How can T help me initiate difficult topics in therapy?

Yesterday, T asked if it was benefiting me to have sessions 2x/week or if we should go back to 1x/week. It seems he doesn't feel that I am making the most of my sessions. I know this as well.

I have an extremely difficult time initiating discussions about difficult topics in therapy. I emailed T and I told him this, and he responded by asking me what I feel would be helpful.

I am not sure. I'd like for him to help steer me in a direction, ANY direction. But he has insisted in the past that this needs to come from me. So, perhaps the problem I need to focus on is WHY I have trouble initiating discussions about difficult topics.

Can anyone relate? Have you talked to T about this? What ways does T help you get started in therapy?

I'm pretty self-propelled so it's normally not a problem. But when she sees there's a big issue I'm avoiding, she will gently bring me around to that topic. She doesn't expect me to have the strength to 'steer' myself where I should be going.

I don't like it that a T asks a client what would help. I mean, they're the experts. THEY should know of ways. Isn't that why they trained for this job?

Maybe turn the question back to him. Tell him you need help and let him come up with ideas.

How about writing it down and letting him read it?

Yes, and yes. I can totally relate, and I have talked to T about it. When I wanted to start bringing up some topics that were difficult for me, first, I wrote out just the topics, in bullet points. Then, I told my t that I have things I want to talk about, but I can't seem to bring them up and need her help. She had me just read my bullet list, so she'd have some idea of what the topics were. It took me several sessions to even get through that lsit of maybe 5 things.

Once I got through the list, she would ask me about the topics...if I started to struggle or shut down, she'd ask me to just tell her one true thing about that topic. Didn't matter what, just something to get started talking. Then, she'd ask me to tell her more, etc. Once, my one true thing was simply "it sucks." My T agreed and asked me to elaborate. If I've managed to avoid a topic all session, she'll wait until the last 15 minutes or so, and then ask me if I can talk about it for just 5 minutes. That way, it's always there, being talked about, just in very small bites.

The other thing my T does is continually reassure me that it's okay for me to talk about the difficult things.

Or if that seems like it's a bit too big of a task, how about a list of topics you feel you need to talk about?

I journal about . . . whatever is on my mind. I don't focus on how I say things or why I say things, it's more a way to sort of access some part of myself that's not quite on the surface. I usually give my T a copy of my journal, not necessarily every week, sometimes every other week. When I first discussed giving it to him, I asked him if he would let me know if there was something in there that I should deal with. After a lecture on the word "should" and that I shouldn't (ha!) ever feel like I must do something and how it's so important to me to be in control, he said he would. And he has once said that when I was ready, it would be a good idea to look at ___. He has also mentioned specific things that I have written in my journal, last week he mentioned 2 or 3 things. Which is probably one way of seeing if I'm willing to open those topics up . . . and that hasn't happened. I generally spend about 5 minutes freaking inside my head at the mere mention of anything from my journal, because on the rare occasions when I've read some of it, I'm pretty horrified by what I wrote.

Some T's are really more or less directive than others. Mine is very hippy/old school social work/client-centered and if he ever says something to me like, here, now, discuss this, I will fall over. Once I said I was "stuck" in session and didn't know where I wanted to go. He replied, "if you knew, would you be willing?"

THAT was annoying. If his intent was that I never say I was stuck again, then he succeeded. Then he did a mindfulness exercise with me that was pretty useful, but really wasn't what I needed at the time.

Anyway, I think I am hijacking. What I wanted to tell you is how I plan to handle something this week. I want to start by saying that I want to talk about a difficult topic. For me, that's shame, and it has been peeking up its head in my life all over the place this week. So this is how it would go in my imagination:

"I want to talk about shame. Can you help me with getting this started?"

Anne

Writing was suggested, and having your T read it. My suggestion is writing and don't even read it again yourself. Destroy it.

What to write?

Plenty of times during the day things will bother you, right? Write what happened, and how you felt about it. Write why it bothered you. It isn't about the other people. This is about your reaction. The same thing can happen to dozens of people and each one will feel differently about it. Even from day to day, you will react differently to the same situation. Finally, write about how you got into the situation to begin with, especially if it is one of those things that keeps happening to you. This isn't about blame. This is like being in a dream. It is just tracing things back, because there is a tendency to just find yourself in a situation without knowing how you got there. So trace it back. Keep in mind that it could be something as simple as being tired and hungry.

Thanks so much for the feedback. It gives me much to consider....

I wanted to also add that his comments came after what I felt was a pretty cold session. After I talked about things that were going on, he asked me if he could come down hard on me. I said he could try, but I'm not sure how I'll react to it.

Then, he basically laid into me about how I am spending too much time helping others and not taking care of myself...and that I'm being hypocritical....then pushed me to make commitments to certain things that I've been putting off because they're too scary for me. He told me that my friends are using me....and that because I'm not taking good enough care of myself, that, in turn, means I'm not taking care of my daughter as well as I could be. He said that I've immersed myself into situations and making them a priority (like helping to care for my friend's dying mother, helping a pregnant teen whose parents abandoned her, etc.)



Then, he drops the "maybe we should consider going back to 1x/week"....UGH.

I know he just wants me to work towards taking care of myself and to make the most out of my sessions....but I tend to shut down so easily when it comes to the hard stuff. I really need to look at what's causing me to shut down.

Challenging, but you needed to hear it.

That's not nice. But did he really say it like that?

Might he have said, "Maybe twice a week puts too much pressure on you. What if we took some of that pressure off? Would you find it easier to talk? Better one good session than two bad ones."

Hmmm. Why am I backing T here? Because he sounds like a good T and I prefer to give EVERYONE the benefit of the doubt. And I know from experinece how easy it is to hear the wrong thing.

On the other hand, maybe T is just a clumsy goof who slipped up.

My t brings up topics. Unlike most t's who wait for me to direct the session, he keeps the conversation going. He's very talkative. It has advantages and disadvantages. The disadvantage is a lot more of his interpretation of things gets into the session, where if I talk more, it will be my interpretation.

The advantage is it forces me to be genuinely in the moment and not pausing to plan what I want to say ahead and getting lost in my head like I usually am. So I guess I'm saying it's not always a bad thing for t's to steer you in a direction. If you're sure your t won't do it though, idk. I guess the way my t does it, the topics he brings up are fairly general things that might apply to anyone, or they're questions so he's not usually imposing a way of looking at things on me too much.