going weekly to biweekly...

So what happened Zoo?

ugh. It went pretty badly.
T talked about how trauma work is a short process, usually 12 weeks. I told her I cannot imagine processing a life time of trauma in 12 weeks.
She said I could do 90 min sessions w/her and maybe also meet weekly with my case manager. Trigger rejection issues...

Also she told me today that we have 4 more weeks of doing this skills training instead of therapy. Last week she said 3 more weeks, so it should be 2 more, not FOUR more. I am not getting what I need out of doing therapy this way. Period.

tayquincy, to answer your post above about DBT, I have been through the skills training twice as per the usual. During that year, I was seeing my T weekly for 1:1 and also having group skills training weekly. Now that she is teaching me the new "updated" emotion regulation stuff, it is taking the place of my normal 1:1 sessions.

I did call my T this afternoon and left her a message saying that I need time to talk about what is going on in my life, and we need to look at a different way of doing this. I gave her 3 ideas I have: alternating weeks, so one week I could talk about whatever it is, and the next we could do the emotion regulation stuff. Or splitting the session into half and half. Or maybe she has a group going on that is doing emotion regulation right now and I could sit in on that.

I am just not sure I can do this for another 4 weeks, bottom line.

And of course now it has been 6+ hrs since I called her so I am stuck in the waiting-for-T-to-call place and not enjoying it.

Really starting to wonder if I can get what I need from this T or if I'm just holding on to her because I don't like to lose people in my life, especially people who have been important to me, and she has been that. Trigger abandonment...

I hope you hear from your T soon!! I'm sorry you're having what seem like so many communication problems. I never thought I'd be able to leave my T, but I did. If you aren't getting what you need, it's time to change.

(((((((((((Zooropa))))))))))))
I don't really have any good advice about the situation.
I just want to say I am really impressed with how you are handling everything - and voicing your needs. You are being very reasonable and level-headed despite all the abandoment triggers and fears.
I really hope this gets resolved soon and that you are able to work out a good solution with your T.
About the trauma work taking 12 weeks, can you ask your T what happens if it takes LONGER than that? I mean, if at the end of 12 weeks you are not done, she won't just cut you off, will she? I think it would be helpful to know how she would handle that.

thanks rainbow and darkrunner

I did tell my T that I can't imagine processing a lifetime of trauma in 12 weeks. She said the idea is it takes 12 weeks for each traumatic incident. So there are at least 3 that she knows about, and other things I haven't been able to tell her.

What really kind of bugs me about that is I just don't see how anyone's emotional journey and process of going through those huge trauma feelings/flashbacks/memories, whatever it is, how can that necessarily fit into a nice and neat 12 week package? Wouldn't it vary wildly from one person to another?

Anyway, it's been 16 hrs since I called her. Not that I'm counting or anything. Why does she continue to fall down around this phone call issue, time and time again? It's hard to not think it's deliberate, really.

zoo-

im not smart and im new here and maybe that is a good thing cause i am looking at this from an outside viewpoint....

12 weeks for trauma? who can put a limit on it? things affect every person differently. it might take you years to heal and feel better....
your done with all your pain in 12 weeks...bye.
this is a band-aid, not a solution.

16 hours and T does NOT call back in DBT? what is that?
i have not had DBT but I knew kids in it in foster care and they had cell phones with their T's number programmed to call. it was part of the therapy...all times of the day. one kid was supposed to call anytime he was going to SI. as long as T was not in session, T called back within 15 minutes and the kid was supposed to practice skills while waiting the 15 mintues. NOT hours. the same kid called to get help making decisions...he did NOT wait hours....15 minnutes was the contracted time.


omg, zoo. you seem so nice and like you want to try.....this smells bad a mile away to me.

therapy is NOT all about skills....some is important, but so is talking about your troubles and pain. skills are the band-aid, talking and relating is the solution to the pain.

zoo, how long have you been with this T?

and forgive me if I am off, but I read this and was shocked

I did trauma work years ago, and it was only 10 weeks. It was really intense exposure work. Yes, it was only one incident, a major one. I've had other traumas but they weren't the type of traumas that cause flashbacks, body memories.

