Talk therapy

[Dyess]

Do you think Talk Therapy works for PTSD? What kind of therapy do you get and does it work?

[KayFly]

I believe talk therapy can be very effective, especially in early stages of CPTSD...or PTSD.  I'm not a medical professional, but I have used talk therapy for years.  Some of it was constructive, some not, based on what therapist I was seeing.

I believe it is best to find a therapist who specializes in CPTSD or PTSD (which ever one is more relative to you), in the case that you are looking for a therapist.... especially to find someone who specializes in CPTSD if thats what is needed, because it is rare to find treatment for it.

I see an EMDR specialist who diagnosed me with CPTSD.  I started seeing her 10 months ago. I like her more than any therapist I have ever seen, because she properly diagnosed me, and properly treats me.  We had to start out with talk therapy more at first, and slowly broke into EMDR. EMDR, if done too early in recovery, can send you into flashbacks and reliving traumatic events, to where it can be unsafe.  I feel like she always has awareness as to when it needs to be lighter, talk therapy, and when I am ready to do more EMDR work. I have had setbacks in that time, but more so I have had breakthroughs. And I pay a pretty penny for her, but its worth every cent.

[Dyess]

Well if you are getting a benefit from it I expect it's well worth it Shortly after Dad's suicide I went to an EAP counselor. She also did EMDR, on our second visit she was doing EMDR and I kept getting worse. She said it was because I was ready to do the work. I was in such a deep depression and fog I couldn't even focus on her. At some point I got to where I couldn't do it anymore. She said that talk therapy would only prolong the pain and she wasn't really into doing that with me. That's when I went out on my own, the next T, didn't have a clue as to what to do with me, big waste of money. This T seems more in tune with Trauma and I hope she works out. How do you know what therapy they are using? It all seems the same, or maybe she is using the same thing over and over with me. I guess they can mix up the therapies and see what works best. Therapy is like moving into another World, with new language.

[Dyess]

I think EMDR would have a better chance of working now, it was just too soon then. I was in a very dark place and that just didn't help.
Since Dad's death my whole world has changed. Never heard of dissociation, therapeutic relationships with counselors, inner child, inner critic, EMDR, types of therapy, grounding (except in electrical work), I had heard of flashbacks but that's about it.
I don't think the T and I will ever have a therapeutic relationship as defined by most books. She provides a service I pay her for, that's it. That's all I can give to that.
If I can find a way to deal with this on my own it will not bother me at all to let the T go.

[woodsgnome]

I've been up/down/in/out with talk therapy. I think I've seen a total of 9 T's , my last terminating (by me) last December. I found the experience to be a mixed bag, which I suppose only confirms what Walker says when he wrote that freeze types have a hard time staying with "live" therapy. Yup; that's been my experience. On the other hand, it's not like I didn't try—I just ran into some real doozies. I've also had some real confidentiality probs which I outline on a separate thread.

I did have one excellent T—the one who noticed that my issues were indeed ptsd/cptsd related. Unfortunately, that round was cut short due to that T moving out of the area. Since then, I've been hugely disappointed in what passed for therapy. In this remote region, there aren't really any viable options left that don't involve more driving than I care to undertake.

Let's see—one T spent most of her time waiting for me to say something; when I had nothing to say, that was the session. I mean, I love silent meditation, too—but it wasn't exactly what it seemed therapy should entail. I really felt confident  when she was surprised to see me one day—I mean I had an appointment, I'd driven 50 miles, and I know it had been set up during the previous visit. And her reaction was "Well, as long as your'e here..." Grrr.

Another T did all she could to fit me into her academic thesis, as if the only reason I existed was to match her pre-ordained version of therapy. I felt like I was just some experimental test-case. Who knows—maybe I made it into a book of hers as an example of how a life script works.

My last T was a charming fellow, but he'd spend half the time discussing the pros and cons of various chainsaws, as he knew I cut firewood for heat. Like, years ago I did. Well, okay; perhaps he thought that was relevant to something, but I sure didn't catch on to what it might have been. And so many of the other sessions were just glorified chit-chats—I'd resort to reading from my journal and he'd nod away; it was almost as if I was his T, not the other way around. Sure I have a tendency to be critical, and sensitive, but the whole approach seemed so weird.

Maybe that was okay—and/or it was what it was, I guess. It certainly strengthened my resolve to research/learn more on my own, and that's pretty much what I do (a lot)--it helps that I'm a voracious reader. Trouble is, I'd been doing that for years anyway. It isn't all bad, to figure things out for yourself. It's just that, well, it would be cool to find a T as well, get another viewpoint, etc. It's good to know, via this site, that indeed some T's can be beneficial and I wish you well with it.

[DaisyMae]

Hi Trace,

All I can offer is my own experience.  EMDR would be a bad idea in the beginning of therapy.  I know many others have experienced EMDR therapy but my T actually told me that he did not like EMDR that there were better ways to treat.  I am easily triggered now and do not have any feelings of self worth, have low self-esteem, and think I am intrinsically flawed so EMDR would be dangerous for me.  I struggle (putting it mildly) with ideation and thoughts.  It is still too early for me whether my counselor likes this form of therapy or not.

