[Leah123]

I see my T via online chat sessions. She's experienced. I like, respect, and trust her. It's been 5 months. She has stated I have PTSD though I know that technically only psychiatrists/medical doctors can diagnose it. I feel the diagnosis fits, though I wish it did not.

I was upset recently during a session, doubting my self, my old fragmented memories on a topic and the idea that I had PTSD. She has experience with combat PTSD particularly, so, I think I should have faith in her assessment. It's not exactly that I think I don't have it, but that... I was very upset, that sometimes I wonder if I have to own up to such a serious set of symptoms.

My T replied that I could let her be the certain one for now. I told her it was too easy for therapists to be certain, to put together pieces of a puzzle and hastily make a judgement about what was causing a client's distress. She was insulted, said I was trivializing her profession and questioning her personal integrity.

I was reassured by her response because it demonstrated personal pride, but then.... I read a public online Q&A session she had with a customer on another site, where she told them, based on ONE conversation and one online quiz by a bi-polar specializing doctor, that the customer was "highly likely to have Bi-Polar" and also, told the customer she would need to be on lifelong medications. I will say, she did also refer the customer to a psychiatrist and the quiz had a disclaimer, but her language was very strong and I would say it would be life-changing for that customer. I think those statements were hasty and ill-advised. (I asked a psychiatric nurse I trust to read it, and she said that type of thing was common but not appropriate.)

So, I wrote my therapist a letter asking her to explain. I was very very careful in how I phrased it. I fear she will be angry and defensive, but... I just need to know if she thinks she was playing it fast and lose with that customer, and I want to feel that she is not being cavalier with me.

I believe she cares about me deeply, and I care about her. I am so scared that I sent her my concern. I am so scared of how it will affect our relationship, or that she'll even terminate me. When I raised my point about therapists being quick to judge originally, she said maybe we shouldn't even continue if I doubted her so much after our time together.

Anyone have any comfort or perspective for me please?

[Asiablue]

To be honest, this raises alarm bells for me. She seems like she can be quite defensive when questioned or challenged. To me that sound like she has quite an ego getting in the way of your therapy and that is never acceptable, therapy is about you not her, she needs to keep herself out of your session. Already you are scared to question her, scared of her response and scared that your feeling might get you terminated. This is not a good basis for a safe secure mutually respected therapeutic relationship.

In my personal opinion, if you have a trauma history then online therapy is not for you. How can she possibly keep you safe or contained thru a chat window? I think you need to find a trauma therapist that you can go see in person.

[Perna]

I think looking on while part of a conversation takes place between two people, it can be difficult to understand all that is taking place. From what little you have said, it does sound like the person suspected they might be bipolar, had seen quite a few signs and in talking to your T, was actually asking, "Does this look the same to you?" or, "What does this look like to you?" Your T replied, "looks good to be bipolar disorder, go see a psychiatrist, medication can help."

Diagnoses are for the professionals, not us. They made them up to help themselves kind of get oriented in how to best start treating. Just like we might have trouble remembering the difference between a cold, brochitis, flu, and a bacterial respiratory infection, the name, for us, should not be that important, mostly we tell the doctor all the symptoms we have and they judge from that.

I have asthma and caught a cold winter before last and then suddenly could not breathe so I had to go to the ER in an ambulance. They said it was bronchitis and gave me an antibiotic. Well, you might think, hmm, if you read anything online it says don't use antibiotics for bronchitis!

But, the small print says:

If you have no other health problems, experts recommend that antibiotics not be used for acute bronchitis. Whether your doctor prescribes antibiotics and what type depend on the type of infection you have, your age, any other medical conditions you have, and your risk of complications from acute bronchitis, such as pneumonia.

from: Antibiotics for acute bronchitis

I would only pay attention to your T when she is talking directly to you about your situation and conditions and I would not "trust" her particularly, I would see if how she treats you helps you! If you do/do not have PTSD is not the problem, what is done to treat it is, whether it is effective for you.

