One hour a week just not enough?

The thread by GenCat about session endings and timing got me thinking and brought into awareness something that’s been starting to bother me in my therapy – the way one hour a week just isn’t enough time to achieve any of the things that I seem to be needing from therapy (or more to the point, from T.)

I gather there’s a whole range of different approaches Ts take to length of sessions, out of session contact, availability to the client on an as needed basis etc but I’m stuck with a T who adheres to one hour a week and absolutely no out of session contact whatsoever, no correspondence will be entered into and this is really starting to bother me.

I’m beginning to see that my inability to feel safe or to trust T (apart from other factors as well) has a lot to do with the fact that he’s simply not there for me outside of that one hour and that what I’m really needing is to know there is someone on my side 24/7, to the point where if I needed or wanted to, I could get in touch with him whenever I chose. I’m finding it exceptionally difficult to envisage ever opening up to him emotionally because what can be done in one hour a week with so many years’ worth of pain and rage? And then I’m left to carry the burden on my own for the rest of the week and that’s not ok – I didn’t shut down on everything in the first place just for the hell of it, there was a reason I couldn’t cope with it all by myself all along.

What I’m wondering is how others cope with this set up – how do you ever get to feel safe with and trust your T when they put such (in my opinion) draconian conditions on their availability, how have you gotten to the point where you are able to open up during that one hour and managed to deal with the fallout for the rest of the week without shutting down on T and therapy and feeling abandoned because of it? And ending up hating and feeling totally disconnected from T in the process? Can you really do deep emotionally intense work in just one hour a week? And how do you fool yourself that T is there for you the rest of the time when s/he so patently isn’t?

Thanks for any thoughts

Torn

Hi, Torn--

I very much empathize with what you're saying here. Honestly, there's no way I could have learned to trust my therapist on just one hour a week with her making herself available to me in between sessions. I did not realize I needed this, but as it turns out, it's been huge.

My other favorite therapist (who worked with me in college) was awesome but I could only see her every other week and therefore despite really liking her as a person, never opened up much. Oh, a little here and there...but never anything more. Again, I had no idea what I needed.

With my current therapist, I was falling apart at the seams long before I was contacting her as frequently as I do (daily.) I have specifically told her that it seems like a cruel joke that I am supposed to walk in her office, open a box of worms, and then leave before it's resolved and have to spend the week picking up the pieces of myself, only to do it again 7 days later. It does feel like repeating my own abandonment trauma, over, and over, and over, and over. I am finally moving past this (I think?) but only, ONLY because I am starting to trust that I really can contact her whenever I need to, so I do it pre-preemptively now and thus my breakdowns have gotten to be fewer in number and more manageable at the time. I am starting to understand that she is my "person." I will probably start seeing her twice a week in the future to really deal with some ugly stuff.

As for your situation...it's a toughie! I guess you need to be frank about this with your therapist. I should also say, congrats to you for figuring out what you need; this is a huge step! So, how would it feel to be totally honest with him, knowing that he may not change his stance? Talk yourself through his possible responses and be prepared for the worst. What IS the worst case scenario? Would you need a different therapist who can give you what you need? Or can you work it out with this one? Only you can decide. I wish you the very best as you navigate this!

I see two different ones. Usually they are not unavailable at the same time.

Interesting this subject is being brought up because today my T brought up timing in our session...I guess I'm lucky because if she doesn't have a client after me she will go an extra 15 minutes...I have told her in the past that she can cut me off whenever, otherwise I will keep talking. But sometimes she's the one talking and trying to wrap things up.

She discussed how sometimes there's a rhythm to the conversation and some people need a little longer so she is willing to do that if she can...I thought it was a little random she brought it up (I actually mentioned that there was just a thread about this lol). I feel bad for going over, even though she tells me it's okay. So I will discuss this next time and tell her that I feel this way, but she is the one to establish the boundaries...

I would also say to bring up your concerns to your therapist. If the two of you cannot figure out the best relationship between you then I would start to consider your options. My therapist does let me contact her outside of hours, but I don't do it often, I write my thoughts down and save them for the session so I can get right to things.
Hope you can work things out.

