Tag Archives: TF-CBT

Long-Term Psychoanalytic Therapy & Short-Term Trauma Focused Counselling

Posted by What It Takes To Be Me in Family Dynamics, Flashbacks, Psychology, Psychotherapy, Psychotherapy with A, PTSD/Extreme Emotional Stress Disorder, Sef-Awareness, Sexual Abuse, The Therapeutic Relationship and tagged with , , , , , , , , , , , , , , , , ,

I have been meaning to update my blog for a long time now, but blogging has had to take a step back in the midst of coping with what has felt like an ever-increasing onslaught of flashbacks. Still, here I am now, neatly posed in front [well, technically, behind] my computer and though I will more than likely have to make many stops to work my way out of flashbacks, I still wanted to write a little, just to keep you all in the loop as it were.

Firstly, I would like to apologise – or perhaps not so much apologise as acknowledge that my previous post was of a rather difficult-to-read nature. I know that some people found it a little too hard to cope with. And, at the same time, I have also had emails from people saying that they found it helpful in one way or another, and I suppose, at the end of the day, this blog, it is – as it states on the tin – an honesty focused blog, and does come with an explicit warning that it sometimes deals with difficult issues.

Now, moving on from that, you will be pleased to know that this post will be perhaps a little less difficult to stomach. I can’t guarantee that it will necessarily be joyful, but it won’t be leaving you with any particularly nasty mental images, I shouldn’t think.

So, what’s been going on in my life? Well, as mentioned above, there have been the flashbacks, and sometimes it really feels like that is ALL that there is, but, really, that’s not true, and I am hoping that – eventually, with plenty of hard work – I will get to a place where those will take a back seat.

As regular readers will know I am currently in twice weekly psychoanalytic therapy, and have been for nearly four years [thrice weekly, a lot of the time]. In fact, A.’s and my four year anniversary is coming up later this month. Perhaps time to crack open the champagne, or share a celebratory cigar ála Freud? But more than anything, I think, time to reflect.

People often ask me if my therapy helps, and what does A. say about all these flashbacks that I’m having, about self-harm, about feeling suicidal? And I find myself forever explaining that it’s not that type of therapy. It’s not the type of therapy in which A. and I sit and practice grounding techniques or where she advices me on what I should and shouldn’t do. It just isn’t. Psychoanalytic therapy isn’t a short term crisis action plan. But that is not the same as saying that my therapy isn’t helping. No, it doesn’t immediately offer relief from flashbacks or other psychological ills, but it helps in different ways. It helps me see things from different perspectives, it helps me develop self-awareness, it helps me understand why I sometimes react very differently to other people, it helps me see patterns in both my behaviour and in my way of thinking and relating. It helps me in a very broad way. This is not trauma focused therapy. We look at a lot more than ‘just’ the sexual abuse I experienced, we look at all different aspects of my life. It’s colour photography, as opposed to black and white, and I feel that it offers a bigger and more stable platform to stand on, when looking at all the various angles of being alive and being human. So, yes, therapy absolutely does help. It’s just that it is rather more complex than a plaster cast on a broken arm.

That said, the one thing that impacts my day-to-day life more than anything else is without a shadow of a doubt the flashbacks, the horrible experience of being made to relive the abuse again and again without warning. It’s a painful and uncontrollable mental bombardment which severely alters the way I live my life. Apart from, of course, being extremely emotionally exhausting (both the actual flashbacks and the aftermath of them – it’s simply not a case of OK, I’m out of the flashback, everything is fine now..) they also impact on a very practical level. Firstly, the unpredictability of when they [the flashbacks] are going to happen, means that it is very hard to relax. I don’t have easily identifiable triggers which give me warning that I might soon have a flashback, so, even when things are good, when I’m only having perhaps six or ten flashbacks in a day, I don’t know when they are going to happen, and so have to always be on the ready to deal with them. Secondly, when things are bad – like at the moment when I’m having anything between sixty and eighty flashbacks in a day – it leaves little time or energy to spare for doing other things. I can’t read, I can’t watch telly, because I’m constantly being interrupted by these flashbacks, and by the time I’ve come out of them and calmed down, I’ve forgotten what I was reading or what the storyline was. Also, having so many flashbacks makes venturing outside something to be avoided. It’s simply too hazardous, as I won’t notice traffic lights changing, I’ll keep walking while having them ending up getting lost, I’ll miss my stop on the tube etc etc. Even something so simple as making myself a cup of tea can become quite dangerous, as I discovered the other week; I was pouring out the water, had a flashback but kept pouring.. as a consequence the boiling water spilled onto my lap, and I got a burn on my thigh. So, even though the flashbacks are not psychotic; I do know where I am, it is like being in two places at once, it’s an altered state of awareness which affects daily life a lot more than people realise. I have to do a million different work-arounds just to get by, like being on the phone with someone whenever I’m out walking (so the person can help me notice if I have a flashback and tell me to stop walking), ask bus drivers and tube staff to make sure I get off at the right stop, meet friends in places that are easy for me to get to and generally meet at the station rather than at the cafe or restaurant we’re going to, to minimise the potential for getting lost on the way. Etc etc etc.