[Leah123]

Thanks Asiablue. The online therapy works really well for me, luckily. It's not that which concerns me. I feel scared, but hope she would not actually terminate me. If so, then indeed, I would need a new therapist. It's because I'm so attached to this one that I worry so, and because of what she said about us not continuing (she said that after the part about feeling insulted, sorry I didn't mention that in my original post), which was in the heat of the moment.

I'm not sure about this one though: "she needs to keep herself out of your session" It's in the relationship that she thinks the healing occurs and I agree. Of course, that can make things a bit messier, but I appreciate her selective sharing.

Thanks Perna, I think you are soooo right, and now I'm very scared that I sent her my concern, because maybe both of us were too hasty. Goodness. But.... if she is a professional... she'll be able to step back and see my fear and be constructive, right, not just be insulted and react really badly? Do you think?

[Perna]

Yes, I think it will be a wonderful conversation you and she will have. I think it is great that you are thinking of these things the way you are. The other side of the coin is that I saved my life in 2003 by figuring out what treatment I needed and "making" my doctor try it. It had been five months and many dollars and doctors and I hadn't gotten a correct diagnoses. My husband just accepts what the doctor tells him, does not look at how it affects him at all.

I would not think of it as challenging your T's credibility, you can't really do that unless you are another T in training and experience? You are just trying to better understand how it all works and what you think and feel about how it all works. If you are not comfortable with how a T does something, don't "agree" with it, you have to decide whether or not to see another T and getting all the information you can is important.

[Favorite Jeans]

Wow, "trivializing her profession," huh? To me, it's totally understandable that you would be reluctant to identify with a psychiatric diagnosis (whether it fits or not) and that you would tell your T essentially that it's easier for her to label you than it is for you to live with that label. (Again, the issue of how apt the label is actually immaterial.)
She might have said something like "Oh, you feel it's a hard thing to live with?" Or "Hmm... So you think maybe I've been hasty or cavalier, I wonder if there's information you think I'm missing?" Or just accept that you prefer not to have a diagnosis. In the end, especially if she's not a psychiatrist, how much does the diagnosis matter? It's your history and how it's affecting you now that matter, right?
So whether it's PTSD or sub-clinical PTSD or some other type of anxiety does it really matter what you call it? You work through it more or less the same way.
I don't feel reassured by her professional pride at all here. I feel alarmed by her insecurity. When she feels insulted she should be able to sit with that feeling, observe it, breathe and process it later. She should not be reacting to you from a place of hurt pride. This process is about YOUR feelings, that's why you pay her instead of chatting with a friend.

[Leah123]

"I feel alarmed by her insecurity."

Favorite Jeans, I see your points and appreciate them. My feeling, which I hope to find confirmed when she replies to me, is that she said that in the heat of the moment. Therapists have feelings too, and may say too much on occasion. I've been telling her PTSD fits me to a tee for a couple/few months now, I imagine she's challenged by my recent level of doubt about everything under the sun, and made a valid response, if not a perfect one.

[ultramar]

I'll just comment on the bipolar issue (as someone with bipolar disorder and have done a lot of research):

No way, no how bipolar disorder can be diagnosed by an on-line quiz and conversation. This is a very tricky diagnosis. No responsible psychiatrist (nor psychologist, though psychologists are not the experts in diagnosis) would diagnose someone bipolar in one *face to face* encounter. It takes some time, sometimes a long time, to make such a determination. It's utterly irresponsible. I would hope that an on-line psychiatrist could not prescribe meds and this person would have to see someone face to face anyway (hopefully). But bipolar meds can be very strong and have terrible side effects. A wrong diagnosis can have all kinds of repercussions.

I'm sorry, but on this alone I would judge her rather incompetent.

Is there any way you can see a face to face therapist?

Are you questioning the PTSD diagnosis because you think she doesn't have enough information and is jumping to conclusions, making assumptions, putting together a puzzle with many missing pieces? If this is the case, then I think it's good that you are at least questioning it. She may ultimately be correct, but she does sound diagnosis-happy, and very irresponsibly so.

