Understanding the process of therapy

[Dyess]

I wish I had a better understanding of Therapy before I needed it. When you need it most is not the time to try to understand it, and deal with all you are dealing with. Thing is there's no real guidelines out there to go by.
During my deepest and darkest times, since Dad's death, I thought seeing a counselor was the right move, also saw the EAP person. Now I see this was really not the correct route. I should have seen a psychiatrist who could get me on the right meds and help me move from that period to the next. At some point when feeling much better, seeing a counselor would kind of be the polishing off part. Where things were settled , understood, and less anxiety/depression/fog/dissociation etc. More or less the final step in recovery.
Not going in this order I think has slowed my healing time down to a crawl. I went at it backwards and seeing the counselor and EAP person made it even worse, but I didn't know that back then. I didn't know any better, but they should have.
So what are your feelings on this? Did you find an approach that works well?

[BigGreenSee123]

In my opinion there is no hard and fast rule for treatment and therapy when it comes to any psychological disorder, including CPTSD. I think what's best depends on so many things - what the individual is dealing with, personality type of the individual, personality type of the therapist (or doctor, etc.), therapeutic approach/orientation (biological model, psychodynamic, CBT, etc.), not to mention other factors like availability, affordability, and so on. And this is all resting on the unfortunate facts that 1. any doctor, therapist, social worker, etc. you see is only human and has limitations in what knowledge or experience or skills they have and 2. there's still tons we don't know about most disorders in general.

I find it hard to accept all this given that people are in pain and there doesn't seem to be an ideal system in place to help them. But, I do think, as things stand, the best (only?) way to find the help that's needed is to be willing to use some trial and error and be as informed as possible. It is a catch-22, though: it's hard to go searching for the right person when you're desperate for someone, anyone to help but because you're desperate for help you may end up with someone who's not right...leaving you feeling just as desperate as when you started. So, I realize this is a tall order. And I don't mean to be so pessimistic about things but this is my honest opinion on the situation.

That said, I don't think things are entirely hopeless - it just takes some persistent effort. For me, I first tried medication. I didn't go about it in the healthiest way the first time - just went to my GP and said I was depressed and she gave me a script for Lexapro. After a fearful buildup lasting years I was in and out of the appointment in under 20 minutes. It was astonishing. I was never monitored though and, looking back, I feel like this wasn't an ideal scenario. I quit cold-turkey a few years later when I felt like they weren't doing anything for me, something which I now know is not safe.

While I did use meds again later, for me I've decided I prefer not to be on them whenever possible. I don't at all say this with judgment and there are plenty of times where I consider returning to them when things get particularly tough. For my particular situation, though, I think they were preventing me from truly working on challenges I faced. It was like they made things just bearable enough to not want to actually put any effort into addressing what I needed to in my life. It took me a long time to understand this is what I wanted and needed, though.

In regards to talk therapy - I tried many before I landed on the person I am currently seeing. Others didn't work because I wasn't ready or the circumstances just didn't work out or it wasn't a good fit (I remember during one session with a previous T the lights went out so right in the middle of things she got up to chat with her colleague across the hall about what was going on - this didn't mesh well with what I was looking for). Even after finding someone who I felt was a good match for me it took a long time to understand what the heck I was even doing in therapy and how to really get the most from it. I'm still learning. It's not an easy process at all; I suspect it's difficult for everyone.

As I said, it is unfortunate the way the system is right now. Psychology is still a young science and researching people is not as easy as researching molecules or skin cells; there are so many variables to control it makes things incredibly challenging. I don't think it's best, plenty people have a rough go of it trying to find appropriate treatment. But in my experience, keeping as informed as possible is key followed but as much effort and self-advocation as can be managed.

[Dyess]

I think maybe when the first T told me I wasn't ready for counseling she may have been talking about I hadn't worked through the hard stuff yet, so I wasn't ready for the final touches of counseling. If she had said something like this it would have made it easier for me to understand. I really didn't understand what I was suppose to do next.

[Dyess]

So in summary I guess it depends on where you are (what shape you are in) at the time.  For me the psychiatrist would have been my first best option for meds and therapy. Then the counselor. Instead I went to GP, EAP, and then counseling.

[Kizzie]

This is a great thread Trace, tks.  In my case I only got the help I really needed when I told my GP everything that was going on with me.  I had never told any of my GPs (we moved a lot as my H was military so I had a few) the whole story, mainly because I wasn't sure I had been abused (covert NPD M), and very afraid to say things out loud like I often felt like I was falling apart (which as I found out were EFs). I just said I was depressed.

Anyway, she was my point of entry to all the help I needed (psychiatrist, addictions counselor, therapist and ongoing care by her), but it could have been problematic if she had not known about CPTSD.  Fortunately she did, but I don't think that's true for the majority of GPs yet.

It might be useful to have a resource here that could be downloaded and given to GPs, etc as a way of educating them about CPTSD.

