Therapy Difficulties - Online Therapy An Option?

[Abstract]

Franciemarie,
I truly thank you for sharing. You helped me find the courage to come back and continue with this. Was struggling a lot with self hatred and wishing I could obliterate everything I wrote. And then wondering how I could fool myself that I could do any type if therapy when I can't even tolerate doing a thread like this.

I felt inherently offensive and that I emanated some kind of ineffable stench of the soul

But the conflict between what I knew and what I felt was so extreme that my level of discomfort simply sitting with the therapist was nearly unbearable. I couldn't relax because I was kind of trying not to breathe, trying to exist "less", which of course is impossible so it was very stressful.
Ironically, the physical looks of me were such that some therapists (the lesser ones) couldn't believe I had any problems, that I was exaggerating symptoms

Because of the denial of what went on as a kid, I still go a little nuts when people deny my reality. I have felt judged by my persona and look, and not heard many many times

I could have written your whole post. With the exception of having your deafness disbelieved and substituting that with something similar in concept.

I have realised too that my invalidation wounds go right to the centre of me. A lot of why they are there seems quite subtle and it is hard to accept that such things have had such an impact on me. And I seem to now how a rampant introjected invalidator that is out to destroy me in a truly cruel way. To add to the fun it seems I find being "seen" or being aware of reality intolerable and the invalidation may be protective at the same time.

Having my reality denied results in me sometimes having extreme annihilation experiences where I can see the molecules of my body coming apart and feel my "self" shattering. I think they are mostly depersonalisation but they edge over towards hallucinations. Sadly I suspect it does not say good things about my psychological health.

With the therapist before the last one I had seen her for 5 years and only realised near the end of that there was something very wrong. That there was so much I had unintentionally hidden. That there was so much I was not able to stay aware of. That there was some serious disconnect in the way I was interacting. I plucked up the courage to tell her I was suicidal and had self harmed around this time (it was the first time in my life I had ever told someone I was in trouble in the present). She did not believe me. And after eight further months of sessions about it she still didn't believe me.

She insisted that she "would have felt" if I had been feeling that way and much more. It cracked me open in ways that I am deeply ashamed of. And in ways that I don't think can be fully repaired. Its like an existing crack continued and something in me came apart that can't be put together again. The level of self hatred and shame about my weakness is hard to put into words. I can see why it happened in many ways and that it is totally to do with what I said and didn't. What I didn't show. And when I share it tends to be matter of fact and dispassionate. It also seems my dissociation was almost entirely seen as non compliance rather than what it was. And I had close to zero self awareness so it didnt even occur to me to mention that I often did therapy with me to the side watching the whole thing. Or that I saw "pictures" of past events etc.

She was also newly qualified and think knew extremely little about trauma. I know someone socially who has done the same course as she did and am astounded how little she knows. I did not know that I needed anyone different and was trying as hard as I could to appear "normal". Consciously on some level but also unconsciously in many deeper ways.

The only person I ever told was my husband, and no one ever shared they felt like that with me. It's good not to feel alone in this!

I am glad you shared! It helps me too. A lot! As does the fact that Pencil and MD relate too.

I actually had to have therapy with the lights off at one point as the whole experience of being in that room with t and her being exposed to me felt intolerable. Not that it helped.

Pacing myself but shall be back with more.

Thank you everyone.

 

[Leah123]

I want to suggest something, but please take it with a grain of salt. I really appreciate you for helping me so much, I feel a connection because some of the things you've shared are similar to my struggles, and I empathize, but... I know I don't know you well enough to do more than follow my intuition and read your posts closely. Based on those, I suggest that instead of focusing mostly on what's going 'wrong' in your head, why you can't talk, and what inner workings trouble you, that are hard to communicate, you give yourself permission to be very gentle, and talk about small, easy things to begin with.

I lost two years seeing a therapist because I argued in my head all the time about how to say things, and what I really meant, and if I could trust myself, and if I could trust her, and if I was being manipulative, or difficult, etc. In other words, my internal debate was so consuming, I didn't risk much, and I didn't gain much. Part of that was how hurt I was, part was a bad fit with the therapist, I think.

