Where Did The Therapist Come Up With This Stuff????

[gymmgirl]

Hi everyone,

Yesterday my therapist provided me with a list of his diagnoses of me (characterized into primary, secondary, and other), as well as his treatment plan which included long-term goals, short-term objectives, and the therapeutic interventions he will use. I had asked for a general outline of the plan for the course of treatment so I could attain a better understanding of how this therapy thing was proceeding - I already knew that PTSD would be the primary, and that there would be something related to the marital issues I am currently having, but didn't know what else the therapist was thinking.

Some of the secondary diagnoses bothered me a little, but considering they are only "labels" I can deal with them for now even though I don't agree that they relate to me. I wasn't given the opportunity in therapy to read through the document, only to look at the list of diagnoses, but when I did read through the entire thing, I became extremely irate and frustrated. I felt that some of the long- and short-term goals were completely irrelevant (and insulting) to me, and I felt that the therapist had not listened to my concerns or issues with my marriage.

Relating to my marital issues, my husband has been coming to therapy with me, and he has also had an individual session with the therapist, as after almost 6 weeks of separation, he is still not sure whether he even wants to work on the marriage because he thinks I am so broken that it might not be worth his effort. My husband said that in his individual session they just talked about his feelings and very little about me specifically.

One of the major things that I am struggling with is that only I was given this type of document – my husband did not receive one. Obviously I have more issues (thanks to the PTSD), but considering that we are also doing marital counseling, and that my treatment plan also focuses on the conflicts in our relationship, I am not sure why my husband didn’t get one. It makes me feel that everything my husband has said to me in anger and frustration (I am 100% to blame for everything; he has done nothing wrong ever; the feelings I have are not valid and are all in my head; and he doesn’t see why he should have to change at all because I am the one who is broken) is actually what the therapist thinks too. I know that I may have an altered perception of things, but I am not that far gone that I can believe everything is in my mind.

For example: I was upset that my husband applied for a job in another state and didn’t tell me about it, but had been looking online with his parents at houses for us and his parents to move into. My husband claims that it is unreasonable for me to be upset that he told his parents about the possible job and not me, and that because he was looking at houses for us, I have no right to be upset that he didn’t tell me that he applied for the job. To me, this is an issue, and I would have thought that most people in my shoes (PTSD or not) would be upset by this, but the fact that the therapist has ignored this (and the many other things like it), has me very upset.

As for the issues I have with the irrelevant goals and objectives, I am not sure if my husband said some things to the therapist that lead the therapist to believe them (although my husband says he didn’t), or if the therapist just came up with them on his own. For example: I need to show a commitment to specific steps that will be taken to ensure no more physical violence will come to spouse, as well as making amends and restitution for the physical hurt caused.

I have never once in my life intentionally physically harmed anyone or anything, let alone my husband. I do not believe in violence (considering my PTSD stems from multiple attempts on my life) and have never done anything to even give the slightest feeling that I am violent or could become so. I specifically asked my husband about this, and he says he never mentioned it, and that he also agrees it is not true.

I have already been fighting so hard to be open and honest with the therapist, but this is such a slap in the face that I just want to throw in the towel, but I know that if I do that I will not only lose my marriage, but also the shot that I currently have at getting this disease under control. During the therapy sessions, I always felt like the therapist was listening and understanding, and some of the vulnerability and anxiety associated with therapy was waning, but now, I feel like I have taken four steps back. It is also a red flag that the therapist created this document the same day my husband had his individual session, and that has me very concerned about what my husband said – I want to believe what my husband says – he promised he would not lie to me anymore, but……

I am wondering if anyone else has experienced anything like this, or has any advice?

 

[Queen Boudica]

I guess I have a question.

Why do you want to save your marriage? Do you feel that there are good things in it. Do you feel that your husband loves you? Have you been happy? Does he make you feel happy? Do you have common goals? Do you relate to each other on the same level? Does he respect you? Do you have fun together? Is there any glimmer of happiness?

I don't know when you write that your husband has told you that

you are 100% to blame for everything; he has done nothing wrong ever; the feelings you have are not valid and are all in your head; and he doesn’t see why he should have to change at all because you are the one who is broken

That does not sound like a husband who is working on the marriage or cares for you at all.

And the bit about finding the house and not telling you about the possible job and house. Well sorry, that is just completely ignoring you. IT IS WRONG.

I would find an independent therapist who focuses on you and not your husband. You have the right to a second opinion and personally from what you write, I think you need it.

Just because you have PTSD does not mean you are paranoid or in the wrong.

I have just been going through all this with my husband. So maybe I am biased. The marriage counsellor believed him, hook line and sinker and just wanted me to work on the marriage despite all the stuff he has done, including being violent towards me, emotionally abusive and controlling.

Luckily I have an my own psychologist. Therapists are not infallible. Get another opinion.

