Therapy Difficulties - Online Therapy An Option?

[BloomInWinter]

I felt like all my other years of therapy were wasted, too, once I found out about how much of my life has been lost to dissociation. But now, I realize that those therapists were helping me based upon the best info they had available at the time, and they kept me alive. So I don't believe any of it is a waste, but I sure do wish we had known.

 

[BloomInWinter]

Since this is a thread about online therapy, I'll post about my own dissociation in the dissociation section. I don't want to drag this thread off-topic.

I will say that online therapy is far better than no therapy. But the most growth I have had occurred because I forced myself to keep going back to that therapy room, knowing I'd keep being triggered, feeling the apprehension and fear and doing it anyway.

Because my therapist kept responding differently each time, eventually, my system learned I'd be safe in that room. That I could speak up for myself if it was too much for me.

...and I crossed over into the land of fully living for the first time ever. Once I learned what inner safety felt like and how to keep it, I could take those skills out in the real world.

That truly has made all the difference.

 

[Abstract]

Bloom, I do realise that therapists in the past only did t in accordance to what they knew. What we knew. Probably made worse by none of them being trauma t's. That does not mean that I don't have moments when my head reels with realisations and shock that they could have got me so wrong. With shock about what I did not know about myself. With questions about their lack of knowledge. Especially the one I saw for 5 years - my second last therapist.

There were many other things I got from therapy and would not be here today without having had it. Even though it damaged me and slowed my healing in other ways. And so I couldn't choose to not have done it if I could do it again as in the end I am still here and a trillion times more self aware.

I don't want to drag this thread off-topic.

Please do not worry about taking the thread off topic as feeling that I and a t can deal with this aspect of therapy is central to what I decide would work for me. Therapy at all - online or in person. But another thread would be good as well and any answers to my questions appreciated. Things such as the recording of sessions etc are very relevant. Just to be clear too - I don't have DID.

Thanks.

 

[BloomInWinter]

I meant no minimization of the pain and shock of realizing the depth of loss that comes from discovering only now the truth of the depth of our injury.

There is a full grieving process with discovering such a basic truth of my damaged self that I think has been even worse than the PTSD diagnosis. It's like discovering that the person I thought I was turned out to have been a costume and now that I know my true self, I'm furious, grief-stricken, disgusted, and profoundly sorrowful of what essentially has been a lost life for over four decades.

I wasn't trying to tell you how you 'should' feel or that isn't a deeply painful journey to self-discovery. Just that eventually, I have finally come to a place where I can accept my reality as it is. Also, I no longer feel like nothing was accomplished along the way, since I felt that for so long. Even if I had never before lived as the true self, I still did have some measure of life, since I made friends, found loved ones, and survived.

But until someone pointed out the costume, helped me take it off, and survive the tidal wave of emotions that came with it, I never knew my true self. I still find it shocking and distressing. It's a journey, for sure.

 

[Abstract]

I understood your meaning Bloom, thank you. Didn't misunderstand you.

I still find it shocking and distressing.

It is shocking and distressing. Thanks for saying it is for you too.

 

[Abstract]

Dear Leah,
Thank you!

and I'll try to do better.

Please know that this isn't a case of anyone doing well enough answering me or anything like that! Any support I give is without strings attached. And any support given to me is just about that person can offer and what I can take from it is totally down to me. Noone elses responsibility.

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 understand what you are saying and think it is very relevant of course. I wish I could do that. Unfortunately the problem is that doing that in the past has ended with me being damaged by therapy. I am afraid I can't trust that I am going to be understood sufficiently to be "safe". Not when it has repeatedly proven to backfire in the past.

When things happen again and again and again then the only possible conclusion I can come to is that something about how I interact has to change as that is the only common factor - me. And that is why I have now practiced hard online (for about 2 years now) to try to break down some of the walls it seems were stopping me from getting help. And I have to say I am two hundred times more open. Fear of the possible consequences of not doing so helps to mitigate the fear doing so. More recently I have thought that the right therapist would have been able to see me and help me regardless in the past but I am afraid I have no trust of that happening.

So although I want to avoid rumination and self doubt and I try very hard to contain it, if I am realistic I know it is bigger than me at present.

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.

The trouble is that this has never happened for me. Ever. In all the therapy that I have had. And probably largely because I am unable to show that I am as vulnerable as I am, share what is happening inside me or ask for help. And because the signs of these things were totally misunderstood and seen as non compliance.

let me lead

The lead or be led dilemma is a huge one isn't it?! And both are useful. Someone not being directive in general works much better for me. But having someone start the conversation sometimes would be very helpful. And in the way you describe.

I don't wait for our session

That would help me too and I have done this is the past too. I do a lot of preparation always.

music

That wouldn't work for me as music and other creative means of expressing my feelings would feel more vulnerable not less.

if I want to just stop the session

The problem is that I would not be able to indicate that I wanted to stop the session if I react as I have in the past. I would not be able to do anything.

If I just need tea and sympathy, I can tell her

This is another example of the problem. I would be very unlikely to be able to say this.

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

It is terribly maddening! Sorry you went through this too. Actually very hurtful and crazy making rather I find for me. Again, the problem may be that I won't be able to say the words. We seem very different in that respect.

