Therapist says I need higher level of care, but there aren't any options available. How do I start processing trauma in therapy?

eroday1

New Here
Hi all. I've been working with my current therapist for about 2.5 years and she is amazing. However, I'm in a bit of a conundrum.

I have schizoaffective disorder and PTSD. For about the past year, I was in a major psychotic episode most of the time. I think I've been doing better, functioning and communicating better, for the past 2-3 weeks.

My therapist says I need more intensive treatment. However, I'm on medi-cal and very limited on my options. The only IOP/PHP program available to me are at a local hospital that I've had very bad experiences at and I know is poor treatment. Additionally, it's not even trauma informed. I've asked my psychiatrist, people in my support group, etc. if they know of any intensive trauma groups nearby, or even just weekly support groups. They don't. Many said they have actively looked and can't find anything. I have searched the internet high and low. Also, I don't really want to do trauma processing in a group setting. I really don't think that would be helpful for me. For some reason, she doesn't seem to quite believe me that there is nothing available. Maybe she's just frustrated. To make matters worse, I have no friends or family I can go to. When I did have friends, they'd just say something like, "you should really talk to your therapist about that." Eventually they ditched me because, well, I have nothing to offer so I'm not worth the trouble.

Basically my only option is once a week therapy (that's all my insurance will cover, and that's all she can provide). That's my option, along with bi-weekly psychiatry. Also, I've spent a long time learning to trust her and slowly opening up. She says she wishes she had a full week she could just work with me, but of course that's not a possibility. I'm ready to start processing my trauma because it is extremely debilitating and leaves me feeling constantly like I want to die. An intensive program is NOT an option and also not something I am super interested in. Her website says she treats trauma/PTSD, and she's even said she does. In the past, she's said that she wants to process my trauma with me. Then, she said something along the lines of that she couldn't push me because of how constantly stressed out and unstable I was, but that there was "so much work I want to do therapeutically with you" or something like that.

Then, last week, she says how I need more intensive treatment, and then she says "because this is just a once a week check-in." So it's not therapy?? I'm just so, so confused. I am ready to start slowly processing my trauma and I actually trust her, but I'm feeling hurt by this. I can only do so much work on my own, but I am doing what I can in between sessions. I need to try to heal my PTSD. I feel emotionally paralyzed. I'm also worried she's just gonna terminate me or insurance will stop covering it. I got a DBT workbook for psychosis I've been working on, and she says it can also help for PTSD, but I know that DBT skills are not the answer- only some helpful tools to try to help lessen symptoms, but at the end of the day, I still feel the same, and the skills are effective maybe 20% of the time, only if my symptoms are mild. I can't be expected to heal my disorders completely on my own, especailly when I'm in therapy and have been led to think that it would be ok to process my trauma when I'm ready. I really, really don't want to change therapists. It is SO hard to find a good therapist who keeps it real, 10x more so with medi-cal.

Does anyone have any insight as to what could be going on here? Or any advice?

Please help.
 
i can sympathize with your situation, i have been with my therapist for almost 3 years, and i have made huge progress, but i also have had many hospitalizations. she is committed to my treatment, there are many options beyond her program wise, i am going to be going back to sheppard pratt trauma disorders unit. you might consider the same maybe there a path towards success they can help you figure out.
 

EveHarrington

MyPTSD Pro
If you only have 3 weeks of stability under your belt, you’re nowhere near ready to start processing your trauma. IMHO.

The stabilization portion of healing can honestly last years for those of us who are very destabilized.

The reason that stabilization is so important is that talking about trauma can be incredibly de-stabilizing, and thus you need to have a number of coping skills that work well for you. Your therapist doesn’t want to dig into the worst things you’ve ever experienced only to have you go home and spiral out of control

Are you aware that DBT is typically a 6 month program, and therapists recommend that you go through the program twice? This is so you can have the skills down pat.

I know you say that coping skills don’t work all that well, but sometimes it takes a long time of working on a skill before it works for you. I have multiple skills that took me almost a year or more before I could say yes, it’s a skill that works for me.

I completely understand that you want to get better. This disorder sucks! However, everything has an order to it. Right now it sounds that being stable is most important, not processing your trauma. It sounds like this is how your therapist feels, too. It sounds like she knows she can’t give you the level of care that you need. If she were to go through with processing and it puts you in a bad place, this could be malpractice.

