Should I stay or should I go? - Therapy edition
May 3, 2015 2:14 AM Subscribe
I've been in therapy for PTSD since October 2014 with a therapist who is trained in gestalt therapy. I'm feeling confused, angry and anxious about therapy and I'm trying to figure out whether this is something is should work through with my current therapist or whether it is a sign to change therapists. More detail below.
I've been in therapy before while I was studying abroad, for approx. 4 months. No particular issues there, but I did not go as deep in those sessions. This is my first time in therapy for an indefinite duration.
Some therapy sessions with my current therapist have been very helpful: I've been able to talk about some issues whilst staying present instead of checking out, some weeks my anxiety diminished considerably, I've taken steps to talk about my trauma with family.
But sometimes I will talk and the therapist's response leaves me feeling very alone or blamed/shamed or belittled. I will mostly bring up feeling this way during the session or in the next one, but most of the times (though not always) the conversation that follows leaves me feeling equally distressed and also confused or manipulated. My therapist will express that they feel bad that they made me feel this way and we try to examine why I feel this way. The conclusion though generally seems to be that I am projecting. They also mentioned a few times that I would likely feel the same way if I changed therapists. When I bring up that this second conversation makes me feel confused or manipulated this results in the same discussion, with the same outcome for me.
I also have sessions where at the end and for days/weeks after I feel sad/anxious/angry because the things I discussed are horrific, sad or anger inducing. The situation I described above feels different from these sessions.
Is it normal that (as a PTSD sufferer) therapy makes me feel this way? At this point I don't trust my own assessment of the situation and I don't trust my therapist in discussing this. Would changing therapists help or is it important that I work through this with my current therapist? I would love to hear an outsiders opinion or experience if you've been in a similar situation.
I've been in therapy before while I was studying abroad, for approx. 4 months. No particular issues there, but I did not go as deep in those sessions. This is my first time in therapy for an indefinite duration.
Some therapy sessions with my current therapist have been very helpful: I've been able to talk about some issues whilst staying present instead of checking out, some weeks my anxiety diminished considerably, I've taken steps to talk about my trauma with family.
But sometimes I will talk and the therapist's response leaves me feeling very alone or blamed/shamed or belittled. I will mostly bring up feeling this way during the session or in the next one, but most of the times (though not always) the conversation that follows leaves me feeling equally distressed and also confused or manipulated. My therapist will express that they feel bad that they made me feel this way and we try to examine why I feel this way. The conclusion though generally seems to be that I am projecting. They also mentioned a few times that I would likely feel the same way if I changed therapists. When I bring up that this second conversation makes me feel confused or manipulated this results in the same discussion, with the same outcome for me.
I also have sessions where at the end and for days/weeks after I feel sad/anxious/angry because the things I discussed are horrific, sad or anger inducing. The situation I described above feels different from these sessions.
Is it normal that (as a PTSD sufferer) therapy makes me feel this way? At this point I don't trust my own assessment of the situation and I don't trust my therapist in discussing this. Would changing therapists help or is it important that I work through this with my current therapist? I would love to hear an outsiders opinion or experience if you've been in a similar situation.
It is always okay to get a second opinion. Your therapist sounds very passive aggressive.
Some therapist will leave you raw for days to try and get to the bottom of it. Some will end on a positive, happy note, sending you out into the world with an assignment and a way to still live life. It sounds like you have the first one. I don't like the ones who tear you up. It takes forever to heal when you don't have anything to hold on to.
Don't dump your therapist unless or until you find another one. At your next appointment, simply say that you need to take a break from the deep issues and you want to talk about functioning in your day to day life. Don't let your therapist take you farther than you want to go.
posted by myselfasme at 4:26 AM on May 3, 2015 [4 favorites]
Some therapist will leave you raw for days to try and get to the bottom of it. Some will end on a positive, happy note, sending you out into the world with an assignment and a way to still live life. It sounds like you have the first one. I don't like the ones who tear you up. It takes forever to heal when you don't have anything to hold on to.