I think I have a bit more clarity about our common experiences and the differences between us that are relevant to what may influence what would work. We have much common ground but it seems to me that you are very brave and skilled in expressing what you need and don't need, what you feel or are experiencing and even using creative means to express these things when words fail you. That when you are unable to talk you are eventually able to communicate that that is the case and end the session and that you are never left with a situation where you are unable to end it at all. I don't mean that any of this is easy and realise it is very difficult. And I think its all a credit to you. And if I have any of it wrong them please feel free to tell me! I think to sort through this I have to look at how I am likely to react.

The main point I was concerned about with dissociating and not being able to reply is that there could be no end to it if there was noone there to get me out. So all the communicating of how I was feeling or any of those things would not be possible. It may not happen online but I would want some idea of how it would safely be managed if it did.

I do have a couple of ideas:

So sadly most of those things wouldn't work for me if I react as I have done in the last lot of therapy I had.

To give you an example of how therapy mostly went last time:
Abstract approaches therapy practice. Stands outside for 10 mins wanting to run away. Forces herself inside. Enters therapy room and starts feeling spacey. T enters and spaciness increases. T asks "how are you"? Or "how have you been"? Abstract attempts to answer and finds that the vocal cords are not working. No sound comes out. She tries again and in seconds is "gone" completely. T tries repeatedly to get Abstract back. Abstract may get to say a few sentences over the whole session. Leaves T and can't remember anything about the rest of the day or longer.

I am still keeping an open mind about everything. The wonderful thing is that I have been able to stay with this thread which is big progress from before.

 

[BloomInWinter]

I had many sessions like that.

Once I realized what was happening, I started to attack my anticipatory anxiety building up to the appointment. I took my i-pod and listened to music in the waiting room. I also got there at least 15 minutes early so I could have enough time for the anxiety to run to the apex of its course and enter the letdown phase before my appointment began.

Though still anxious, it began to get better. I didn't know it was dissociation causing me to switch off. I did notice that in the real world and in therapy, I seemed to have a hearing problem, even when I'd try to listen.

I told my Cognitive-Behavioral-Therapist this by saying "the's something wrong with my hearing....when you're talking my ears seem to shut down. I can't hear or remember what you're saying. I'm not trying to be rude or inattentive. I just can't hear you."

I remember the look on his face. He seemed pleased, which frightened me. He said "I'm SO glad you told me. That's something we can work on in here!"

I felt ashamed for some reason. I could only mutter "ooooookayyyyy....."

He began testing topics of conversation which were not triggering, until we both discovered that he could ask me questions about some of my job duties without triggering me. So, he'd watch me for signs of dissociation and engage my right brain to help lower my anxiety.

But I still kept switching him off about other topics. So, I told him that, though usually I didn't realize I did it in itt until I listened to the tecording. I asked him if it would be ok if I recorded our sessions so I could listen to them before my next appointment so I could actually absorb what was being said.

This was WAY outside his comfort zone. I could almost hear the wheels turning in his head. They never used to allow that. He had to ask his supervisor. They did decide that people with PTSD had valid needs for being able to do so, and I got permission. I bought a little digital recorder, and it was like magic to me.

Listening to us between sessions, on my own time, when relaxing at home in a safe place allowed me to hear the content and inflections in our voices. I discovered that he truly said things in a completely different manner than I experienced them in session.

I began to trust him more, and began to understand that my traumatized brain was often pushing alarm buttons that didn't need to be pushed.

It allowed me to see that the abuse wired me fantastically well for safety from threats while in real danger, and absolutely worse than useless for everything else.

I was imprisoned by my defenses. I literally shut him and everyone else off automatically on cues from appearance, smells, the appearance of light, objects in the environment...and far, far too many unknown combinations. The original traumas were literally buried under a mountain of generalized fears and avoidances have been very time consuming and frustrating to identify.

But every single avoidance I have confronted, I conquered. By being triggered by my senses then brought back in the therapy room, I learned how to identify and employ the skills for dealing with the emotions and allowing them to be experienced safely.

After so many over the past several years, now I trust the process of transforming trauma into post-trauma. For me, it requires fully experiencing my fragmented memories with the emotions and cognitions as well.

I have to walk right up to it, but employ my skills to stay within the window of tolerance. My therapists watch me for signs of flooding and pull me back out if I'm getting overwhelmed. We try, and try again, and it can sometimes take weeks for me to finally navigate safely through. But we don't give up. We learn something new every session.

No efforts are wasteful, I've learned. Even if nothing but getting through it happens, I still can use that as a way to strengthen my inner resources and work to develop them further when I'm not triggered.

This is the hard stuff, for sure. I have great compassion and understanding why most people just can't do it. I won't beat myself up for finally not being able to do this work anymore, or take a break.

Dissociation is a prison made up of cells of avoidance. It takes a long time.

 

[maddog]

I think Bloomin's last post is an excellent and very poignant example of what face-to-face therapy *might* (and I really do stress that is only a tentative *might*) be the safest and perhaps even the only way to help you navigate a path through the dissociative anxiety barriers.

