Unknowns of starting therapy

[Pioneer]

I have been aware for some time that I will probably need a therapist to help me further along my recovery. I feel like I've gotten to a safe/stable enough place where that is a possibility. And with the support of a friend and my husband, I was able to talk to my physician about starting therapy with someone knowledgeable about trauma. So, she has referred me to a place which seems to deal a lot with people who are dealing with addictions but along with that they also do therapy for trauma. So, I will be going there for a first appointment, I'm assuming for an evaluation, this week. And the receptionist told me that it would take a half an hour at most. I'm not totally sure I believe her, and if that is true that seems really fast 

I have used some of the forums from OOTS and filled them out to take along (they may have a copy of them already since I gave them to my physician too who made a copy). I feel fairly confident about the visit, which reminds me of the healthier me. But realistically, it is a pretty big deal considering that there are a lot of unknowns. I had a bad experience with a counselor in the past. And the article linked in this forum talking about the signs of a bad counselor was very helpful in identifying and solidifying why it was a bad situation. So, hopefully I am a bit more prepared this time.

I am wondering if you have any other suggestions of things I should be looking for or considering or taking with me for the appointment?

My insurance will be able to cover the therapy and I will be able to do much of my therapy appointments online so I won't have to travel in. That is pretty important to me since we live very rural and I watch our kids throughout most of the day.

[woodsgnome]

Therapy these days seems such a mixed bag. My own has stretched out over several T's with a variety of approaches. It took some while to find someone who I felt truly comfortable with.

I've come to accept that I need deep therapy for lots of reasons. I think (reluctantly)of trauma therapy as a lifelong project, and I know my best therapy comes from what I can absorb internally, sometimes on my own (reading, videos, etc.). Yet I'd feel truly lost without a wise T's expertise to validate and support my own efforts.

Yes, I'm a patient, but my T's style veers more towards respecting that any client deserves respect, and credit, for being fully human and all that involves. Sadly, from what I've been able to observe, this isn't always the case with how T's approach their 'caring' side.

Hopefully your T will have reviewed the materials you've given by way of the M.D. Especially important is to discern if the T truly knows the full scope of C-ptsd vs ptsd. Even bringing a favoured book might help to at least establish where you're at.

It's natural to be a bit nervous. Many of us are quite sensitive, for obvious reasons. I hope, all things considered, your experience with T will be helpful for your healing journey. 

 

[Kizzie]

I don't have any suggestions Pioneer, it seems you are well prepared (), just wanted to wish you well and hope this new T works out better than the last.   

It sounds like if they treat addictions and trauma they may have some understanding of the link between the two (not that you're going in for an addiction but that they get how lasting and injurious trauma can be and how people need to find ways to cope, to survive).

[OceanStar]

I'm not sure if this is of any help...

When I went in for my first assessment and then my first session I had in my mind to see if I could one day trust this person enough to speak my past. I didn't have to trust them there and then but just that there was a possibility of one day perhaps I could. That has always been my bar, if I get to the point where I feel I DO NOT TRUST YOU then it's time to leave. Maybe one day I will, but not today is ok, it can take a long time to build trust, but it is possible.

The person doing my assessment also said that saying 'I don't want to answer that question' was a valid answer and an answer that they would respect really helped too.

I hope it goes well.

[Pioneer]

Thank you woodsgnome, Kizzie and Oceanstar  I feel supported! Those are all good thoughts as I head into the appointment. It makes sense that it is a process, just like CPTSD and healing are a longterm process. I hope I can talk to someone who is interested in learning about CPTSD if they aren't already familiar with it. Having resources in mind for that is a good idea.

[Not Alone]

Did you have your appointment? How did it go?

[Pioneer]

Thanks for checking, notalone! Yes, I did and it seemed to go pretty well. I didn't know what to expect and it was just an intake with a case worker. He was pretty kind and so was the receptionist afterwards. I will go back in at the end of next week for about a 2 1/2 hour assesment, the first part with him again and then with the therapist after that. It sounds like they will ask a ton of questions, including about my childhood. So, we'll see how that goes. I feel pretty at peace about it at the moment.

One thing that really helped me to relax and feel more safe was when he asked me what was going on when I had a rough day recently. I started to explain that everything had been going so well and so I got triggered, and I didn't even have to finish my thought. He already understood and chuckled with me. I mentioned that I had starting sabotaging on that day, and he was not surprised. I was relieved by that. It was refreshing to feel like I wasn't the only one.

