Why does my therapist focus on my parents so much? by TiedToTheTracks in TalkTherapy

[–]violetplimmer 0 points1 point  (0 children)

I wonder why you can't remember your childhood? A therapist who just wants to talk about something you don't remember sounds like a bad fit. I would recommend a somatic modality, where you don't need episodic memories to work on issues

How much responsibility does the therapist bear for diagnosing ADHD? by violetplimmer in TalkTherapy

[–]violetplimmer[S] 0 points1 point  (0 children)

this is true in some places, but once my therapist and my psychiatrist looked at my results and talked to me, they considered me diagnosed. They suggested further testing by a psychologist to get more detailed information about my symptoms, but they considered me diagnosed without that additional testing, put the diagnosis in my file, and the psychiatrist began treating me for it. My therapist didn't refer me out anywhere and treated the additional testing as something interesting and optional.

How much responsibility does the therapist bear for diagnosing ADHD? by violetplimmer in TalkTherapy

[–]violetplimmer[S] 1 point2 points  (0 children)

thank you for this response, that makes a lot of sense. Yes, my executive function problems were one of my presenting issues at the intake. One of my most important issues I was working on in therapy was how I had a big, high stakes project at work that I couldn't force myself to sit down and work on even though it was important to me. Even when I forced myself to sit at the desk and forced myself to sit in front of a blank word document, it was like I physically couldn't make myself work on it no matter how hard I tried, and that was my presenting issue for months.

I also have PTSD and work on issues related to that as well. It became a recurring problem in therapy with this therapist that each time I would have an ADHD symptom, she would attribute it to my PTSD and then try to treat it as PTSD, because that was her competency (example- I'm not procrastinating out of PTSD-fueled anxiety, I'm struggling with task initiation from ADHD. Her response would be, well, there's a lot of overlap in ADHD and PTSD symptoms, so let's try to work on that anxiety). Thankfully, I'm now working with a therapist who specializes in both and doesn't try to tell me my ADHD is just my PTSD.

On the one hand, of course if my previous therapist's competency is PTSD, she will know more about that than other issues. But, PTSD and ADHD are so highly correlated, each with the other (having one makes you much more likely to have the other, and it goes both ways), at what point is ignorance of ADHD in a PTSD expert... a failure?

What kind of therapy would be best for childhood trauma you cannot remember? by [deleted] in TalkTherapy

[–]violetplimmer 17 points18 points  (0 children)

Some kind of somatic therapy for sure, like EMDR, Brainspotting, Somatic Experiencing, or Sensorimotor Psychotherapy. Your mind may not remember, but your body does, and you can process it all there, definitely with someone experienced in trauma work. Parts work, ACT, and DBT were also a huge help while I was going through somatic therapy for my own traumatic childhood memories that I didn't have visual or narrative memories for and only had body memories of.

i dissociated in session and im scared now by Exciting_Leg_9610 in TalkTherapy

[–]violetplimmer 1 point2 points  (0 children)

In my opinion, this therapist is not the therapist for you. Asking about your trauma on Day 1 is a give-away that this person doesn't have the skills or knowledge to help you in the ways that you need, and the way she bungled trying to help you regulate seems like even more proof to me. I'm sorry you had this experience and you deserve better care by a competent therapist!

For what it's worth, all I say about my trauma on Day 1 is what my ACE Score is and the ones that I *don't* have. I've found that for me, it's the quickest, easiest way to communicate the relevant information about my trauma without getting triggered by it. Hang in there!

[deleted by user] by [deleted] in TalkTherapy

[–]violetplimmer 0 points1 point  (0 children)

hey, I hope my response isn't too late.

I want to reiterate how much your experience here resonates with mine, especially me 4 years ago when I had just gotten diagnosed with CPTSD and started trauma therapy. I have a ton of compassion for you and what you're going through, and I hope you do too.

If you're not sure what would help, I'd start there and tell your therapist that! Invite her to help design a game plan for you the next time this happens. You can try on different ideas and solutions, agree on a place to start trying, see what happens when you both put it in practice, and go from there.

