Jdcoopers journal

[jdcooper]

I'm putting a list of questions to ask my potential therapist here so I can quickly get to it with my cell phone.

1. What experience do you have in working with someone who suffers from  narcissistic abuse?  Do you understand the scapegoat, golden child and other dysfunctional family dynamics?

2. What is your approach to therapy in working with these situations?  Would you be willing to try different approaches if one approach doesn't work?  Have you ever combined approaches e.g. cognitive with psychodynamic?  What training have you had with these approaches?  do you focus more on the past or the present?

3. Do you tend to be more directive or consultative?

4. Do you give homework in between sessions?

5. If I start having lots of problems between sessions what can I do?

6. What is your ideal client?

7. If I wanted to bring someone else to my session will that be a problem?

8. Do you tend to lead the session or would I do that?

9. What role does our relationship play in therapy?

10.  What are your strengths in your work?

11.  Have you been in therapy? Have you experienced any adversity in your life?

12.  Do you have anyone you consult with on your cases?

13.  How long do you think therapy will last?

14.  Will we be setting treatment goals together?

15. Have you ever worked with someone on career transition?

16.  How many years have you been seeing clients?

17.  What professional organizations do you belong to?  Are you active in them?

18. Do you understand complex trauma?  How do you define it?

19.  Have you ever treated a complex trauma survivor?  How many?

20.  If so, what methods do you use and why? Have you had specific training, supervision in that method?  How long have you practiced it?

21.  Do you have experience treating common co-ocurring conditions like addiction?

22. Do you know how to help me establish safety in the moment?  In the long run?

[jdcooper]

My impressions of my first consultation (of 5) Yes I am interviewing 5 different therapists. From the Sidran Institute.  My Impressions.

LMS

I felt safe and reasonably comfortable.  Yes.

I felt understood and taken seriously.  Yes

I was treated respectfully.  Yes

We generally agreed about the nature of the problem.  Yes, although I am not sure if she thought I had PTSD or CPTSD.  She asked what my psychiatrist diagnosed, Major Depression?; and I said yes.  I told her I had self diagnosed myself PTSD.  That my Psychiatrist never bothered to ask about my childhood etc.  She didn't really elaborate on that.

This feels like it could be a good match. Yes.  She was very warm and I liked that she gave me a hug at the end.  I was in a bit of an emotional state because of terminating my previous therapist relationship and not sleeping.  I had told her that I blew off my volunteer position twice this week because of the emotional distress and lack of sleep.  I told her I am going into shame spirals because of missing time from this position even if it is voluntary.  I told her I needed guidance on whether I should go in today-that I was conflicted and felt on the verge of tears, exhausted from not sleeping etc..  She said, just go and try it for 10 minutes and see how you feel. If you can't continue just tell them you don't feel good.  I am so glad that she said that because even though it was hard I went and stayed the entire time and now I don't have to feel guilt about not going.  She brings her dog with her to work and I love dogs.  She had a tiny office which felt kind of cramped; but I don't think that would really bother me. 

Did you feel comfortable and able to begin discussing your problems?  Yes.  She took a history of my life and we got into the major traumas I have been through as well as good stuff, like my marriage, and the problems I am currently experiencing, lack of sleep, self-medicating with alcohol, not exercising.  She said I need to exercise 30 minutes a day and she would be a stickler about it.  I liked that.  My other therapist said If I didn't feel up to it don't do it.  I need someone to really hold me accountable.

Did the therapist seem to understand what you were talking about?  Yes.  We talked about how I just ended my previous therapist relationship this week, how difficult the last couple of weeks have been because of the conflicts we were having.  She said she was sorry I had had to go through that.  And she said a simple phone call to terminate would suffice; that I wouldn't have to go into a lot of detail about why I am terminating therapy.

Do you feel your concerns were taken seriously and that you were treated with respect.  Yes.  She seemed to grasp the complex series of traumas I have faced.  She was very respectful.

Were the two of you in general agreement about the problem and your expectations for therapy.  Yes.  What I really liked about her is she said there are no guarantees; that therapy might stall and have to be looked at etc.  She understood I didn't want to be in therapy for years-but I think she felt like I was a bit more complex case which would take more time.  Can't remember if she put it into years or not. Like one or two.  Don't remember.  When I told her I had been putting off going to the doctor and getting a mammogram and pap and colonoscopy.  Things you are supposed to do when you are over 50.  She said you need to make an appointment to do these things right away.  I liked that.