I understand exactly try every two weeks due to insurance and I can leave her voice mails but does not mean she will call me back no email no texting no anything and I'm working on trauma so I know where your coming from she is also backed up so even if I had insurance for right now I could not see her weekly once you warm up and get started its time to leave I know other ppl have email and text options and god bless them for it

When I was not doing well, I saw my T up to three times per week. I once saw her for a 1.5-hour session too. My T is also available to talk on the phone if needed. She regularly checks her voicemail, and is very good at returning calls. She and I actually talked today about the therapeutic relationship and how important it is for clients to be able to trust their therapists and feel like they are there as a support. All those things helped me bond more with her and feel safe with her. I trust her and know that she is there. She has never shown me anything to the contrary. She kind of gives me bits of advice like this now, as she knows I am starting grad school to be a T in September. It interesting to hear these things from her perspective....

This is about DID therapy, but i think the idea behind it applies nonetheless:
(Written by a therapist)

Freedom of Choice and Client Empowerment or Therapeutic Exploitation? | Discussing Dissociation

Good topic!
Torn I'm curious as to what you have in mind when you say you want greater access to your T. I absolutely get the wish, I know that many of us wish we could have T there to help us through our hard moments in your week, when we feel anxious, when we're having flashbacks or coping with difficult memories etc. But what do you feel would be a realistic set-up for you (bearing in mind that pretty much no T with appropriate boundaries will give you the okay to call day or night)?

PE I think your description of therapy as a kind of reenactment of abandonment trauma week after week is brilliant. I'm curious about the format of your daily contact with T. Do you call? Email? Text? Does s/he respond each time you contact or is it enough to be able to leave a message about what you're thinking and how you're doing. How long are these interactions? Do you pay extra for them?

Every now and then (maybe once every 2-3 months or so) I will email my T when I am having a rough time. She usually answers quickly but her emails are very brief and not especially satisfying. However it's still nice to know she's there (usually she'll write something to the effect of "how you're feeling isn't forever/we'll talk more"). Once we spoke on the phone for about ten minutes when there was a death in my family. Other than that we generally don't communicate outside of sessions or just brief emails to confirm or change appointments.

Hope this is not a hijack!!

Our daily contact is usually just a few short texts. Occasionally an email. It used to be primarily email but I found that just reaching out a little before meltdown-mode ensued, was very helpful. We talk about our contact all the time and we are both comfortable with it. I wrote a lot more on this thread about our contact. She always responds to the first few texts. I don't pay extra for them. That part freaks me out. I'm always worried that she's giving too much or I'll become a pain in the ***** somehow, so am very careful about boundaries and always making sure everything is okay on her end. She is constantly reminding me that she can "take care of herself, thanks."

Honestly, I dont know how I would handle the original poster's problem. I think exploring the need behind the contact is a good place to start, and imagining a situation where the contact could be "enough" and also discussing it with the therapist!!

I was not doing well one day a week. I found a therapist I could see twice a week and every other week I see my original T. I can not function right now once a week.

I think the questions surrounding contact amount and timing and situation are complex. T's are always juggling the effects of their actions consciously in the moment and unconsciously longer term. And they can be in conflict.

More sessions per week can be helpful, or it can be overwhelming. The same with the length of an individual session. The time in between sessions I think is a delicate balance between processing and recovery: maintaining enough psychological tension to keep the work going, but not so much as to overwhelm with anxiety. And those needs change over time with the work.

Contact outside of session--phone, e-mail, etc--can be useful, or undermining. A lot depends on the underlying personality issue that brings the client to therapy. Boundaries can feel annoying, but still be psychologically helpful.

For me, the consistency of generally once a week meetings at the same time and place, was soothing. There were short intervals when twice a week was necessary to achieve the same containment and balance.

Because I was loathe to reach out, my T encouraged me to trust in and use that option by calling him if I was feeling anxious or overwhelmed. On the rare occassion when I called, it usually led to an extra session.

But if my personality make-up were to express my insecurity through a constant need for contact, I suspect he would have imposed strict limitations. It's not to punish or from a lack of caring, but rather to create and sustain a secure frame for the therapy work.

It also depends upon the developmental deficit caused by the trauma. Different stages of development need different responses. We were pretty sure my trauma began between the end of the rapproachement period and the early Oedipal period. Trauma at a younger age creates different attachment challenges.