10 weeks was plenty, and it helped significantly reduce the flashbacks and body memories. I rarely have those anymore. During the 10 weeks, i basically told and retold my traumatic event as i remembered it. All of it was tape recorded and my homework was to listen to the tape throughout the week. Each week it was retaped, so it was a little different (more details come out). If you are not good at using DBT skills, it could be a disaster. The skills are crucial to being able to pull yourself out of emotional pain when you are done with the homework. You have to be able to function on your own throughout the week. Yes, T is there if needed, but the point of DBT is to be able to use the skills on your own.

Usually, if you are still in suicidal phase, the focus is not anywhere near trauma work. That usually comes after skills are well established. I did three rounds of DBT skills training, and then was in an advanced group for application of skills for several years. During that time, i did the trauma work.

I don't understand any therapist doing trauma work unless the patient has plenty of good coping skills under their belt and can use them when in severe distress. Anyone (I'm not saying you zoo) but others who are processing trauma and still self-harming, suicidal, well it shouldn't be done! It doesn't work, can retraumatize instead of heal.

What Tay just said would explain why your t is taking the time to go through those skills with you. While it may seem frustrating to you, those skills are vital, and since you had a recent suicide attempt, it is important to reestablish those skills. Even though you may have been through the skills before, clearly they needed to be taught again and reviewed before any trauma work can be done.

My trauma work didn't take anywhere near 12 weeks either. I was ready and safe when it was done and it didn't take going over and over the trauma to heal. As they say, "There's more than one way to skin a cat."

I'm going to respond to solarwind's post--

I;m still in therapy years later after trauma work. Same therapist. The ten weeks of trauma work does not mean nothing else gets processed and that everything is fixed. The trauma work, for me, was about talking about what happened, the facts of what happened over and over in order to get exposure to the event. After my trauma happened, i never talked about it with anyone, and spent years trying to push it out of my mind. Flashbacks and body memories are a way of the body to say "it's still here!!, it happened, you can't deny it!" Once it's out, internally and externally, it can be processed, felt (expression of feelings verbally, etc) I still talk about my trauma, but i am not triggered in the same way. I can talk freely and not have aflashback, or relive it as if it was happeneing right now. I've been able to put it to rest for the most part and move past it.

Tay, I disagree with your "insight" into therapy and trauma work and what "should" and shouldn't be done. Just knowing coping skills in itself is often not enought. Sometimes continuing to sh or whatever whilst working through ones wounds is normal. There are no hard and fast rules to any of this. I know you feel that perhaps you have some control over recovery by making such exclaimations, but they can be harmful to say this shouldn't be happening or that shouldnt be happening until ABC is in place, sorry it doesnt work like that, we're human, not machines. I'm sure everyone is aware of work "coping skills" are, there everywhere to be read, any fool can look them up, but whether one can manage them until healing has taken place is another matter. No malice intended in my reply, but I've picked up a couple of times your insistance of what works.

guh. i'm so angry at your T, (((((zooey))))). im seriously confused about why she is acting the way she is and i, too, am wondering if she's the right T for you. i feel so sad on your behalf - what you said about not wanting to let important people go. i found myself in the same situation with my old-T; knowing he wasn't good for me (therapeutically, he never transgressed any ethical boundaries) but too scared to leave because there had been occassions when he had helped.

i wonder what is going on with your T that she is being such a... (maybe i won't say exactly what i think about her). i mean, i'm wondering, but at the same time i don't care - because she's meant to be the professional in this and she's letting you down.

my T doesn't practice DBT with me (it triggers me too much) but he practices it with any client who will let him. the longest i've had to wait for him to respond to a phone call/email/text was an hour, and even then he apologised and explained he'd been in a meeting. usually he txts back straight away and lets me know exactly when he will call.

my pdoc can be sucky at returning calls, sucky at showing up to appts on time, sucky at writing referral letters.... BUT on the rare occassion i've been assertive enough to light a fire under... (as you so eloquently put it in your first post ) he's been nothing but apologetic, and he's made every effort to follow through on changing his behaviour.

i dont understand how difficult it is for your T to put a system into place where she keeps her fricken' mobile with her!!! she could buy a bumsack if she really was that hopeless and keep it on her person at all times. i'm angry at her, ooh.