Were you satisfied with your therapist's answers to your questions.  Yes. For the most part.  She did say she has had therapy.  She said she consults with others about her cases.  When I asked if she had experienced any adversity in her life she said yes.  She did say though that she had wonderful parents who were very much in love and she uses that as a basis to explain things in therapy-I guess like she has a model of what a good marriage is.  She said she uses lots of stories and analogies.  I kind of would like a therapist who has been there done that in terms of a bad childhood but it wouldn't be a deciding factor here.

My questions were answered adequately.  Yes.  She answered all my questions.  She was a little vague about her knowledge of narcissists but said she was certainly familiar with them.  Not so sure she has directly dealt with those who have experienced narcissistic abuse but she said she had dealt a lot with trauma survivors.  She said she had been in this line of work since the 1980's.  She said she would be available between sessions by text.  I was so glad as this is what I liked about past therapist.  I texted her and she instantly responded.  She had her phone glued by her side.

My treatment goals were addressed.  She asked me to tell her what I visualize would be a successful outcome of therapy; what my life would be like.  I tried to answer, (get back into my hobbies, get a job, find new friends) but got tripped out on the whole career issue; since this is one of my major issues.   I asked if she helps people with career transition and she said yes.  She says she doesn't draw up treatment goals per se but that we would constantly assess how therapy was going and whether it was helping.  She said she was open to any feedback, critical or otherwise and it wouldn't bother her at all if I felt like I needed to move on with another therapist.

This individual is clinically qualified.  Yes. She is a masters addictions counselor, (helpful because I self-medicate) She has a masters degree in guidance counseling and is a licensed professional counselor.  She also has a law degree which is what attracted me to her-just to have that commonality.  Evidently she has worked in mental health centers, Detox Clinics, Universities, Correctional Facilities, and hospitals.  She has also worked for large corporations in areas that were vague to me by looking at her bio.  She gave up the corporate gigs to do what she loves which is therapy. So that's great.

I can afford it.  Yes, she takes my insurance and knows the reimbursement rate and is fine with it.

I can get there with relative ease.  Yes.  It might take 45 minutes with traffic, 30 minutes without.

Do you feel you could grow to trust and work with this person.  Yes.

Overall impression.  Good

[jdcooper]

dealing with a flashback this morning that could be related to terminating my relationship with my therapist and having to start completely over.  inner critic is going crazy that I got two bad therapists in a row this past 2 years.  I might be flashing back to abandonment - my therapist is gone and I don't have a new one so I feel alone in my pain now. Ok So Pete Walker is tellng me to refuse to shame, hate or abandon myself. The self-criticism is unfair.  I have done the best I can over the past two years.  My severe depression led me to just accept the therapist I was presented with.  I didn't research and analyze because I was too severely depressed.  I am better, more self aware now and I am interviewing 5 therapists most of which have expertise with trauma.  I exercised this morning.  I picked up a book to study and will spend time doing that today.  I have a good husband who is even reading Pete Walkers book to help me and printed out managing emotional flashbacks and put it where I could see it without him even knowing I was having a flashback this morning.  Well now he knows.  I am doing the best I can to manage the very real, horrible traumas I experienced.  I have to acknowledge that this takes time and see I have come along way.   I still have trouble validating that what I went through was truly horrible and that its ok to grieve and feel bad about that.  I have got to be patient with myself.  I handled the termination with my therapist very well and I can move on now with gratitude for the help she did give me.

[Hope66]

Hi Jdcooper,
I just wanted to say that I hope you're coping ok with today - I have read your last 2 entries in your journal, and I am so impressed by your interviewing and researching of your 1st new therapist, and it sounds like you're in a different place than you were last time - it's understandable that you are facing some triggering stuff and fearing abandonment, but I think you're handling these things really well - and I am so glad to hear your husband is supporting you with reading Pete Walker's book.

Sending you a hug from me - if it helps 

Hope 

[jdcooper]

Thanks so much Hope, it does help.  Feeling it bit better now.

