What should I expect from therapy?

[TruthSeeker]

Every week it's the same thing. "how are you and what's going on?". Alot of the time we don't talk about me but about my kids or other things in my life. Is that normal or is there specific stuff I'm supposed to be doing? Am I just giving myself an excuse to quit?

Can you stay kinda grounded in the here and now and talk about the past? ....I needed my T to help with that. Maybe staying better grounding in therapy is a good goal.....??

 

[HealingMama]

As others said it depends on what you want out of your therapy. I was seeing a trauma therapist and would go in with a list each week of symptoms and issues in functioning to help paint a picture of where I was at. Now I see someone just to try to deal with my relationship problems, self care, present day stuff.

Part of the benefit of therapy is learning that it is safe to speak up when our needs aren't being met so I do encourage you to consider telling your therapist that you're not sure if your appointments are helping you. A good therapist can use such a statement to give you an incredibly fulfilling session.

 

[Deleted member 48866]

This is helpful. l need to work on past trauma in my life. l can't bury it , l need to talk about this.

 

[The Albatross]

I took a different approach... rattled like a tea pot for about 10-15 minutes after the first few sessions then would turn it to me or ask okay so 'nuff about them what are we gonna do with me today? Taking the reins and driving my own dialogue was an important part of the process.

 

[Mach123]

I agree with the above: what are your goals? That question in itself has often been too hard for me, and I’ll spend the odd appointment just working on that. What should my goals be? What can I improve? What am i avoiding?

My T starts each appointment the same way: how are you? She knows, by now, that’s not a particularly helpful question for me. But I also know - that’s my cue. I can go 2 ways with that question.

I can chat. About stuff. Sometimes that’s exactly what I need. Sometimes I do that because I’m just plain old avoiding the hard stuff.

The alternative, is I can use that question as a springboard for a hard work session. When she says “How are you?” My response is usually not all that much about how I am, so “I’m doing okay, so I’d like to talk about/work a bit more on...”.

I think people often misinterpret that initial opening of “How are you?” as common politeness (that’s the normal thing to say to a person you’ve just sat down with to speak to), or “My T hasn’t planned anything for today’s session. Again.”

Depending on the type of T, though? That’s absolutely not the case. Many psychotherapists deliberately let the therapy process be guided by you, at the pace you dictate. You decide what to work on, rather than them, and when that work gets done.

That is intended to build trust, but more importantly, leave control and ownership of the healing process with the client. Particularly with trauma patients, one popular theory is that the client feeling in control of the relationship, how quickly things move, what you’re prepared to talk about and when you’re ready to do that.

Trauma patients often come from a place where they have had little or no control over a significant relationship, and will naturally fall back into that dynamic. In essentially forcing the patient to take back control of their own healing, this type of approach is intended to help the patient not just gain the T’s trust, but relearn what a healthy relationship dynamic should be like.

It doesn’t work for everyone. For example, when Marsha Lineham originally coined DBT, she very deliberately forced patients to commit to a set process with fixed topics for each work, expectations about homework and preparation for the following week. That approach was because DBT recognised that, particularly for people who have BPD, they oftentimes come to therapy with a lot of resistance, and letting them control those initial skill-based parts of therapy was essential to getting anywhere.

With you? You’ve been journalling some really intense stuff, stuff that I think it would be helpful to have your T helping you process. You probably also have particular symptoms or function issues particular to you that you’d like to improve.

So, perhaps at the next appointment, you could go in ready with some notes about those things, and ask for your T’s help with (1) planning some therapy goals; (2) getting your T’s advice on the best way to prioritise and work towards those goals; (3) whether your T has their own thoughts about things they think you would benefit from working on; and then (4) coming up with a rough plan of how that’s going to work.

Your T is likely to keep starting your appointment with “How are you”, even having agreed the week before “We’re going to start processing my traumatic experiences so I can move on”, or “We’re going to discuss my children’s situation and how to manage that”. Because at each appointment, your T is likely to want to leave it up to you to take control of the process.

I hope that’s helpful. I floundered for a long time with seemingly endless, ‘wasted’ appointments where my T would ask me how I was and we’d spend the time discussing that, and ridiculously minor issues cropping up day to day, not realising they were waiting for me to stand up and say “This is what I need to work on - please help me with that, because I find it hard to just open up of my own accord”.

If it’s any consolation, some T’s take an even more rigourous approach to this. Freudian T’s are still around who will insist that any input from them is counter therapeutic. My sister spent several years with one of them, and since she didn’t want to talk? Many of those years the majority of her appointments were spent in complete silence, with her getting no feedback, inout or questions, and her (and her stubbornness!) quite happy to play the silent game! Not helpful!!

Yes I have to say I've told every therapist I've had that the "client centered approach" so common today, is total nonsense. If you leave it up to me to work on the stuff I need to do I'll get better I'll never do it.