I always think of it in horse training analogies: it's the "Whoa, easy" school of thought. When a horse is spooked by something, some react by "Whoa, easy" in an attempt to soothe the horse's fears. It sounds reasonable, but often it has the reverse result: it tells the horse, "Hey! There really IS something to be afraid of here, and my person is scared!" So it feeds the horse's anxiety, and can even create a habit of spookiness where there wasn't one.

The alternative is to steady the horse gently by quietly confirming the command: it diverts the horse's attention from the spooky thing to you, and gives the horse a task to complete. It builds confidence, usually for horse and rider.

I don't think the issue of trust is about the T being there or not being there outside of session: I think it's more about the abilty to maintain the attachment, and feel contained by the frame.

PumkinEater you’re describing exactly how it is for me – I could probably deal with one session a week, as you described for you, if I had the option of regular out of session contact – I really fail to see how I’m going to be able to trust T or get a sense of continuity otherwise

And exactly about re-creating one’s own abandonment trauma, that’s what’s coming up for me at the moment, all this enactment stuff with T. And you’re right on about if you can get that consistency and support when you really need it, eventually you start to feel safe and can stop needing it as much. There’s a truism in there that Ts don’t seem to get.

Thanks for the suggestion – I’m seeing him today and will probably bring it up (am a bit scared to because I know I’ll get a no and that will send me into a real tailspin of rejection) but I have to get it out there, have to bring up the neediness and such like. Changing Ts isn’t an option, so I’ll just have to see if things can improve with only the one hour a week contact and decide further down the line.

Lol Stopdog – I like the way you’ve set it up with your two Ts . I guess though you don’t feel like you need endless contact with either of them, though I can see how having two different Ts could create a whole different dynamic and meet different needs all the same.

ks33182 I felt the same as you when I had a T who would run over by loads – I kept offering to pay her for the extra time because it was so arbitrary and I got used to having 90 minute sessions (which I think is the optimal T session time by the way) and wanted to ensure I’d always have them. Well blow me down but she accepted my payment and then proceeded to cut the sessions short! It’s definitely worth having an agreed length of time, if only to avoid that sort of thing.

(((((( Sweepy ))))) That sounds so difficult, got to admire you for persevering and making the best of what sounds a frustrating set up.

Content30 that’s something like the sort of set up I envisage would work well for me. I’m glad you have such an accommodating and caring T

Starry thanks for the link. Yeah the willingness of DID T’s to be much more there for their clients is something I’ve been aware of for a while, but over here DID Ts are pretty thin on the ground. And not all of them are as willing to give that kind of security to their clients. I did actually see a supposed DID T for a while but she made it clear that any extra sessions or out of session contact or loaning of transitional objects and the like was a temporary thing at best, and I felt like she couldn’t be trusted to be there when I needed her… I suppose with a T who is not prepared to give any extra at all, at least that fear doesn’t come up because I already know he’s not going to be there when I need him

Favourite Jeans that’s a good question and my honest answer would have to be (very unrealistic!) that I want the reassurance of knowing that if I needed to call at say 2am then I would be ‘allowed’. I’m not sure what it would look like realistically, because whatever’s realistic is always dependent on what’s actually on offer. I suppose my issue is that my neediness is so huge and all encompassing that it couldn’t ‘realistically’ be met anyway . But that doesn’t stop me from needing it

PE not a hijack at all, I’m very interested in the details of other’s therapy anyway

Interesting point you make about freaking out that you are taking ‘too much’ and monitor yourself and make sure you don’t push too many perceived boundaries. I think if I were given carte blanche in the contact stakes, I too would be careful not to overdo or overuse the option – again something T’s don’t seem to give clients credit for…

And you’re dead right again that all I can do in my situation, is bring up the need behind the contact and see where that takes me/T. You know I have no idea what ‘enough’ would be, because I’ve never really had it and so have to rely on my imagination to foretell how much might realistically be enough, but emotionally, enough in real world terms equates to too much

MoxieDoxie I’m glad you managed to get the extra contact help. Interesting that your original T is happy to continue working with you while you see another T at the same time. A number of people here seem to have two Ts on the go at the same time and that seems ok, over here in UK every single T I’ve ever seen has been adamant that they would not work with me if I was seeing another T. Rather limits one’s options…

FKM, post full of wisdom as always .

I needed to comment on this that you said though, because it reinforces for me something that I think is received wisdom in therapy and not actually based on what clients might really need.