[jdcooper]

Therapist number two


1.  I felt safe and reasonably comfortable.  Yes, she had a nice comfortable office.
2.  I felt understood and taken seriously.  Yes,  she knew right away what narcissitic abuse was, the issue of splitting that Narcissists do with children, the fact that I had no childhood memories, meant pretty serious trauma.  She is the first to say definitely that what I have is CPTSD. finally.
3. I was treated respectfully.  Most definitely, she was impressed with my research and also said at one point that there quite a lot of hope for me getting better; in that I was resourceful and had done so much in my life despite my upbringing
4.  We agreed about the nature of the problem.  Yes we went over all the major traumas
5. This feels like it could be a good "match."  Yes, she is a trauma survivor and she has achieved quite a bit and that is inspirational to me and I felt immediately that we could dialogue very well together
6. My questions were answered adequately.  Yes.  She said she didn't know the length of therapy that she treated people with very specific phobias in just several sessions but someone like me was more complex.
7.  My treatment goals were addressed.  Yes, we weren't quite done with assessment but I mentioned a couple of goals and she wants me to bring in more for the next time we meet so we can go over them.
8. This individual is clinically qualified.  Yes she is a PHD level with training by experts in the field of complex trauma.  She is also very familiar with personality disorders though she said she knew more about borderline that narcissism
9. I can afford it.  Yes.  She takes my insurance.
10. I can get there with reasonable ease.  Yes.
11.  Did I feel comfortable and able to begin discussing your problems.  Yes, I even volunteered painful stuff; she had not yet got to.  I wanted her to have a clear picture
12. Did you feel your concerns were taken seriously and that you were treated with respect?  Yes
13.Were the two of you in general agreement about the problem and your expectations for therapy?  Yes.  She explained that I had a lot of different traumas so there was a lot to work with but we would come up with treatment goals
14.  Were you satisfied with the therapists answers to your questions.  Yes.  She said she uses an integrative approach.  She also said cognitive behavioral therapy sometimes doesn't work as well with those that are pretty good at analyzing things in their heads.
15.Did you feel that you could grow to trust and work with this person?  Yes - The only thing I didn't like is per her agreement that she will not accept any texts or emails about therapeutic matters.  That I could call but it could be 24 hours before I got a call back.  Sounds like she doesn't want to do any work in between sessions.  She says she would be recommending websites and apps but that unlike some therapies mine probably wouldn't be as homework intensive; rather just reflecting upon what was done in session.  She said she felt like the client/therapist relationship was the most important thing in therapy as a whole; which I quite agree with.

[jdcooper]

Therapist No. 3
1.  I felt safe and reasonably comfortable.  Yes
2.  I felt understood and taken seriously.  Yes, although I did feel at times that some of the distressing events I was describing were not fully appreciated by her.  She didn't have a sense of outrage - just more of a sense that she had heard it all before and that my story was not that shocking.
3. I was treated respectfully.  Unfortunately, due to a scheduling screw up she had two 6 o'clock appointments and I had to wait an hour to see her.  I didn't give me the greatest feeling.  She has someone else control her schedule somewhat and that person screwed up.  I also wasn't told how to get out of the building and at 8 pm the doors were locked and I couldn't get out and I had intense anxiety about being trapped in there and went back up and luckily caught her. She took me back down and showed me a very obscure small button to push to get out.  The moments in the elevator were awkward and I couldn't wait to get out of there.
4. We agreed about the nature of the problem.  I asked her what she thought about my diagnosis at the end.  Whether she thought I had PTSD or complex trauma and she said that she was sensing a lot of anxiety and she wouldn't say for sure what she thought my diagnosis was.  She didn't say it was too soon to tell.  She just said something about anxiety driving things.  I felt a little frustrated by this; but other therapists have also been reluctant to put a PTSD or CPSTD diagnosis on me.
5. This feels like it could be a good match.  She was very soft-spoken - almost to the point I couldn't hear her at times.  I almost felt like my conversational style was much more bold and direct than hers.  It made me feel like I wanted more of a reaction out of her aside from her quiet observations that I had had a lot of loss and betrayal in my life.
6. My questions were answered adequately.  Yes.  She stated she loves DBT and CBT and that it saved her life.  She is a victim of domestic violence in her childhood and adulthood.  She feels like the therapy is "evidence based"  and even more so in the last ten years it has become better developed.  I told her I thought DBT was for suicidal and borderline patients and I felt I was neither and she said it works with those without those "greater problems."  She talked about mindfulness-which most of the therapists I have talked to have mentioned.  I also told her I had been frustrated with a CBT workbook I had tried to use and how overwhelming it is to try and address even a fraction of my negative thoughts.  I told her I can intellectually understand things but when it came to feeling things-they were different than my intellectual view.  For instance knowing my fathers abusive behavior was not about me and certainly not my fault.  But yet somehow still feeling like they were my fault.  She also stated I could have email and text access to her in between sessions.
7.  My treatment goals were addressed.  She said we would be setting treatment goals.  I told her I wanted better occupational and social functioning.
8.This individual is clinically qualified.  Yes.  She has extensive training in her chosen treatment modalities, DBT and CBT.  She has over 20 plus years experience.
9.  I can afford it, through insurance and it is easy to get there.
Overall impression is just fair because I am not quite a believer in her chosen methods of treatment CBT and DBT.