When speech and any other form of activity and input are unavailable, there is no other means for the therapist to observe and respond other than by watching you for subtle non-verbal signs of dissociation (having occurred or impending) or discomfort. Bloomin's therapist was obviously skilled at such observation, which, when combined with her ability to articulate the difficulties at a time when the dissociation wasn't present, obviously created a workable way forward.

Abstract, I think your summary of the differences between yourself and Leah at this stage was very honest and probably very true. Personally, it gave me much pause for thought, because I think I am stuck somewhere between these two states at the moment. But whichever way, I think that unless you can be reasonably confident that you will not lose your ability to communicate at all, in some form or other, during online therapy, there is some considerable risk in this, particularly if you are alone and without direct support in your real world at the time.

But I do keep coming back to the fact that there are huge advantages in written or other forms of indirect communication too, and a good therapist should be open to your making use of them. Sending e-mails to my therapist in advance not only helped me to communicate, albeit indirectly, with him when the need spontaneously arose between sessions, but also allowed me to find the right words, with the time and space to do so, that I would have struggled to find when highly anxious and stressed during therapy. It also meant that he had a good insight into my likely emotional state when I arrived, based on what I had indicated I wanted to talk about, and could lead me through the early stages of that discussion with a degree of insight that wouldn't have been possible if he hadn't already had some information. I think my own distress and numbing would have been too overwhelming to allow me to continue if he hadn't been able to give me this added guidance early on.
So while I'm obviously advocating for face-to-face therapy overall, I'm also a strong supporter of other forms of sharing and communication if these work for you and help to lessen your anticipatory anxiety even just a little.

I truly recognize how significant it is for you just to have stayed engaged with this thread. I hope that saying "well done" doesn't sound patronising, because it's meant sincerely. It takes enormous courage and determination to be so honest about your situation here, and I hope there is at least a little empowerment in it for you. You deserve a skilled and safe and empathic therapist so so much...

Maddog

 

[Abstract]

Having a bit of a hard time. Same old same old.

 

[franciemarnie]

But it can feel as intense as the first time can't it?

I am sorry you are having a rough time. That was me three or so days ago. Just ready to break, but thank goodness it went away. For me that time, it was a case of releasing a bit of trauma. The days leading up were awful.

I don't know what is going on with you, but I am sending healing wishes and energy to you wherever you are tonight.

 

[maddog]

Warm thoughts offered to you too Abstract, hope you're ok.

Maddog

 

[Abstract]

Was wondering if I would be able to start again so am grateful I am back. Was once again consumed by self hatred about me making everything up and leading everyone astray. Making them think there is something there when I am liar and an attention seeker. And when others have real things to deal with. Just trying to ignore all that and continue. "Talking" is always complicated.

Thanks for your input Franciemarnie.

I had no idea for eg. when I was tired.

Oh me too. In fact to a certain extent I did not know if I was hot, cold, tired, hungry, thirsty, angry ... anything. Most of the time it did not occur to me to check. And when I started checking in with my preferences (for example food preferences or clothes) I would be hit with waves of pure fear.

Now after a few years, I can "see" me better and I can tell instead of relying on others to tell me my reality, which is what I grew up with. It's a small thing but representative of my near complete alienation from self..

That's wonderful! Good for you. Yes me too. The part that is the hardest is to do with trauma and the inner workings of my mind ... such as dissociation etc. In other areas of my life I am quite outspoken and even opinionated these days. I don't feel any need to go with the masses in my work environment or discussing politics or books for example. But other stuff.....

Depending on their agenda, if they had one, it lead to dangerous places.

It seems that when I am in danger or someone problematic comes along I become what I call a zombie. Infuriating and frightening. Like something takes me over. Sorry it led you into danger.

When I have had the courage to tell someone, particularly an "expert" (therapist) my experience and they denied it - whoa! Truly life shattering.

This is the arena that I am most vulnerable in. I think they say that t's are like surrogate therapists for us and I wondered if that is what it is. As long as I am not discussing my mental health it is OK mostly. Touch on that and I am eggshell fragile. Thanks for sharing. I have a lot of shame about how I reacted to that therapy situation so hearing that helps me.

I used to wear a lot which makes symbolic sense, trying always to cover up the sense of inherent offensiveness.

I had similar feelings but expressed them in an opposite way. I would not wear make up as it felt like putting lipstick on some faecal matter - absurd and probably nauseating to see.

it felt and looked like my facial features were coming apart

Sorry franciemarnie. It does sound very similar! I think its a graphic representation of what is happening inside isn't it?

it was terrifying

I find it terrifying now but I have a vague impression of it happening throughout my life at home and like with everything else I seemed to just not "register" what was happening and never "thought" about it. I don't think I will ever be able to get my head around that.

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

Yes.

to have it withstand anyone's denial,

I too wish I was sure I could and would but when it comes to discussing the past or my inner self then I know I am still very vulnerable.

The other thing I find is that my understanding of reality when it comes to my inner self changes. I don't know any better way to say that. I worked very hard on developing my self identity and self and feel I have largely been successful. Probably more than others in some respects. And yet things are still not cohesive. Its like I loose things.