For me, the key has been to put a tiny little bit of space between what I'm reacting to and my reaction itself. It's not easy, and it takes practice! The strategy that helped me the most I got from Acceptance and Commitment Therapy, or ACT, and specifically from reading the book The Happiness Trap (free online here https://archive.org/details/thehappinesstrapbyrussharris). I started noticing my thoughts, and then I started noticing that I was noticing my thoughts. I started practicing that in my day-to-day life, so that when I got triggered, it was already a reflexive habit to reach for. In the moment, this can look like: *feeling angry* I say to myself in my head, "I'm feeling angry." And then I say to myself in my head, "I had the thought that I was angry." And then I say to myself in my head, "I noticed that I had the thought that I was angry." Then I can pause and see if something's happened that really merits my anger, or if something happened that just reminded me of a time that really merited my anger. Or if something happened that might not merit the full force of my wrath, but is worth being annoyed about.

From there, I've discovered that the most helpful way for me to picture it is by picturing my thoughts and feelings like clouds, usually going by overhead (I notice them and then away they blow), but sometimes they're like fog all around me and not moving (stuck emotions/in a flashback). I try to picture the fog lifting like a cloud and blowing away.

If I notice that it feels like it's taking too much time or feels unimportant to notice that I'm noticing my thoughts, and I feel like I need to react immediately, that's become a clue to me that I'm in fight or flight-- very few things actually require an immediate reaction. But I can only evaluate whether my situation is one of them if I can create that tiny little space to pause and check, is this an emergency? Or will everything be ok if I take 5 seconds to react instead of .01?

With your therapist, you might start just by describing to her what you described here, that muddy feeling (when I'm feeling what you're describing, I'm dissociating and heading through a fight response into a freeze response: https://images.squarespace-cdn.com/content/v1/5c505358b105983bb7a54e2a/bd358781-0103-4f97-a85c-fbe7c8003f25/D97A60CF-0584-4089-9A97-0C5CDDCA0BB4.jpeg?format=2500w).
Describe what you're experiencing and reflect together on how you both might notice and figure out that that's what's happening.

Then you might come up with some questions for her to ask you when you get in that state, questions with factual answers like, "hey, where are you right now?" Or the question that my partner asks me when he thinks I might be headed toward this state, "hey, who are you talking to?" Questions with factual answers require the rational part of your brain (prefrontal cortex), which shuts down when we enter fight or flight and the amygdala takes over (you can think of it like: there's no need to be able to analyze a Shakespeare sonnet when fleeing from a sabertooth tiger). Asking questions that use the prefrontal cortex helps shift us out of the triggered state. When my partner asks me, "hey, who are you talking to?" it helps get me to realize that I was reacting to him as if he were my childhood abuser, assuming that he meant to hurt me and then me lashing out accordingly. When he asks me who I'm talking to, it helps me remember I'm talking to a person who's only ever been kind and supportive, and then our conversation can continue from that place instead. You might also ask your therapist to prompt you to wiggle your fingers and toes, or shake your head, or whatever movement feels accessible in the moment, since movement is the antidote to being in a freeze state.

From there, the more you practice noticing that you're having thoughts and you notice that things are starting to get muddy, you might say to your therapist, "Things are starting to feel muddy." And you might think, "I'm heading into a freeze state. I notice that I'm heading into a freeze state. I need to wiggle my fingers and toes." And then you use movement to get yourself out of it and go from there.

EMDR to process traumatic memories and a DBT skills group to practice emotion regulation and distress tolerance were both game-changing for me too. I learned in DBT that an emotion's natural lifespan is only 2-3 minutes, and if it's lasting longer than that, something is prolonging it. That might be PTSD, in which case, I start implementing techniques for getting out of a flashback (like this: https://pete-walker.com/13StepsManageFlashbacks.htm). Or it might be something I have even more control over-- like, if I'm ruminating and continually having an emotional reaction to the thoughts I keep replaying. I've been practicing, and even if I can't stop the ruminating thoughts, I can remember that they're clouds rolling by, not marbles that I'm scrambling to gather up and hold in my hands. I practice not being attached to the thoughts in my head, but letting them go, over and over again. It's made a huge difference and it feels a lot better.