So, my suggestion, just for you to try on for size, would be to ask yourself.... if you found an experienced, reputable, trauma-focused therapist that you liked, could you talk to her about anything? For example, could you tell her what you ate for breakfast? Could you tell her about a show you watch and why you like it? Could you tell her about a hobby?

A good therapist will not rush you to force out all your worries, secrets, fears, and deepest struggles. A good therapist knows that needing therapy typically means we have GOOD reasons not to be trusting, and a good therapist will take the time just to let the trust naturally develop. If you're hurt and disconnected enough (please forgive me if I phrase that badly, I'm very tired) that you fear not talking for 47 minutes of the session, a good therapist will work foremost on easing your discomfort and very gently helping you feel safe, connected, and comfortable. It's OK for that to be a long process.

I can go silent for almost the whole session and only come out after with some effort on the part of the t. That may not happen online but if it did do you have any ideas? Can you see this playing out?

I do have a couple of ideas: my therapist likes to let me lead the conversation and although it's hard for me to open up, I truly appreciate it, because in the end I feel a greater sense of control, feel less manipulated, less as if I'm being graded, and less pushed. However, sometimes... I panic so hard or feel so mad or hopeless that even for me, a very talkative person, it is *extremely* difficult to say a single word.

So, there are a few things that help me.

1. I ask her if she will lead, and ask me questions. She will do this sometimes, and usually sticks with safer, easier, present-day topics to start with, in other words, she's gentle with me.

2. I write a lot- I don't wait for our session, I write the morning of, very often, but also other times when I'm feeling troubled, emotional, etc. that way, I do have something to share- I can just copy and paste it if I want to, but I don't have to.

3. I use music in the worst times, when I feel entirely hopeless or furious, I feel too scared to talk- I will give her a song link. She will listen, and sense something of my mood from that. It helps me just to know that when I'm feeling SO alone, someone cares and is listening to the same song as me- we're sharing something. If songs don't work for you, maybe poems would, or pictures of art, or anything at all that moves you- animal pictures, funny videos, anything at all. I even have shared a post here with her... that helped me a lot. But a key, is trust- I don't force myself to share if I know i will dissociate- I push my comfort level a little, but only after she's proven I can trust her, and only when I feel safe *enough* and have enough time and feel moved to do so.

4. When I can't say anything at all, no matter what, if I want to just stop the session, she understands, and tells me that she'll be around later if I need her. I feel a flood of relief even typing this right now! It's SO nice to have the flexibility of a freelance, online therapist who doesn't require fixed appointments!!! I do have appointments to guarantee our times, and to motivate myself to work on my issues, but... I have a lot of freedom to work with her when I need to or want to.

5. My therapist isn't afraid to share with me. If I need some empathy, she'll tell me about her life and past struggles. If I just need tea and sympathy, I can tell her, and she'll just give me a 'shoulder' to cry on. If I want to talk theory, she'll tell me about her psych studies and about her favorite concepts and people, like a Jung exhibition of mandalas she saw, etc. So... if I can't talk, sometimes I get a lot out of listening. One time, she even said, to end a session, let's each go have a cup of tea, and send a healing thought to one another, or, if I'm afraid/triggered, the other night, she said to me, when we're done, why don't we go watch a show "together" that's starting soon, it's very funny, we can have girltime and maybe distract you.

Sometimes- just *knowing* I can reach her later- the minute I end the chat or hang up the phone, I'm suddenly flooded by wanting to say something, and I'm able to send her a message or chat later when I want to.

I do hope it helps, and if I'm off base, I hope you'll ask me again or give me more info, and I'll try to do better.

It also seems my dissociation was almost entirely seen as non compliance rather than what it was.

P.S. That's the trouble I had for two years with that therapist also. So maddening now that I think about it!!! That's one thing I find actually *better* about online therapy- my therapist has to trust my words more, in the absence of body language, verbal cues, so she takes my words very seriously.

 

[franciemarnie]

Abstract, I can't tell you how much you are helping me (and no doubt innumerable others) in sharing your experience.