 

[anthony]

I would simply go back and question your therapist... because goals must be a combination of their clinical experience backed by explanation which you understand and approve, but more importantly, what you want to achieve from therapy. Therapy is not about the therapist... however; if you are paying them to get to x, and you want to stop at n, then you're employing them to push and motivate you towards x. Saying that, goals should be an agreed discussion, not a, here it is and suck it up, approach.

The document may simply be for you to read, then question them in the next session. That is what you should be doing, raising your concerns with the therapist and agreeing on mutual goals. If the therapist doesn't listen to you, then they are not a good therapist and not the person you want to be seeing to treat your PTSD.

The secret for a professional viewpoint, is that any professional should know that the goals are really quite flexible, and with the right questioning by them during the process, they can get you to see different things that they see, and you will change the goals yourself, being your decision... so a good therapist shouldn't need to force something upon you, because to some degree, they should manipulate you in the right direction, for your best interest, not there own, which is how therapy works. It really is a subtle form of manipulation for a greater good, not a negative purpose.

 

[ronin47]

Where you mainly frustrated because the goals did not relate to your marriage as much as you'd like?

You can't have a whole and happy relationship unless you are each whole and happy on your own. In all honesty I think that may be the stance your T is coming from. He may want you each to have your own space and your own "you" time so you can each be whole and happy on your own so as not to contaminate your relationship with eachother. Right now your marriage is a giant tangled mess. You need to unravel it and straighten the threads out before you can try weaving it back together again.

Also, you should definately communicate with your T about anything that you think is being misrepresented. I know your husband promised he wouldn't lie, but the rest of his current behavior puts a significant dent in his credibility. That's something that's important to do in many situations, communicate. The other day, my boss had asked me to do something and I didn't do it by the date that she'd requested. Even though it was hard, I went into her office and explained to her why asking the other employees to volunteer their time for the program I was in charge of made me uncomfortable. She was actually very receptive and I felt much better afterward. I know it's not the same as talking about your marriage with someone, but I'd be willing to bet you'd feel better if you spoke with your T directly and voiced your concerns about the implication that you've physically harmed your husband.

 

[gymmgirl]

Hi everyone,

Thanks for the suggestions and questions to ponder. I do plan to address my concerns with my therapist when I have my individual session next week - I don't intend to give up on therapy, I just have a very strong desire to know why these things are part of my plan, and I am trying to avoid the temptation to just accept things that I don't feel are true and feel even more worthless and broken than I currently do.

I'm actually pretty happy with the overall plan and treatment for my PTSD (although it will be challenging), the frustration and anger stem more from the feeling that I haven't been heard (or what I have said hasn't been valued or deemed relevant) along with the contradiction I am experiencing about whether I am 100% to blame for everything wrong in my marriage, and life in general.

Ignoring the marriage for now, the therapist has spent countless hours trying to change my way of thinking to get me to realize that I am not at fault for my mother attempting to take my life multiple times. Yet part of the treatment plans states that I have to accept the role and responsibility I played in each instance (there were 9 total, one when I was a few months old, and the rest aged 17 onwards), and then write a letter of apology to my mother apologizing for everything I did to contribute to the situation. To me, this is a complete contradiction - am I partly to blame or not? Even with my low self-esteem and negative self-talk, even I can't draw a line as to how I shared responsibility in my mother attempting to take my life when I was a few moths old!!!!!!

As for the marriage, that is a whole separate ball game. I do still want the marriage to work and be successful, but I am also well aware that it takes two to make that happen, and currently one person isn't sure that is what they want. I am OK for now with my husband needing complete space away from me and time to think (although for my own sanity and planning, he will have to make a decision one way or the other soon - not necessarily an action, just a thought as to which way he thinks he wants to go), but a lot of my treatment plan calls for a support network (which I don't have without him), and also a "babysitter" to note down their observations on how I react in certain situations, and after certain interventions (which the therapist has indicated will be him).

I just don't understand how someone who barely communicates with me outside of therapy (I get emails, not even phone calls, when he needs to let me know something, and he has asked that I only contact him in an extreme emergency), can take on the role of observer and supporter. I am also struggling with how I am meant to open up and make myself vulnerable (which I struggle with), when I don't feel any love or respect, let alone support. I have voiced these things twice previously, but they seem to have been ignored.

This thread sounds like I really dislike my therapist, but that is not the case. With the exception of this treatment plan, I have felt that he has been listening and understanding, and has had my best interests at heart. I guess I just have to organize my thoughts and questions and present them to the therapist and see what he says. There are many more examples than what I have posted, so maybe this is just a test by the therapist to see how I react - I know he is trying to completely break me down so he can build me back up - maybe this is just testing my ability to cope with things he knows I struggle to cope with.

Questions, comments, queries, concerns, and advice always welcome!!!!

 

[anthony]

Are you positive there is no ambiguity between what you are reading / interpreting, and what the therapists view is?

 

[gymmgirl]

I have thought long and hard on that, and anything that I wasn't 100% certain of I dismissed (erring on the side that the therapist knows better, and my perceptions may be skewed), but I was still left with a few things were just exasperating.