Don't dump your therapist unless or until you find another one. At your next appointment, simply say that you need to take a break from the deep issues and you want to talk about functioning in your day to day life. Don't let your therapist take you farther than you want to go.
posted by myselfasme at 4:26 AM on May 3, 2015 [4 favorites]
Gestalt therapy may not be the best fit for what you need from therapy. It focuses on your relationship with the therapist in the present moment, and also on your personal responsibility and agency for the things that occur in your life. Many people experience some discomfort/strife in their relationship with the therapist as part of this problem. If you are wanting to focus on PTSD issues, remaining centered and not dissociating and the like, this isn't really an approach that is focused on those skills. And to be honest, I'm not aware of any literature that supports Gestalt therapy as an approach that is effective for PTSD. Have you considered something that is more in the family of cognitive behavioral therapy? That would focus on helping you develop tools to cope with the emotional experience of addressing your trauma, and then gradually and gently exposing you to aspects of your trauma to give you practice coping with those memories and experiences. Over time this drastically reduces the fear, dissociation and other symptoms of PTSD.
posted by goggie at 5:32 AM on May 3, 2015 [9 favorites]
posted by goggie at 5:32 AM on May 3, 2015 [9 favorites]
I'm also a therapist, and I specialize in treating sexual assault/abuse trauma. In my experience, the six-month mark is often right about when clients working on childhood trauma issues tend to start really experiencing their own anger, which generally comes immediately out of finally realizing their shame/guilt is misplaced. My clients at this point in the process tend to start feeling angry at everybody and everything, as the anger toward their perpetrator(s) that they've shoved down because it was too scary starts emerging, but there can be a difficult combination of shame/fear/anger when it first does. It's often a one- to two-month angry period, with the anger gradually subsiding, feeling less frightening, and getting more focused on the appropriate people, as long as the clients let themselves feel the anger rather than running from it. I generally frame it as the client finally learning that anger can be healthy (it's what lets us know that someone is violating us and gives us the fire to say "No"), and we generally get a lot of productive work done at that point on learning to set and enforce healthy boundaries.
So it could be that your therapist is seeing that process play out, and that's what they mean by "projection"; my comfort with that interpretation would be enhanced if you and your therapist had established that you're feeling that way, to some extent, with everybody, or that you often feel that way with any authority/maternal/paternal figure. Absent that, I agree with dancing leaves that it's a bit of a red flag -- a therapist's goal should be to help you become independent, not dependent on the therapist (though feelings of dependency are a normal part of the process, they should diminish over time).
posted by jaguar at 7:16 AM on May 3, 2015 [5 favorites]
So it could be that your therapist is seeing that process play out, and that's what they mean by "projection"; my comfort with that interpretation would be enhanced if you and your therapist had established that you're feeling that way, to some extent, with everybody, or that you often feel that way with any authority/maternal/paternal figure. Absent that, I agree with dancing leaves that it's a bit of a red flag -- a therapist's goal should be to help you become independent, not dependent on the therapist (though feelings of dependency are a normal part of the process, they should diminish over time).
posted by jaguar at 7:16 AM on May 3, 2015 [5 favorites]
It used to be that "Gestalt" was used to describe a multitude of totally different modes of treatment and that may or may not still be true, but Gestalt as it is originally formulated is more of a growth/meaning-of-life type of treatment than a method of alleviating specific symptoms. Even the formulation "PTSD" seems at odds with the philosophy of gestalt in which calling something a disorder makes it "not you" while gestalt is all about owning your own life. In that sense, the term "projection" is not used exactly as it would be in other modalities and refers to something in which you play a part but want to see as totally "other." It is not an accusation, but an opportunity to reframe.
If you are primarily interested in getting rid of your PTSD symptoms as quickly as possible, I'd go. If you're into the "big picture" then stay.
posted by Obscure Reference at 9:25 AM on May 3, 2015 [2 favorites]
If you are primarily interested in getting rid of your PTSD symptoms as quickly as possible, I'd go. If you're into the "big picture" then stay.
posted by Obscure Reference at 9:25 AM on May 3, 2015 [2 favorites]
I don't know much about Gestalt therapy, but I've been in therapy for ages for issues including PTSD. And I'm curious if you specifically sought out a Gestalt therapist for your PTSD and, if so, why.
