should I stop seeing my therapist?
October 28, 2019 11:16 AM   Subscribe

The thing is, I very badly need therapy. But on the other hand, I am disappointed and upset by his failure to listen to me and am wondering if it constitutes negligence either ethically or professionally.

Please be gentle with me. I am very ashamed and upset about my destructive behavior that I describe below and desperately want to fix it.

I am bipolar, I have anxiety, and I have C-PTSD. A few months ago, I began EMDR therapy with a therapist who has been specifically trained in EMDR techniques. At first, I was thrilled as I was noticing very discernable changes in my mood, cognitive functioning, and ability to withstand stressful situations. However, we seem to have hit a wall, and I am very upset about it.

One of the biggest reasons I entered therapy is because I grew up in abusive home, with a father who would fly into blind rages during arguments without much provocation, scream curse words and invective at me and my mother (who was in and out of of cancer remission) and break dishes and glasses, punch walls, kick things on the floor to send them flying, overturn coffee tables, smash cordless phones and remote controls against the walls, yank the cords of lamps out of walls and overturn or kick them, and on occasion throw glasses of cold water in my face. One time he hurled a bar stool off of our balcony (it landed in a tree and not on a person thankfully). When my mom and I would ask, after the fact, why he kept breaking shit in our house (or in some cases, literally breaking our house), he would say "You weren't listening to me, and so I needed to get your attention somehow," like that wasn't a totally deranged explanation for a frightening display of hostility and abuse. I swore that I would never, ever behave like this around anyone I loved or cared for.

As of late, due to several stressors in my life over the past two years (feel free to look at my questions from January of 2018 for some context) and also due to a pretty hefty self-destructive streak, I myself have not been handling my anger well, and on five occasions, I myself have broken some household objects - not for the same reason that my dad did, but just due to losing complete control while angry. Loss of control while experiencing intense emotions is not unusual for people with C-PTSD, as I understand it. But the breaking things is inexcusable, as far as I am concerned, and when it happens I flip out because I have essentially triggered myself by causing flashbacks to my dad's anger. It takes me a long time to recover from the trigger, and then after it does I feel deeply ashamed and full of self hatred, as I fear I am turning into my father, who still to this day frightens me with his anger even though I am rapidly approaching middle age. This is violent behavior, and I don't think of myself as a violent person. But here I am, being violent.

My psychiatrist suggested EMDR as a potential option to help identify my triggers and learn how to have more control over my emotions without flashing back to prior trauma and engaging in violence.

I was very clear with my EMDR therapist when I began the process that my primary therapy goal was to address the violent behavior and work on how to put a stop to it. He assured me that this was totally do-able. But since then, we have basically never touched on the issues that tend to trigger my rage. He took a detailed intake on me during our first two sessions, as most therapists do, and then has spent a lot of time helping me with other peripheral concerns I have in my life - self esteem issues, drawing boundaries, standing up for myself, identifying toxic people before they suck the life force from me. Don't get me wrong - these are all things that I definitely needed help with, and this therapist has made tremendous progress with me on these fronts, and it has improved the quality of my life.

THAT BEING SAID... we have not fixed my decline into violent behavior when provoke into a rage. I bring it up during each session, and he assures me we will get there. But it's been like four months, and two of my five breaking-things episodes have happened while I was under his treatment. One of them happened THIS PAST FRIDAY..

I feel that this is unacceptable. I came to therapy in good faith and was brutally honest about how much I wanted to overcome this issue, and how I considered it to be the highest priority because of how much it frightens me (not to mention those around me). I don't want to be an emotional terrorist. I have been asking week after week after week when we are going to address this in therapy and nothing has come of it. I have zero emotional tools to help me stop this behavior - this is WHY I came to therapy.

It seems to me that people who treat patients with mental illness whose mental illness manifests in ways that are unsafe and violent have an obligation to prioritize that issue, or admit that they are out of their depth and need to refer said patient somewhere else. He has done neither of these things, and so here I am, losing my shit on Friday and breaking plates. I can't afford to buy more plates, and furthermore, I just can't keep losing my shit like this and descend into the shame spiral + flashbacks of my dad + inevitable depression. This is not ok.