Because of this, I have decided that on top of my normal therapy with A. I am going to do some short-term specialised trauma-focused counselling, aimed at trying to reduce the number of flashbacks I have. I’ve talked to A. about it, and although it’s not the norm to see more than one therapist at any one time, it is something I really want to do. And I think that doing it this way, while I am still seeing A. will help me cope better with what can’t be anything but very painful trauma work. It’s one of those I don’t think it is meant to be easy, I think it’s meant to be WORTH it sort of things. Because, if it helped reduce the frequency of the flashbacks even just a little, it would improve my life enormously.

So, although there is much to discuss, not least of all the reasons why I am chosing to do this work with someone other than A. [is it to protect her? is it to protect me? maybe fear of ruining our relationship? etc etc], for now, I am waiting with some trepidation to start this new (additional) type of counselling. So do stay tuned. Updates will be forthcoming once I actually start.

All the very best,

xx

Being The Perfect Therapy Client

Posted by What It Takes To Be Me in Abandonment Issues, Attachment, Coping Strategies, Expressing Emotion, Flashbacks, Psychology, Psychotherapy, Psychotherapy with A, Psychotherapy with B, PTSD/Extreme Emotional Stress Disorder, Rejection, Sef-Awareness, Sexual Abuse, Suicidal Ideation, The Therapeutic Relationship and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

I know this is a bit like the London double-deckers; for a long time there’s not a single bus, and then there are five all at once. The Heinz Ketchup effect.. But, you see, one of my readers commented on the post I uploaded last night, and in responding to his comment I realised that it could well be turned into a blog post in its own right, so here I am again, updating my blog merely hours after my last offering. You’ve got to strike while the iron is hot and all that.. I hope you don’t mind.

Anyhow..
The comment was in reference to my mentioning that five years ago, following an initial psychological assessment, I was deemed to be too high risk and unsuitable for psychotherapy, and the commenter said that “From the posts I’ve read by you, you certainly seem like the sort of patient that therapists are delighted to have.” My initial reaction was to feel flattered by this comment, and I instantly thought that I rather agree, biased as I am; I do think I make a good client. I have a bit of a chequered past, quite a few things in my baggage – obvious material to work with so to speak – and I am also reasonably self-aware, rather analytically minded and fairly articulate. Not a bad prospect for a psychotherapist.

Then again, I am no different to any other psychotherapy client; I think we all want to see ourselves as good clients – interesting, intelligent people – who therapists are happy to work with. And we all wish to be the favourite client, the one our therapist is really looking forward to seeing, because we challenge them just the right amount without being burdensome or draining. [If you’re in therapy yourself, I’m sure you will know what I mean.]

Yet, having been turned down by the NHS for therapy I really struggled to find someone who was willing to take me on. Naturally I had to give up on the idea of getting free therapy on the NHS, but I figured that outside of The Service there had to be plenty of privately practicing therapists who would want to work with me.

