My ongoing therapy dilemma

[Daniel E.]

The hidden links between mental disorders

Psychiatrists have a dizzying array of diagnoses and not enough treatments. Hunting for the hidden biology underlying mental disorders could help.

www.nature.com

There are already hints that generalized treatments could work just as well as targeted therapies. A 2017 study randomly assigned people with anxiety disorders, such as panic disorder or obsessive–compulsive disorder, to receive either a therapy for their specific disorder or a generalized approach. Both therapies worked equally well.

 

[gooblax]

Maybe. I'll see. The thing that my psych is suggesting I do with upsetting stuff is "choose to let it go". I'm not 100% sure how to do that. It's one thing when it's a thought, but another thing when it's mostly a feeling with a bunch of stuff that could be behind it but all I'm really noticing is the feeling. It's hard to see the difference between choosing to let it go vs. being dismissive.

Things are feeling kind of hopeless today because I was thinking about the clothing thing. But that is one thing that I can let go of temporarily.

 

[Daniel E.]

"choose to let it go". I'm not 100% sure how to do that.

A therapist said that to me a few years ago. It didn't really help me at the time. Maybe in the longer term it was helpful...for some things.

Or you could let go of letting go. Beat the therapist at his own game

How to Let Go of the Past: 8 Tips to Accept and Release

Letting go of what hurts may be difficult but it's possible. These tips may help you let go of the past, including someone who hurt you.

psychcentral.com

I often hear from people who have gone through great personal challenges, both mental and physical, that they have no idea how they did it. They will often look back with amazement on their certainty at the start that they would never make it. This has been my personal experience as a cancer survivor, and the wisdom I share with my clients who are struggling with letting go. My new catchphrase is, “Let go of your need to let go, pay attention to what is happening now, and life will move on, you cannot stop it.” Not as pithy as “Hang in there, baby,” but much more useful.

 

[gooblax]

I can see how it might be helpful as a short term thing. Like when I'm talking to him, then get stuck in my head or feeling something that makes me stop talking / engaging - to re-engage I need to let go of the thing that's keeping me stuck (or use something to gently pry off the stuckness). But more generally it doesn't seem that useful, or seems like something I naturally do already.

 

[Daniel E.]

Exactly.

 

[gooblax]

The thing that's upsetting me now is that psych is easily in my 'top 10 important people' and maybe even top 5, but I'm not even in his top 500. Not even the client category. How I feel about that is both stupid and disgusting, given that I don't even know him as an actual person and I'm certainly not an actual person to him.

The last mental draft of my 'quitting therapy' email also involved billing instructions, given that I'd have to delete my email account after sending the email... so the receipt would bounce when he sent it.

 

[Daniel E.]

Do your worries about therapy seem to compete with each other?

For example, if you start to feel better about the "I'm not good enough for therapy" issue (fear of self), are you then more prone to worry about the one-sided nature of the therapeutic relationship (not just right feeling)?

 

[David Baxter PhD]

The thing that's upsetting me now is that psych is easily in my 'top 10 important people' and maybe even top 5, but I'm not even in his top 500. Not even the client category.

How do you know that? Maybe you are in his top 10. What if you're "only" in his top 20? or top 30? or top 50? How high up would you need to be to feel valued?

How I feel about that is both stupid and disgusting, given that I don't even know him as an actual person and I'm certainly not an actual person to him.

Of course you are an actual person to him, even if it's only an actual person who is a client. Therapists cannot be functional therapists if they don't see clients as actual real persons with actual real lives and actual real problems.

The last mental draft of my 'quitting therapy' email also involved billing instructions, given that I'd have to delete my email account after sending the email... so the receipt would bounce when he sent it.

Why would you have to delete your email? This all sounds very much like catastrophic thinking to me.

 

[Daniel E.]

Surrender as something more than just "letting go":

Existential OCD

https://psycnet.apa.org/record/2010-19091-001 Persons high in perfectionistic concerns not only tend to catastrophize their life experiences but also struggle to accept their life experiences and to negotiate a sense of purpose, direction, and coherence in their lives. With both a catastrophic...

forum.psychlinks.ca

 

[gooblax]

Do your worries about therapy seem to compete with each other?

For example, if you start to feel better about the "I'm not good enough for therapy" issue (fear of self), are you then more prone to worry about the one-sided nature of the therapeutic relationship (not just right feeling)?