10.  Did you feel comfortable and able to begin discussing your problems.  For some reason with her I really unleashed every negative detail of my life and felt like I was just gushing with stuff.  i am not sure why I felt compelled to dump just everything out there.  I almost feel she should have steered me better and not let me get into so much painful detail.  When it was time to end I felt extremely vulnerable and exposed.  To her credit she said she thought things would crop up with me later and that I could call her.
11.  Did the therapist seem to understand what you were talking about.  She understood in a general way by saying things like betrayal and lost.  When I explained how I was soon going to cut off contact with my family she had no input or thoughts about whether that was the right or wrong thing or even validating that was what I felt was necessary.  She was almost too neutral about it all.
12. Did you feel like your concerns were taken seriously and that you were treated with respect.  Unfortunately I had dumped so much out there and we had little time to address things.  I couldn't get a sense about what she thought.  She just had a soft spoken way of saying that it was a lot of trauma and that I had done very well considering all I had been through.  I didn't feel any sense of outrage at my family that other therapists have had when I have described some things.  I know her background in being a victim of physical violence and almost thought that since that was not what I experienced that my issues were not as severe - maybe than other peoples.  I told her I was afraid to ask my dad to roll up a window when I was freezing cold as a child and she said - were you afraid he would hit you.  And I had to quickly say no no that was never the problem.  I was spanked but never physically assaulted out of the blue.  I was just screamed at. 

13. Were you two in general agreement about the problem and your expectations of therapy?  Again, she emphasized CBT and DBT.  I have previously had two therapists that do not think that CBT is the way to go with me.  One therapist simply doesn't like it at all.  Another therapist said that for someone like me who is very articulate, intelligent and logical it might not work.  Thinking isn't really my problem.  Feeling is.

14.  Were you satisfied with the therapists answers to your questions.  Yes.  She said we would focus on both the past and the present.  She said she would use aspects of those two main therapies CBT and DBT.  She said I would be the one directing the session.  She said I could contact her between sessions.

15. Do you feel like you could grow to trust and work with this person?  I am not sure.  I really wanted to like her because she is a survivor of trauma and I thought she would be the one to most understand what I had gone through.  I just didn't like her steadfast belief that DBT and CBT saved her life.  My perceptions of DBT are that it is for people with Borderline Personality Disorder and suicidal, self harming people and that CBT isn't going to work with someone like me who already thinks well and intelligently and logically.  I don't think my thinking is the real problem.  I think my problem arises from feelings. The thought of having to focus on my thinking to solve the feeling seems counterintuitive to me.  She gave me a worksheet and it felt almost kindergarten level.  I have been an attorney for years and know how to validate someone and see things from the others point of view and it just felt way too basic for me.  I don't think my depression is a result of faulty thinking.  I think my depression stems from not recognizing my true feelings about situations.  My thoughts were very rational.  I just never trusted my gut feelings.

