Help me deal with hysterical reactions in therapy
August 25, 2010 2:52 PM Subscribe
Help me deal with hysterical reactions in therapy
I guess I thought that therapy would be sort of like strength training... gradually building up healthy ways of thinking and increasing my ability to tolerate unhappy thoughts without falling apart. Instead what seems to happen is that I bring up an unhappy thought, then fall apart, and the therapist tries to get me to describe where I am emotionally, which is impossible, because by then I'm usually too out of it to form a coherent sentence. This is unsatisfying to both of us, and ultimately I've just started avoiding bringing up unhappy thoughts in therapy, which is not really a good long-term solution.
My theory is that I have an "emotional allergy" to certain thoughts/feelings/topics. What I feel is a hysterical / exaggerated version of a normal reaction. Once I'm caught up in the exaggerated reaction I'm unable to stop it, except by waiting for it to run its course (preferably in seclusion). Various people have tried various ways to break me out of the reaction - from hugging me to slapping me to trying to discuss the situation logically - but none have been helpful. My life is fine as long as I avoid these thoughts or anything that might trigger them.
(For what it's worth, what I think of as an "unhappy thought" is basically something pointlessly cruel that can't be tested. For instance, I might be fulfilling a prescription for birth control and I think "the clerk is thinking: Why is she wasting her money? She's obviously single and she's too ugly to rape." Or I might be thinking about my family and think, "They tried so hard to love me. I wish I could have been the type of person they could love." These type of thoughts won't always trigger a hysterical reaction, but if my emotional defenses are low they often will. By a "hysterical reaction", I mean uncontrollable crying, an inability to speak, sometimes trouble breathing, sometimes nausea/vomiting.)
So... should I keep bringing these things up in therapy, even though my ability to handle them doesn't seem to be getting any better? Or should I try to address them in a different way? Has anyone had success with dealing with this type of problem?
I guess I thought that therapy would be sort of like strength training... gradually building up healthy ways of thinking and increasing my ability to tolerate unhappy thoughts without falling apart. Instead what seems to happen is that I bring up an unhappy thought, then fall apart, and the therapist tries to get me to describe where I am emotionally, which is impossible, because by then I'm usually too out of it to form a coherent sentence. This is unsatisfying to both of us, and ultimately I've just started avoiding bringing up unhappy thoughts in therapy, which is not really a good long-term solution.
My theory is that I have an "emotional allergy" to certain thoughts/feelings/topics. What I feel is a hysterical / exaggerated version of a normal reaction. Once I'm caught up in the exaggerated reaction I'm unable to stop it, except by waiting for it to run its course (preferably in seclusion). Various people have tried various ways to break me out of the reaction - from hugging me to slapping me to trying to discuss the situation logically - but none have been helpful. My life is fine as long as I avoid these thoughts or anything that might trigger them.
(For what it's worth, what I think of as an "unhappy thought" is basically something pointlessly cruel that can't be tested. For instance, I might be fulfilling a prescription for birth control and I think "the clerk is thinking: Why is she wasting her money? She's obviously single and she's too ugly to rape." Or I might be thinking about my family and think, "They tried so hard to love me. I wish I could have been the type of person they could love." These type of thoughts won't always trigger a hysterical reaction, but if my emotional defenses are low they often will. By a "hysterical reaction", I mean uncontrollable crying, an inability to speak, sometimes trouble breathing, sometimes nausea/vomiting.)
So... should I keep bringing these things up in therapy, even though my ability to handle them doesn't seem to be getting any better? Or should I try to address them in a different way? Has anyone had success with dealing with this type of problem?
Print out your question and take it to your next therapy session. Talk about this with your therapist. Perhaps medication might help you.
posted by Carol Anne at 3:09 PM on August 25, 2010 [3 favorites]
posted by Carol Anne at 3:09 PM on August 25, 2010 [3 favorites]
When I used to do therapy (typically some variant of CBT for depression, with the knowledge now that it was due to undiagnosed ADHD), I would always wind up in tears, and I'd leave every session feeling completely awful - I'd be no good for anything else for the rest of the day. This really didn't fix things for me.