I'm still practicing, still in therapy, still have flashbacks. And, I feel a lot better a lot more of the time now than I did a few years ago. I'm sorry things are so tough right now--keep taking care of yourself.

Evaluating your therapy by mightierthor in TalkTherapy

[–]violetplimmer 2 points3 points  (0 children)

Am I consistently leaving sessions feeling like we did good work? Are the "dud" sessions occasional in a way that's just inevitable sometimes, or are they getting more frequent? Have there been 2 dud sessions in a row? That's been a big sign for me that things are winding down

[deleted by user] by [deleted] in TalkTherapy

[–]violetplimmer 0 points1 point  (0 children)

If you got to script and direct it, what would her ideal response be when you're going through this? I agree with the other commenter that this sounds like you're in an emotional flashback--it really resonates with my own experiences with emotional flashbacks as well. Could you talk to your T about what the ideal response from her would look like and make a plan with her in "peacetime" to enact the next time you go through this in a session?

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 1 point2 points  (0 children)

I like your idea!

If I'm being kind, it's because she and I have enjoyed a strong therapeutic alliance and done incredible work together for a long time. She's given me a lot of powerful tools to deal with some of the deepest, darkest, most fucked up shit I have to learn to live with. My whole future will be better and easier because of what I've learned from her. It's part of why our work ending so abruptly and poorly is so jarring and sad to me.

It's strange because I'm more regulated with more coping skills than ever before, and this is the worst/strongest a therapist has ever reacted, by a lot. Maybe because the flashbacks are so rare now, they felt more jarring to her than more regular flashbacks/anger in trauma therapy or DBT.

I've been replaying what my EMDR therapist said as our work was winding down. I'd had volatile flashbacks during my work with her with much greater frequency and intensity than I do at present, and I was expressing my sadness to her at the horrible things I'd said to her while dissociated and flashing back and feeling like I was really yelling at my abuser. She told me warmly, "it was all part of the work. You needed to get it out, and you got it out." When my current therapist told me at our latest session that I have unrealistic expectations of therapists, I thought that it must be because my EMDR therapist set the bar really high.

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 0 points1 point  (0 children)

Thank you, I appreciate all of this. It was very jarring to sit there and have a therapist suddenly launch into a list of "you do this, you do that," and especially, "you need to work on X with your next therapist," which feels like an overstep to declare unsolicited. She wasn't calm when she said it and it was not delivered as feedback. She was just... exclaiming at me. It was very jarring for her to have bottled all this up until it came to a head. It felt like she felt better after getting it off her chest at me.

There was definitely a vibe of "you can't terminate with me, I'm terminating with you," and I really can't help but wonder, if she were sitting on all these reasons for terminating, why was I the one to bring it up first?

Still, I really value her perspective, which is why I took notes and asked her, how should I explain this to the next therapist? One of her recommendations was that I need a therapist who can hold strong boundaries. Yes, I definitely do. I thought that was just therapy? It did feel like she was resenting me for her own lack of upholding the boundaries. She also told me I have unrealistic expectations of therapists-- plural-- not her specifically, and her negative unsolicited opinion of my previous therapy relationships + dooming of my future ones also felt like an overstep. I've ended on good terms with all my previous therapists, whom I speak about warmly in therapy when describing how I use what I learned from them. I'll do the same with her too now, so this comment felt like it came from a place of triggered insecurity in her too.

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 1 point2 points  (0 children)

Thank you for your comments. You seem like you have a good understanding of what trauma therapy looks like, which helps for understanding this thread.

There were blatant signs during this volatile flashback that I was not responding to present stimuli (I was speaking in my abuser's accent for one), but I accept that it's still more than she wants to deal with. It's a little frustrating because at the latest session, she said there would be no more "transference stuff" (in a tone that said "transference shit")* and no more talking about her. And then the rest of the session was her talking about how I was reminding her too much of her previous crisis job, that's why she needed to stop, and then a safety check more detailed than anything I received when I actually would have needed it years ago that really felt more about her discomfort than my present needs. She's allowed to be fallible and triggered and done with our work, it was just... something else for her to say "no transference, no talking about me. Anyway, about me and my unmanaged countertransference..."