Denial of our reality, or I should keep it in the first person because I cannot stand when someone tells me how I am feeling or what my experience "really" is as opposed to what it is, denial of my reality was mind blowing and it 100% contributed to destroying my grasp on reality all of my life. It was almost like going thru life blind, always having to ask others what I see and where to go and what to do. Depending on their agenda, if they had one, it lead to dangerous places.

But in my formative years, this was how my world view formed. Others know the truth, my experience of it isn't valid. When I have had the courage to tell someone, particularly an "expert" (therapist) my experience and they denied it - whoa! Truly life shattering. My fragile conception of my life experience literally shattered by someone's opinion. And it makes sense given how my mind was formed.

I can identify with seeing your body's molecules coming apart. Again here - illness as metaphor, or our body trying to tell us something. When I was going thru one of the worst times, I remember how scary putting on make up was before work. (I used to wear a lot which makes symbolic sense, trying always to cover up the sense of inherent offensiveness.) Anyway, it felt and looked like my facial features were coming apart. It was terrifying. Knowing they weren't but feeling and seeing that they were. I'd have to focus - work on one eye, ignore rest of face, mascara, eye liner, move on to other eye, don't look at rest of face, move on, etc.

It was mirroring what was going on internally - the sense of coming apart.

The way I had lived, the sick way was dying but I didn't know it so it was terrifying.

Not too long after this, I told a woman who I had come to love and trust something that had happened long ago, something I had carried for years with guilt and shame, and she not only listened compassionately and without moral judgement, she pointed out something that made me see after decades that I had done nothing wrong and in fact great harm had been done to me.

I cannot put into words the relief that came over me mind, body and soul. It was the beginning of my climb back into health.

To have my reality dismissed and denied - truly annihilation of self.

To be heard, believed, and recognized as I am - my life was returned to me.

It would be great to have my own experience of self and reality be enough, to have it withstand anyone's denial, but I am not altogether there yet, which makes complete sense given my background, but I am on my way.

A dream therapist - and md and Leah and others seem to have found them - would certainly help enormously to rebuild a person's sense if self.

 

[Tinyflame]

I can't stay to write, and don't want to butt in, but I certainly relate to most of what has been written, the #33 post of franciemarnie especially. And I too forget (can't remember), also 'present' well, lose the words, cannot share what I feel. I too like this last post just revealed something, I am shocked what one has to deal with mentally and physically just having a reality confirmed. I had 'forgotten' what I was supposed to say to the mirror, probably only for a day but I think daily for now is necessary. I am used to not 'seeing' myself even in the mirror, also. So much of what has been written fits to a T.

I hope you find what's best Abstract. Invaldation- now that would NOT be. JMHO, but you are so expressive, I would be inclined to agree with MD, in person I would think would be most (more) helpful. If you are like me, too many defenses and ways to hide if it was solely online. And too many ways to cognitively 'reason' ourselves out of it. Best leaand bounds of progress seem to come in the facing and 'doing' of all of it.

Whateve seems the right choice, you can do it. :) :hug:

 

[Abstract]

Hi MD!

Thank you so much for your input.

I hope that's ok.

Its more than OK. It is very helpful. You said a lot that is important for me to discuss and contemplate. And you did not force anything on me. And it's good to have a different perspective so I can try on different possibilities.

in-person therapy is, simultaneously, almost unbearably difficult, yet critically important.

Yes! It's such a double edged sword. I think this says it in a nutshell.

mage in my mind of the therapeutic scenario/relationship that I can just imagine as being ideal for you.

That all sounded wonderful. Someone who is very intuitive and is able to deal with wherever I am and whatever I am dealing with and without pressure.

a time in my life when regular therapy and a standard therapeutic relationship would have been impossible for me.

Thank you for sharing. Nothing you have ever shared about your relationship with your t has made me think that there is anything unethical about it. Yes, strict CBT types would see it as a paid friend but there are many other approaches to therapy and we all have to find something that fits for us. Most of the therapy I had over all the years was very directive and it did not suit me at all. I believe it actually distanced me from myself even more than before. And so many of my problems relate to disconnection from self and self judgement. I only started making progress when I started less directive therapy. I love the idea of him letting you lead. Staying one step behind you.