What is working *for me* (YMMV) is a much more mindfulness-based, and "reality-based" (problem-based?) approach - we don't talk about my feelings in the abstract so much as the things that I'm doing/experiences that I'm having/reactions I'm having...and *then* touching on how I feel about these experiences/my reactions to them/etc. For example, this fall I had a difficult work situation come about (I was feeling really under-appreciated, and burnt out). With the type of therapy I used to have, we would probably have talked about how this might feed my negative self-talk/how negative self-talk influenced my perception of the problem. Cue me in lots and lots of tears. With my current counsellor, we did a "replay" of the situation, talking about my behavioural reactions, and we got around to talking about what made it "okay" (what made me able to keep working the next day? what made me not completely break down in the workplace on that particular day?) - and what made it okay was knowing, while I was in the situation, that I would be able to process it out afterwards (this is the mindfulness part) in counselling, and we would come up with solutions to help me work through the issue.
I hope that I am expressing myself clearly enough - your question really resonated with me. I guess what I've discovered over the last year is that counselling doesn't *have* to leave me feeling completely battered and bruised. In fact, I'm probably more mentally healthy than I have been since I was a teenager. Feel free to MeMail me if any of this seems helpful and you would like to chat further!
posted by purlgurly at 3:09 PM on August 25, 2010 [4 favorites]
What is working *for me* (YMMV) is a much more mindfulness-based, and "reality-based" (problem-based?) approach - we don't talk about my feelings in the abstract so much as the things that I'm doing/experiences that I'm having/reactions I'm having...and *then* touching on how I feel about these experiences/my reactions to them/etc. For example, this fall I had a difficult work situation come about (I was feeling really under-appreciated, and burnt out). With the type of therapy I used to have, we would probably have talked about how this might feed my negative self-talk/how negative self-talk influenced my perception of the problem. Cue me in lots and lots of tears. With my current counsellor, we did a "replay" of the situation, talking about my behavioural reactions, and we got around to talking about what made it "okay" (what made me able to keep working the next day? what made me not completely break down in the workplace on that particular day?) - and what made it okay was knowing, while I was in the situation, that I would be able to process it out afterwards (this is the mindfulness part) in counselling, and we would come up with solutions to help me work through the issue.
I hope that I am expressing myself clearly enough - your question really resonated with me. I guess what I've discovered over the last year is that counselling doesn't *have* to leave me feeling completely battered and bruised. In fact, I'm probably more mentally healthy than I have been since I was a teenager. Feel free to MeMail me if any of this seems helpful and you would like to chat further!
posted by purlgurly at 3:09 PM on August 25, 2010 [4 favorites]
Personally, I have more success dealing with these types of thoughts when I'm alone, because it removes the worry about looking good in front of someone.
I give myself permission to cry and yell as much as I want to. Depending on the trigger, it can go on for a long time. But eventually it ends, and I'm no longer in tears, and then I write. What was that thought about? Oh, the situation with the pharmacist. No, what was it really about? Well, the fact that I'm too ugly for anyone to want me. Is that really a fact? ... and then I explore that to its logical end, which is the belief that I am not lovable. Generally any hysterical reaction boils down to this belief.
Then I counter the belief. What if it's true? How would I know it's true? If I can't prove it, is it better to believe that I am lovable or that I am not? My inevitable conclusion is that it's far better to have faith that I am indeed a lovable person, and to take that perspective in any interaction I have with people. Otherwise it leads to endless questioning of everyone's potential motives, which brings forth lots of suffering. I've never done cognitive behavioral therapy, but from what I understand, there are some similarities in my approach.
There are of course times where you will be triggered in a public place and it's inappropriate to be so emotional. I employ various tricks here - meditation and deep breathing being the most effective. By keeping my head level but looking up with my eyes, it seems to "pinch" my tear ducts so that I can stop crying. I busy my mind with other things; if I cannot concentrate on a book, I will mentally rearrange the letters or count ceiling tiles. However, this is different from suppressing or fighting the feeling. It is a storm cloud passing over my sky; nothing I can do about the rain except bring an umbrella.
posted by desjardins at 3:10 PM on August 25, 2010 [1 favorite]
I give myself permission to cry and yell as much as I want to. Depending on the trigger, it can go on for a long time. But eventually it ends, and I'm no longer in tears, and then I write. What was that thought about? Oh, the situation with the pharmacist. No, what was it really about? Well, the fact that I'm too ugly for anyone to want me. Is that really a fact? ... and then I explore that to its logical end, which is the belief that I am not lovable. Generally any hysterical reaction boils down to this belief.
