My ongoing therapy dilemma

[gooblax]

Nothing wrong with having positive feelings for your therapist, gooblax.

It's hard though. It feels bad to miss him and want to talk to him more often and all that stuff. I don't know how to have the positive bit without the gross 'longing' or whatever going with it.

He's the one person in the world right now who wants to help you be happier with being you.

Well other than us here.

Thanks.

 

[Daniel E.]

It's hard though. It feels bad to miss him and want to talk to him more often and all that stuff. I don't know how to have the positive bit without the gross 'longing' or whatever going with it.

On a possibly related note:

The Love That Dare Not Speak Its Name - Dr. Keely Kolmes

And so we sit together, my client and I. He is weeping, deep sobs making his large body quake. Tears over a woman who could not return his love. I sit with him, holding his despair. My eyes also feel wet and sad, but I notice other feelings within myself. First there is anger – […]

drkkolmes.com

Some have admitted they told long-term patients who were dying or dealing with end of life issues that they loved them. It intrigues me that only in the face of death will some clinicians feel free to say the unspeakable...

 

[gooblax]

On a possibly related note:

The Love That Dare Not Speak Its Name - Dr. Keely Kolmes

And so we sit together, my client and I. He is weeping, deep sobs making his large body quake. Tears over a woman who could not return his love. I sit with him, holding his despair. My eyes also feel wet and sad, but I notice other feelings within myself. First there is anger – […]

drkkolmes.com

Some have admitted they told long-term patients who were dying or dealing with end of life issues that they loved them. It intrigues me that only in the face of death will some clinicians feel free to say the unspeakable...

I've seen that article sometime previously. Still made me cry reading through the article again and thinking about how my psych wouldn't feel that way about me.

 

[Daniel E.]

So maybe this is not the best therapist to be working on your self-esteem with? In any case, there is a belief out there that most people are in therapy to work on low self-acceptance/esteem or to develop "unconditional positive self-regard." And there is some truth to that. Because if you can accept and love yourself completely (at least at times), then you are free to live your life without being beholden to anyone's view of you--including your inner critic.

 

[gooblax]

I'm trying to remain open to the possibility that it's just my inner critic telling me I'm unlovable, and not reality. If I try to look at the evidence, psych said he was genuinely pleased about how the suit thing went and said he sometimes thinks about it when other clients are trying to overcome their fears too. And after I mentioned that our 'connection' was getting to the point where it could be considered good, he agreed and (to counter what I'd said about my recurring thoughts that I should give up the session time and stop seeing him because I'm unworthy and it's a negative for him) said he wants to continue working with me as long as I want that.

So trying to make myself look at the evidence, if we have conversations like that rather than just about practical stuff I need to do or him going off with his own agenda, then maybe he could be feeling something positive and caring a little bit about me as a client. So maybe it's just my thoughts being total assholes.

 

[gooblax]

What's a good therapy strategy for recurring suicidal ideation? Most of the time when it happens it's just passive and I can dismiss it pretty easily, but occasionally I'll get sucked into paying more attention. I think I don't need help with it the majority of the time, just on those certain occasions - even then I'm unlikely to go through with it but it's a whole lot of emotional drama. I was trying to talk to my psych about it last session but I don't think his approach is really adequate - it just seems to be to identify the thoughts as a habit, along with reducing general life monotony. Just wondering if there's anything better I can suggest or if that's as good as it's going to get.

 

[David Baxter PhD]

There isn't a 25-words-or-less answer to your question, gooblax, and at the moment I'm already multitasking (and not very well — I'm male ).

I just wanted you to know I saw your post and I'll try to come back later and respond.

 

[Daniel E.]

BTW:

Habitual suicidal thinking

https://www.psychiatryadvisor.com/home/topics/suicide-and-self-harm/suicidal-behavior-thoughts-associated-with-perfectionist-tendencies/

"A total of 13 out of 15 perfectionism dimensions were positively associated with suicidal ideation: perfectionistic concerns, socially prescribed perfectionism, concern over mistakes, doubts about actions, discrepancy, perfectionistic attitudes, perfectionistic strivings, self-oriented perfectionism, personal standards, parental perceptions, parental criticism, and parental expectations, and Frost and colleagues’ Multidimensional Perfectionism Scale (FMPS-) perfectionism. Neither other-oriented perfectionism nor organization were significantly associated with suicidal ideation."

