorry. Super ramble-y. My brains a little mushy, hope there's something useful in there for you.

 

[sun seeker]

Can you make a list of tangible things - actions - that have been present in the relationship as positives, and a list of actions that caused confusion (negatives), and a list of specific issues that you have questions on.

I can. Only I'm going to send it directly to my therapist. I really don't get a good feeling about the supervisor.

I don't think it's so much about power as it is about stability.

Hmm. I think some of my sense of powerlessness comes from the lack of stability, since stability was the main thing I was asking for/needing. The situation has gotten worse... maybe on its way to getting better, but it's gotten worse. I'm really feeling the instability, which I have a strong reaction to... sometimes I wonder if it wouldn't have been better not to say anything at all, but it's too late now.

Which means you do have an equal stake in this.

Do we? The way I see it, he could walk away from this and get on with the rest of his life, while I would be affected permanently.

Do you think it's possible you aren't being threatened, but rather, are having a catastrophized reaction to a new boundary?

No, not in this case. She was clearly saying that if she showed what I wrote to her supervisor she would recommend termination.

There are a bunch of things that add up to a bad feeling about this. I think I need to stay away from this person.

if you are making demands that exceed the scope of these new interpersonal boundary lines, then it would be inappropriate to mislead you into thinking those demands would be met.

No, I wasn't doing that. I made a few specific requests that she review certain therapeutic techniques with him that would help me to be safe. If I'd said these things to my therapist directly I think he would have welcomed the input. None of it was about interpersonal boundaries. Otherwise, I was giving both an account of what we did in the session and of my subjective experience of what happened. The latter was pretty negative because that was my experience. I feel as though she's angry with me for not having had a more positive experience.

Is there anything going away that you are sad to lose?

Yes. Tons. I'm losing the things that mattered the most to me. I wish we could turn back the clock.

My brains a little mushy

I do know the feeling, but you did just fine anyway. Hope you feel better!

 

[joeylittle]

Hmm. I think some of my sense of powerlessness comes from the lack of stability, since stability was the main thing I was

Oh, I agree with this. I think I'm my head it's more useful to think about regaining stability than regaining power, because power always seems finite to me, but there's always enough stability to go around. But you're right, the two are clearly chicken/egg.

The way I see it, he could walk away from this and get on with the rest of his life, while I would be affected permanently.

I just want to challenge this. I think this might be more about your lack of self-worth than his lack of investment. You're assuming he'd be totally fine, when I think - no. If that were the case, he'd not be doing the work in supervision to get his own issues back in the box.

That seems more factual to me, and your framing reads more like you putting yourself down/seeing this as another piece of evidence for how you are repeatedly abandoned.

There are a bunch of things that add up to a bad feeling about this. I think I need to stay away from this person.

Trust your gut, always.

 

[Friday]

Yes, I definitely feel like I am being threatened. He'll be taken from me if I say how bad it is. So do I write about how good it was before it got so bad? And how will I even know what she thinks or what she is doing with what I write if I can't expect an answer? Oh, and she wants to know more about the specialist - why, if my therapist says he won't talk to her?

If it helps clarify at all... After reading though this thread I can't imagine why on earth you're still seeing this therapist. He sounds like you not only cannot work with him, but more to the point despise him, and are one step away from attempting to have his license revoked for gross misconduct / make sure he's never allowed to work with anyone vulnerable again. And this thread at best is just broad strokes! As another neutral 3rd party, it sounds like the supervisor is thinking much the same thing. Why haven't you fired him & moved on?

So it makes sense to me that she's asking for reasons you might wish to continue. Far from threatening you, is asking for any reason to attempt to salvage...something. What that something is? Would be the reasons you wish to stay on with him. The good parts. Not minimizing the bad parts, but putting them in context of the whole.

 

[sun seeker]

That seems more factual to me, and your framing reads more like you putting yourself down/seeing this as another piece of evidence for how you are repeatedly abandoned.

Well, okay. On the one hand: I really have been repeatedly abandoned.

On the other hand, he keeps saying he won't abandon me.

Back to the first hand, that scares me even more because people have assured me they wouldn't abandon me and soon after, done just that.

On the other hand, he has pointed out that what is different in this situation is that things have gone so badly wrong and he is still there trying to fix it.

Back to the first hand...

I'll have to think about this later. I think I'm having a new kind of anxiety since today when I was at the dentist. It feels like my heart has grown ten times its size and is trying to jump out of my chest.

 

[sun seeker]

I.. can't... think. I feel like my chest is exploding.