Then I counter the belief. What if it's true? How would I know it's true? If I can't prove it, is it better to believe that I am lovable or that I am not? My inevitable conclusion is that it's far better to have faith that I am indeed a lovable person, and to take that perspective in any interaction I have with people. Otherwise it leads to endless questioning of everyone's potential motives, which brings forth lots of suffering. I've never done cognitive behavioral therapy, but from what I understand, there are some similarities in my approach.
There are of course times where you will be triggered in a public place and it's inappropriate to be so emotional. I employ various tricks here - meditation and deep breathing being the most effective. By keeping my head level but looking up with my eyes, it seems to "pinch" my tear ducts so that I can stop crying. I busy my mind with other things; if I cannot concentrate on a book, I will mentally rearrange the letters or count ceiling tiles. However, this is different from suppressing or fighting the feeling. It is a storm cloud passing over my sky; nothing I can do about the rain except bring an umbrella.
posted by desjardins at 3:10 PM on August 25, 2010 [1 favorite]
I might be fulfilling a prescription for birth control and I think "the clerk is thinking: Why is she wasting her money? She's obviously single and she's too ugly to rape."
You sound like me. I've been diagnosed with paranoid personality disorder. The diagnosis was useful in helping me understand that my perceptions arrive with a built-in slant. When I hear people laughing and worry that they're laughing at me, I remember that I'm wired to react that way. I'm not always able to disentangle reality from my view of it. But at least I know that an effort will be required.
As the 12-steppers put it: Feelings aren't facts. If you feel hysteria coming on, challenge yourself to articulate why. If your answer is along the lines of "I'm too weak to confront these thoughts", consider what I believe to be the strong possibility that you're mistaken.
posted by Joe Beese at 3:45 PM on August 25, 2010 [1 favorite]
You sound like me. I've been diagnosed with paranoid personality disorder. The diagnosis was useful in helping me understand that my perceptions arrive with a built-in slant. When I hear people laughing and worry that they're laughing at me, I remember that I'm wired to react that way. I'm not always able to disentangle reality from my view of it. But at least I know that an effort will be required.
As the 12-steppers put it: Feelings aren't facts. If you feel hysteria coming on, challenge yourself to articulate why. If your answer is along the lines of "I'm too weak to confront these thoughts", consider what I believe to be the strong possibility that you're mistaken.
posted by Joe Beese at 3:45 PM on August 25, 2010 [1 favorite]
I've found hypnotherapy helpful for exploring subjects that trigger unbearable feelings because it provides me with a calm detachment. Like wandering around Chernobyl in a hazmat suit.
posted by stuck on an island at 4:44 PM on August 25, 2010 [3 favorites]
posted by stuck on an island at 4:44 PM on August 25, 2010 [3 favorites]
Of course, it's simplistic and IANAS, but trust me, there is value in Avoidance and Denial -- you just don't have to dive deep into every feeling. You just don't. Clearly, you understand when you are over the top, you've give concrete examples. If you slow down, I've no doubt you can start to map the moods that trigger or exacerbate it and gain some small measure of control. That is, make a picture in your brain of a box and put your over-reactives in that box and close it up and continue your session, or your birth-control buying, or whatever other triggers overwhelm you. Plus, please consider -- this might not be the right shrink for you.
posted by thinkpiece at 5:01 PM on August 25, 2010
posted by thinkpiece at 5:01 PM on August 25, 2010
Some people find that they aren't able to fully engage with therapy until they start taking medication to manage their anxiety. As soon as they find a medication that works for them, their thinking becomes more flexible, and therapy suddenly starts making sense. It sounds like you might be in a situation like that. Have you discussed the possibility of medication with your care provider?
posted by embrangled at 5:07 PM on August 25, 2010
posted by embrangled at 5:07 PM on August 25, 2010
One thing that helped me a lot in therapist-type settings is that when I started (and knew I was going to end up in tears fairly quickly), I told her that I knew that I would have these reactions, and that I didn't want her to make a big deal of it, or stop what we were doing to talk about how I was crying and how I was feeling right in that moment. This is, for whatever reasons, a good way to make me more upset and/or keep me in this hysteria spiral - other people focusing on my upset doesn't help me personally stop being upset.