I am not kidding when I say that in every session I ask my therapist when we are going to work on this, and when it has occurred during the time I've been under his treatment I literally beg him to help me in the following session. My most recent appointment with him was Saturday, the day after I broke some more plates. I told my therapist that I was extremely upset and disheartened that after months of therapy, I have not improved in the slightest in the one area I SPECIFICALLY told him I was seeking him out for. I feel like this has been a waste of my time and money and I also feel like this is kind of irresponsible of him as well.

Am I overreacting? Or is it time to change therapists?

Again, please be gentle with me - I know that scary rage and breaking shit is horrible and inexcusable, and I desperately want to fix it, so please if possible I would like to avoid being chastised for this because I already deal with enough shame over this issue as it is.

posted by thereemix to Health & Fitness (16 answers total) 1 user marked this as a favorite
It doesn’t really matter if your therapist is an angel or the devil himself. What matters is that this particular process with this particular person isn’t working for you. You’ve given it a good try with him, time to move on.
posted by Tell Me No Lies at 11:30 AM on October 28, 2019 [14 favorites]

(On the topic of the therapy you’ve done up to this point: I’ve found it can be years before I can evaluate how a period of therapy fits in to my overall life. While I think it’s time for you to move on, I wouldn’t be so ready to discard the work you’ve done so far.)
posted by Tell Me No Lies at 11:37 AM on October 28, 2019 [3 favorites]

" I feel like this has been a waste of my time and money and I also feel like this is kind of irresponsible of him as well."

You may be absolutely correct about that, but it's not going to do you any good to ruminate on it. Change therapists, but don't expect to find any happiness in finding fault with your current therapist.
posted by pupsocket at 11:45 AM on October 28, 2019 [3 favorites]

Absolutely be okay with moving on. Anger management is a pretty standard thing that therapists offer and yours, for whatever reason, isn't offering it for you. I know it's oversimplifying to say that this is exactly what you need, but mostly to point out that it's a normal thing to ask for and expect to receive, it's not way "out there" in terms of a therapy ask. I am sorry, this must be so scary and upsetting. If you feel like saying anything about it, I'd just say "I'm moving on because my #1 priority is to get my destructive rages under control and we're not doing that."

I would also agree with pupsocket, I wouldn't spend any time focusing on fault with your current therapist (it can be like an itch to scratch "It's THEIR fault" but ultimately non-helpful) just feel okay moving on.
posted by jessamyn at 11:46 AM on October 28, 2019 [12 favorites]

Find a new therapist.

He may be helping you. You may have improved in ways that aren't immediately apparent; it's possible that you're making progress on underlying issues that will, in the long run, help fix your rage-expression problems.

But your therapist not helping you in the area that's most important to you, and he's not explaining why he's avoiding that. It doesn't sound like he's saying, "we have to first get past X stumbling block" or "it is more important to not perceive yourself as evil for having these problems, than to stop breaking things when you're angry."

He's also not saying, "we can work on that specific behavior after you have reached X milestone," nor has he said, "that's not something that can be worked on directly; you will need to make adjustments in other areas that won't look immediately connected."

If he's not giving you goals that work on the behaviors you want to change, and he's not explaining why in a way that makes sense to you, this is not the right therapist for you.
posted by ErisLordFreedom at 11:51 AM on October 28, 2019 [15 favorites]

I do have a question if you are breaking objects around other people, which you don't mention, and that does make a difference. Because you throwing things while alone unhealthy isn't actually harmful to anyone . If your doing it around others that's different and requires more immediate addressing..

I did treatment for CPTSD for a really long time. There are some behaviors that were yeah let's hospitalized me NOW behaviors, some where behaviors that needed immediate addressing,
some where really embarrassing felt or of control to me but were really ultimately harmless behaviors, and over time I added more good coping skills .

Part of the process is that your feelings, whatever made you throw the plates ate still there. You will have feelings like that again, and you will choose a way to cope . Sometimes when a therapist/I moved to fast on changing acoping skill (like screaming my head off in my bedroom alone, which is embarrassing but ultimately isn't harming myself or anyone else) I might have chosen something even less healthy like disassociating or self injury or food restriction. That wasn't the goal. The goal isn't just to stop the behavior it's to process the trauma and that takes time.

I did have behaviors that needed to be full on stopped ASAP. And I was hospitalized for them. I did stop them.

You may want to ask your therapist why it isn't a priority or about how you feel like it isn't being addressed. You may want to ask him about your care plan and what he says. You should be working together . you can tell him how you feel like leaving because this one thing is super important to you. It's a relationship, work with that person the best you can.

