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


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.


You haven't mentioned this yet, but what is your relationship with your psychiatrist and do they know you want to start processing your trauma on your own while free living in the community? If you've had psychotic episodes while attempting to work on this in the past, you may need to have a medication plan in place that will help prevent you from full-blown psychosis and another "danger to self or others" psychiatric hold. I know the medications really suck and are only somewhat effective but I really think you will need to take them regularly while you go through this process. As you know psychosis begets psychosis and keeping the spark from the kindling is really important.

On another note, I also checked out the WRAP website, WRAP is . . . | Mental Health Recovery , and I am going to do it myself too. Very practical stuff, I particularly like the early warning signs part. Maybe a plan like this that you could share with your therapist and your psychiatrist would help?