I guess I see them as a part of the same thing. Like my typical thought is along the lines of "I'm not good enough for therapy, even my psych doesn't think so because he cares about other clients more than me, yet I care about him a lot so I'm bad." So I guess it just depends which part of that is most upsetting at the time - me being not good enough, or being bad, or not worth caring about, or unlikeable, or not a 'real person'.

How do you know that? Maybe you are in his top 10. What if you're "only" in his top 20? or top 30? or top 50? How high up would you need to be to feel valued?

I don't know. Being too high up wouldn't be healthy and would also probably weird me out, but that's not something I have to worry about. And I know that I'm not high up because I'm a client, I'm "not easy to talk to" even if it's only some of the time, he doesn't put any priority on emails even knowing how much it upsets me when he doesn't reply, he cares about me less than some other clients (wherever that puts me in his ranking system), and I'm not a real normal interesting person who has proper interests and friends and stuff. I'm also not giving him anything back. Not even money while he's behind on billing.

Of course you are an actual person to him, even if it's only an actual person who is a client. Therapists cannot be functional therapists if they don't see clients as actual real persons with actual real lives and actual real problems.

A lot of the time I'm not even an actual real person to myself. I could be replaced with a bit of AI, or sometimes even a pretty simple program, and no one would notice. Maybe he doesn't see it 100% that way (cause last session when we spoke about identity stuff he reflected back my thought that in an effort to fit in or not be unacceptable I became more of a blank-nothing than being myself, but he seems to see that as something that can be changed rather than it being fixed... which would suggest that he thinks there's some form of 'self' in here) but I don't think it's enough to make up for the rest.

Why would you have to delete your email?

I'd have to delete my account so I wouldn't be hopeful about hearing back from him, hoping for a 'goodbye' reply or 'contact me if you change your mind' or whatever. Because I have to assume that he'd never reply. And the only way for me to move on is to make sure I don't keep checking for something that will never come.

No matter how things end with him, I may still need to delete my email account. That's why before I contacted his office, I created an account exclusively for communications with his office/him. I also had a separate account when I contacted the EAP person and kept that same one for the other counselor while I was seeing him (because I figured it was ok to merge those together since there was less of an emotional attachment with those).

 

[Daniel E.]

Where or when do you feel more "real"?

 

[gooblax]

Where or when do you feel more "real"?

I've been trying to come up with an answer, but the best I can come up with is just when I'm not so much in my head.

 

[David Baxter PhD]

That's a good answer. Now what do you think that means?

 

[gooblax]

I guess there are a few things it could mean:

• That I need to do more, think less.
• That the problem is only because I think it to be so.
• That the problem is only more obvious at some times more than others, just like certain sensations or actions are more noticeable when you pay attention to them rather than other things.

 

[David Baxter PhD]

Exactly! Well done @gooblax! That's absolutely spot on!

 

[gooblax]

I still find it weird how far behind my psych has become with billing. It raises the questions - is he this far behind billing everyone and hasn't had money coming in for almost 2 months? Or just some clients, and why? Maybe he's raising his fee and keeps forgetting to tell me, but hasn't proceeded with billing knowing how I responded when he raised it without informing me. Or maybe it's just that his logistic disorganisation has become even worse with trying to start at a new office location. Either way I intend to find out next week. I still check my emails multiple times a day to see if he's billed yet - spoiler alert, no.

On another topic, assuming I'm successful in not recategorising my feelings of liking-to-talk-to and missing my psych as being bad things about me, what's a good way to handle the feelings instead?

 

[David Baxter PhD]

How about trying to view then from the standpoint of transference and thus a normal part of therapy (and even an essential part to some degree) instead of something pathological that makes you unworthy or whatever negative thought comes to mind for you?

Transference: What It Means and How It May Be Used in Therapy

Transference occurs when an individual has emotions about one person that are actually related to their feeling for another. It's common in relationships between a therapist and client and may even be used to help the client. Therapists are trained to be aware of transference and how to manage it.

www.healthline.com

Transference occurs when a person redirects some of their feelings or desires for another person to an entirely different person.

One example of transference is when you observe characteristics of your father in a new boss. You attribute fatherly feelings to this new boss. They can be good or bad feelings.

As another example, you may meet a new neighbor and immediately see a physical resemblance to a previous spouse. You then attribute mannerisms of your ex to this new person.

Transference can happen even in the face of distinct differences. It often makes you look past these dissimilarities to the likenesses.