I think that your best bet is to keep working on coping skills and try to maintain stability. Once you have more time being stable, your therapist will be more likely to attempt processing with you.
 

eroday1

New Here
If you only have 3 weeks of stability under your belt, you’re nowhere near ready to start processing your trauma. IMHO.

The stabilization portion of healing can honestly last years for those of us who are very destabilized.

The reason that stabilization is so important is that talking about trauma can be incredibly de-stabilizing, and thus you need to have a number of coping skills that work well for you. Your therapist doesn’t want to dig into the worst things you’ve ever experienced only to have you go home and spiral out of control

Are you aware that DBT is typically a 6 month program, and therapists recommend that you go through the program twice? This is so you can have the skills down pat.

I know you say that coping skills don’t work all that well, but sometimes it takes a long time of working on a skill before it works for you. I have multiple skills that took me almost a year or more before I could say yes, it’s a skill that works for me.

I completely understand that you want to get better. This disorder sucks! However, everything has an order to it. Right now it sounds that being stable is most important, not processing your trauma. It sounds like this is how your therapist feels, too. It sounds like she knows she can’t give you the level of care that you need. If she were to go through with processing and it puts you in a bad place, this could be malpractice.

I think that your best bet is to keep working on coping skills and try to maintain stability. Once you have more time being stable, your therapist will be more likely to attempt processing with you.
I understand this and thank you so much for your response. My only thing is that the PTSD itself is one of the two main reasons why I am not stable (along with the schizoaffective disorder), or was not stable. The PTSD is destabilizing me much more as of now and recently, whereas some of my schizoaffective symptoms have abated a bit and bit more under control. I just feel like I'll deteriorate more and more if I don't get the PTSD treated.

If you only have 3 weeks of stability under your belt, you’re nowhere near ready to start processing your trauma. IMHO.

The stabilization portion of healing can honestly last years for those of us who are very destabilized.

The reason that stabilization is so important is that talking about trauma can be incredibly de-stabilizing, and thus you need to have a number of coping skills that work well for you. Your therapist doesn’t want to dig into the worst things you’ve ever experienced only to have you go home and spiral out of control

Are you aware that DBT is typically a 6 month program, and therapists recommend that you go through the program twice? This is so you can have the skills down pat.

I know you say that coping skills don’t work all that well, but sometimes it takes a long time of working on a skill before it works for you. I have multiple skills that took me almost a year or more before I could say yes, it’s a skill that works for me.

I completely understand that you want to get better. This disorder sucks! However, everything has an order to it. Right now it sounds that being stable is most important, not processing your trauma. It sounds like this is how your therapist feels, too. It sounds like she knows she can’t give you the level of care that you need. If she were to go through with processing and it puts you in a bad place, this could be malpractice.

I think that your best bet is to keep working on coping skills and try to maintain stability. Once you have more time being stable, your therapist will be more likely to attempt processing with you.
Do you think my therapist will stick with me through this? I've been working with her for a couple years and she's really great

If you only have 3 weeks of stability under your belt, you’re nowhere near ready to start processing your trauma. IMHO.

The stabilization portion of healing can honestly last years for those of us who are very destabilized.

The reason that stabilization is so important is that talking about trauma can be incredibly de-stabilizing, and thus you need to have a number of coping skills that work well for you. Your therapist doesn’t want to dig into the worst things you’ve ever experienced only to have you go home and spiral out of control

Are you aware that DBT is typically a 6 month program, and therapists recommend that you go through the program twice? This is so you can have the skills down pat.

I know you say that coping skills don’t work all that well, but sometimes it takes a long time of working on a skill before it works for you. I have multiple skills that took me almost a year or more before I could say yes, it’s a skill that works for me.

I completely understand that you want to get better. This disorder sucks! However, everything has an order to it. Right now it sounds that being stable is most important, not processing your trauma. It sounds like this is how your therapist feels, too. It sounds like she knows she can’t give you the level of care that you need. If she were to go through with processing and it puts you in a bad place, this could be malpractice.

I think that your best bet is to keep working on coping skills and try to maintain stability. Once you have more time being stable, your therapist will be more likely to attempt processing with you.
Like I said, once a week therapy is my only option. So I don't know if she'll just give up or if she'll accept that. I could not function without regularly therapy, even if it's just a check in. That's what confused me when she said this is "just a once a week check-in." Like wtf?
 