Treating CPTSD is a long journey, four months really isn't that long especially if you are making progress in other areas. Sometimes that progress is scaffolding to tackle more scary issues with a better foundation.
posted by AlexiaSky at 11:51 AM on October 28, 2019 [10 favorites]

(1) Is it possible that these new bouts of anger are actually signs of success in the therapy, in that your brain and soul is being forced to process emotions it hadn’t been able to successfully completely process before (thus the PTSD)?

(2) Is it possible that you are wanting to leave this therapist as a way of escaping from the pain of that process? That you are fleeing not the therapist, but the therapy?

(3) Anger will always be experienced by human beings. In your mind, what experience of being angry would leave you feeling, “Yes, I handled that right”?
posted by WCityMike at 12:14 PM on October 28, 2019 [6 favorites]

If you think the work you are doing with the current therapist is helping you address the long-term, underlying issues then I might consider looking for an anger management group as a supplement to the individual work. Most anger management groups are very focus on changing the immediate behavior - which is exactly the piece that is missing. It is also quite a bit cheaper than individual therapy. Where I live, such groups are often offered by the major medical centers.
posted by metahawk at 12:31 PM on October 28, 2019 [1 favorite]

What does your therapist say when you ask/beg him in every session to address this? Presumably he says something even if it's not what you want to hear. Not that it really matters-- if you want to leave, you can-- but you're asking us to evaluate whether he's been negligent, so it seems important.
posted by acidic at 12:51 PM on October 28, 2019 [4 favorites]

Hi acidic - he says that that remains our long term goal and not to worry as we will eventually address it. I would feel better about this if he explained why he doesn't want to tackle it now - he's the expert, not me, and if there is a reason why he doesn't feel I'm/we're ready to delve into this he needs to tell me why.

And yes, I have asked him why we keep pushing it off, and he says because it's such a complicated issue (the fact that in breaking I am triggering myself which is a bit of a recursive mess), and he tries to talk me into coming in to see him 2x a week, or scheduling longer appointments, so that we can devote one session or one hour a week to this topic and work on other stuff in the other hour/session. My work schedule and my personal finances do not afford me the ability to add more sessions or more length, so I feel stuck.

To answer a question from earlier - 99% of the time I break things when I'm alone at home. The plate breaking incident on Friday happened in front of someone else. However, even when I do break things alone at home, eventually it becomes evident to others what has happened, either because we suddenly have less of [insert breakable household object] and I don't want to lie when asked about it, or on some occasions because I have been caught in the act of cleaning up the mess, and one one occasion because I vacuumed the floor but missed a chunk of glass and then stepped on it, causing my foot to bleed and then when asked why there was a chunk of glass in the floor I again didn't want to lie. I want to own this behavior so I can fix it, not downplay it.
posted by thereemix at 1:37 PM on October 28, 2019 [2 favorites]

self esteem issues, drawing boundaries, standing up for myself, identifying toxic people before they suck the life force from me. Don't get me wrong - these are all things that I definitely needed help with, and this therapist has made tremendous progress with me on these fronts, and it has improved the quality of my life.

it's very possible that your therapist thinks being around "toxic people" and drawing insufficient boundaries are two of the issues contributing to the buildup of anger that then manifests itself in violence -- he might think he's laying groundwork for a gradual improvement.

however, that doesn't matter and it doesn't address your immediate urgent needs. if he hasn't convincingly made this case to you -- if he hasn't really made any case or explained his plan and rough timeline for improvement -- it doesn't really matter if he's kept your goal in mind all this time. You are the person with the most knowledge of your symptoms and you are the one who knows best whether you are being helped.

I told my therapist that I was extremely upset and disheartened that after months of therapy, I have not improved in the slightest in the one area I SPECIFICALLY told him I was seeking him out for. I feel like this has been a waste of my time and money and I also feel like this is kind of irresponsible of him as well.

this is great (that you told him, not that it happened.) therapists often assume their work is helpful, simply because it is difficult for them to perform and because patients keep coming back for more of it. it is very good for them to know when they are wrong. If he has no adequate response to this, leaving is probably a good idea.

