My ongoing therapy dilemma

[gooblax]

Mostly therapy, being ok with the counselling relationship.

 

[Daniel E.]

How about this: The more accepting you become of yourself, the more accepting you will be of your interactions with others.

In other words, a goal of therapy can be having a greater sense of security -- especially if that was lacking while growing up. And as you feel more secure (or engage in "reparenting"), you will care less about what others may think about you -- even your therapist:

Learning to Parent Yourself as an Adult

If you've ever felt like you learned life lessons 10 years after most people, you are not alone. Learn to parent yourself for improved self-esteem and healthier relationships.

www.psychologytoday.com

“The child is brought up to know its social duties by means of a system of love-rewards and punishments, and in this way it is taught that its security in life depends on its parents (and, subsequently, other people) loving it and being able to believe in its love for them.” —Sigmund Freud

A related theme:

“The shame-based person is nearly always enmeshed in some way with one or more people. While we are in a dysfunctional, shame-based relationship, we may feel like we are losing our mind, going crazy. When we try to test reality, we are unable to trust our senses, our feelings and our reactions.”

― Charles L. Whitfield, Healing the Child Within: Discovery and Recovery for Adult Children of Dysfunctional Families

 

[gooblax]

It's ridiculous that it's this hard. What am I doing wrong that after 2 years it's still somewhat torturous? I don't understand how some people can just go to therapy and feel accepted and cared for by their therapist... and then there's me, who every couple of days is plunged into the stark reminder that I'm not important or worth caring about except on a surface level, that my therapist doesn't care about me much, that I'm only acceptable to the extent that I can joke around about things, that on the inside I'm just bad and disgusting for how I feel. I can't imagine it being different.

 

[Daniel E.]

It's ridiculous that it's this hard.

Personally, I have been actively ruminating about existential issues for more than half of my lifetime -- over 25 years. How ridiculous is that? On the other hand, I realize I have OCD and would rather have that than wake up tomorrow and have my brother's ongoing battles with bipolar disorder and related substance abuse: "Better the devil you know than the one you don't.”

In any case: "Disturbing yourself about your disturbance is often the major factor in life-long (endogenous) depression, severe anxiety, and panic attacks." ~ 5 Major Differences Between REBT & CBT

Or to put it another way: With rumination, over time, you are left to think about your thinking since you have been stuck inside your head for so long. That's why a motto of acceptance and commitment therapy is: "Get out of your head and into your life."

So the belief "it's ridiculous that it's this hard" could be at least partially replaced with something more accepting like:

I am willing.
I am wired to win.
I got this.
I embrace the uncertainty.
I am not my thoughts; I am what I do.
I am relentless.
I expect nothing and accept everything. (source)

But usually people have to hit a relative "rock bottom" again and again and again to become more accepting of themselves (self-acceptance) and of life itself (life acceptance). Acceptance is correlated with age -- it gets easier as you get older.

And it is a marathon, not a race: "We are all just walking each other home" (Ram Dass). "Ram Dass was talking about coming home inside of ourselves. He was talking about finding our wholeness – knowing who we are at the deepest and most profound levels of our being and building our lives upon that foundation" (Alan Seale).

 

[Daniel E.]

The Cycle of Suffering

The Dynamics of Emotional Mind and It’s Role in Driving Destructive Coping Behavior: When Emotional Mind Drives…We Wreck Out…and Our Lives Become a Total Wreck by Melanie Gordon Sheets, Ph.D., The DBT-CBT Workbook blog This hand-out :acrobat: addresses the dynamics of Emotional Mind and its...

forum.psychlinks.ca

This hand-out addresses the dynamics of Emotional Mind and its role in driving destructive emotion-driven coping behaviors..

I actually tell my patients that it’s “normal” to be “abnormal” and entirely abnormal to be so perfectly normal and in control of ourselves...

I believe that when we are in recovery…we remain “works in progress.” Sometimes it’s a daily battle and sometimes, an occasional battle. We’re emotional critters and creatures of habit…and when we hurt or are feeling desperate and “out-of-control”…we tend to fall back into old patterns of relief-seeking behaviors…or to certainly think about doing them!..

Sometimes, I grow tired of the battle and dealing with my emotional, willful self. At those tired, weak moments, I remind myself….”Mel, what do you want…peace and stability or chaos and pain?” Isn’t it horrible that you have to parent yourself even when you’re a grown-up!?