TruthSeeker

MyPTSD Pro
Hi all. I've been working with my current therapist for about 2.5 years and she is amazing. However, I'm in a bit of a conundrum.

I have schizoaffective disorder and PTSD. For about the past year, I was in a major psychotic episode most of the time. I think I've been doing better, functioning and communicating better, for the past 2-3 weeks.

My therapist says I need more intensive treatment. However, I'm on medi-cal and very limited on my options. The only IOP/PHP program available to me are at a local hospital that I've had very bad experiences at and I know is poor treatment. Additionally, it's not even trauma informed. I've asked my psychiatrist, people in my support group, etc. if they know of any intensive trauma groups nearby, or even just weekly support groups. They don't. Many said they have actively looked and can't find anything. I have searched the internet high and low. Also, I don't really want to do trauma processing in a group setting. I really don't think that would be helpful for me. For some reason, she doesn't seem to quite believe me that there is nothing available. Maybe she's just frustrated. To make matters worse, I have no friends or family I can go to. When I did have friends, they'd just say something like, "you should really talk to your therapist about that." Eventually they ditched me because, well, I have nothing to offer so I'm not worth the trouble.

Basically my only option is once a week therapy (that's all my insurance will cover, and that's all she can provide). That's my option, along with bi-weekly psychiatry. Also, I've spent a long time learning to trust her and slowly opening up. She says she wishes she had a full week she could just work with me, but of course that's not a possibility. I'm ready to start processing my trauma because it is extremely debilitating and leaves me feeling constantly like I want to die. An intensive program is NOT an option and also not something I am super interested in. Her website says she treats trauma/PTSD, and she's even said she does. In the past, she's said that she wants to process my trauma with me. Then, she said something along the lines of that she couldn't push me because of how constantly stressed out and unstable I was, but that there was "so much work I want to do therapeutically with you" or something like that.

Then, last week, she says how I need more intensive treatment, and then she says "because this is just a once a week check-in." So it's not therapy?? I'm just so, so confused. I am ready to start slowly processing my trauma and I actually trust her, but I'm feeling hurt by this. I can only do so much work on my own, but I am doing what I can in between sessions. I need to try to heal my PTSD. I feel emotionally paralyzed. I'm also worried she's just gonna terminate me or insurance will stop covering it. I got a DBT workbook for psychosis I've been working on, and she says it can also help for PTSD, but I know that DBT skills are not the answer- only some helpful tools to try to help lessen symptoms, but at the end of the day, I still feel the same, and the skills are effective maybe 20% of the time, only if my symptoms are mild. I can't be expected to heal my disorders completely on my own, especailly when I'm in therapy and have been led to think that it would be ok to process my trauma when I'm ready. I really, really don't want to change therapists. It is SO hard to find a good therapist who keeps it real, 10x more so with medi-cal.

Does anyone have any insight as to what could be going on here? Or any advice?

Please help.
I understand that there are phases to trauma. If your therapist thinks that you aren't in a safe enough place to process the trauma, then she's likely going to wait until you are functioning pretty well. I understand trauma processing is like phase 2. Phase 1 is safety. When things get too intense, my T slows things down, and reduces the trauma processing and moves back to safety and basic functioning. Phase 3 is maintanance........integration.....ongoing therapy to keep one from back-sliding. That's just my understanding.....

So, being successful with phase 1 was something my T made perfectly clear: basic self-care, being able to remain mostly grounded in everyday life, finding other things to do during the day than lie in bed, cry, or stare at walls, taking meds regularly and eating , doing basic chores to take care of ones self, paying bills, taking care of medical issues, etc. To get through trauma processing.....you have to be meeting the minimum self-care and safety limits.....because trauma processing is hard, exhausting, and takes so much out of one emotionally. Do you feel you are doing these things regularly and daily?

There have been times I wanted to plow through the trauma.....but then I'd dissociate so badly.....so it was kind of a waste, because I wasn't feeling the feelings and my go to dissociation habits would screw up any chance of actually discussing it. This is going on my experience.....but I did a lot of processing through reading about dissociation and trauma, journaling every day, drawing my feelings. There's a flip side to just "processing" is finding some fun things in life which become great distractors when you are in the processing phase. Do you have hobbies and fun things you enjoy and can do everyday as a distraction to the feelings you feel about the trauma....you need to have some "fun" go to things in life to do....when processing different traumatic events.....and a daily schedule to keep you in a routine. These things help immensely when doing phase 2 trauma work.