1 in 4 young people are reporting suicidal thoughts. Here's how to help | CNN

Large numbers of young people, particularly Black or Hispanic, are reporting suicidal ideation, depression and anxiety during the pandemic. Psychologists urge them to seek counseling or to call the National Suicide Prevention Lifeline at 800-273-8255.

www.cnn.com

"In the general US population, the CDC reported that 11% of adults surveyed had seriously considered suicide in the past 30 days before they completed the survey. Among those identifying as Black or Hispanic, the numbers were worse: 19% of Hispanics reported suicidal ideation and 15% of Blacks reported suicidal thoughts."

 

[Daniel E.]

Personally, I think about death a lot since my dominant OCD theme is the meaning of life/death/impermanence. But I go through cycles -- or different OCD channels. When I am feeling good, I worry about something external harming me (e.g. false imprisonment) and I am too busy enjoying my Starbucks to care about existential issues. When I am feeling neutral or bad, I am more likely to be thinking about death and suicide. When I am severely depressed (like a few times a year), then I go through a 24-72 hour period of doom and gloom and then my brain resets itself. When I was young, especially in my late teens and early 20s, it took longer to get out of it.

The main reason I am in therapy is to prevent a relapse into severe depression -- which is what may happen when my OCD gets worse than usual (as in secondary depression). But really it was when I was a young person with lots of impulsivity that I was truly in danger to myself since I did have a number of attempts (between the age of 17 and 19) since I was very new to depression and OCD. Part of the reason I was attracted to Psychlinks was because it helped normalize my suicidal ideation by reading the experiences of others.

 

[gooblax]

Every time I get to the point of "things are going reasonably OK, I dunno what to talk about this session, maybe it's time for a break" I seem to get caught back up in really feeling like I miss my therapist. :/

 

[Daniel E.]

I dunno what to talk about this session

BTW, an existential, here-and-now approach to therapy:

Yalom on the Here and Now

Perhaps the most powerful yet simple tool in psychotherapy is the here and now: sharing the raw, honest thoughts and feelings about what's happening in the moment.

www.psychologytoday.com

Perhaps the most powerful yet simple tool in psychotherapy is the here and now: sharing the raw, honest thoughts and feelings about what's happening in the moment. The concept has been around forever...

https://www.drbarrybrody.com/blog1/?p=21

...On my good days in the consulting room I can wait. Wait for something to emerge without the need to control the experience. I guess on those days I have faith. Faith that if I can tolerate waiting and not knowing an experience will emerge from some unknown place. Unknown to both myself and the patient. I imagine that this unknown “truth” has been waiting for the patient to arrive. If only I can stay out of the way and wait.

Beginning patients often ask “Where do I start?”, or immediately sit down and recite their list of what they think they came to talk about. Other, more seasoned patients make lists to bring in what they want to discuss. And others rehearse mentally on their way to the session. There are many ways to avoid waiting for the truth to emerge.

Recently a patient who had been to many other therapists discussed stopping treatment. They said that they had told me all they had to say--their story. They said that “there would be nothing to talk about”. We continued therapy and we stumbled across a long-buried truth that had been waiting for them to arrive. The patient said “Now I understand what therapy is about”.

The problem for both myself and the patient is waiting.

If one or both of us can wait, then who knows what we can discover? A baby born too soon, too late, not at all, or perhaps the truth that has been waiting for us all along.

 

[gooblax]

My thoughts are telling me that there's still plenty of time to cancel the appointment.

I guess things are better in that there's a different completely unrelated decision where I'm trying to decide what will upset me less rather than knowingly thinking about the one that will upset me more.

 

[David Baxter PhD]

My thoughts are telling me that there's still plenty of time to cancel the appointment.

I guess things are better in that there's a different completely unrelated decision where I'm trying to decide what will upset me less rather than knowingly thinking about the one that will upset me more.

Try inserting some additional thoughts that there's absolutely no need to cancel the appointment.

 

[gooblax]

Try inserting some additional thoughts that there's absolutely no need to cancel the appointment.

I guess. It's hard to ignore the thoughts that say that I'm a negative in my therapist's schedule so I'd be doing him a favor by cancelling. But as long as I delay making the decision I'll end up at the appointment.

The unrelated decision is about whether I want to share birthday cake at work. I've brought a little one but I'm still undecided about if I want to tell people or not. And because I usually have self-destructive thoughts on this day I don't know if they'll be worse with or without having anyone acknowledge my birthday in-person.
My parents sent me a nice e-card so I'm trying to use that as an indication that I'm not a negative in everyone's life. But it doesn't change what I am to my therapist.