This isn't totally related, but worth mentioning that I did have a really rough day yesterday. Part of that was probably the sabotage that comes with a success like that first appointment. But I was also triggered (was honestly already triggered by some extended family drama that has come up) by the fact that I had a medical appointment immediately after the intake therapy appointment.  I was expecting the medical appointment to lead toward a resolve but found out that I need to be referred yet again (4th time for this issue in the past several months) to a place 3 hours away. I was mad and frustrated and scared and just threw a fit yesterday with all kinds of obsessions to "cope" (which really doesn't work for actual coping). My husband and I were able to break through it, and today was a better day but still learning to release it all.

Thankfully, we do have healthy family that live nearby the new place I am getting referred, so we can stay with them.

Overall, I feel relief that I may get some quality therapy soon. The receptionist said that the therapist is good and from the way she said it, I believed her. And I need to try to let go of what I can't control. Thanks for the support everyone!

[woodsgnome]

So refreshing to hear of a good first step, Pioneer.  Wishing more good vibes as you venture into this new leg of the journey. It might be rough at times, but you already know that.

Best wishes as you seek safe harbour. 

[Kizzie]

  and  Pioneer!

[Pioneer]

Thanks, Woodgnome and Kizzie 
I had my long assesment today. I felt respected and listened to and affirmed by the staff I interacted with and that felt really good. It was not with my new therapist, and I only very briefly and casually met her. I will start meeting with her online next week.

It sounds like I will be diagnosed with PTSD, which is the first time I have officially been diagnosed with anything other than depression so that feels good. I think once I meet with the actual therapist I can talk to her about CPTSD as well and how that might affect therapy. Does anyone have any suggestions for what might be helpful to bring up as far as differences between PTSD and CPTSD treatment? I am excited and thankful for the opportunity to process my trauma and thought processes. I know my brain has been trying to do that - I've had bad dreams (again) lately as my brain tries to process the grief and trauma.
Thanks all 

[Not Alone]

I'm so glad that you felt heard. I hope the new therapist is a good fit for you.

[Pioneer]

Thank you, notalone! Me too.

[Kizzie]

Does anyone have any suggestions for what might be helpful to bring up as far as differences between PTSD and CPTSD treatment?

Many T's don't know that CPTSD has been accepted by the World Health Org in their ICD-11. The ICD is one of two major diagnostic manuals used by professionals in medicine and mental health, the other is the APA DSM. As such, it might be helpful to bring along some info about the difference between PTSD and Complex PTSD.

The ICD-11 diagnosis descriptor reads as follows:

Complex post traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse).

All diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterised by severe and persistent 1) problems in affect regulation; 2) beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and 3) difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning. (Source = https://icd.who.int/en/https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/585833559 ) 

In a nutshell; PTSD has 3 symptoms which are shared by CPTSD but the latter has 3 additional symptoms:

Shared Symptoms - The following three symptoms are shared with PTSD and are characterized as fear responses to loss of safety and threats to the physical self of harm or death:

    RE –Re-experiencing past trauma in the present (flashbacks; nightmares)

    AV – Avoidance of traumatic triggers (thoughts, feelings, people, places, things)

    SOT – Persistent sense of threat (hypervigilance, heightened startle response)

Unique Symptoms - The following three symptoms result from interpersonal threats to the psychological self, resulting in disturbances to self organization (DSO) including harm, disintegration, or death of the self:

    AD – Affective dysregulation (shame, fear, anger/rage, grief; hypoarousal - numbing, dissociation, depersonalization, derealization) 

    NSC – Negative self-concept (highly critical of self; feeling defective/inferior/worthless; perfectionism)

    DR – Disturbed relationships (attachment disorder, social anxiety, desire to isolate, feeling different than others, mistrust, fear of vulnerability or intimacy)



Hope this helps 

[Pioneer]

Thanks Kizzie  I had some of those facts about the differences between PTSD and CPTSD written down for my first appointment in case I needed them.

Thank you so much for all the support leading up to my therapist appointment. It went really, really well. She seemed to understand everything i was saying and was very supportive. She had helpful questions and seemed to want to go in a helpful, healthy direction.

It was odd (but not all that shocking after all the medical things we have gone through) to find out that she doesn't have any notes on me after all that time with the assessments leading up to our first appointment. But thankfully, with her good questions and discernment and minimal explanation on my part she understood where I was coming from. She seemed to have experience with the type of abuse and neglect I have been suppressed with.

I feel so grateful and encouraged.

[Kizzie]

            That's awesome to hear Pioneer