I read a lot of self-help books and watched some videos which were helpful..... as well as helped educate me and give me ideas for coping strategies to make me more functional...! Journaling was immensely helpful, and it helped to get it out of my head. Drawing was also helpful....oh, and poetry....I did a lot of poetry for over a year....that was a huge help.....to make sense of my feelings. I'm still doing trauma therapy, and I still process things....but I trust my T to help me gauge the pace so I don't get overwhelmed and go "to the dark side."

I think it is great that you can see functional progress in the last 2-3 weeks....good on you! Getting functional everyday for me was hard work......changing behavior patterns can be tough....so pat yourself on the back for the progress you have made.....and don't push yourself too hard, too soon. Having a strong foundation to process the trauma will make it easier in the long run. Good luck with your T and your therapy!
 

eroday1

New Here
I understand that there are phases to trauma. If your therapist thinks that you aren't in a safe enough place to process the trauma, then she's likely going to wait until you are functioning pretty well. I understand trauma processing is like phase 2. Phase 1 is safety. When things get too intense, my T slows things down, and reduces the trauma processing and moves back to safety and basic functioning. Phase 3 is maintanance........integration.....ongoing therapy to keep one from back-sliding. That's just my understanding.....

So, being successful with phase 1 was something my T made perfectly clear: basic self-care, being able to remain mostly grounded in everyday life, finding other things to do during the day than lie in bed, cry, or stare at walls, taking meds regularly and eating , doing basic chores to take care of ones self, paying bills, taking care of medical issues, etc. To get through trauma processing.....you have to be meeting the minimum self-care and safety limits.....because trauma processing is hard, exhausting, and takes so much out of one emotionally. Do you feel you are doing these things regularly and daily?

There have been times I wanted to plow through the trauma.....but then I'd dissociate so badly.....so it was kind of a waste, because I wasn't feeling the feelings and my go to dissociation habits would screw up any chance of actually discussing it. This is going on my experience.....but I did a lot of processing through reading about dissociation and trauma, journaling every day, drawing my feelings. There's a flip side to just "processing" is finding some fun things in life which become great distractors when you are in the processing phase. Do you have hobbies and fun things you enjoy and can do everyday as a distraction to the feelings you feel about the trauma....you need to have some "fun" go to things in life to do....when processing different traumatic events.....and a daily schedule to keep you in a routine. These things help immensely when doing phase 2 trauma work.

I read a lot of self-help books and watched some videos which were helpful..... as well as helped educate me and give me ideas for coping strategies to make me more functional...! Journaling was immensely helpful, and it helped to get it out of my head. Drawing was also helpful....oh, and poetry....I did a lot of poetry for over a year....that was a huge help.....to make sense of my feelings. I'm still doing trauma therapy, and I still process things....but I trust my T to help me gauge the pace so I don't get overwhelmed and go "to the dark side."

I think it is great that you can see functional progress in the last 2-3 weeks....good on you! Getting functional everyday for me was hard work......changing behavior patterns can be tough....so pat yourself on the back for the progress you have made.....and don't push yourself too hard, too soon. Having a strong foundation to process the trauma will make it easier in the long run. Good luck with your T and your therapy!
Gotcha. This all makes sense. I really don't find joy in anything. I've been trying but I have absolutely no desires and everything feels draining. Everything. It's really tough. I hope maybe the chemicals will shift in my head enough sometime to where I can feel a small amount of joy at least, but so far the meds don't help my depression and "negative symptoms" (of psychosis) like anhedonia and avolition, and I've tried all the meds my insurance will cover and my psychiatrist will prescribe. I also agree this all makes sense, I'm just confused on if my therapist is actually willing to/trying to do that. Her saying "this is just a once a week check in" really threw me off. Like what does that mean? It's supposed to be therapy, right? I'm so confused. She's tried to start light trauma processing in the past, then I destabilized more, and she said she thought she pushed me too hard, but I really don't think she did. I hope she's not just giving up and feels completely helpless/hopeless toward my situation and thus is pressing the brakes on any deeper work. I don't know. I was just really disheartened by that. Hopefully I took it the wrong way or she meant something else?
 