also: yeah, 12 weeks imo is a bit unrealistic to process lifelong trauma. i can understand that for singular events it can be very effective (as tayquincy described) but - gosh! - i think i've spent about 5 sessions spread out over years just getting the bare minimum out. and on those rare occassions, pdoc has seen me twice (or even 3 times) a week, and probably talked or txted me every other day in between.

i wish i could give you my austin-t, zooey . he is committed to practicing DBT properly and being fully available for his clients (AND he's told me he has clients he's worked with for years processing one event of trauma). and because you're ready to do this, he'd probably be so excited by you that he'd happily give me the flick and bend over backwards to help you. that's the sort of T i think you deserve, zooey.

i dont think it's anything wrong with you that's making T act and say inappropriate things, because i know a good T would welcome you with arms wide open. but i AM sad about what you said about not wanting to let go of T and i don't know what to say. wish i could sit down and have a cry with you and then go kick her in the shins.

I completely concur with this experience.

I just want to thank you, each of you, for your replies. I'm really sad and overwhelmed with how I'm feeling right now and I can't write out the long reply I would like to, but for now I just want to say thanks, I feel validated and understood and a little less like a waste of a person. As usual, you have given me some new ways to look at this and things to think about. I'll be back later.

I think what you are seeing here is that many of us have been through trauma work, and no two of us have had exactly the same experience. It is a very individual process. To me, spending 12 weeks working on one trauma event seems WAY too much. To others, that doesn't seem enough. Your t is probably giving you a pretty good estimate based on her experience. I doubt that at 12 weeks she would say, "Okay, your 12 weeks are up. You're healed." If that isn't the case. Try not to get too far ahead of yourself. Let the process be the process. A day at a time.

Zoo, I'm sorry that you aren't getting what you are needing right now. But you are doing an awesome job of verbalizing what you need and you are sticking with it until you get it. Very good work! You might not get it from this T (or you might?) but you will get it somehow and from someone if you don't give up. I'm sure that you are hearing old messages right now about your self worth as you are experiencing what is going on right now with this T. And abandonment messages. They are only old messages. I know they are powerful, but the people who put those messages there were messed up people. There is a better way and a better life out there Zoo and you are going to find it. It takes time and sorting through the crap to get there. Hold on Zoo and keep kicking and accept our hugs along the way ..............

im sorry, but to me, some random number like "we spend 12 weeks on trauma therapy" is not even considering the client. it is a random response...maybe 10 weeks works for that client, maybe 2 years works for that client.

maybe ONE trauma needs 10 weeks.
maybe 18 years of trauma needs 10 years.
but maybe ONE trauma needs 10 years.

how can someone say up-front what it takes. it's about the client, not time.

people can experience the same events and process it, accept it, be affected by it in different ways. no-one is the same. if that were the case, people would be "healed" in a very cut-and-paste fashion.
it's not...

..and simply stating that the trauma, whatever it is, only gets 12 weeks to be dealt with in therapy...i thought the client drove the therapy.

..and skills. My T told me "vices" are there for a reason..if you remove them all, or remove them too suddenly, it causes problems. You can't simply replace a vice with a skill unless you understand why you do what you do. ... because eventually, the skills will break down if you don't heal the reason for doing it.

..the work of therapy solves the problem.

there are numerous accounts of clients with self-harming behaviors who through the process of therapy, stop or reduce without the focus on the behavior. in fact, many T's ignore the behaviors

the behavior is indicative of something which needs to be addressed. it's a behavior, a vice. it's far more tramautizing to take that behavior away and ask someone to "heal" when that behavior has been a coping mechanism for many years.

none of us know how much time zoo needs to deal with the trauma..only zoo knows that and honestly, i think it is a growing knowledge.

some people can deal with it every session, some need to deal with it one session and spend the next 5 sessions getting stronger. but simply ignoring the client factor is what is troubling.....

Melba,
I don't care if you agree with me, but this is DBT therapy and Zoo is IN DBT therapy. So I am explaining what I know about it. Anyone who still SI's should not be doing trauma work until they have the coping skills to handle it. period. And learning those skills and how to actually use them is not something one can do easily by reading about it or looking them up. That is ignorance on your part. SI needs to be replaced with coping skills first. That is my opinion, and DBT protocol. I have a lot of experience with this type of therapy and it has worked for me and many others.