I agree that a second opinion could be a good idea, and not dumping your current therapist until you are sure.
posted by mermaidcafe at 9:59 AM on May 3, 2015 [1 favorite]
I agree that a second opinion could be a good idea, and not dumping your current therapist until you are sure.
posted by mermaidcafe at 9:59 AM on May 3, 2015 [1 favorite]
This sounds kind of like my experiences with therapy for grief. I've tried multiple therapists and I've never had therapy that wasn't just me crying endlessly and feeling horrible, both in and out of session. Every. Single. Time. I wish I could say something eventually helped me, but nothing has, and I quit therapy. Supporting Safe Therapy is aimed at people in the UK, but it gives general principles for when therapy isn't helping: "From our current understanding, regardless of the therapy approach, any exacerbation or worsening of symptoms should only be short-term, be linked to exploring some difficult area that you were previously avoiding, and relate to the problem or experience that was the reason for entering therapy[...]Not everyone who undertakes therapy has a successful outcome, with somewhere around 30 - 50% of people leaving therapy with their problems largely unresolved and their feelings largely the same. Also, the majority of people who change in a positive way make somewhere between a 30% and 80% improvement in a helpful direction. "
posted by Violet Hour at 1:33 PM on May 3, 2015 [1 favorite]
posted by Violet Hour at 1:33 PM on May 3, 2015 [1 favorite]
Therapy needs feedback. You need to talk with your current therapist on which parts do you think are helping and which ones are not helping. S/he will be able to modify the regimen and/or suggest new ones (including a fellow therapist who may be more suitable).
posted by kschang at 3:34 PM on May 3, 2015 [1 favorite]
posted by kschang at 3:34 PM on May 3, 2015 [1 favorite]
Leave. If the therapist isn't empathetic and you don't feel supported, you won't benefit. Ideally, the best person is someone who both uses an evidence based technique for PTSD (not gestalt!) *and* has good rapport with you, but if you have to pick just one, pick good rapport and feeling connected. The single most important factor in recovery from trauma is having more and higher quality relationships— if the therapist can't model this and help you in it, they are unlikely to help long term
posted by Maias at 5:38 PM on May 3, 2015 [1 favorite]
posted by Maias at 5:38 PM on May 3, 2015 [1 favorite]
If I were you, I'd start looking for a new therapist. Look for someone who specializes in treating PTSD and make sure you feel comfortable with them, as Maias says.
I don't like that your therapist is ignoring your feedback and basically manipulating you into feeling like it's all your fault that they're failing to create the safe space you need to process these extremely negative emotions. I also wouldn't trust any therapist who discourages you from seeking treatment with a different therapist who might better suit your needs.
Not every therapist is a good fit, even if they're generally good at their jobs. A good therapist will recognize that they're not able to help you and refer you to a colleague if possible. The fact that your therapist isn't doing that and is actively discouraging your from looking for someone else is definitely weird in my book, maybe even a red flag. You have the right to stop seeing a therapist for any reason (or even none at all) - it's your decision, not the therapist's.
posted by i feel possessed at 8:59 PM on May 3, 2015 [2 favorites]
I don't like that your therapist is ignoring your feedback and basically manipulating you into feeling like it's all your fault that they're failing to create the safe space you need to process these extremely negative emotions. I also wouldn't trust any therapist who discourages you from seeking treatment with a different therapist who might better suit your needs.
Not every therapist is a good fit, even if they're generally good at their jobs. A good therapist will recognize that they're not able to help you and refer you to a colleague if possible. The fact that your therapist isn't doing that and is actively discouraging your from looking for someone else is definitely weird in my book, maybe even a red flag. You have the right to stop seeing a therapist for any reason (or even none at all) - it's your decision, not the therapist's.
posted by i feel possessed at 8:59 PM on May 3, 2015 [2 favorites]
Response by poster: Thank you all for your response so far! I found them really helpful in thinking through this.
I did not seek out Gestalt therapy in particular, but the therapist comes recommended for having experience with my type of trauma. For those of you who asked for an example, I'll give the example of my last session.
I started the session telling that I had the most difficult week so far and made a suicide plan, something I had promised myself I would never do. I told her I was very angry with everyone's lack of support and with therapy so that I felt I had to resort to such measures to get through my day. I told them I wanted to discuss alternatives for me so that I could cope differently with how I was feeling; so that I could stop feeling suicide was the only thing that would help me.