TruthSeeker

MyPTSD Pro
Gotcha. This all makes sense. I really don't find joy in anything. I've been trying but I have absolutely no desires and everything feels draining. Everything. It's really tough. I hope maybe the chemicals will shift in my head enough sometime to where I can feel a small amount of joy at least, but so far the meds don't help my depression and "negative symptoms" (of psychosis) like anhedonia and avolition, and I've tried all the meds my insurance will cover and my psychiatrist will prescribe. I also agree this all makes sense, I'm just confused on if my therapist is actually willing to/trying to do that. Her saying "this is just a once a week check in" really threw me off. Like what does that mean? It's supposed to be therapy, right? I'm so confused. She's tried to start light trauma processing in the past, then I destabilized more, and she said she thought she pushed me too hard, but I really don't think she did. I hope she's not just giving up and feels completely helpless/hopeless toward my situation and thus is pressing the brakes on any deeper work. I don't know. I was just really disheartened by that. Hopefully I took it the wrong way or she meant something else?
I go to therapy once a week. But, to get to a stable place, I had to want to do it.....regardless of my fear issues, total lack of motivation.....and fatigue. So, I started small, and decided to create a schedule for my day.....to build consistency and new habits at home. Starting with three things I'd do in order in the morning to make them habit forming, and three at night. I picked three things that needed to be done every day....and started there. So meds was one (I didn't always take meds on time), feed/let out my cats so that they didn't poop on the floor because I didn't climb out of the bed, and drink a protein shake (to get the bulk of my protein in so my neurons will fire better and reduce foggy feeling). The TV remained off because if it was on.....I would sit and watch it all day and not even get 3 things done. I made a check list on my phone, and checked each off as I did them. I also posted them at the end of my bed. At night, I started with three things also, scoop litter box (kinda prevents the am issues), brush teeth, and make a list in my phone of 3 things during the day to get done (like dishes, trash to the dump, and go to grocery store-these three things were variable-and medical appointments/threapy didn't count). This is all considered phase 1 safety/stability.

As time went on, I added things to the daily schedule, like use the Instapot and make and freeze meals (That is the best invention......soups, meatloaf and mashed potatoes, green beans, and corn on the cob all done at the same time in one pot.......as well as stews, Italian foods, fried chicken (air fryer part), and even desserts! So now, Sunday is Instapot meal day and freeze food day. Having precooked meals in the freezer that are healthy and that I like the flavor of has been really helpful and healthy eating. This all falls under self-care......which is phase 1.

That's 9 things in a day.......but to function.....I now do many more than 9 things in a day, but I started with 3 in the morning, 3 during the day, and 3 at night. Things eventually become habits, and then you feel you need to do them.....because it needs to get done. No reward system is needed when you get here.....

I gave myself rewards for getting my act together and getting motivated. At night, I couldn't climb in bed until the 3 evening things were done.....and then the TV came on. If I got the three things in the morning done.....then I could do something fun....like paint some curtains, make a favorite meal, take my camera and go do some photography, write a story, or get a pedicure. Many things became rewards....so I gave myself a treat for learning a new schedule and sticking with it. I'd even tell myself, "good job" when I got all three things done. Learning healthy habits is work......especially if you have none, and don''t get much accomplished during the day. Change is hard....so I'm good with personal rewards.

So, getting functional is a process...and is phase 1..get good at a schedule, reward yourself, tell yourself kind words, and incorporate self-care even as a reward ( pedicure, hot bath, a hair do, a body soak in olive oil (feels good to me), whatever floats your boat and feels good. One thing I finally did to stay out of bed was to incorporate making the bed every day.......and not getting back in it till at least 8pm. So, when you decide you want to live, be organized, and function each and every day, you will need to self-motivate and self-reward, and be positive with yourself.

Consider meeting other people....isolation is not healthy.....communication skills and being around others is healthy.....and it is needed even with Covid. I have Instapot, music, and puzzle day on Sunday with one or two other folks who are "safe" to be around. Having someone to the house is motivating in that the kitchen is clean, I do something nice for them.....have an Instapot surprise lunch, and we play music or work on an ongoing puzzle. It is my only social day .......day with others, and it happens every Sunday. It's a habit, too.