You can also get a few second opinions before permanently ceasing treatment with your current guy, to give you greater perspective on the options and therapy styles available. I don't have any personal experience with the acronym therapies, but I think both CBT and DBT are supposed to give you mental exercises to do in the immediate onset and aftermath of crises like these. Whatever type of therapist you choose, they should be able to tell you something to do (or think about, or a number to call, or...) when this hits you in the moment, not just promise you gradual improvement in the complicated long term.
posted by queenofbithynia at 1:39 PM on October 28, 2019 [5 favorites]

To me you seem very different from your father. For one, you're not trying to influence or frighten or hurt or intimidate other people with your breaking. I agree with you that you need to figure out how to stop the breaking because it distresses and scares you, and it can be dangerous (cut foot), but I think you might be kinder to yourself and less ashamed of the breaking--no less committed to stopping it, though!--if you could see how it is different from your father's behavior. You're not slowly inevitably becoming your father. You're your own person. Your problem is different and you're striving to treat your problem, which is admirable.

You probably got or eventually will get something helpful out of time spent with this therapist--I sometimes look back on various counselors and realize that I've figured something out thanks to them, though usually not whateveritwas that I came to them for. Sometimes years after--it's like retrospective help. But that's not what you need most acutely right now, so I would find a new therapist.

This: I want to own this behavior so I can fix it, not downplay it. is so brave that I just can't resist quoting it. I know we're internet strangers, but I feel proud of you.
posted by Don Pepino at 3:26 PM on October 28, 2019 [9 favorites]

While it is possible that his reasoning is that there is groundwork that needs to be done before getting to addressing something as large as that particular situation - from my understanding of the process, the methodology generally says to approach that way, rather than going hard on the big thing right away without tools to get you through that safely - it does seem peculiar and frustrating that he won't explain it in those terms and keep explaining it until he's certain you understand his line of reasoning.

I think you should try at least one more time to understand better what the plan is and maybe even how long he's thinking it's going to be before you get there. It may be his professional and trained decision that you are not ready to get into that yet, but if that is the case I agree with others that he should be offering/referring/recommending other ways to handle these incidents for now. But maybe you should ask exactly for that and see if he can help. It's possible that he's hyperfocused on the thing he does and isn't thinking about the bigger picture, which people tend to do when there's a very specific thing they do.

I'm sure it feels to you like you've arrived in the emergency room with a gunshot wound and would expect to go straight into surgery, but many times what actually happens first is hours of work to get you stable enough for surgery, get imaging so the surgeon knows exactly what to do, treat the shock so you'll survive anesthesia, etc. Or compare it more to a video game model, where you have to knock out some of the lesser bosses to get the skill and gear to have a chance against the big boss. You may be rushing something for the right reasons but really risking the outcome, and he should be at least giving you that explanation and making sure that you have that information even if it's not the way you want it to go.

He may also be super reluctant to give you any feeling of a timeline for fear you will unfairly hold yourself up against it, or hold it against him, if it doesn't pan out exactly that way, but I think maybe the two of you should try to talk about that generically because your expectations that you're expressing now, that it's been months and a number of things are better but this thing isn't fixed yet, that sounds about right for what I understand the process to be. It takes time, especially with C-PTSD, because it's...C, you know? You chip at it with a chisel, not dynamite. This is a lot of metaphors, I'm sorry.

It's possible that you are extremely focused on how "bad" the behavior itself is/how "bad" you are (you are not bad) and really burning with shame (and yes, completely practical concerns about possible consequences) so you want it out out out. But this is deep-programming shit, this is a thing that was done to you and that is its source, and getting at deep source stuff with EMDR is not an instant process. I do think you deserve some kind of short-term help to diffuse your rage when it rises like that, for your own safety and comfort, but that help probably looks a LOT more like CBT or DBT mechanisms than something this guy can just eradicate in a session tomorrow. At least rage/uncontrollable frustration are pretty well studied and there's probably materials out there that will give you decent relief in the moment for cheap or free. (It seems odd to me that he hasn't at the very least been like "oh hey, here's a book/series of videos/something", it definitely feels like he doesn't understand the distress level you're experiencing.)

If he can't help with that, I think it would be reasonable to say you need to pause the current line of treatment for long enough to work with someone who can help you get some management techniques on board, before you return to the EMDR. I don't think you should end a therapeutic relationship with someone who is successfully treating you, but yes if you want to put that aside for a minute to get this more under control so you've got management strategies going forward before you do reach the stage of treatment that's really going to hammer at it, that seems like a reasonable plan.
posted by Lyn Never at 3:43 PM on October 28, 2019 [8 favorites]

EMDR is ...not gentle. It brings up the trauma as though it’s fresh. Practitioners are trained to make sure the client has the resources to self-regulate when confronted with that trauma before they bring it up. This is often the longest part of the EMDR process, IIRC — developing resources and self-regulation skills so that you can delve into the heavy shit. Without that there is a serious risk of re-traumatization. It can make you worse.