[Dyess]

Hmmmmm that's a thought about the download. May give them a better understanding of CPTSD but as far a diagnosis and coding I think they will still have to go with PTSD, Major Depression, etc. If they could just get the CPTSD in the DSM it would open doors for training and proper care. My T told me about some big change in the new DSM for Police , Fire and EMS though I think it's a good thing, but not sure because I'm not sure what, if anything, had been written before.http://www.policeptsd.com/2011/07/18/ptsi-ptsd-recognizing-emts-firefighters-or-police-officers/

[tired]

Think of therapy as three types; urgent, short term and long term. If you're in crisis, you need to address that first.  Then you add in short term behavioral strategies to cope with day to day life, while keeping up with a backup crisis care plan.  Then you find a therapist to help you delve deeper into issues; that will probably last a lifetime, with or without a therapist.  When you start working on deeper issues you still need that behavioral therapy setup and a backup crisis number to call, because you start to think about things and your day goes to *. You have to live, and enjoy life, in the middle of all this.

I tried to make it sound systematic but it's a messy process no matter how you do it.  It's never going to be smooth, easy, predictable, manageable or timely.  It will be rocky and it will take time.  You can only make logical plans and expect to make changes and adapt as you go along.  And make sure to remember that your life doesnt begin when all the therapy ends. Your life is now. All the fun you're going to have also has to happen now.

[Dyess]

Thanks Tired. Funny thing is that I had that name "Tired" on another forum My first T told me to call her if I was in crisis, this one has not mentioned it. She's very unavailable between sessions. That's why I look into to some online sessions to fill in.

[woodsgnome]

Tired said:

"...make sure to remember that your life doesn't begin when all the therapy ends. Your life is now. All the fun you're going to have also has to happen now."

Yep. Ain't easy, seems totally elusive, if not hopeless, and will it ever reach what's called recovery? That's a biggie--this waiting for the green light to proceed with this life. Well, that life isn't going to wait, it wants us to know that.

"Fun" may seem odd to include in this discussion. This cptsd stuff hurts, I hate it. True enough, but there's still lots of fun to be had; it's allowed. Why miss it just 'cause one isn't "there" yet?

For me there's music, books, nature, the cat--they're not just for coping, they're for living. Now. Someday will still be there, but missing now will likely mean regret then.

I've often been hung up on the someday project...the "over the rainbow" syndrome when all would be well again. Maybe it will, but right now should count for something too.

Thanks for the reminder, Tired.

[Dyess]

There are some very good responses, and ideas, here. Thanks everyone for your contribution. Our expressions are not only venting of our own thoughts and feelings but hopefully will be of some value to those who come in here after us. So again thanks.
In my post I kind of started at the most recent event, the progression there. I think my CPTSD started much earlier in life and therefore peaks and valleys of happiness and severe depression. Once I tried online therapy and it got me through a hard time. Another time I had a counselor who believed in that silent treatment, I walked out of her office. Now this time with Dad's suicide it has brought a deluge of memories that were not issues in those past times, not even including those times, so this one seems to be the " big one" for me. Those past situations were simple mainly single event issues. Took some time to work through but not nearly the sense of overwhelm as this is. This time it is more complex, by dealing with so many different types of trauma at one time and the experience being different. I never remember dissociating, maybe I did , and I just wasn't aware of doing it or that there was a name for it. So it does make me wonder if counseling at an earlier age would have made a difference or not. Guess we will never know. I do think if I had the guidance of where to go, who to see for what, that my recovery may have been further along than it is.

[Kizzie]

Hmmmmm that's a thought about the download. May give them a better understanding of CPTSD but as far a diagnosis and coding I think they will still have to go with PTSD, Major Depression, etc. If they could just get the CPTSD in the DSM it would open doors for training and proper care.

I think you're right about the problem of CPTSD not being in the DSM.  That said, many of us have been diagnosed by our GPs/pdocs so I wonder if they are using other diagnostic resources which could be included in a download - must look into that.   

I never remember dissociating, maybe I did , and I just wasn't aware of doing it or that there was a name for it. So it does make me wonder if counseling at an earlier age would have made a difference or not. Guess we will never know. I do think if I had the guidance of where to go, who to see for what, that my recovery may have been further along than it is.

What many who come after us have that we didn't is a name for what we suffer from (even if it isn't in the DSM yet).  There is more and more validation for the diagnosis and information about the disorder which no doubt will result in more people realizing they suffer from it and getting into treatment earlier than we did.

And as more and more of us come to the realization that we have CPTSD and begin to show up in GP's and therapists offices, I'm hopeful our sheer numbers will force change in the health system and that we will receive better support, services and treatment. I was just thinking of Pete Walker's comment in his book about a colleague who suggested that if CPTSD were ever officially recognized the DSM would shrink to a quarter of its size.  Change will come