So, climb out from behind your big words that mean you aren't motivated, make a bucket list......as many things as you can thing of, and decide which ones you can knock off the list.....or work on the skills needed to knock them off the list. I learned to play an instrument with other folks......but since there were no other folks, I found a site online that would play the music and the notes would light up and play. I learned a musical instrument via computer so to speak. I've learned a number of card games, and play with people over the internet. I watch YouTubes that teach me how to do things I want to do....then I go try. I love YouTube for this reason.
I guess what I'm saying is think about your ideal self, and make a list of all the things you'd like to do in your lifetime......then figure out which ones you can work on or work toward....and go try. Part of phase 1 work is self-care and part of self care is finding things that you enjoy......to allow you to feel good about talents, products you make, and interests you have. This was very helpful in getting me more active and living life....not just watching it go by. Good luck there.

Oh, I wouldn't worry about your T's comment about "check-in" but try a different approach.....try working on functional skills, and things that make you feel good, so you have something positive to bring to therapy. Doing this will give you the groundwork and help you to feel more solid when you are ready to do phase 2 work. Maybe your T could focus on your progress on being functional.....and you could explore what activities might make you feel good about yourself. Just a thought......but it will feel like work because it is a change.
 

shimmerz

MyPTSD Pro
What @TruthSeeker said. Back when I had my complete meltdown, my T said I needed 5 day a week care. Of which there was none. lol. Years later, what got me on track was a program called WRAP (Wellness Recovery Action Plan). It threw my brain back into high gear and helped me to recognize that everything I needed to heal was right inside of me. I haven't looked back since.
 

eroday1

New Here
What @TruthSeeker said. Back when I had my complete meltdown, my T said I needed 5 day a week care. Of which there was none. lol. Years later, what got me on track was a program called WRAP (Wellness Recovery Action Plan). It threw my brain back into high gear and helped me to recognize that everything I needed to heal was right inside of me. I haven't looked back since.
I just looked into the WRAP program and they are saying the next session starts on March 30, but they want $300. Currently I'm taking the NAMI peer-to-peer support class for learning to live with a mental illness/managing it. I also go to support groups but, honestly, they don't help. They just ask what I would like from the group (???), and then expect me to contribute advice as if I know. And they're only through Zoom, but cameras aren't allowed, which makes things just weird.

I genuinely have looked high and low for programs. I have to stay within my county because it is medicaid/medi-cal. Even though I live in a big/urban county, there's nothing other than a really, really shitty for-profit psych hospital I've had terrible experiences with in the past (and the staff who lead groups inpatient also do the outpatient/PHP groups). It's just frustrating that my therapist doesn't seem to believe me. Not only that, but I've voiced my concerns about how I think this programs don't really benefit me and how I don't feel comfortable sharing my trauma in a group setting. My experience with PHP in the past was that it was just some handouts, a social worker teaching from a manual, and being thrown in a group of random strangers who don't really want to be there, most of which just complain about their marriage or job.

I have MHN managed behavioral care through medi-cal, and she thinks it is the same as regular MHN behavioral care when it absolutely is not. Where I live, MHN through medi-cal will technically only cover "mild to moderate" mental illness, only 1x a week therapy and occasional psychiatry- no intensive outpatient or anything. If you need "intensive" services, you basically get booted off the MHN plan and onto the "County Mental Health Plan", which I know for a fact is terrible. I did, however, look into all the "intensive" programs they offer. They only offer residential for people who were homeless or were in a psych hospital long-term, or they have community clinics. Supposedly, one was supposed to have a day program. Yet I call them and they say they only will set you up with a weekly or biweekly therapist and a psychiatrist. Most of whom are interns or new therapists, and frankly most aren't that great of providers from my experience, plus there is so much red tape and frequent turnover. UGH. I'm scared they'll involuntarily bump me over to the "county plan" and I'll lose my current therapist and psychiatrist who I have worked so hard to trust over the years.

This is long. I'm sorry.
 

grit

MyPTSD Pro
First thank you for sharing your story. I am sorry you are experiencing these type of unnecessary barriers among those who supposed to help you. I just want to add one thing I find often we tell others: when, how, where to process trauma (regardless of how we are able, unable we are or seem to others), it is up to the person experiencing. Maybe the reason the person is breaking down is they need to process some trauma just to start walking upright. So I applaud your need and want to process trauma and I am sorry your therapist thinks once a week therapy is just check in and is trying to send you off to some where else for intense therapy. I just hear your struggle in this. It is hard for a healthier person to navigate let alone for those of us who need it the most.
 

