Relationship Therapist In Training - What Advice Can You Give Me?

[falling_wave]

@falling_wave, At the same time, being vulnerable and being hurt because we choose vulnerability around the wrong person or in the wrong circumstances can exacerbate symptoms and compound the original trauma. That is why being in a position where a client reaches out for that connection is almost a sacred trust. There's a huge amount of responsibility there and it isn't something you can rush.

@sun seeker Thank you! I am working every day to get bether at staying present and true understanding and knowledge of it is what does it for me. It's a journey but one that will be worth it.

I really agree with what you said. I never thought about it that way. I do feel loss a lot but this is probably because I open myself up to people in the need to fill that longing for connection when maybe it is not someone worthy of It. Sometimes it's like I just don't have enough people to be selective. Lol. I know bad reasoning. Luckily I have an amazing therapist who I trust with my life and even though vulnerability with her scares me a lot when I am in the moment I trust her more than myself so it's okay. Vulnerability is a double edged sowrd. I kind of like letting go because I feel connected and it is a relief to let go a little bit from holding everything together but I kind of hate it because it is so scary to do and makes emotion so raw. This is something I will think about.

 

[falling_wave]

My therapist also challenges me and confronts me at times which can be uncomfortable but I trust her more because I know she is not just telling me what I want to hear. I also can feel that we are doing work when that happens which needs to be done to make progress. I want her to challenge me but she doesn't do it authoritatively or with judgement. She asked questions and makes inferences trying to understand why I am choosing to do something or react some way that may not help me. Another thing for good or bad I think when a therapist and client have a good connection the therapist has a lot of influence on a client. It's the power differential. Sometimes I feel like I could never attempt such a big step but she keeps working on getting me there and sometimes I'll just make a blind leap because I trust her and as hard as it is I can do it and I move and grow. If you respect, work to understand, and are honest with a client you can build this relationship and move your client along.

 

[sun seeker]

I kind of like letting go because I feel connected and it is a relief to let go a little bit from holding everything together

Oh yes, I get this. I just had to add a word of caution, having had it backfire. I still haven't recovered from a relationship that ended over three years ago, with someone (close friend, not therapist) who encouraged me to be that open and vulnerable and then decided he couldn't handle it and suddenly left me. It almost destroyed me. I don't know how much longer it's going to take to get back even to the level of ability to trust that I was at before this.

 

[holdenmonty]

For me personally I would say just be personable and do what you can to help them feel comfortable talking to you. Each person will be different as I'm sure you have probably learned already.

 

[Digz]

For me, I guess there are a few things I could say are 'vital'. The first is establishing a good client/therapist relationship, becoming known to the client enough that they can begin to trust you, but not over-stepping the mark and letting them into your world too much that it enhances transference issues. I think this is very tricky.

As many people have said, 'silence' kind of goes with PTSD and therapy and I think you need to be prepared for that. Many therapists are taught to just sit in silence and wait. My first therapist was smart enough to see that that wasn't going to work - that I just 'couldn't' talk - ,my anxiety was that great that it inhibited my ability to think about what I was going to say, let alone get it out and trust someone with it. In the beginning, he would get me to write things down and email them to him, so then he knew what to ask me, explain to me or reassure me about when the session started because he knew I wouldn't be able to get the words out. Then he slowly transitioned me into talking. If I was stuck, he would leave it for a while to see if I could get it out, then he'd reassure me, help me or move on and come back to it. My favourite line I always remember him saying is, 'just say the simple, honest, dumb stuff that comes into your head'.

For me, I was diagnosed with PTSD and DID. Some therapists do not believe in DID. This is not helpful and makes those who actually have it feel crazier, more worried than they actually already are. I used to be paranoid when I heard things like that, thinking to myself, 'Oh crap, what if I'm just so unhinged I've somehow made all this up?!'

I think sometimes with PTSD and especially DID patients, you have to be understanding, but also quite firm on boundaries. We're, or at least I was, very damaged. We'll over-step the mark a million times given the chance. Make the boundaries clear, remind us when we overstep it, but show compassion and even better, educate us about WHY we are overstepping the mark - what is the root cause that makes us do this?