It might be disconcerting for other people to see me cry, but it was actually really empowering to find out that even when I was crying really hard in front of someone, I could still participate in a conversation, or at least listen to her talk about what she thought of the situation I was describing. She told me she usually with clients likes to do the 'what are you feeling right now' routine, but we just do it later, once I'm more calmed down. Processing your emotions right when you are feeling them is not the only way to do things, and you might talk w/ your therapist about if there's another approach you could take during your sessions.
posted by heyforfour at 8:09 PM on August 25, 2010
It might be disconcerting for other people to see me cry, but it was actually really empowering to find out that even when I was crying really hard in front of someone, I could still participate in a conversation, or at least listen to her talk about what she thought of the situation I was describing. She told me she usually with clients likes to do the 'what are you feeling right now' routine, but we just do it later, once I'm more calmed down. Processing your emotions right when you are feeling them is not the only way to do things, and you might talk w/ your therapist about if there's another approach you could take during your sessions.
posted by heyforfour at 8:09 PM on August 25, 2010
Just have the feelings. Let them out. Let them overwhelm you, and consider that your "strength training", given that over time you'll get so used to letting them out that you won't be so overwhelmed any more -- then you can talk through them. No sense trying to talk through them when you still have such a skewed sense of what they are (emotional allergy? that's a cop-out, not a theory.)
posted by davejay at 10:45 PM on August 25, 2010
posted by davejay at 10:45 PM on August 25, 2010
I second embrangled. If this is a very frequent phenomenon for you and you're unable to get anywhere in therapy because of your negative thoughts and anxiety, I would talk to your therapist or doctor about medication for anxiety and/or depression.
Medication doesn't solve all your problems, but it can allow you the control to deal with the things you need to deal with in order to improve your life.
posted by threeturtles at 11:59 PM on August 25, 2010
Medication doesn't solve all your problems, but it can allow you the control to deal with the things you need to deal with in order to improve your life.
posted by threeturtles at 11:59 PM on August 25, 2010
i cried through my 1st 12 therapy sessions & was barely able to get the words out. i just had to let it happen, let it pass but it helps to have the right therapist...makes all the difference. seems like a thought triggers the emotional response. you want to deal with the trigger w/o the emotional response...perhaps you need help to get present & base thoughts in reality.
i 2nd hypnosis.
posted by UltraD at 7:55 AM on August 26, 2010
i 2nd hypnosis.
posted by UltraD at 7:55 AM on August 26, 2010
I'm new, so I apologize if this is too long or rambly. I'm a little nervous about posting this, but I think it might help and I have buckets of empathy for your situation.
As someone who used to be a therapist (obligatory IANYT) and used to have a similar visceral/hysterical reaction (to criticism), I can tell you that there his hope. One of the hardest things about therapy and emotional exploration in general is that you have to specifically delve into some of the things that make you most uncomfortable. Therapy can really test an individual's ability to tolerate discomfort and this is a big reason why a lot of people leave treatment prematurely.
Professionally, I would guess that you have a tendency to want to control and suppress your unpleasant emotions. I could be way off base, but in my experience the more we try to avoid the negative, the more intense it becomes when it rears it's ugly head. I think it would be really worthwhile to tell your therapist how hard it is to talk about these things when you're so overwhelmed with emotion. Who would want to dissect their feelings of worthlessness and self-disgust when thinking about it makes it hard to breathe/think/exist? You might even try making a list of topics and ranking them on a 0-100 scale in terms of how uncomfortable/on the verge of meltdown they make you feel. Then you could gradually build up to talking about the things that set you off the most (while working on coping skills and relaxation/breathing techniques along the way). This way you can identify and slowly build up a tolerance to the thoughts/feelings that trigger the "allergic" reaction.
I would also recommend considering group therapy. Group therapy seems kind of lame, but it can be enormously helpful for people who are very self-conscious and afraid of what others think of them. See what your therapist thinks and if he/she can recommend any groups in addition to your individual therapy. Groups are also quite economical and can be a great way to keep working on yourself after individual therapy has run its course. Even if you don't do any group work, I'd really recommend you stick it out with your therapist and resist the temptation to avoid these topics. Good therapy is hard work.
Personally, I was only able to reduce my own hysterical reactions after figuring out the core emotion that fueled them. For me, it was shame (shame can be a HUGE factor in low self-esteem). I ended up having a shame reaction during a group therapy-esque experience that pretty much changed my life. Like you, I always preferred to deal with these reactions in private, but having to endure and process it in the group was very helpful. Not only did I receive support from other members, but I think there is also something very healing about experiencing shame publicly. Ever since I figured out that I have an emotional predisposition to experiencing intense shame, it doesn't bother me as much anymore. If I feel some negative emotion coming on and it seems like it might be out of proportion to the situation at hand, I take a mental step back and ask myself if I feel ashamed. Somehow simply recognizing that my reaction is related to this totally unfounded and irrational emotion calms me down. This may also hinge on self-acceptance and understanding that I don't actually have anything to be ashamed of (half the battle, I guess).