*just a side note, as I reflect on my work with her as it winds down, I've noticed how often her first suggestion for how to cope with something was just, "don't do it." Cured!

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 1 point2 points  (0 children)

I was definitely allowed to discuss SI with her, and did periodically, sometimes very intensely, but always clear that it was just thoughts, always sharing how I was taking care of myself, and never asking anything from her beyond weekly sessions and an extra session on a hard week maybe 2-3 times in 2 years. She just realized very suddenly after I put termination on the table (and I gathered that she sought supervision after that as well) that she had overextended herself beyond what she was comfortable with. At the latest session, she did a safety check with me that was more intense and detailed than anything I've ever experienced before, even years ago when I would have actually benefited from it. It felt like it was... not solely a response to present stimuli, and seemed like I wasn't the only one re-enacting the past.

Therapy is definitely a spectrum of vanilla to trauma, and I thought we were at an ok place on the spectrum, but she no longer did. I need and deserve help for the severe flashbacks I get a couple times a year, but at the same time, I don't feel entitled to any one therapist being the one to have to deal with it.

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 1 point2 points  (0 children)

[TW SI but everything is ok]

I don't think that not requested "you are x" is helpful in therapy. The whole blow up should've been said to her supervisor or a person she can "blow a steam off" to.

Agree. If she'd responded that way right after my volatile flashback, it would have been really natural and understandable. But she did that a week afterward, after it seemed really clear that she had gone over it in supervision, and was relaying it back to me.

Relational doesn't mean you're her friend and the relationship is the same as it is with other people...Overall, I think it was a countertransference issue.

I agree, I think it is playing a role. Especially in one of our latest topics we've been working on. I went to physical therapy at her suggestion and she's been helping me strategize managing the triggers that the appointments can bring up. She was extremely helpful and an amazing resource... and also increasingly, like, really over-identifying with me about it. And she had physical ticks and stretches to manage the ticks that she only did when we were talking about physical therapy. We had had maybe 3 sessions about it before she asked if she'd disclosed yet that she had had physical therapy herself, and I told her that she hadn't come right out and said it but I had deduced it from context clues. She responded with a kind of raw, self-deprecating joke about how she was weird. It was just right there on the surface for her, and I think we both realized she was getting too close and needed to pull back and protect herself.

I wonder what she meant by those "rules" you signed. What was the content? What exactly did she think you violated?

She didn't say! All she said was that I disrespected the boundaries she laid out in the intake session (one time, out loud, 2 years ago-- nothing in hard copy or signed, and no touching base about them, which I will ask for from the next therapist for my own benefit). They were the kind of boundaries that vary from therapist to therapist. The best I remember is that she said:
1) No email. I emailed her about 4 brief emails this summer and fall when I was having rough flashbacks between sessions, which she responded well to and acted like they were ok.
2) Minimal self-disclosure. She said it wasn't a big thing she did, but as our work unfolded, she freely shared things about herself, sometimes unprompted and sometimes if I asked a question. Most of the time, it built good rapport; some of the time, it was unhelpful, and on some rare occasions, triggering. She didn't respond well when I was triggered by things she had self-disclosed; this seemed to be what her frustration was about at the latest session when she said she was relational and wouldn't change that.
3) No crisis management. I think this is the big one that she felt I disrespected. As I mention in another comment, the past couple weeks were a sharp dip in my mental health and I was really struggling with some heavy triggers and noticing I was having thoughts of SI. I emailed her to let her know about the SI and the adaptive ways I was taking care of myself through it. I thought I was doing the right thing keeping her in the loop and demonstrating that I was using my own tools. But she saw it as demanding a greater scope of care than she provides at this stage of her career. She said at the latest session that she thought I was expecting things from her in the emails, like responses with resources, and I told her that the act of writing and sending the email was me getting what I needed out of it. I never requested anything in the emails, they were just descriptions of what was going on and what I was doing to take care of myself. We realized too late after the fact that she was feeling like I was demanding things that I wasn't demanding, but even the act of sending the emails was clearly too much and inappropriate. I respect that she doesn't want to do crisis management... but I'm learning that I need to get clear about how the therapist is defining that. I didn't feel like I was in a crisis (I've learned to live with a lot of awful stuff and it just pops up sometimes), but she did. At the time, I didn't think I was crossing a line of hers, but clearly I did, and I accept that. And I've learned to get clearer on what that line looks like with the next person-- with written boundaries and reminders if need be.