If we have other people who are good for us in our lives, encourage us to lean on them to, not just on you, because ultimately that's where our life lies outside of the therapy room and we need to progress ourselves towards it as we become stronger.

Encourage us to be getting out and doing something. Some of us with PTSD can't work - I know I couldn't in the first couple of years of flashbacks, when I was really bad. But doing volunteer work, going out and seeing a friend for a drink or a walk - these simple things kept my life going, kept me grounded and when I was really bad, although I didn't feel like seeing anyone, it would distract me at times. In fact, the days when I didn't go out and there was no one around, I could guarantee were my worst days.

Don't offer vague encouragement if you can help it, like, 'it will get better one day' or 'things get better when you're older'. I used to hate that. I want the concrete. What can I do NOW, because the future, when you're going through something so intensely horrible, seems so far away.
And lastly, I would say, take care of yourself and have a good work-life balance. I know nobody is perfect, but if you are stressed or not looking after yourself, you won't be on the top of your game in therapy. And I feel like this is a horrible thing to say, but I find trusting a therapist who seems obese or not 'together' a bit like trusting a skinny chef or a very ill doctor. I can't help it. I think, 'well, how are they going to help me if they can't help themselves?'

Good luck with your work. Thanks for coming on here and thinking beyond the textbook, because of course there are similarities in everyone's stories, but every story is unique and requires unique perspective.

 

[Rumors]

@orangeweezel
Simply put for me, just letting your clients know that your office is a safe place for them to come and share and that you are willing to listen and brainstorm ideas that can make them feel more secure with the unknown. If they have no other place in the world they can come and feel like they can just breathe, they can in your office. I deal with great big unknowns in life all the time and for an hour a week I feel like I have a place that represents something stable. I have never had that..ever.

 

[Changing4Best]

I had trouble doing trauma therapy, and so my therapist does a smattering of other more gentler therapies on me, such as CBT. I also did a group therapy for over a year with emphasis on DBT and learning grounding techniques. One thing I did learn from our leader, Anthony (anthony on myptsd.com) is that EMDR is not for the elderly, which I am (aged 60).

My therapist is very gentle and kind to me and I would not have it any other way. She also gives me examples from her own life about how she solved similar problems to mine. She would also give me examples of how an unnamed patient of hers solved something similar sometimes too. These examples are very helpful and comforting, as I feel like I am following something that was successful, so it helps me that way to have confidence in trying it.

She's got a very friendly office space with a lot of pillows and stuffed animals. I like being there and feel safe there.

My previous therapist helped me during the time I was homeless and being abused by my boyfriend. She used CBT on me and eventually on my own I ran away from the abusive relationship and and got my own place. She said she was so proud of me for doing that. My parents had never said they were proud of me, and that was so important to have it said by someone. It comforted me greatly.

I hope all this helps you! May the Lord bless you in your career.

 

[Born to Run]

I think it is great to have an education in clinical psychology, but to treat people with ptsd efficiently, you will need more trauma specific treatment tools. Before being properly diagnosed with ptsd, I have done 20+ years of psychotherapy, some groups, longest on psychoanalytic basis for depression and even if the diagnosis had been correct, I am sure those therapists would not have had the tools and knowledge about ptsd.
The trauma therapy I do now is totally different from the psychotherapy I have experienced in the past, and that is because the treatment is entirely different.

My therapist integrates several trauma treatment methods, as every patient is different, and one patient may need different approaches during different phases of therapy. The basis of my therapy is based on Somatic Experiencing (SE) and Ego State therapy and especially for early trauma I consider SE a life saver. Key elements of SE are the Polyvagal theory by Stephen Porges and Hypnosis as done by Milton Erickson. Other techniques to consider are EMDR, CBT, PE (Prolonged Exposure therapy) and there are many more. Another Somatic method that is becoming popular is Sensorimotor psychotherapy, Pat Ogden has just published a book on this.

Apart from methods you really need to understand the brain, the neurobiology of the ptsd brain. I would consider these authors, researchers; Daniel Siegel, Bruce Perry and Bessel vd Kolk. Of course this list is incomplete.

Ptsd therapy is not for the faint hearted therapist, as you need to be prepared to hear stories that go beyond your imagination of cruelty day in day out.