Solar, I think you are misunderstanding what "trauma work" is in DBT. It is time-limited exposure therapy. The trauma has to be specific. If you were traumatized in general for 18 years, that is not the same as a specific traumatic incident. Not all DBT patients do trauma work. It is generally for the PTSD from specific events, so whether someone does trauma work at all depends on what their specific experiences are.

That is why skills training in DBT takes a lot of time and patience, and compassion. No one expects anyone to just get them right away, you work through why you do unhealthy behaviors (what exactly goes through your head at the time), and practice new ways to cope.

oh wow. So many responses, I wish I could reply to each and every one but this post is going to be long enough as it is. So first just a blanket thank you and for everyone who cared enough to read or reply to this thread.


solar, first of all, you ARE smart and articulate and your input means a lot, no matter how long you have been here.

I agree my T is bad about the phone call thing. This has become a major source of frustration for me. It's just not in line with DBT protocols, period. I struggle with this because on the one hand, as T is constantly reminding me, she is only human and bound to make mistakes. On the other hand, it IS therapy interfering behavior on her part and as such needs to be addressed.

To answer your question, I've been w/this T for a little over a year and half.

I'm curious, tay, if you have been seeing the same T all this time? Your DBT T? Because that in itself is unusual in the world of DBT, to be in it for years. A couple of years, sure, but several? I'm just curious.

THIS. And I get tripped up by this a lot, because my T is very rigid in her adherence to DBT protocols (except where they apply to her, that is) and it feels very restrictive at times. There are no "rules" and my emotions, anyone's emotions, don't always fit neatly into this box or that flow chart, etc.

(((((deli))))) thank you so much for your response. It makes me feel good to know that you feel so strongly on my behalf. I wish we could sit down together, too.

I appreciate so much you saying that it's not anything wrong with me, because of course that is how it FEELS. Even if I can intellectually know that it's not her personally rejecting me by ignoring or putting off returning my calls, it FEELS like a very personal, passive-agressive attack.

thanks, farmergirl. I always appreciate your no-nonsense, down-to-earth replies. You remind me of my T in some ways, actually, very matter-of-fact and everything sounds so easy the way you phrase it.

thanks again, solar. I just wanted to add that I have learned a lot about ME during the times that I have done trauma work w/my T, and as hard as I thought it would be, it is exponentially more difficult. Harder than I ever imagined. And there is a lot of fear there, too. Fear about what going deeper w/trauma work will bring up, and fear of not being able to manage those feelings once they start bubbling up.

interesting that you say that, Tay, because I was in fact traumatized repeatedly throughout my 18 years of marriage. And yesterday my T said that we will spend 12 weeks dealing with that, the same as we will spend 12 weeks dealing with an isolated incident of SA that happened, and 12 weeks dealing with csa. It seems to me that it'd be difficult to say that all those different kinds of trauma are each going to be processed the same way and in the same time frame. And I know from experience now that I likely cannot spend 12 weeks straight talking about nothing but the SA, for example. The thought makes me go

I just want to add that my T did call me back this morning, although I missed the call so I didn't talk to her. She left a message saying that yes, we can look at different options, and for me to write my ideas down so we can talk about it on monday. I guess I should just be glad she called back at all.

And just because it will feel GOOD to say this: my T totally sucks at the phone call thing. TOTALLY SUCKS. I feel sorry for her other clients, too, because not everyone has this kind of support network I have become a part of here. I bring so much messed-up-ness to our therapeutic relationship, so many issues and triggers and problems, that it feels good to lay this particular area of difficulty and source of pain (for me) firmly at HER feet. She needs to work on this, and she knows it, and yet she hasn't seemed to make any progress in that direction. Someone is going to be hurt or worse some day because they depended on her and she flaked out. But that someone is not going to be me.

Zoo,
I am not specifically still in DBT therapy, per se, but i have multiple diagnoses and the treatment is ongoing for those issues. DBT is not a cure all for everything, but it is designed for patients with borderline personality disorder and those who are chronically suicidal and self harming. I no longer have those kinds of behaviors, so regular therapy is effective and I use the skills i've learned.

It wasn't unusual to be in DBT for years when i was in it ( but it may have changed since then). Skills training for me was almost two years...i went through the modules three times, and then went on to advanced DBT.