A few of the examples are:
- I know that I never used physical violence on my husband or anyone.
- I know that I have never been aggressive or argumentative with authority figures.
- I know that I have never lost friendships (excluding my husband - and he is addressed in his own section) based upon my "antisocial behaviors"

I did also ask my husband whether he could help me identify one instance where any of the above occurred and he couldn't, so I do have a little validation that what I think is actually the real truth (then again, the best explanation for how these ideas came into my therapists head are either from my husband's individual session, or through the therapists carelessness in putting together the plan, so perhaps my husband isn't the best validation!!!!)

I don't think I will know the answer until I ask my therapist.......I just need to stop obsessing over it until then, and try not to let it get the better of me and retard my progress any more than it currently has, or let my negative self-talk and low self-esteem claim this all to be true. Both those things are destructive, and I need to alter my destructive behaviors in order to overcome / control this disease.

That's why this forum has been fantastic for me - I can read about what other people have experienced, and I can get feedback from people who have been in my shoes.

 

[Queen Boudica]

It sounds a very confusing place to be in. And I really feel for you.

Think you need to ask some hard questions with your therapist like why she thinks you have been violent? Is that from your husband or is it something you have said or done to give her that impression? And the stuff about writing a letter to your mother, think you really need to understand why? Doesn't make sense to me when I read what you wrote. You need to understand why you are doing it, surely?

My experience with my therapist is he does say stuff that I don't get sometimes. And I can get a bit paranoid about stuff. And I think, he just does not get it. But, generally, if I go home and think about it and work on it I can see where he is coming from. And I can dismiss my paranoia eventually. And now I can see he was right about lots, I've had to work on that and check it out, but I think he could see it very early on and I could not. I feel like he is on my side, even though I know I have to do a lot of things I never wanted or thought I would be able to do.

I'd be very concerned if he was asking me to work on stuff that I knew 100% I had not done. That just sounds wrong. And that is how I felt about the marriage counsellor, but I think I would have done exactly what she had wanted, if my psychologist had not been there to help me out. And that would have been wrong. He is getting me to trust my own judgement. I definitely can see that now, even in the past week with things that my husband is saying and doing. Sorry I'm going on about my stuff, but it does sound like there are paradies.

Yes, I would question until you are sure what you are being asked to do and you are happy with it.

I really wish you luck in this and hope you find your answers. Hope that helps.

 

[ronin47]

Interesting that he suggested you write an apology to your mother. That reminds me of the apology I gave to both my mother and father. I was a small child when they inflicted the trauma they did on me. But since I had become an autonomous adult and started real therapy I came to accept the fact that my parents were not going to apologize for what they did, and if I wanted a peaceful relationship with them, I was the one who was going to have to take the initiative. So I apologized to them. I knew it wasn't a gaurantee they would change anything they'd been doing, but if nothing else it was a way for me to almost let go of the relationship with them, as paradoxical as that probably sounds. By apologizing to them, I could take a deep breath and confidently tell myself that I had done the best I could to improve my relationship with my parents. If anything negative happened between us after that, I didn't have to be stressed about it because there was nothing more I could do to make things different. Sort of like..."Okay, I've said sorry for my part, however small or arbitrary it was. I've said said sorry for anything you may have thought I did wrong. Now, if you're still bitter or angry, it's on you."

I don't know if that makes even a tiny bit of sense :cautious:. I know I was a small child when most of my trauma happened and I couldn't have been expected to know how to handle it. But that was then, this is now.

Sorry, bit of a digression.

 

[anthony]

A few of the examples are:
- I know that I never used physical violence on my husband or anyone.
- I know that I have never been aggressive or argumentative with authority figures.
- I know that I have never lost friendships (excluding my husband - and he is addressed in his own section) based upon my "antisocial behaviors"

So your therapist came up with these points of concern, yet these points never actually existed!

Is that correct?

If so... then I agree, you have a lot to be concerned about with the therapist if that is the case.

 

[gymmgirl]

Hi everyone,

Thanks for sharing your stories and suggestions......believe me, it does help. I am feeling a lot calmer today :-)

Anthony: the answer to your question is yes. These are things the therapist came up with, and these are not things that I have done / currently do, nor are they things that we have even discussed.

Considering that I have calmed down, and am no longer chronically obsessing over this plan, I feel I am in a much better place to get through the weekend. Then I will be able to discuss my concerns and ask my questions to my therapist early next week in a clear and logical fashion and go from there.

Thanks for all the support - it is much appreciated.

 

[anthony]

Then I will be able to discuss my concerns and ask my questions to my therapist early next week in a clear and logical fashion and go from there.

That sounds like a veryyyyyyy good plan. I would be questioning the therapists motives and view of what your problems are... therapy 101 training, is NEVER go off on some route that the client is not aware of. That is a typical psychoanalytical approach... where the psychiatrist / psychologist 'thinks' they know what is best for the client, but aren't listening to the client in order to discuss with the client what is 'actually' best and what the client 'wants'.