In reality it took me quite a few months to find a therapist. I had to go to many ‘first appointments’ and found myself being repeatedly rejected. Many of the therapists I saw, said exactly what the NHS assessor had said; that I was simply too high risk, what with my recent serious suicide attempt and my habit of using self-harm as a coping strategy. And I can understand that. I imagine it can be quite challenging – scary even – to work with, and in a sense – be responsible for – a client who may well choose to down a litre of anti-freeze rather than turn up to session. Naturally, not everyone will be up for that. But, at the same time, the way I always saw it – and I would always make this clear at assessments – I’ve always seen therapy as the way forward for me, the thing which will eventually help me manage my past in a more positive way, and also – while I have many times become depressed while in therapy, I’ve never made an attempt to end my life when I’ve been in therapy or had counselling. That has only ever happened when I’ve not had a place to take my thoughts and emotions, when I’ve felt I’ve not been able to share what’s going on for me.

The other reason given to me, when therapists declined taking me on, was that they felt they simply didn’t have the experience they needed to be able to work with someone with such a complex background. There are quite a few aspects – issues, if you will – to work on; I was adopted, so a high potential for major attachment and abandonment issues and possible identity crises. I was sexually abused and suffer from intense flashbacks of this, and so more than one therapist said that I should probably look for someone who specialised in this area, perhaps a therapist trained in EMDR or TF-CBT. I have one parent who is gay, I have another parent who has struggled a lot with the rollercoaster that is bi-polar disorder. So lots of different things to work on in therapy, perhaps too many, for some.

I also suspect, although I don’t know this for sure, that I probably came across as someone who might be a bit of a handful to manage in session, because I happen to be ridiculously well read on the theory of psychotherapy, particularly psychoanalytic and psychodynamic therapy, which was also what I wanted to do. I am not someone who will hold back on commenting if I feel that the therapist is ‘text booking’ me. And also, there is a definite barrier to get through; the fact that I often, knowingly or unknowingly, intellectualise and theorise in order to not have to deal with actual emotions. Hiding behind my theoretic understanding of things, so as to not really have to deal with anything. I don’t do it so much anymore – in fact, these days I tell myself off if I notice that I am slipping back into this pattern – but five years ago, that was certainly something I did a lot.

In the end, having tried for a good few months to find myself a therapist and failed, I asked the house therapists in the therapeutic community I had recently moved in to, to set me up with one of their trainees, because I felt I would never be able to get anyone to take me on on my own.

Long-term readers of this blog with remember that this turned out to not have been a great idea, as the person who was ‘assigned to me’ wasn’t a particularly good match for me and the chemistry just wasn’t there. Having thought it through, I ultimately decided to terminate with her, as I felt that I could probably carry on seeing her for years and still never get what I wanted from our work together. It wasn’t a decision I took lightly, but, I always felt it was the right decision for me. I’m sure B. – my previous therapist – is a great therapist; she just wasn’t the right one for me.

As it turned out, I actually managed to find a therapist that seemed a good fit for me before I had even let B. know for sure that I was going to move on. Almost as if by magic, I had completely by chance contacted two different therapy organisations, both of which A. happened to be affiliated with, and already the first time I spoke to her on the phone, I felt she could be the right person for me to be doing this very important work with. Going for my first initial appointment with her I was nervous, but also felt decidedly positive. I had a good feeling about it.

I have since asked A. how come she decided to take me on – thinking about the many people who had turned me down – and, although she slightly dodged the question in her funny little way, she did say that she never considered not taking me on. I am still not entirely sure why that was, but maybe she saw it somewhat similarly to how I saw it; I seemed like someone she could work well enough with me to give me a chance.

We’ve certainly had our moments over the years, A. and I, and I know that I can definitely be more than just a little challenging at times, and not always in a nice way, but I do think that we speak similar enough languages to be able to communicate well and to work things through. I also know that A. can stand up to me, and that she won’t be cornered or pushed around by my intellectualisations or red herrings, something I really appreciate. In fact, only the other session, she was challenging me and I commented that she’s asking very difficult questions, to which she responded Good! and we exchanged a quick smile across the room.
And I think that illustrates our relationship quite well.

I don’t know if I really am that magic Favourite Client, and by now that doesn’t even seem all that important anymore, but I do feel that we have a decent enough relationship that I could be.

And that’s enough.

xx