[ultramar]

I just saw your post about you feeling that the PTSD diagnosis fits, so it sounds like you don't think she's off on this, so you can ignore that part of my previous post.

It's in the relationship that she thinks the healing occurs and I agree

I definitely agree with this and I think it's the crux of a lot of therapy, especially with a history of trauma. But I have to say that I'm skeptical that the kind of relationship needed to develop to heal and to work things out can happen on line. I think this is best played out in person. Is this all via e-mail or also Skype? Of course this is just my -general- opinion, if you feel you can make progress and heal with her in this modality, then you know yourself best.

I do hope she learns to be accepting of criticism. Not only might this make you feel freer to say what's on your mind, but it's also good modeling.

I wish you the best and good luck.

[Syra]

Originally Posted by Leah123

...and now I'm very scared that I sent her my concern, because maybe both of us were too hasty. Goodness. But.... if she is a professional... she'll be able to step back and see my fear and be constructive, right, not just be insulted and react really badly? Do you think?

ABSOLUTELY. That's what should happen.

[Favorite Jeans]

Originally Posted by Leah123

"I feel alarmed by her insecurity."

Favorite Jeans, I see your points and appreciate them. My feeling, which I hope to find confirmed when she replies to me, is that she said that in the heat of the moment. Therapists have feelings too, and may say too much on occasion. I've been telling her PTSD fits me to a tee for a couple/few months now, I imagine she's challenged by my recent level of doubt about everything under the sun, and made a valid response, if not a perfect one.

Yeah I get it. You want to accept that she's human and flawed. But to me this is a concerning kind of reactivity (needing to be right, getting defensive, raising the spectre of termination when you question her.) This is exactly the type of feeling she has been (or should have been) trained to cope with instead of getting her back up. At a minimum I think she should be initiating the discussion of what went wrong for her and apologizing without you having to bring it up. Therapy is a place for you to question and contradict yourself and your T without having to worry much about her feelings. It's her job to worry about yours.

[feralkittymom]

At the risk of opening a can of worms, can I ask about your T's credentials? You say she has experience, but exactly what is her training and what licenses does she hold? I ask because I don't know of any reputable T who would conduct trauma therapy on-line. It's simply too high risk. I also know that the laws are generally lagging when it comes to regulating the on-line delivery of counseling services. It sounds quite worrisome.

[Ain'tNoCrazyHere]

Originally Posted by Asiablue

To be honest, this raises alarm bells for me. She seems like she can be quite defensive when questioned or challenged. To me that sound like she has quite an ego getting in the way of your therapy and that is never acceptable, therapy is about you not her, she needs to keep herself out of your session. Already you are scared to question her, scared of her response and scared that your feeling might get you terminated. This is not a good basis for a safe secure mutually respected therapeutic relationship.

In my personal opinion, if you have a trauma history then online therapy is not for you. How can she possibly keep you safe or contained thru a chat window? I think you need to find a trauma therapist that you can go see in person.

I agree. If a therapist cannot be open to hearing questions or concerns from a client, it seems to me she is in the wrong profession.

[Favorite Jeans]

I was out biking today and thinking some more about this Leah and I realized that I may have come across as argumentative which wasn't my intention. I think what I'm trying to get at is that I believe you should have a pretty secure attachment to your therapist. Kind of like a child with their parent (ideally--I realize that many of us did not have this). Can you imagine your child disagreeing with you or questioning you and saying to her/him "well sweetie, if you don't trust my judgment maybe I just won't be your mama anymore!"
Of course we get mad at our kids and say stuff we shouldn't. But then it's our job to fix it. Our kids shouldn't think "if I make her mad she'll abandon me." A therapist has some amazing advantages compared to a parent: special training and education, dealing with one person at a time for a very limited time, generally working during peak productive hours etc... It shouldn't be so hard to keep from losing it with your client.