One more thing, then I'm done.
If you are starting to suspect that your therapist might be inadequate, try voicing some very specific complaints about how he/she response/fails to respond to your needs in session (i.e. "I don't find it very helpful when you keep asking me to describe my emotional state when I'm really freaked out. It makes me feel like you don't understand what I'm going through in the moment." If he/she makes some changes and encourages your feedback, rock on. If he/she becomes defensive and keeps doing the same old thing, look for a new therapist.
posted by Mrs.Spiffy at 11:20 AM on August 26, 2010
As someone who used to be a therapist (obligatory IANYT) and used to have a similar visceral/hysterical reaction (to criticism), I can tell you that there his hope. One of the hardest things about therapy and emotional exploration in general is that you have to specifically delve into some of the things that make you most uncomfortable. Therapy can really test an individual's ability to tolerate discomfort and this is a big reason why a lot of people leave treatment prematurely.
Professionally, I would guess that you have a tendency to want to control and suppress your unpleasant emotions. I could be way off base, but in my experience the more we try to avoid the negative, the more intense it becomes when it rears it's ugly head. I think it would be really worthwhile to tell your therapist how hard it is to talk about these things when you're so overwhelmed with emotion. Who would want to dissect their feelings of worthlessness and self-disgust when thinking about it makes it hard to breathe/think/exist? You might even try making a list of topics and ranking them on a 0-100 scale in terms of how uncomfortable/on the verge of meltdown they make you feel. Then you could gradually build up to talking about the things that set you off the most (while working on coping skills and relaxation/breathing techniques along the way). This way you can identify and slowly build up a tolerance to the thoughts/feelings that trigger the "allergic" reaction.
I would also recommend considering group therapy. Group therapy seems kind of lame, but it can be enormously helpful for people who are very self-conscious and afraid of what others think of them. See what your therapist thinks and if he/she can recommend any groups in addition to your individual therapy. Groups are also quite economical and can be a great way to keep working on yourself after individual therapy has run its course. Even if you don't do any group work, I'd really recommend you stick it out with your therapist and resist the temptation to avoid these topics. Good therapy is hard work.
Personally, I was only able to reduce my own hysterical reactions after figuring out the core emotion that fueled them. For me, it was shame (shame can be a HUGE factor in low self-esteem). I ended up having a shame reaction during a group therapy-esque experience that pretty much changed my life. Like you, I always preferred to deal with these reactions in private, but having to endure and process it in the group was very helpful. Not only did I receive support from other members, but I think there is also something very healing about experiencing shame publicly. Ever since I figured out that I have an emotional predisposition to experiencing intense shame, it doesn't bother me as much anymore. If I feel some negative emotion coming on and it seems like it might be out of proportion to the situation at hand, I take a mental step back and ask myself if I feel ashamed. Somehow simply recognizing that my reaction is related to this totally unfounded and irrational emotion calms me down. This may also hinge on self-acceptance and understanding that I don't actually have anything to be ashamed of (half the battle, I guess).
One more thing, then I'm done.
If you are starting to suspect that your therapist might be inadequate, try voicing some very specific complaints about how he/she response/fails to respond to your needs in session (i.e. "I don't find it very helpful when you keep asking me to describe my emotional state when I'm really freaked out. It makes me feel like you don't understand what I'm going through in the moment." If he/she makes some changes and encourages your feedback, rock on. If he/she becomes defensive and keeps doing the same old thing, look for a new therapist.
posted by Mrs.Spiffy at 11:20 AM on August 26, 2010
This thread is closed to new comments.
Of course they're not helpful. Your emotions are completely, 100% valid and need to be addressed head-on and worked through, not suppressed. Hugging/slapping/applying "logic" to get you to stop emoting do nothing but make you feel ashamed of your emotions, which makes you try to bury them even more. Burying and avoiding them doesn't make them go away, it makes them force their way through with a vengeance (i.e., "the hysterical/exaggerated version of a normal reaction").
posted by headnsouth at 3:06 PM on August 25, 2010 [1 favorite]