Changing therapists – my therapist responds

In the last post, Changing therapists – what to consider, I presented a list of questions for my therapist and I to explore, in my quest to decide if I should change therapists. This is a summary of the discussion. While it is targeted to me, if you have some of the same questions I had, you might gain some insight from these answers.

What is the endpoint of therapy, how do we know I am done?

You know you are done when you are living life fully in various contexts (situations/selves). Engaged in life. Right now, she says I need therapy and meds; and with these, it may be possible for me to get there. That I have a good prognosis. I started very good last year, but I am now in a “painful setback.”

Like many, I am losing faith in the process, and she encourages me not to lose faith. We are still waiting for the meds to work, which makes it even more agonizing. I told her I wasn’t sure how I would take it if they don’t work for me. She did nod in support, that it would be very hard to take after all this time of waiting and hoping.

Milestones to gauge progress

Since I have memory issues, I have trouble remember what we accomplished and their importance. So I feel like I have been spinning my wheels. Without milestones it is much harder to see my past progress, and to see where I am going.

She relayed that I have reached several milestones already.

1. A huge milestone is that I was able to tell my story – what happened to me.

2. To let out the secret that has been inside me for so long.

3. That I could reveal the sides of me (my selves), and that we found my core personality.

Going forward, she identified three major milestones:

1. Continue to see the overlap of the functions of the personalities – to feel good in the various roles I have. Currently, I can feel very good and satisfied with myself as one personality, but am unable to get those good feelings across several other selves. I can’t access it; sometimes can’t remember that it happened. I can SEE other parts of me with joy and success, but am unable to FEEL it if I am a different self. Therefore, there are times that I should feel complete joy over an accomplishment, but I can only feel that when I am the self who achieved that accomplishment.

This goal is that my feelings be more constant and available across my selves. It is a good realistic milestone that is not way out in the nebulous unforeseeable future, but something I can work on now. I am very happy for this shorter term goal.

2. Another milestone and goal for therapy is giving value to me. Abuse brings about a sense of being devalued. Unvalued. (And maybe why I can’t remember or encode in my memories or truly believe that people are here for me. I have put others before me, and facilitate that devaluation of myself.) Therapy is to help me get over that – to realize that I do have value and that I do deserve to get better.

3. This is really the immediate milestone – for me to feel safe and valued in her office. (And this is really a fundamental problem I have. But I have this issue of trust with everyone, and not just her. So that may mean changing therapists will not fix this.)

Shopping around for another therapist

She offered that I should “shop around” – that she provides a service and so do others – I should talk to others on the phone or in person and see if I click with anyone else.

She offered that she is not a specialist in dissociative identity disorder, but that she feels that does not prevent her from helping me. Her expertise is trauma with children and adults, which does include PTSD and dissociation in its less severe forms. Her main goal is to address the current suffering. She says that she has not treated anyone with this severity of dissociation, but she seems confident that she can help. She did not answer my questions about her training in the area, or her continued training. We didn’t specifically address my list question by question, so either we just didn’t get there, or she didn’t want to get into a discussion that she did not have this training. I would have felt more secure if she had been more forthcoming about people she has treated and how they did and how long it took.

She did offer that other people do specialize, and that I might contact a university for researchers in the area. Since I am a researcher too, and this is how I approach things, she thought I might be more comfortable with that type of person. I said that I wanted someone with clinical experience, not just a researcher. She relayed that some people do both. That makes sense, and something I had not thought of.

Impediments to successful therapy

I asked about the impediments to my success in therapy. I am in this hole of anger/depression/numbness (or as she calls it, this major setback), how do I get out? We had discussed before that I seem to focus on the times when people do not support me and not on the times they do help me. I see this is possible, but I also see how this is very related to my past – of needing to be accepted. And as a result, I am hypersensitive to anyone being upset with me or yelling at me. It crushes me inside. And I feel a compulsion to get them to forgive me or understand me, because I can’t have that feeling over time. It hurts me that I hurt other people, especially now that I am more aware of it. I think this goes to my lack of sense of value as well. And that I want help on my terms and am angry if someone can’t help me.