The therapist said they felt that the anger I expressed was unfairly directed at them. I agreed that part of the anger I felt was not for them and that I also had expressed anger to others in my life, but that I was also angry with therapy and feeling like I had no alternative coping mechanisms and that I lost trust in therapy and in getting better. I asked for alternatives and for some assurance that I would be getting better. The therapist told me that they could not give me any assurance that therapy would work, but that they were committed to doing what they can. Than they told me that they could not work under pressure. I again asked for alternatives to cope. They told me the only alternative available to therapy is to learn to compartmentalize the trauma feelings (which at this point they believed I could no longer do). We went around in circles with me re-expressing how bad I felt and asking what to do when I felt suicidal again. They told me I could call them and could consider medication. At this point they also told me I would be feeling like this with any other therapist. Given the way the session was going I would not trust the therapist to be more helpful if I called them saying I was feeling suicidal, but I did not tell this.
The therapist forgot to put the timer 10 min before the end of the session, so we were interrupted by the next appointment ringing the bell. They apologized for this, but it still meant that I was rushed out the door. In the end I felt like I had fucked up at asking help and did not deserve to be helped because I asked for it inappropriately (i.e. angrily).
I know me mentioning suicide will have some of you concerned so I do want to add that I am having an appointment with a psychiatrist very soon (I had my appointment planned before all of the above occurred) and that I am leaning more on family to help me through this. I am taking care of myself and don't feel like I will act on my suicidal feelings at the moment.
posted by schamper at 2:29 AM on May 4, 2015
I did not seek out Gestalt therapy in particular, but the therapist comes recommended for having experience with my type of trauma. For those of you who asked for an example, I'll give the example of my last session.
I started the session telling that I had the most difficult week so far and made a suicide plan, something I had promised myself I would never do. I told her I was very angry with everyone's lack of support and with therapy so that I felt I had to resort to such measures to get through my day. I told them I wanted to discuss alternatives for me so that I could cope differently with how I was feeling; so that I could stop feeling suicide was the only thing that would help me.
The therapist said they felt that the anger I expressed was unfairly directed at them. I agreed that part of the anger I felt was not for them and that I also had expressed anger to others in my life, but that I was also angry with therapy and feeling like I had no alternative coping mechanisms and that I lost trust in therapy and in getting better. I asked for alternatives and for some assurance that I would be getting better. The therapist told me that they could not give me any assurance that therapy would work, but that they were committed to doing what they can. Than they told me that they could not work under pressure. I again asked for alternatives to cope. They told me the only alternative available to therapy is to learn to compartmentalize the trauma feelings (which at this point they believed I could no longer do). We went around in circles with me re-expressing how bad I felt and asking what to do when I felt suicidal again. They told me I could call them and could consider medication. At this point they also told me I would be feeling like this with any other therapist. Given the way the session was going I would not trust the therapist to be more helpful if I called them saying I was feeling suicidal, but I did not tell this.
The therapist forgot to put the timer 10 min before the end of the session, so we were interrupted by the next appointment ringing the bell. They apologized for this, but it still meant that I was rushed out the door. In the end I felt like I had fucked up at asking help and did not deserve to be helped because I asked for it inappropriately (i.e. angrily).
I know me mentioning suicide will have some of you concerned so I do want to add that I am having an appointment with a psychiatrist very soon (I had my appointment planned before all of the above occurred) and that I am leaning more on family to help me through this. I am taking care of myself and don't feel like I will act on my suicidal feelings at the moment.
posted by schamper at 2:29 AM on May 4, 2015
I am a mental health counselor, and though I don't do Gestalt therapy, what most concerns me about your situation is your description of feeling "very alone or blamed/shamed or belittled' and then "distressed and also confused or manipulated" when you try to talk about those feelings with your therapist. Yeah, projection is a thing that happens, but that shouldn't keep your therapist from being validating and empathetic; therapy can be distressing but it shouldn't feel manipulating (and this is just my opinion, but if you're getting into trauma stuff your therapist should be giving you "cool down" time at the end of your sessions). Another red flag, like dancing leaves and i feel possessed mentioned upthread, is your therapist's insistence that things would be the same with another counselor. All therapists are different and it's possible that Gestalt therapy isn't for you. Don't feel bad shopping around for a therapist until you find one you're comfortable working with, personality- and theory-wise. Speaking from my own experience, I always tell my clients in our first session to fire me if they feel like things aren't working out. Therapy's a very personal thing and it's hard (especially with trauma) to do that kind of processing if you're in a room with someone who makes you feel invalidated.
posted by clavier at 7:50 AM on May 4, 2015 [2 favorites]
posted by clavier at 7:50 AM on May 4, 2015 [2 favorites]
I'm so sorry for what you're going through. I know how daunting it can be to find a new therapist, especially at the time you most need one. But please, please try to find someone else.