I think it is a separate problem that you feel your therapist hasn’t explained this process to you, and that needs to be addressed. From your posts here it sounds like that withholding is itself triggering for you. It would be for me too.

EMDR requires extraordinary trust between therapist and client, and without that it can go horribly wrong. Right now it doesn’t seem as though you trust him, and the stonewalling / lack of explanation is itself triggering to you. I would talk to him about this. Start by showing him this thread. His behavior in the therapeutic relationship is possibly contributing to destabilizing you, and that is something that has to change, either through a change in your relationship or a change in therapists.
posted by schadenfrau at 5:23 PM on October 28, 2019 [8 favorites]

First: I am very sorry to hear about your having to go through all of this. It sounds very difficult to experience and perhaps even more difficult to orient yourself from within the experiences you are having. I congratulate you on doing the work and advocating for yourself and your own process and healing. You are doing a lot.

Second: In my opinion you do not need to build a case for or against a therapist. There will always be a lot of confusing transference when therapy is successful and there is certainly an enormous amount of frustration when it is not (especially if you are doing so much work!) Whether you continue to see your therapist or try another one (or both for a bit) is simply entirely up to you. You should feel very relaxed about how you feel about your process and making choices about whether it is or isn't working for you. If you make it about your therapist being bad or good you may cloud your own ability to assess how YOU feel.

Third: Try some other therapists and see what you see -- I have found it difficult to find a new therapist that worked for me in the past.. the last time it took almost six months. I would have been better off continuing to see my therapist while I looked... perhaps switching to every other week for a period of time. You should assess how it would go if you ceased your current work and spend several months trying to find another (better) therapeutic relationship before you cease seeing your current therapist. If you decide that it would be OK to go without that is a big piece of information about your current work.

Last: Your therapist should be able to handle and support a meta-conversation about your work. Your therapist should be able to handle very direct communication about how you feel and how you feel about them, even if it is extremely negative and angry information. You might try to be as blunt and direct with them as you have been here -- or more so. If you find that your therapist cannot support this kind of discussion in your session that could be an indicator that they are not able to do the work that you need them to. In my mind any therapist worth their salt should be able to support me even if I am telling them they are the worst. You know what I mean?

Just my thoughts on your situation. I really hope you find what you are looking for -- the kind of work your doing sounds very challenging, but I can only imagine how good it feels to make progress.
posted by n9 at 9:08 AM on October 29, 2019

CW self-harm mention

Not specifically about your therapist, but if you haven't already it might help to remind yourself that what you're doing isn't remotely comparable to what your dad did. It sounds like he was quite deliberately using uncontrolled anger to intimidate the people around him into doing what he wanted, and to avoid the responsibility for what he did when he was angry. You're not doing that at all - you're not directing those rages at people, you're not using them to manipulate people, you're trying to minimise their impact on other people and you're taking responsibility for trying to stop them.
That doesn't mean it's all fine or that it "shouldn't" trigger you - uncontrolled anger is frightening in yourself or other people, and seeing behaviour you associate with your dad in yourself is going to be triggering. But it might be helpful to remind yourself that you are not like your dad, your anger is different from his.

As far as the therapist is concerned, yeah, he doesn't have to be a bad therapist to not be helpful to you. I can imagine there might be valid reasons why he's not focusing on your rages specifically yet, but if that's the case, in your position I would at least want a very clear explanation for why we weren't directly addressing my main concern yet, a specific plan for when and how we were going to, and ideally some advice on how to cope with it and keep myself safe in the meantime.

For comparison, I saw a therapist for a while about self harm. I wanted him to help me stop. He wanted to help me sort out the stuff that was causing me to need to self harm first, because self harm was a self- regulation tool, if not a great one, and I needed to have other tools to replace it so it would be safe for me to stop. But he did explain that, so it felt like we were making progress towards that goal even when we weren't focusing on it directly, and we set up some systems to keep me safer in the meantime.

If your therapist isn't giving you that, it's understandable that you don't feel he's really listening to you, and to go find a different therapist who will.
posted by BlueNorther at 4:15 AM on November 2, 2019 [1 favorite]

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