We talked about my memory problems – that I can’t remember the success in therapy, can’t remember when people support me. It is both long term (partial amnesia of the events) and also forgetfulness now. I have always been an amazing multitasker and now I can’t even get through chores without forgetting to finish them. And that frustrates me. She offered that I should avoid the multitasking and focus on one thing at a time, even if it takes longer, because I do get a sense of accomplishment from my work. Even if it is just the laundry.

My anger. It is here now in full force – how do I deal with it? She asked me to think of what my responsibility is for the negativity that I am feeling. I have set up this situation by being angry. I am not sure how to answer this – I am not doing this on purpose – if feels like I have been dragged down into it and I don’t know how to get out.

I understand that I am getting triggered and just massively overreacting to the situation. We discussed a recent episode where I felt taken advantage of – I was also in a situation where I had no control. Being massively overcharged for an item I needed while in a store in the airport. You are trapped there past security, and they can take advantage of you. Without going into details, I massively overreacted, switched to that very angry and resentful part of me, and just seethed. I was so far gone and disconnected from my surroundings that there was apparently some question as to whether they would let me on the plane.

We talked about how I can recognize that this is happening and stopping it. Heh, very hard to do, as I can go from 0 to rage in a very short time. I relayed that my husband and I have set up a few signals and actions that he and I can try that might be able to deescalate those situations. Time will tell if they work.

But this issue of my resistance. Resistance to therapy and to the process. I don’t know quite what that means or what is causing it now. I don’t know why I can’t trust, and if this has always been underlying in this therapeutic relationship but has come to the forefront now that I am in this setback.

What do the therapists want/think?

I finally had the nerve to ask the question on my mind. Our entire conversations the last few sessions have been kind of sterile, factual. That this choice is mine alone. I feel flapping in the wind, unable to make a decision, and not getting any indication from her of what she would recommend I do – what SHE wants.

So I asked, “What do you think of this relationship? Do you want me to stay?”

It was the first time I saw genuine emotion burst out of her in a while. “Yes, I want you to stay. Of course. Our work here is not done.”

Finally, I felt something positive from her, rather than just the sterile facts. That made me feel wanted. Valued. Like she had been telling me therapy would give me value, but I wasn’t feeling that in her words – I had not gotten the sense that SHE wanted to keep working with ME. Now why the heck would that be important? I am just a client and I need to remember that. Why is it important to me that she wants me to stay? I guess because THAT gives me worth – that I am more than just a job for her, even though I am just a job. Contradictory, I know.

What do we do next in therapy?

Finally, I asked, okay, if I stay, what next? I asked if I stay, what do we do about my trust issues, my memory issues? How do I make progress against this? What do we do next – where does this therapy take us?

She told me that we continue to process incidents that have happened, as we have always done. So I can learn from them – what caused the trigger, how I handled it, and what to do next time. That we continue to process dreams, which works rather well for me.

I told her about the dream I just had – the knife on the table between us. That I don’t feel comfortable yet, but no one is holding the knife so there is no decision and no immediate danger. The issue is between us, and this relationship is on the table. For discussion.

This all seems to trivial – process events and dreams – but at the same time, logical. It is what we have been doing, and I was expecting something different when the rage came. And there is nothing different – we just keep doing the same thing. I had expected “the process” to expand to include this new elemnt. But how do I communicate in the rage? Why has this suddenly intensified my distrust or discomfort in her office?

That is a question I can’t answer. So I will have to take her advice and shop around. Maybe I will find someone I can feel more comfortable with who is in my insurance plan, maybe I won’t, maybe I will try to stick it out with her through the discomfort and see if it changes.

A sort-of second opinion

I just talked to my meds doc. He said the most important consideration is if I feel I can work with my therapist. That I have invested a lot of time and suggested I spend a few weeks trying to work it out. And he would give me recommendations for other therapists at my next appointment in 2 weeks.