 

[David Baxter PhD]

A long time ago, in a galaxy far, far away, you were concerned that your therapist was indifferent to you. That concern seems to have been largely — although not completely — resolved.

How did that concern morph into "I'm a negative in my therapist's life"? And what "evidence" does your OCD say exists for that thought?

 

[gooblax]

For the most part I don't factor into his life. I see him 1hr every 3 weeks, or 0.198% of time. So that's the upper bound of any significance I may have, without factoring in history, influences on other time or opportunity costs. So that in itself is worth being indifferent about. Part of operation Be More Likeable is just accepting my global insignificance and trying to not be upset about it or do anything that highlights it to myself.

Of that 0.198%, I dunno. It's an hour of working, which is more negative than an hour of free time. It's an hour of talking to someone who is sometimes "not easy to talk to" which is more negative than someone better. Then there's just the fact that I feel positively about that hour with him which seems like it should have a default inverse proportional relationship to how he would feel.

 

[David Baxter PhD]

Almost all of that is almost certainly not accurate, gooblax.

 

[Daniel E.]

What is the relationship between fear of self, self-ambivalence, and obsessive–compulsive symptomatology? A systematic literature review

Guidano and Liotti (1983)...theorized that people with OCD have a “double view of themselves” and...this causes the person to have a need for certainty (to find out which view is the true one) and perfection (to act in such a way to conform to the more positive of the two views of self). These authors suggest that, in the context of an unacceptable intrusion, this need for certainty and perfectionism provides a context for the development of obsessions and compulsions. If the unacceptable intrusion activates the feared self, the person is likely to pay attention to the intrusion and attempt to neutralize it, which, evidence suggests, increases the likelihood of further intrusions.


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Self-ambivalence in obsessive-compulsive disorder

According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, perfectionism and an overestimation about the importance of thoughts. Despite much support for this hypothesis, there is a lack of...

minerva-access.unimelb.edu.au

The patient’s ambivalent experience of self is hypothesised to originate from early mixed messages of approval and rejection. Thus, the client may have difficulty accepting the therapist as empathic, genuine or trustworthy. Therefore, it is important that the therapist relate to the patient in a consistent, caring, non-judgmental manner that validates important aspects of the client’s being (Rogers, 1961; Safran & Segal, 1990). This style of relating allows the patient to feel accepted and understood. The feeling of being understood in a manner that mirrors one’s own appraisals of self is helpful to establishing a sense of attunement in the relationship, where the client accepts the therapist as a sensitive and accepting parental symbol. This type of interaction on the part of therapist is consistent with Young’s notion of ‘limited re-parenting” which aims to provide the client with a new relationship in which to develop a sense of self-worth (Young, 1994; Young et al., 2003)...

Changes in self-ambivalence did not relate to relapse, once controlling for inflated responsibility or beliefs about the importance of thoughts. However, changes in self-ambivalence remained predictive of relapse of compulsions, after controlling for changes in Perfectionism.

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What are the most common causes of OCD? - OCD and Anxiety

What are the most common causes of OCD and why do infancy and adolescence play such an important role in OCD? In this article we'll explain this and more.

ipitia.com

General characteristics; cause and effect​

• Role models with obsessive compulsive tendencies.
• An excess of responsibility and perfectionism.
• Strict moral and religious upbringing where thinking something is the same as acting and wrong and right are instilled excessively in the child.
• High levels of guilt.
• Complete control about his thoughts and an overestimation of their importance.
• Low tolerance for uncertainty and spontaneous elements.
• Magnifying: “If I make a mistake it will have severe consequences”.
• Overprotection
• Rigidness.
• Traumas (accidents, separation, bulling, abuse or maltreatment…)

 

[Daniel E.]

Then there's just the fact that I feel positively about that hour with him which seems like it should have a default inverse proportional relationship to how he would feel.

What Movies And Therapy Have In Common

What Movies And Therapy Have In Common Psychology Today blog: Reel Therapy by Jeremy Clyman How successful therapy can be going to the movies In my last post I suggested that the treatment approach implemented by reality-television star Dr. Drew was flawed. Since it is all too frequent and...

forum.psychlinks.ca

"A parallel story, this mentally healthy version of life, must begin to emerge so that the glaring differences between this story and the patient's unhealthy story can be exposed. These gaps become treatment targets to zoom in on and tweak."

 

[gooblax]

Almost all of that is almost certainly not accurate, gooblax.

It could be, though. He's been responding fairly positively lately so the negative parts might not be true, but it's hard to know. I just don't like how much I like and miss him.