It was months, literally, before I even disclosed I had a trauma background,

Thanks for sharing this too! Since I realised how little I disclosed in therapy in the past (despite having so many years of treatment) the internal pressure I have started putting on myself is enormous. And revealing anything is so counter intuitive and alien to me.

all of the connectedness and humanity of an in-person relationship, but all of the safety buffers of an online one, sounds like what you might be seeking.

Yes! I think so. I have been thinking about this more and there is something that is niggling at me when it comes to in non face-to-face therapy that I can't find words for. That does not mean that I dismissing anything at present.

recording them for later playback.

This is actually an excellent idea. I am not sure if I could do it for a few reasons. It may backfire. But it is certainly something to consider and theoretically would help me feel less out of control and afraid of what I am missing. Whenever I have potential solutions it helps me feel a little less hopeless.

One of the things I am not sure about is if it's possible that silent and face-to-face may be more healing than communicating more but from a distance. of course something going wrong would potentialy be more damaging too.

I never would have found the trust in myself, or in someone else, much less the self awareness, ability to articulate and personal insight, to allow me to get there.

Yes I understand this. And I am so glad you found someone who recognised this. Trust feels like an impossible step to take.

 

[Abstract]

OK. I think something has become a little clearer for me. Something about not being face-to-face that feels as if I would have less control. I thought about this and initially it did not make much sense as in some ways having the distance between us should give me more rather than less. And in some ways it would.

I think it could be about me not being able to read the therapist. I think it's possible that I would feel less safe/trusting not being able to read the cues one has access to with face to face therapy. Online relationships with others such as on here are different as people discuss a lot about themselves and therapists don't and shouldn't.

Tone off voice, that intuitive sense of something being wrong, that sense one gets of who the person is, are some of the things one can get in-person. You can get some of that through written communication of course but the person is much more able to hide things if they wish to. Another aspect of feeling safer is them being able to get some information from me when I cannot speak. Silences can be very misunderstood I have found. They may be even more so when not in person. Especially as it is very possible I will not be able to say what is or has happened for me.

 

[Abstract]

Hi Pencil! Thanks for answering this.

Not really, as there is a general fogginess associated with this.

Do you mean a general lack of information fogginess or something more?

Nothing was lost forever,

It isn't for me either. It isn't from dissociative trance as that, as as far as I understand it, would mean the information is not encoded in the first place. One thing that may be different to yours is that it is often very small chunks of time but patterned. In other words I can often remember all that happened but (for example) not that the person insulted me. And I can have a relationship with the person for a year and not know that they are someone who regularly insults me. Until something "switches on" and then I have access to all those moments and all at once. And am shocked to discover the person is not who I thought they were.

at I said something in session 1, in session 2 she reminded me of what we talked about, but I could for the life of me not remember what it was about.

This sounds close too. Actually your description sounds closer than any other I have found before.

It has taken me about 6 years of looking and diarising to get the amount of understanding that I now have.

I just wish I knew when I didn't know something. When something was missing.

Thanks for sharing.

 

[maddog]

Abstract, I think you are hitting on a really important realisation about the increased safety and control of face-to-face therapy... or any form of relationship for that matter. For those of us with a lot of fear and anxiety about relationships, it is quick and easy to default to the assumption that the less contact and directness, the better and safer. I know that was always my conscious view...

And then at some point I realised that I'd actually been taking the exact opposite form of security from my relationship with my therapist for a long time... I just hadn't realised it. Sometimes there is added control and security in knowing that the other person can read and infer some of what we don't or can't say. While this can at times seem threatening, if the rapport is good and ever-developing, the sense of reassurance is also ever-developing, and knowing that he is already likely to have read something into my silence, hesitation, body language etc, often gives me the courage to go ahead and say what I otherwise wouldn't have been able to. It's as though I can take some courage from the fact that he already likely at least partly knows, and so it won't be as difficult and risky as it would be if I had to tell him something he had no idea of...