So, it seems that the meds doc I DO trust is making a concrete recommendation. I really like this guy, who HAS treated people with the disorder as severe as me, because it tells it like it is. No beating around the bush, just straight talk and a lot of humor to get through the hard stuff. I really wish my therapist were more like him – making the suggestion of a timeline or something. I’d like to see this guy full time, but at $350 an hour, it is not quite feasible. Sigh.


1 Comment»

  Shasta wrote @

I interview therapists before I see them. If they are reluctant to talk to me informaly to tell me about themselves then I cross their name off the list. First impressions, I have found are usually right. One session should be MORE than enough. I do not judge this by how much they push my buttons. I WANT them to. Why would I pay to sit with them and have nothing happen. If I wanted to just talk I would take a friend out to Starbucks. The contradictory part is that I want them to provoke me but then the war begins. . Usually my child has the best sense of whether or not there is a connection. For this reason my wife (who is a far more of ally with him than I am) says I should let him decide. However there are, other considerations which I am more in a position to evaluate like, for instance, the therapists theoretical orientation. I know a great deal about these approaches and while I definitely do NOT like head games I know that a mainly cognitive approach will not work when it comes to issues of trauma – at least it does not work for me. Oddly enough though, Colin Ross is very cognitive and mental. I have observed him in action. Personally though, I do not think he is a very good therapist and I am not alone in this opinion. But as far as theoretical understanding and overall strategies he is very capable. The therapists he has trained (certainly no all but some) are very good and he leaves all the affective stuff to them. Again this is a very biased opinion which is based on my needs. I think cognitive therapy consistently works well when it comes to depression but, I do not think it works well when it comes to trauma. You see, CB therapists want to promote rational thinking which is based on linear processing but children do not think that way and it is often they who carry a great deal of the emotional pain. I would like to see these very adult therapist try to corrrect the thinking of a crying or angry child! Maybe, as a part of their training curriculum they should be required to teach a kindergarten class for a month or so. As I have told them before “If you want to talk rationally I do that all dayt but if you want to deal with the deeper emotional issues” you will have to talk to _____I do not think I am a difficult client (my wife does) but if I make things difficult for therapists it is because of the complexity of my defence system which keeps me trapped in conundrums and contradictions. Parts oppose each other in such a way as to cause conflict and then negate the others. I guess I need a patient therapist, Really though it is not about how frustrating I am to their goals of what OUGHT to be happening. As hard as it might be to them. How do they think it must be for me wandering in a mirror maze locked in by irresolvable paradoxes? I do not enjoy therapy. I only go because I have to! Of course I am confusing. It is the very nature of my problems that we hide in paradoxes which my mental self cannot unravel. But arent contradictions a part of dissociation? When I am questioned about my childhood experiences ask “which view do you want.” there is mine and that of the others. I have been in therapy off and on for 9 years, ever since certain parts revealed themselves to my first counselor. She referred me to another one who referred me to another who referred me to another. That one disarmed me by saying “but has that (intellectualizing) helped you. Let’s just take what is.” I stayed with her longer than any other one – about 4 months, then I quit…..two years out….back in for 3 months…quit…back in two months….quit……Every time the opposing forces fought until none of them could do anything. Then later something would trigger me and I would go back. Now here I am again. I have interviewed about 7 counselors. I had an appointment with one of those aloof skeptical ones. That was the last. I went to a very good one, colleague of Colin Ross – not on my insurance. The next one – two sessions and she found some complicated insurance related reason to refer me to someone else. Her rationale made no sense. My wife said she had gotten in over her head. I called about…4 more I think. One was clicking but she was leaving the country. The other counselors said they did not deal with that. Then I encountered another one of those aloof highly cognitive types whom I could tell thought it was all a fad. Oh they doubt it? As I told one of them, “you could never doubt, deny or disbelieve any more than I have.” At this time I can receive FREE counseling but I have not been able to find one. For the moment I have stopped looking.

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