Transference can also happen in a healthcare setting. For example, transference in therapy happens when a patient attaches anger, hostility, love, adoration, or a host of other possible feelings onto their therapist or doctor. Therapists know this can happen. They actively try to monitor for it.

Sometimes, as part of their therapy process, some therapists even actively encourage it. As part of psychoanalysis, therapists try to understand a person’s unconscious mental processes. This can help them comprehend that patient’s actions, behaviors, and feelings.

For instance, the therapist may see an unconscious reaction to intimacy in their patient’s inability to form strong bonds with significant others. Transference can help the therapist understand why that fear of intimacy exists. They can then work toward resolving it. This may help the patient develop healthy, long-lasting relationships.

How is transference used in therapy?​

Transference in therapy may be unintentional. A patient redirects feelings about a parent, sibling, or spouse onto the therapist.

It could also be intentional or provoked. Your therapist may actively work with you to draw out these feelings or conflicts. This way they can better see and understand them.

In all cases, a therapist should make the patient aware of when transference is happening. This way you can understand what you’re feeling.

Unaddressed transference can be problematic for the patient. It may even prevent them from returning for treatment. This is counterproductive.

Here are some of the situations a therapist may intentionally use transference:

Transference-focused psychotherapy​

In a well-established therapy relationship, a patient and a therapist can choose to use transference as a tool of treatment.

Your therapist may help you transfer thoughts or feelings about a person onto them. Then your therapist can use that interaction to better understand your thoughts and feelings.

Together, you can develop better treatments or behavioral changes.

Dynamic psychotherapy​

This is most often a short-term form of psychotherapy. It relies on the therapist’s ability to quickly define and breakthrough a patient’s problems.

If these issues involve feelings or thoughts about another person, the therapist may purposefully try to upset their patient with that information.

This type of transference can help the therapist develop more quickly an understanding and begin treatment.

Cognitive behavioral therapy (CBT)​

If you’re open to understanding how your past has shaped your current problems, your therapist my use CBT.

CBT ultimately teaches you to understand your old behaviors so you can recreate newer, healthier ones. This process may bring up emotional issues that remain painful.

Transference in this situation can happen when the patient finds in the therapist a source of comfort or hostility that heightens some of those feelings.

What emotions are involved in transference?​

Transference involves a wide range of emotions. All of them are valid.

Negative emotions of transference include:\

• anger
• disappointment
• frustration
• hostility
• fear
• frustration

Positive emotions of transference include:

• attentiveness
• idealization
• love
• affection
• attachment

 

[gooblax]

That's all well and good from a "why not to think about it negatively" point of view, but it doesn't help me deal with the intensity of the feelings.

 

[Daniel E.]

The feelings about the therapist/"other" can be used to motivate/restore relationships outside of therapy, even just small talk to cashiers, co-workers, etc. Even relatively minor relationships like acquaintanceships require some amount of time dedicated to them, e.g. a weekly book club. And part of modern society is having less time/place for that unless one makes it a priority, even if the place is cyberspace/Zoom.

But in general when I think of emotion regulation, I think of Dialectical Behavior Therapy, like the distress tolerance skills:

All of those above tips are body-centric. And there is a lot to be said for somatic exercises/therapies, especially if they foster a feeling of being safe/okay/grounded.

 

[gooblax]

The feelings about the therapist/"other" can be used to motivate/restore relationships outside of therapy, even just small talk to cashiers, co-workers, etc. Even relatively minor relationships like acquaintanceships require some amount of time dedicated to them, e.g. a weekly book club. And part of modern society is having less time/place for that unless one makes it a priority, even if the place is cyberspace/Zoom.

None of that stuff really interests me. Like sometimes I'd find it nice to have a friend to do things with, if only it didn't mean having to do the thing with them. That's part of why these feelings about my psych are so abhorrent - they don't fit anywhere in my normal life. They've come up with other people in the past and it's never been a healthy thing (although at least in the case with my bf, they somehow wore away without ending in a mess).

But in general when I think of emotion regulation, I think of Dialectical Behavior Therapy, like the distress tolerance skills:

All of those above tips are body-centric. And there is a lot to be said for somatic exercises/therapies, especially if they foster a feeling of being safe/okay/grounded.

I guess those are things that could help. I always find the DBT terminology to be so belittling but that infographic is non offensive.
I understand that my current strategy of continuing to think about my psych and things he's said, or even looking at a photo, aren't useful and often don't even help.