This is very much the, if the client wants it, deny them (ostensibly in client’s own best interests) because give an inch they take a mile. If the client doesn’t want it, then it’s safe to push it on them because the T can be assured the client won’t ‘abuse’ the offer…

While I think I can rationally see what you mean when you talk about such denial creating a secure frame, I’ve never experienced it as particularly valuable or useful, to me it just recreates the denial and detachment and arbitrary control on the part of attachment figures I’ve endured all my life .

But I don’t mean to oppose you on this, as it’s pretty clear that what I’m needing, therapy by its very nature may not be able to help with anyway. I’m just struggling with it because I put a lot of hope in every T I meet and the needs get awakened every time and I end up floundering neither getting those needs met nor being helped to deal with having them. Being denied is not my idea of being helped to deal with my needs

This isn't what I mean. It's not denial for denial's sake, and certainly not denial for the T's convenience (well, not with a good T, anyway). When you say "I suppose my issue is that my neediness is so huge and all encompassing that it couldn’t ‘realistically’ be met anyway . But that doesn’t stop me from needing it " it sounds to me like unlimited contact wouldn't satisfy the need, but intensify it and disappoint. The research seems to bear this out as a major cause of ruptures.

This--"I think if I were given carte blanche in the contact stakes, I too would be careful not to overdo or overuse the option – again something T’s don’t seem to give clients credit for…" seems inconsistent to me with how you characterize your need. I'm sure you believe this, but I think trying to satiate the need actually encourages it to grow, making this sort of control of self extremely difficult and painful. I think experienced Ts want to avoid creating that struggle. Inexperienced Ts, in over their heads, can easily out of the best intentions want to "be there" for their clients in this way, but story after story shows that it often ends badly.

The challenge is to find a way to take in the empathy as real as it's offerred. And it could be that 2-3 sessions a week could help (though it often intensifies transference, for better or worse.) But I think the out of session contact, with the exception of an emergency, doesn't generally help because it rarely feels satisfying (so it nudges the need, but doesn't relieve it).

BTW, it isn't about "opposing me"; it has nothing to do with me, it's psych theory.

I agree that getting SOME of what I think I'm needing might only serve to intensify the need without actually satisfying it, but I have to maintain my view that being deliberately denied nearly all of what I perceive to need does not have any benefit to me or my healing.

I don't see any inconsistency in what I wrote, as although I experience myself as having this huge all encompassing need, I am still in charge of it, to an extent, and can see myself very clearly being careful not to alienate the potential good attachment figure. I think I'm also eminently self aware enough to be able to bring up and discuss how disappointed I might be at not getting enough. But I still want the option of being offered way more contact than I currently have. Just having the option can go a long way to satisfying a big part of the need.

Oh and it is about opposing you, because you are in this instance the mouthpiece for the psych theory you are explaining and I happen to disagree with it, whereas I get the impression you pretty much see it as correct

I agree with the theory; that's different from saying it's correct. I'm quite willing to separate any ego involvement in ideas.

Ask your T for what you want and see what he says. But if he won't accommodate you in this way, will it derail your therapy?

I'm not sure that I would continue seeing my T if I could not contact her via email outside of sessions. Email was initially how I contacted her in the first place.

Before meeting me she gave me her cell and office number. She explained that she doesn't give it out for just free contact, but she knows sometimes its needed to do her job. So while I know I have her cell phone number, I would never use it (unless I was on the edge of killing myself, and even then i'd probably choose to text her).

She replies to my emails in at most, 24 hours, but usually I can expect one around 2-3 pm. So I hound my email box for those two hours lol. She says that she likes that I email her because they express my thoughts more, and she see's me giving her little "trust tests" in them (where I give her an inch of trusted information and see what she does with it).

The last email I sent her was quite lengthy (things I had wanted to tell her last session but couldn't) and she read it, printed it out, and hopped immediately on it to discuss. I told her there was no need to respond back since we could discuss it in session, but she still sent me back a quick response letting me know she received the email, thought it was a good suggestion to discuss this next session and gave me a little reassurance on how I was feeling.

I'm not an expert on therapists but, if it was that cut and dry with the contact, i'd feel less like a person she wanted to help and more like a 9-5 chore...which would likely cause me to stop sessions pretty immediately.