TruthSeeker

MyPTSD Pro
I just looked into the WRAP program and they are saying the next session starts on March 30, but they want $300. Currently I'm taking the NAMI peer-to-peer support class for learning to live with a mental illness/managing it. I also go to support groups but, honestly, they don't help. They just ask what I would like from the group (???), and then expect me to contribute advice as if I know. And they're only through Zoom, but cameras aren't allowed, which makes things just weird.

I genuinely have looked high and low for programs. I have to stay within my county because it is medicaid/medi-cal. Even though I live in a big/urban county, there's nothing other than a really, really shitty for-profit psych hospital I've had terrible experiences with in the past (and the staff who lead groups inpatient also do the outpatient/PHP groups). It's just frustrating that my therapist doesn't seem to believe me. Not only that, but I've voiced my concerns about how I think this programs don't really benefit me and how I don't feel comfortable sharing my trauma in a group setting. My experience with PHP in the past was that it was just some handouts, a social worker teaching from a manual, and being thrown in a group of random strangers who don't really want to be there, most of which just complain about their marriage or job.

I have MHN managed behavioral care through medi-cal, and she thinks it is the same as regular MHN behavioral care when it absolutely is not. Where I live, MHN through medi-cal will technically only cover "mild to moderate" mental illness, only 1x a week therapy and occasional psychiatry- no intensive outpatient or anything. If you need "intensive" services, you basically get booted off the MHN plan and onto the "County Mental Health Plan", which I know for a fact is terrible. I did, however, look into all the "intensive" programs they offer. They only offer residential for people who were homeless or were in a psych hospital long-term, or they have community clinics. Supposedly, one was supposed to have a day program. Yet I call them and they say they only will set you up with a weekly or biweekly therapist and a psychiatrist. Most of whom are interns or new therapists, and frankly most aren't that great of providers from my experience, plus there is so much red tape and frequent turnover. UGH. I'm scared they'll involuntarily bump me over to the "county plan" and I'll lose my current therapist and psychiatrist who I have worked so hard to trust over the years.

This is long. I'm sorry.
So, what I hear you saying......is that what you have available to you isn't working or doesn't sound like it is what you are comfortable with. I'm sorry you are having trouble getting what you need. Programs are generic, so you have to tweek them to fit your life style, personality and personal needs..(take what you like...leave the rest attitude)..regardless of the program, but some may be better than others. You said that you've been functional for about 3 weeks and I hope that continues. What can you do to make sure you stay functional? It certainly is your life and your therapy. I can only say, that it took me about 6 months of hard consistent daily work to get a daily routine and regular hobbies and self-rewards. I wrote my own plan to get better, checked out a bunch of trauma books, or Brene Brown's videos....(.I love her positivity) and shut out the negative. In my case, I read a lot on trauma, and decided I needed to be my own therapy bus driver.....so more therapy work was done at home, journaling, poetry, making routines, and finding hobbies.....having hobbies is a way to connect with others and gives me something to talk about besides my traumatic lot in life. Small steps every day, makes for big changes in 6 months. I learned so much from this support group.....in my case, it isn't just knowing the info or telling someone my trauma stories....but it's making the decision to put what I learned into action. I decide what I want to talk about in therapy each week based on my journaling, sleep (if sleep is a problem), current issues that can derail my progress, health concerns, and I don't do trauma work every week all the time......that will put me back to square one and back to bed totally depressed .......I pick one thing to discuss (e.g. my last lousy therapist) and I journal about it, and then take my notes with me and discuss the things I think are important.....thus using my time wisely....since it is only once per week. It just sounds like you need to be your own therapy bus driver and figure out what it is you want out of therapy.....do your own homework, and come to therapy prepared to follow through in discussing what you have thought about for the week.

I used the one T day a week I had during that time to talk about what I was doing, what changes I was making, and my motivations for making them-early on when I was trying to create/maintain a functional schedule. The T brought in ideas to enhance performance, find easier ways to do things, look at the situation more positively or differently, and give me ideas how to relax at home....and not stay keyed up after a session....along with teaching me grounding skills. Regulating therapy so that you discuss one horrible event....and letting it rest.....is important so you don't disintegrate/destabilize and lose months of progress is important.

I wish you the best, and consider reading up on the phase model of therapy. That was helpful to me. Good luck.
 

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