But it also works in reverse. Being able to read non-verbal cues from the therapist is also very empowering, particularly as it allows us to notice and receive further forms of support, validation and empathy that go deeper than the words they say/write. So much of what constitutes true human empathy is conveyed through more than just words, and I know that some of my deepest memories of the times I have felt most validated and supported are actually times when neither of us said much at all. I just know that such powerful unspoken connection would never have been possible if we weren't sitting in a room facing each other, and while arguably you can do without them if the content of the linguistic exchanges is good, I think you gain that little bit extra... on so many levels.

Managing silence effectively and productively is actually, I believe,a very high order interpersonal skill that many people never master. But silence can convey a lot... and it's actually an incredibly amazing and empowering experience to be part of that, even if only occasionally.

I wish I could ship my therapist over to you... he'd love the holiday I'm sure, but I'll have to come too... sorry to be selfish!!

In all seriousness though, I don't want to put him, or any particular process, on a pedestal - I know you know that there are always bumps in any road and downsides to every relationship. For instance, while it's mostly been great that he allows me to lead most of the time, sometimes I flounder, and need him to be more directive with me, and sometimes that doesn't happen. Not saying that's got anything to do with face-to-face versus online therapy, just pointing out that every benefit can be a challenge at times too, and every relationship will form and norm in its own way and will require you to have to sacrifice certain things for certain other things.

Again just rambling... but I think you have amazing insight into what you need and don't need, perhaps it's more an issue of having the conviction to stand by those instincts... or perhaps I'm being presumptuous again, and if so I'm sorry. But really, your insight and ability to analyse yourself and others is extraordinary. I know, from personal experience, that that's only half of the battle and probably even more reason that a good therapist is necessary, but don't be afraid to trust what your analytical wise observing mind tells you... because figuring out what you need is the part of the job it can do for itself.

Maddog

 

[Leah123]

the times I have felt most validated and supported are actually times when neither of us said much at all.

I don't find that to be exclusive to in person therapy, actually! We enjoy long pauses in our chats, and they do help. We share songs, too, which conveys some of that nuance/context that's harder to find in exclusively written conversations. And the phone chats allow for those gentler, quieter cues to come through when I'm in doubt or want that more direct contact. The only thing I miss on rare occasion, is a hug, but honestly... that's a complicated topic and probably easier to avoid. I do have some real life supports though too, so... I imagine that makes a big difference.

I completely agree with Maddog that the key is for you to trust your instincts and conviction on this topic.

 

[Abstract]

Bloom,

Thanks so much for sharing!

I record my sessions now since I dissociate so much I lost the interaction entirely.

If you don't mind would you share how you found out that you were loosing so much? Did your t believe you? Any information on how this developed would be helpful.

You strike me as someone quite decisive and that self doubt is not a big problem for you. Would you say that is true? You also don't seem obsessive to me. Did hearing yourself in the recordings cause any problems?

Also if you feel OK to would you share what type if dissociating you mostly do, when you realised you did it and how, and what way your t managed the disconnect in your interactions. Did she figure it out before you? What would you have looked like in T?

No pressure. Thank you!

 

[BloomInWinter]

My CBT therapist knew I was very dissociative right away. He didn't tell me, though. Instead, he focused on developing trust, identifying the boundaries of where I would leave, and continually changed his approach with me to carve out a therapeutic 'safe space' where I didn't check out.

He worked also on teaching me how to learn to lower my activation level and how to tolerate distress. Unfortunately, since I wasn't a talker, he had to do this by going fishing with questions. For subjects I was reactive to, I'd get triggered. He helped me just by not reacting with anger or dismissiveness, but with tolerance and helping me name the emotions I was feeling.

Once you learn what it is and what it looks like, it stands out in stark relief against those who do not do it. I suspect this is why predators have such an easy time preying on people like us.

Wow, this is a hefty question and is making me think. My diary has my journey in it but of course, it's long and rambling. I'll add more to this later.

 

[Abstract]

Thanks Bloom. I appreciate it. It has been difficult for me as have had a lot of therapy over the years and only the last T realised what was happening. Essentially in many ways almost 20 years of off and on therapy was wasted in many respects. And I never thought of discussing trauma or thinking it was trauma.