Right now we are working to "peel back the onion" and get me to open up, be more honest about how I feel or the lack of feeling in many cases.  So I am heavily involved in CBT (Cognitive Behavioral Therapy) and DBT (Dialectical Behavioral Therapy).  He has also tried some Solution Focused Based Therapy (SFBT) and Mindfulness but I do not think I was quite ready for these, still have a lot to learn about emotional regulation and self-worth, actually how to take care of myself.  The CBT and DBT are really helping at the moment and I am hoping to progress enough to get out of the dark and actually start working with Mindfulness and the goals defined utilizing SFBT.  Also, I have learned to trust and be honest with my T.  I trust him more than my family or my husband to understand and try to help me.

So, basically I think Talk Therapy is essential in the early treatment phase of CPTSD.  But at some point you have to move on in to more challenging forms of therapy to learn self-protection skills and resiliency.  That could be EMDR, Mindfulness, SFBT.  Everyone has their own unique set of circumstances and everyone responds differently to the various forms of therapy,

  DaisyMae

[Dyess]

Wow Woodsgnome, I don't know that I would have kept trying other T's. If you are familiar with the process of T's or therapy it's hard to say what's good or bad, what's working or not. I'm sure some forms may take some time to find out if it's working. Like anti depressants, sometimes you have to build up the medicine in your system before you notice something is actually happening.
I've come across a new word Transference. Holy crap, it sounds like there's suppose to be this relationship just short of love with your T. Are you kidding me? The people I do love, it's at a distance and they have been in my life, most of it. It's going to be hard for me to develop that type of relationship with the T. The whole concept doesn't sound healthy, but there are tons of things written saying it is. It scares the crap out of me and concerns me that she may notice there's not that relationship and stop our sessions. She's the only one that seems to "get" CPTSD, that's a rare find around here. I guess if she cancelled it wouldn't be the worse thing in the World, may go back to online counseling, that was easier back then.

[Dyess]

DaisyMae, thanks for your response. I agree, I think it was too early and it did trigger a lot of past issues. Maybe if we had not done that all this other mess would have not surfaced. When I went to see her it was just to deal with Dad's suicide and finding him, that's all. Now it has turned my world upside down with all the childhood issues and through adulthood. I don't know for sure that the EMDR did all that damage, but I certainly don't think it helped.

[stillhere]

Reading this thread, I thought I'd pass along a link to an article I read a few weeks ago:

http://www.psychotherapynetworker.org/component/content/article/485-the-limits-of-talk


It focuses on a leading trauma researcher (Bessel van der Kolk, a psychiatrist) whose work has impressed me.  I have yet to read his new book:

http://www.amazon.com/The-Body-Keeps-Score-Healing/dp/0670785938


But I've been reading much about CPTSD in the past few months, since I came to identify with its explanation.  Pete Walker's book was enormously helpful. 

Van der Kolk's main point is that talk therapy is limited for resolving long-term trauma (pretty much the definition of CPTSD, yes?).  His research shows that trauma leaves imprints in the brain, below the level of consciousness.  So accessing the effects of trauma requires more than talk.  He advocates mind/body work, especially yoga.

All this makes sense to me.  I spent some years in therapy in the late 1980s and was encouraged to dredge up memories of verbal/emotional/physical abuse in an effort to resolve them, somehow.  The process helped me make sense of my experience and helped move me toward going NC with my NM.  And life got better.  But now that she's found new ways to undermine me, the symptoms have returned.  I'm back in therapy, with someone who's encouraging me to explore multiple paths forward.

Curious about the experiences of people here.

[Dyess]

I have a book, I think it's called the Body Remembers and it's pretty good. A lot of it is over my head and so I just glance through it and read what interests me at that point My T has my Pete Walker book, hopefully she will finish it soon.  I'm kind of regretting starting counselling at this point, it has brought up so much other stuff and I didn't need more to deal with and she's not offering a lot of ideas on how to help with this. Kinda how the other one started out, was comfortable and impressed and the beginning and a couple months in it kind of fizzles out. Last session she said she hadn't had time to read the notes from our last session and so she needed a moment to glance over them. Talking about making you feel less important......and that's how the session started. All of you people who have a good T that truly cares, you are very fortunate. So far we have gone over two chapters in the PTSD workbook and that's about it. Then I had that bad dissociation event right before leaving, and drove from the office and I think she could have talk to me a little more to stay in the lobby or something until I got clarity again. But there were clients waiting, not like I haven't had to wait for clients before me, ya know? I guess it's just MY issues flaring up.

[stillhere]

You might ask your therapist some direct questions about what you can expect, or you could get a sense of her thinking by asking her to respond to Walker's book (what she agrees with, whether she's had the same experience with clients, etc.). 

Yes, beginning a session by reading notes is bad form.  The idea is to have a committed 50 minutes.  I have learned that therapists disengage after that.  They have other clients, notes to write, lives of their own.  But they owe you that almost-hour.  The challenge for you is to participate in using it.

I know in the past, now long distant, I sometimes wandered through many sessions without much direction, but back then, I was minimizing my story.  This time, I'm trying to be more self-directive.  The problem is that people in therapy aren't in the best place to do that.