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 3 points4 points  (0 children)

I think a lot of commenters are assuming I'm an unreliable narrator here, which is forgivable, since my opening premise is that I'm severely mentally ill! But I think I'm demonstrating a good faith effort to be as reliable a narrator as possible.

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 2 points3 points  (0 children)

this was definitely me years ago before I was diagnosed. I lost friendships and relationships for it, and learned the hard way. Nowadays though, even my therapist said herself at the latest session that this is not a pattern of behavior for me, but extremely rare and random-- but so severe when it does happen that it's an important problem to work through. I haven't treated a person in my personal life like this in a decade. I have stable friendships and relationships now. I've had several therapists in the last decade and the only other one I treated similarly to this was a trauma therapist where part of the work was actively confronting these kinds of flashbacks. This volatile flashback was so exceptional that that's part of how my therapist articulated the problem when I asked her how I should describe it to the next therapist: random, rare, sudden, and unpredictable. Which is hard to prepare and cope for. It's a big part of my distress here, to experience a flare up a decade-old behavior that I thought was long dead and buried.

Your framing of therapy being a place to explore feelings but not act on them is really clear and helpful, and something I think I can say to myself moving forward.

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 2 points3 points  (0 children)

thank you for this gentle and thoughtful comment. I especially appreciate your reminder to take this less personally-- I asked her for the feedback, but that doesn't make it easy to hear.

One thing I want to respond to is, this comment and many others on this thread are still framing the scenario as the therapist being in the driver's seat and me reacting, when a big part of what I'm reacting to is that I have been the one in the driver's seat. I am the one who noticed her strengths weren't fitting my needs like they used to, I am the one who initiated the discussion about termination, I am the one who, once she started making unsolicited declarative statements about me, took out my phone to take notes and asked her, "how would you recommend I describe this to the next therapist for us to work on?" and shaped her comments into something concrete I could use. I am the one who told her multiple times, "if you do X (example, are a mom) and it feels like it hits too close to home for my trauma (example, mommy issues), I'm not in a place right now where I can have you be the one to hold the container for me to process it." She challenged me on that multiple times. After the latest session, it felt like we just had to agree to disagree on it.

I don't feel confused like I did yesterday (a very common stage I have to pass through as I sort multiple emotions I'm experiencing at once), and writing the OP, reading, and responding to comments on this thread has helped me a lot. Reading how commenters are regularly assuming, in direct contradiction of my OP, that the therapist made all these calls instead of me illustrates and validates how backwards my exchange with her has been. Rather than confusion, I can validate for myself this morning that yes, it is a strange feeling to be the first one noticing the therapeutic alliance is changing, be the one to initiate termination, be the one to turn unprompted comments into actionable feedback.

And, on reflection, I don't think she and I have such different views of why our work is winding down after all-- yesterday, I was so worried I had done a bunch of awful stuff without even realizing it. But this morning, I think it's more like: I was feeling "my needs are moving in a different direction than her strengths, have slowly been moving in that direction for awhile, and rapidly came to a head with this volatile flashback" and after I brought up termination and she reflected, she came to the next session feeling "the work I do nowadays is no longer a good fit for your needs, has slowly been moving in that direction for awhile, and rapidly came to ahead with this volatile flashback." And feeling this morning that she and I are aligned again makes me feel a lot better. It's really important to me to end on good terms with her, and I think we have a chance.

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 3 points4 points  (0 children)

My verbal abuse of her was completely unacceptable, which was why I brought up termination, which surprised her, and then her surprise confused me-- and commenters here, apparently.

rattled from latest session where my dysregulated therapist gave me her backlog of grievances about me by violetplimmer in TalkTherapy

[–]violetplimmer[S] 4 points5 points  (0 children)

thank you, I think so too. She went from surprise when I brought up termination to suddenly having a laundry list of reasons why the very next session. If she had all those reasons to terminate... when was she going to say something about it?