[sanmagic7]

hey, jd,

first, i give you so much credit for this whole interview process you've chosen.  i think it's great!   good for you for taking the power into your own hands with this. 

second, i admire how much you know about yourself regarding you and the therapeutic dynamic.  i agree with you that cbt is not always the greatest fit for trauma/healing therapy. 

just a note on communication between sessions - some therapists won't use cell phones because they aren't secure, thus confidentiality could be compromised.    same with emails and skype.    i didn't have any of those options when i was working, so communication between sessions just wasn't an option, and i never gave my phone number out to clients.  that was pretty routine practice back then.   how things have changed. 

i'm not surprised you had a little bit of a rough time between interviews.  you're bringing up stuff to strangers without the ability to process much of it.  just remember it's only your brain reacting to something new in the only way it knows how right now.  i believe that will change.

i give you a lot of credit, also, for being willing to take a chance and get back into therapy.  very courageous, and it shows a lot of persistence and determination to tackle this beast of c-ptsd.  i have no doubt you'll get to where you're wanting to go.  it may be rough at times, bumpy, messy, but you will continue to learn and allow your brain to change and heal.  all my best to you, jd.   big hug!

[jdcooper]

Therapist 4
1. I felt safe and reasonably comfortable.  Yes.  She has a calm manner.
2. I felt understood and taken seriously.  Yes.  I told her about the major traumas and she seemed to agree there was significant trauma/loss in my life.
3. I was treated respectfully. Yes.
4. We agreed about the nature of the problem.  Yes she agreed I have complex trauma
5. This feels like it could be a good "match."  Yes.  She is from the New England area of the country and this is where most of my roots are so we had that commonality.  I liked that she was older.  She is 63, 11 years older than me.
6.  My questions were answered adequately.  Yes.  She said that I could call her in the middle of the night if I needed to that if I had a problem I could text or call.  She said she does Cognitive Processing Therapy quite a bit - that she likes the written aspect of it.  She said she has had therapy herself and that she did have some adversity in her life.  She said she meets with a group of therapists where she could discuss if she had a difficult case.  She said the therapist relationship was the most important.  She has had experience working with those who have suffered from narcissistic abuse.
7.  My treatment goals were addressed.  Yes.  First she wants me to have a consult with a psychiatrist to get a second opinion on my meds and talk about TMS - she seemed concerned about needing 100 mg of seroquel and a xanax to s.  Second she wants me to quit the volunteer work because it was causing me distress.  Third I need to get engaged in new volunteer work.  Fourth I need to decide what to do about pursuing the medical coding career.  We will go into this on the next session.  She wants to establish our relationship first before delving into the trauma. 
8.  She is clinically qualified.  She was a OB/GYN who choose to pursue psychotherapy as a second career.  She has over 10 years experience in therapy.  She works at the VA during the week with PTSD and veterans.
9.  I can afford and and she offers weekend appointments making it quite easy to get there.
10.Did you feel comfortable and able to begin discussing your problems.  yes.  We talked about my 14 year old self and the series of rejections I experienced and how that affected my self-esteem.
11.  Did the therapist seem to understand what you were talking about?  Yes most definitely; she immediately picked up on my feeling of being "invisible" in my family and other situations.
12. Did you feel your concerns were taken seriously and that you were treated with respect.  Yes most definitely.  She smiled at a couple of things that made me have a warm feeling about her.
13. Were you satisfied with the therapist answers to your questions.  Yes.  She answered everything clearly.  She said she was more directive and I liked that because I feel I need that right now in my life since I am suffering from uncertainty in so many areas.  I need advice on how to tackle some major life issues.  She said she only focuses on the past to the extent that the past hasn't been processed yet.
14.  Did you feel that you could grow to trust and work with this person.  Yes.  She seems like a perfect fit and I told her that I chose her out of the four therapists I have interviewed.
14.

[Hope66]

Hi JdCooper,
So glad to see that you've chosen your therapist, and I really admire your process of interviewing them all and deciding - really having an informed decision, and I would like to wish you well with your therapy with this person.
Hope to hear how you get on.
Wishing you well for positive outcomes and progress.
Hope 

[sanmagic7]

hey, jd,

so happy you found a fit.  from what you wrote, i have to admit i agree with you.  she sounds informed, concerned, caring, and willing to show some emotion to what you're saying.  i also like the fact that she has some medical background - there are so often physical ailments that go along with this.  and i'm glad she wants to review the meds you're on.  i think that's a very positive attitude to have. 

so, forward it is.  if you care to share any of how it goes with her, that would be great.  if not, that's ok, too.  i think you did a great job, jd.  well done!   big hug!!!

[radical]

You are an inspiration, JD.  Wishing you all the best.