 

[David Baxter PhD]

It's ridiculous that it's this hard. What am I doing wrong that after 2 years it's still somewhat torturous? I don't understand how some people can just go to therapy and feel accepted and cared for by their therapist... and then there's me, who every couple of days is plunged into the stark reminder that I'm not important or worth caring about except on a surface level, that my therapist doesn't care about me much, that I'm only acceptable to the extent that I can joke around about things, that on the inside I'm just bad and disgusting for how I feel. I can't imagine it being different.

To bring up a recurring theme, is it possible that this is as much the fault of the therapist's lack of competency (and basic social skills)?

It seems to me that at times you have made progress that he has then undone by ineptitude, like recently talking about other clients in your session.

 

[Daniel E.]

Some mental health professionals are just as "wounded" (if not more so) as they are "healer." My first psychiatrist -- many years after I saw him -- was sentenced to 16 years in federal prison for a record amount of Medicare fraud. The three therapists who were part of the scheme were sentenced to at least five years.

 

[gooblax]

Sure it seems a bit silly to complain about having the problem, but my biggest frustration is that all the ways of getting help for the problem just seem to exacerbate it, whether that's self help (which invariably turns into self punishment) or professional help.

My psych's style obviously works for some clients, otherwise he wouldn't do it.

 

[Daniel E.]

but my biggest frustration is that all the ways of getting help for the problem just seem to exacerbate it,

Does that mean that you believe that you have not improved at all in the last few years or whatever? It seems to me you have "grown" significantly.

With anxiety, it is easy to hyperfocus on what is "wrong." So for self-help, one thing I like is a mental health app that asks you at random(?) times how you are feeling. And you discover that you are feeling better than you remember. Depression/anxiety makes it a lot easier to recall negative events in the distant/recent past or to feel like only the future is real. But the app asks you how you are feeling right this second.

But I do think you would be better off with another therapist. There's got to be some therapist out there that will click with you better -- and be more professional -- especially with so many therapists being online now.

 

[Daniel E.]

My psych's style obviously works for some clients, otherwise he wouldn't do it.

Therapists do all kinds of things that are not client-centered or helpful, and, arguably, they maintain their practice despite of it -- not because of it. Many therapists would be the last to know what really works because they don't maintain any formal feedback for the most part.

 

[David Baxter PhD]

Sure it seems a bit silly to complain about having the problem, but my biggest frustration is that all the ways of getting help for the problem just seem to exacerbate it, whether that's self help (which invariably turns into self punishment) or professional help.

It doesn't seem silly at all. I can well understand your frustration.

My psych's style obviously works for some clients, otherwise he wouldn't do it.

What @Daniel said above.

 

[gooblax]

Many therapists would be the last to know what really works because they don't maintain any formal feedback for the most part.

Surely I'm not the only one giving him feedback on the things he does that are unhelpful. He doesn't strike me as an idiot, nor as intentionally malicious, so surely statistically with enough data he'd modify approach even if he was lazy or otherwise unmotivated to change. I'm still very emotionally attached to the idea of making it work with my psych somehow. It's not like things were much better with the counsellor - despite me thinking that he would have the specific training and focus to be able to avoid things that upset me, after a couple of sessions he still managed to run into them quite successfully the same way as psych did. So I don't know what I'd look for in a therapist, given that my best guess didn't change the issue.

I am working with psych better now than I used to be. He's asking about my list of topics every session, and doesn't really monologue off-topic much anymore so I haven't had to implement a 15 minute check-in timer. It's a lot more of a dialogue that I can stay in. It's also been a big reduction in the proportion of sessions where I'd end up with strong self harm urges at the end. If we'd been able to start out like this it would've saved a lot of heartache but it needed changes from both of us. However the various 'upsets' haven't gone anywhere and have just become increasingly easy to trigger. That's where I think the biggest issue is - if they can't be resolved. Problem is I don't know how to resolve them.

 

[David Baxter PhD]

However the various 'upsets' haven't gone anywhere and have just become increasingly easy to trigger. That's where I think the biggest issue is - if they can't be resolved. Problem is I don't know how to resolve them.

And that's why you still are (and still need to be) in therapy.

The question is

• Does he know what these upsets are and how they are triggered?
• Does he have a plan for addressing them?
• Is he in fact addressing them or trying to address them or is he merely listening to you describe them?