[woodsgnome]

stillhere said about the current T:

"back then, I was minimizing my story.  This time, I'm trying to be more self-directive.  The problem is that people in therapy aren't in the best place to do that."

I wish I'd done that more when I was in T. Back when I started, I was resistant to it anyway; being a do-it-yourself sort, I guess; but the pain of living without some outside observations drove me to seek relief, even if I didn't fully trust it. 

Lots of hem-hawing through sessions, not enough focus or even distracting, albeit perhaps well-intended, chit-chat from the T. The sessions disintegrated entirely when my last T's chit-chat resorted to his in-depth discussion of chainsaws or life in the woods or...

My own attitude would shift, though, and maybe that threw the T off too; uh-oh, an old mistake of mine just kicked in, while typing this--shift the blame to myself, it's my fault again. Yikes

The deal with me is that I tend to start scared of anyone (T or not), warily figure how to be safe, and too often fall from my freeze perch right into the fawn trap of "what should I be like" in this role of client/patient rather than the "I am" person I can be away from the T chambers. That risks the old kick-yourself routine and it goes downhill from there, another near-hour wasted.

Like Trace, I've looked into on-line therapy and will be keeping an eye on that thread to see if anyone has experience there.

Thank you, stillhere, for that great observation; it's all about making T visits more attentive, I guess. In my own case, if I ever get back to T, it's what do I really need, now--overriding my people fears and fawning that always hit me before...although I've also had numerous confidentiality issues in the past, too. There's a thread about confidentiality in the therapy section.

Funny aside, though...to get to my last T's office, I had to pass by an obvious "children's" area with scaled-down chairs and such. Sometimes I wondered if I shouldn't just stop there and have the T meet me in the kid's zone. Arrested development writ large, or something of that sort.

[stillhere]

Self-direction in therapy is a kind of paradox.  It may make the difference between moving forward and spinning one's wheels, but the person in need is often at a point in life where self-direction is all but impossible.

I've turned to investigating a bit on my own, which is the way I found this site.  I also found Walker's book, which seemed to speak directly to my experience and explain why, after all these years, I seemed to be back where I was in the late 1980s.  Taking what I found to therapy has been a source of self-direction.  If I'm on the "right" track, it's probably saved many months of anguish. 

My T leaves me much room to direct sessions, and I'm lately unsure about what to do with it.  She asks questions about the distant and recent past, and I answer.  But I'm not convinced that talking through the past, over and over, is going to get me anywhere.

[arpy1]

stillhere, you said:     
"Self-direction in therapy is a kind of paradox.  It may make the difference between moving forward and spinning one's wheels, but the person in need is often at a point in life where self-direction is all but impossible."

yep yep, i surely know what you mean. 

i think there are lots of different therapeutic models.  the first T i had was the blank slate type. honestly, it was like talking to a computer. she pushed me to talk about really hard stuff and then just reflected back everything i said with total lack of emotion. she scared the youknow out of me, seriously. i felt humiliated and traumatised with every session.

the T i have now is what is called 'client-led'. it's true, it has been very hard to get to grips with, becos paradoxically, part of me would like someone just to lead me, guide me. that is what i have been used to for decades.      my T just doesn't do that stuff and sometimes it makes me feel like i am not getting anywhere but i think it's better, even if more insecure for me, because it reminds me to be responsible for my own recovery (and i am not frightened of her). therapy has to be a tool, a resource for me, not a rescue package. does that make any sense? i hate the insecure feeling but i think it is what will work best in the long run.

anyway, the whole therapy thing is totally scary in my opinion, and  it's a work in progress for me.

also the van der Kolk book is excellent and so helpful but it was a bit expensive. if anyone is interested, if you Youtube: 'Bessel van der Kolk' you can watch recordings of lectures he gave that cover all the topics in the book. really interesting and very worth a look; it explained me to myself in a way nothing else did, and i felt so reassured that i wasn't making this all up and that there was physiological evidence that explained what had happened to me in my brain, and also that recovery was actually possible. it was a lifeline for a while for me.

in the end, stillhere, we are just that - still here - surviving and recovering and it's good to know there are real people out there who share the journey. 

[stillhere]

Reading posts here, I've been struck by the frustration and disillusionment with therapy.  So many people seem to have tried and tried and tried again, only to feel that their various Ts have been less than helpful/understanding/supportive/ethical . . . .

I can recognize that a therapy practice is just that -- practice.  For the T, the job requires constant assessment and in-the-moment judgment that can sometimes go awry.  I certainly take issue with the T I had in the late 1980s, but I think she didn't grasp the intractability of my FOO, perhaps because I wasn't ready to see it either.

All the same, I thought I was past much of what I've been re-experiencing.  Van der Kolk's work offers an explanation and, perhaps, a way forward with attention to body as well as mind.  I live in my head.   And my body was always a problem and an object of ridicule for my FOO.  Seems as if this realization could be significant.

I'd like to know about successful strategies for managing "client-led" talk therapy.  As you say, arpy1, it's a source of insecurity.

But have people found ways to make it work?  Or at least to make progress?