In fact I'll make sure we work on anything and everything else. If I'm good at taking a direction I'm good at taking the wrong one.

I do think my therapist knows this and does it but I still yell at her occasionally and say "you're not making me do anything." Lol

 

[Deleted member 48866]

Thanks. After reading these responses, l realised that l need to talk about trauma from 18 years back. As l was thinking, my trigger trauma popped up and l realized l needed to unload this at my first session. Because l still struggle with it even though it goes back 4 years, it's a still very vivid thought. l finally accepted and realized 5 years later l am suffering from PTSD. I actually will work on issues. The first time l went for counseling, l was too raw from emotion , (battered woman syndrome) that l was too uptight to even have dialogue. Plus the counselor kept asking when l was going to date again, and that made me fall into major disconnect and l couldn't even call her on it. This time l will tell her what l need help with. I also found a female therapist, because l will feel better.

 

[Starfire]

[QUOTE="Zoogal,
Assuming you are just starting ...your T & you just getting to know each other? When getting to know each other, family & your daily life helps not only to establish a framework but allows T to see where your issue is bleeding into your life. Probably in ways you don't notice but T will. It also establishes safety. If you are like me, there were depths I didn't want to dive into. Learned I needed a safe place & safe person to explore it.

Now I can take time before a session to evaluate what is going on. What I feel needs immediate exploration. I make notes & bring them to the session. Sometimes it is a continuation from the last session. A new insight, a clarification, continuing story, a flashback.

Unfortunately *getting well* is not a defined 5 step process like changing a tire! Take care

 

[NightSky]

I used to feel like sessions talking about my kids or work or marriage were wasted, because what I really wanted was relief from the symptoms. It was probably a couple of years of a little bit of trauma stuff, how the trauma was manifesting, but a lot of day to day stuff I felt was pointless to talk about. Four years down the road, I see that none of that was wasted. The connection I have now with my T, and her deep understanding of the intricacies of my day to day (toddler not sleeping well, preteen’s anxiety, husband’s typical ways of relating to me, job structure and stressors etc) means we can cover so much ground with so little conversation. And she’s able to fit together a lot of things in the big picture I wouldn’t see. Because I’m too often drowning in a triggered state. And I feel so much safer and more grounded now that we are really doing deeper work because she holds that big picture in her mind when I can’t. There were many times if I felt I was seriously struggling and knew I would skirt the issues and stay surface if given the opportunity, I would email ahead of session. That really helped the parts of me that needed to talk, to he heard. But in my experience building the framework is very slow, at times extremely frustrating, but so worth it.

 

[TruthSeeker]

Yes I have to say I've told every therapist I've had that the "client centered approach" so common today, is total nonsense. If you leave it up to me to work on the stuff I need to do I'll get better I'll never do it.

In fact I'll make sure we work on anything and everything else. If I'm good at taking a direction I'm good at taking the wrong one.

I do think my therapist knows this and does it but I still yell at her occasionally and say "you're not making me do anything." Lol

I can totally relate!

 

[Sideways]

If you leave it up to me to work on the stuff I need to do I'll get better I'll never do it.

This is a big statement. I don’t doubt it, but I do wonder where the motivation comes from to attend therapy at all (maybe just wanting to get better, or life to be less awful, or...)? And if you can motivate yourself to get to the T’s office reliably, why hand over responsibility for your healing (is that the right word?) the moment the session starts?

There’s a tonne of reasons that might be. Just seems odd, in and of itself, yeah?

 

[Mach123]

There's me trying to get well and the internal abuser. It's a constant wrestling match. My behavior is self destructive but it looks almost positive like I never stop trying. Failure to flourish, why nothing works.

I'm stubborn I guess, I won't give up.

 

[Rumors]

There's me trying to get well and the internal abuser. It's a constant wrestling match. My behavior is self destructive but it looks almost positive like I never stop trying. Failure to flourish, why nothing works.

I'm stubborn I guess, I won't give up.

I'm reading a book about parts and trauma responses. It make sense that the ways we coped as kids play out in our adult self. Each of those skills we learned as kids, good or bad, are why we survived. It also can account for our "stuckness" when our adult rational self thinks we should be further along in our healing. It also talks about left brain/right brain thoughts. I can't put things in to words and I totally lose my vocabulary and how when bad things happen to kids the two sides don't integrate thus the bad memory stays stuck without integration. Then, you resort to different ways to cope with the memories in order to fulfill everyday life. It makes me feel like I am not so crazy bc I can parallel so many things with what the author writes.
You aren't failing to flourish. You haven't had help addressing the parts that haven't integrated and those young coping skills make it impossible to integrate because they are screaming "danger/danger/danger" Be kind to yourself... you are awesome!!!