"they told me that they could not work under pressure"
and
"...and asking what to do when I felt suicidal again. They told me I could call them..."
This combination constitutes a massive problem. If in fact you were hostile and/or threatening in any way, and they said they could not work under such conditions, they are right (i.e., if you're paraphrasing here, the therapist is not to blame). Otherwise, this person is being unreasonable and unprofessional.
"they also told me I would be feeling like this with any other therapist"
This too is extremely unprofessional, and it's not true.
Anecdotally, I once had a truly horrible therapist. I stayed too long because I was loath to "start over" with someone else. When I quit seeing her, she mailed me multiple handwritten letters using topics from my sessions to convince me of what a mess I was and how much I was indebted to her. That, for me, was a painful betrayal layered on top of the trauma for which I was seeking help, so I took the letters to my first appointment with another therapist. Those first sessions were almost entirely about establishing trust in light of my prior experience with therapy. Several years later, I don't see my therapist very often, but I dread the day he retires, because he has provided a safe place for me to express feelings.
Tl;dr: I strongly urge you to find someone that will listen to your bad experience with therapy and strive to treat you gently. There is such a thing as a bad therapist, and you might have one (a bad match is at least as common, but some therapists do more harm than good--trust your gut). Either way, you need to find someone else.
MeMail me if you want. It's great to seek help and horrible to not find it. I'm sincerely sympathetic. (Also, if you're in the US, I'll do some research and make phone calls; you are NOT alone, and seeking help is admirable--suicide is not, and I think you know that.)
posted by whoiam at 11:15 AM on May 4, 2015 [2 favorites]
"they told me that they could not work under pressure"
and
"...and asking what to do when I felt suicidal again. They told me I could call them..."
This combination constitutes a massive problem. If in fact you were hostile and/or threatening in any way, and they said they could not work under such conditions, they are right (i.e., if you're paraphrasing here, the therapist is not to blame). Otherwise, this person is being unreasonable and unprofessional.
"they also told me I would be feeling like this with any other therapist"
This too is extremely unprofessional, and it's not true.
Anecdotally, I once had a truly horrible therapist. I stayed too long because I was loath to "start over" with someone else. When I quit seeing her, she mailed me multiple handwritten letters using topics from my sessions to convince me of what a mess I was and how much I was indebted to her. That, for me, was a painful betrayal layered on top of the trauma for which I was seeking help, so I took the letters to my first appointment with another therapist. Those first sessions were almost entirely about establishing trust in light of my prior experience with therapy. Several years later, I don't see my therapist very often, but I dread the day he retires, because he has provided a safe place for me to express feelings.
Tl;dr: I strongly urge you to find someone that will listen to your bad experience with therapy and strive to treat you gently. There is such a thing as a bad therapist, and you might have one (a bad match is at least as common, but some therapists do more harm than good--trust your gut). Either way, you need to find someone else.
MeMail me if you want. It's great to seek help and horrible to not find it. I'm sincerely sympathetic. (Also, if you're in the US, I'll do some research and make phone calls; you are NOT alone, and seeking help is admirable--suicide is not, and I think you know that.)
posted by whoiam at 11:15 AM on May 4, 2015 [2 favorites]
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I'm also not in love with your therapist's ESP that lets them know that you'd feel the same way with another shrink. I mean, maybe you're projecting somewhat, but maybe your therapist has a personality type or treatment orientation that doesn't work that well with you?
Finally, the therapy is for you, and you are the one who gets to decide whether you find it healing. There can be some value in working stuff out with the therapist, for sure, especially if it involves projections. But you can also practice self-care and be like "hey, I bring this stuff up and I feel like hell for weeks, and then I also pay this person whose reactions make me feel ashamed, and with whom I don't seem to be able to work things out, and at least that second part I have some control over, so maybe I'll go find someone I like better." Maybe a different school of therapy would suit you better. Or maybe just a different person -- rapport is a huge predictor of how well therapy works.
posted by sockanalia at 3:17 AM on May 3, 2015 [2 favorites]