And why do you think they are becoming "increasingly easy to trigger"?

 

[Daniel E.]

so surely statistically with enough data

It's hard to get feedback from the many clients who drop out. Something didn't jive or did -- but what? If the therapist wasn't getting feedback regularly, then he/she is really guessing then:

Is Routine Outcome Feedback Informing Your Practice? (Part 2 of 2) - OQ Measures

Is Routine Outcome Feedback Informing Your Practice? (Part 2 of 2) Last week we learned about Dr. Tony Rousmaniere’s heartbreaking experience with Grace – a client that unexpectedly died of a drug overdose, prompting a career crisis for Tony, which drove him to find routine outcome monitoring...

www.oqmeasures.com

Like the widespread adoption of the thermometer to the medical field back in the 19th century – 250 years AFTER its invention – use of psychotherapy metrics and feedback systems has been slow.

 

[gooblax]

And that's why you still are (and still need to be) in therapy.

Ha I guess so.

The question is

• Does he know what these upsets are and how they are triggered?

I try to tell him each time it happens in relation to something in our sessions. He was directly asking about triggers last session but I didn't want to be specific because I didn't want to re-trigger myself, having just got over it enough to try to have a productive session. Sometimes he doesn't quite get it but he seems to be trying and maybe we'll gradually get there e.g. last session I had to explain a couple of times that it wasn't because of him needing to reschedule because he was sick (because I was already in a self sabotage frame of mind I just used the reschedule as a way to make things worse), and previously he's attributed it to having trouble making a decision (but it's not the decision that's the problem, I know what I want to pick but get upset because I believe that what I want is bad/disgusting/negatively-judged-by-him).

• Does he have a plan for addressing them?
• Is he in fact addressing them or trying to address them or is he merely listening to you describe them?

I've got some homework that's intended to help with the 'bad, deserve punishment' side of things. And he's trying to help me challenge some negative thoughts and assumptions (or just challenging them himself when I'm too stuck in them which is most of the time when I've brought them up). So it seems like a bit of a plan.

And why do you think they are becoming "increasingly easy to trigger"?

Probably just a cumulative effect because of the history. For example it's easier to assume he doesn't care about me with the history of evidence and each piece of evidence making it a stronger, more upsetting argument... Compared to the gradual less compelling evidence of him caring a bit like asking about stuff that I've told him about, sometimes extending seasons a couple of minutes to wrap things up (or the time he delayed the session when I was late and still gave me almost the full time), saying I could send him the homework from last session to speed up the discussion (even though I know that's a foolish idea given what's previously happened when I've sent him stuff), the fact that now we're able to have more of a dialogue it feels a lot better, occasional complements, challenging negative thoughts for me.

 

[Daniel E.]

This just seems too hard.

Probably just a cumulative effect because of the history. For example it's easier to assume he doesn't care about me with the history of evidence and each piece of evidence making it a stronger, more upsetting argument...

"One sad thing about this world is that the acts that take the most out of you are usually the ones that people will never know about." ― Anne Tyler

 

[gooblax]

Back in The Land of Upsetting Truths. I know I should quit but I'm not strong enough to do it. I'm always going to be too emotionally fucked up to do therapy correctly, and that's on me to handle. But all it takes it slightest thought of sending him the message to end sessions and I start sobbing like a freak.

 

[David Baxter PhD]

That's a pretty strong signal that, whatever the pros and cons of continuing or terminating therapy with him may be, you are simply not ready to make a change right now.

And the recommended action based on that signal would be to continue as things are now until your feelings and/or views change.

There's really no compelling reason to do anything right now that you don't feel comfortable doing.

 

[Daniel E.]

And even if things do go south again, I need new material for my book:

Bad Therapy as Exposure Therapy: How Surviving Therapy Makes the Real World Seem Easy

 

[gooblax]

And even if things do go south again, I need new material for my book:

Bad Therapy as Exposure Therapy: How Surviving Therapy Makes the Real World Seem Easy

Haha

That's a pretty strong signal that, whatever the pros and cons of continuing or terminating therapy with him may be, you are simply not ready to make a change right now.

And the recommended action based on that signal would be to continue as things are now until your feelings and/or views change.

There's really no compelling reason to do anything right now that you don't feel comfortable doing.

I suppose you're right, but it certainly seems compelling.