I just want to mention that my t would not return all phone calls promptly. It depends on what i called for. DBT therapists are supposed to be available by phone for coach and counsel, to help in the moment like Solar said when you feel like you are about to SI and don't know the skills well enough, so you need coaching from T to NOT engage in the behavior. So when you called her for help before your suicide attempt, that is what you are supposed to do (as I understand it). But if you called for something else, that would be different.

I'm bowing out of this conversation now because it appears, once again, that a lot of people are opposed to CBT type therapies and it gets too controversial and riles certain people up. I thought my experience with DBT could help you zoo and thought i could clarify some things about the treatment, but like i said before, your T seems to do things a bit differently. And maybe the program has changed some since i have been in it. DBT is also too complex for me to explain to those who are not familiar with it. It helped me. I was an alcoholic, self harming, suicidal person who could not cope with life in any meaningful way. I suffered flashbacks, body memories, nightmares, etc. you name it. But no more, and I do credit dBT with helping me to save my life.

Anyway, I hope you get what YOU need from whatever therapy you are in.
(((((zooropa))))

Zooropa, I'm glad T called you back. She sounds like she is willing to work with you. I am curious if she has had these phone call 'issues' with anyone else. You've said she's been a T for a long time - is this the first time this has been an issue with a client? Is this something new or has it always been this way? I can tell it is frustrating for you so it warrants more discussion.

Tay - I just want to say I like reading your posts about DBT. It really has helped me to understand it better, and especially to understand Zooropa's T better. It sounds like DBT is very different from what most people experience in therapy, but that doesn't make it any less valid or effective. And I'm so glad it worked for you and helped you turn your life around. You obviously worked hard at it and I am impressed and inspired by your effort and perseverence.

I want to add dmy 2 cents, but realize this is strictly my opinion. . .

Trying to set up a rigid schedule of X many weeks to do trauma work would never work for me. The reason is because some traumas hae affected me much more, and are much more deeply rooted, while others have had less impact. . .for example, a 1-time car accident versus SA versus years of emotional neglect. Also, I can't always go into my session and "do trauma work." Sometimes, I just can't relax enough to let my guard down, or I can't access the younger hurt parts of myself. I can't always "will" it to happen. Also, i need breaks between sessions of doing heavy trauma work. Otherwise, i get overloaded. My t and I generally have to intersperse the more intensive trauma work with relaxation and DBT skills building in between, to allow me to process things without it becoming "too much" and me crashing. It has taken us a long time to figure out that this is what i need, and it is the only way i can do trauma work.

I'm just going to say this one last time. Peaches you are misunderstanding what "trauma work" in DBT means. It is 10 weeks of exposure therapy, talking about the facts of a traumatic event over and over. It's exposure. It's very specific and time limited. THAT doesn't mean working on the effects of trauma is all over with!!! It doesn't mean ALL FIXED and nothing left to talk about. I did my trauma work years ago, and I still do therapy and work on my issues, including the effects of trauma on my life currently, which is WHY I'm still in therapy. The result has been that I can talk about it, work through the issues around it without flashbacks, dissociation, body memories, denial, and all the other defense mechanisms getting in the way of living. I can leave the incident in the past instead of reliving it as if it was going on every day of my life. Zoo's T says 12 weeks probably because of what the definition of this kind of trauma work is in DBT. It's just one part of therapy. Some people do EMDR, for instance, to work on trauma. It's a similar concept. It's a tool to use. I think people are misunderstanding and thinking of "trauma work" in a very general way. Everything in my life has been affected by the trauma i suffered as a child. I can cope now, for the most part (i have other dx's that complicate things. The point in DBT is that regular therapy doesn't work for certain individuals who are chronically suicidal and self harming and those behaviors have to be focused on first before any processing begins. The first goal of DBT is to get those behaviors under control first. Otherwise, you can't really work on anything because you are constantly being triggered. If your trauma was more general, like neglect instead of rape, you wouldn't probably do the DBT "trauma work" It's for a specific traumatic incident.

Peaches, Your spot on, no one can just will recovery. I stay clear of DBT Evangelists or 12step evangelists that try to tell others how recovery should be. RUN!

Tay,

Sorry if i misunderstood "trauma work." I was just speaking from my own experience in reply to the initial post -- I had not read your earlier replies.