[grimtopaz]

This is my first post in this forum, but I have been lurking for a while. I could use some feedback and support from the community.

I have been in individual therapy for chronic Major Depressive Disorder since March, 2013. I see my therapist on a weekly basis (I have seen her approximately 40 times.) Her treatment modality is CBT (she does not think highly of psychodynamic psychotherapy), but she also practices Schema Therapy which focuses on attachment issues. She does not think I meet criteria for any personality disorder. I have never self-harmed, been suicidal, nor have I struggled with addiction (I consider myself fortunate).

Until our last session, I felt my therapist and I had a strong working relationship. She is very intelligent, reasonable, and is firm with boundaries. I never contact her in between sessions and do not push boundaries, so it has not been an issue. She's appropriately attuned, and I respond well to the level of warmth and empathy she provides. In short, I have the outmost respect for her as a professional.

I have developed quite a strong erotic transference (I'm a bisexual female), but I have decided not to address it since most CBT practitioners don't see analysis of transference as a key component of therapy. She has never brought up the therapeutic relationship because it has not been an issue.

In therapy, I constantly bring up that my greatest fear is that I am somehow "different" from others in a bad way, and that when people really get to know me they pull away, reject me, and abandon me. There have been instances of this happening in my life, and they have been very traumatic for me. This fear, has kept me from opening up to others and forming close relationships. I rarely share my feelings and I avoid making myself vulnerable at all cost.

I have managed, over the past year, to become increasingly open and vulnerable with my therapist. This has been very difficult for me, but I trusted her and became fond of her.

During our last session, she told me that she has never said this to a patient before, but she thinks that my attachment issues go "too deep" and that I am too "intelligent" (Ph.D. from a fancy university, which is neither here nor there) and "defended", and that she thinks that CBT and Schema Therapy might not work for me. She wants to refer me to a therapist who does short-term psychodynamic psychotherapy - a therapeutic approach I thought she did not respect.

On a logical level, I understand her reasoning. Ethically, she needs to recommend whatever treatment she thinks is best. However, I just can't believe that she knows my greatest fear is that people think I'm "too messed up" and I dread rejection/abandonment, YET she is acting out my greatest fear and telling me that I'm in fact, too ill for her to treat me. She has also used CBT strategies trying to reason that I'm not "too messed up" and not everyone will abandon me - yet, there she was doing exactly that which I fear the most/defend against.

When she said this, I just started crying and told her that I thought the whole purpose of paying $200/hr to a therapist is that they are NOT supposed to do to a patient what people have done to them in the past.

She was not defensive, but just explained to me that she thinks that another type of therapy would be best. I kept repeating that I understood her from a rational perspective, but that I was hurt and felt like I have failed as a patient. Session time was up, so things ended rather abruptly. She said "I look forward to seeing you next week", so I guess I am seeing her again Thursday.

I am very technically familiar with CBT and Schema Therapy , so I wrote her a brief email explaining why I think Schema Therapy is a good fit for me. I told her I respect her treatment decisions, but this was my opinion.

Sorry for the long rant, I am just wondering the following: What are your thoughts/impressions? If you were in my situation, what would you say to your therapist? I feel incredibly disappointed, abandoned, hurt and somehow betrayed - am I overreacting? How would YOU react?

Thank you so much for your time.

[Freewilled]

I'm sorry I would react same as you. I would be so hurt....I'm confused why she thinks you're too intelligent or defended though. Why? I would want to know where this comes from and how she thinks psychodynamic would be different. And why short-term?

This would have to be sorted out for me because if my T came out and said he couldn't help me anymore (one of my biggest fears is my T not being able to or wanting to meet with me anymore - I constantly hint at it during sessions) I wouldn't be able to continue.

[CantExplain]

((topaz))

Hello and welcome!

I can understand your feelings of abandonment and fear.

It would certainly be frightening and painful if your doctor said "I have to send you to a specialist", or your specialist said "You've been misdiagnosed and I have to send you to a different specialist." It would be easy to feel that you were being shunted around an uncaring bureaucracy and never getting any closer to a cure.

And yet, that is sometimes what happens, and in spite of the unpleasantness, they really are doing the best they can for you.

[anilam]

Too intelligent for CBT? Well, now I know why CBT didn't work for me too...

Seriously though, I think she truly cares for you and is trying to do what's best for you (and you only)- otherwise, she could just keep taking 200 bucks per session till the rest of your/her life. Furthermore, she offered, it's up to you to decide whether that's what you want.
I don't like CBT (as already said it's not working for me) and am in psychodynamic therapy- I'd take her up on her offer. You've got nothing to lose. You still can go back to her if you didn't like the other T. I'd use the next session discussing why you're feeling the way you're feeling, though. Just to clear the air.

[someone321]

I'm very sorry that it happened to you, I would be very hurt and I think I would react the same as you... However, I can understand why your T recommends you psychodynamic approach... I would never say that I'm too intelligent to CBT but I agree that this method might not be for everyone... For instance, I need discussions, exchanging opinions, interaction with a therapist and I want to understand everything, not only to learn how to cope with some emotions/reactions but really to understand them... And according to my knowledge (I might be very wrong) better understanding and going "deeper" in the topic belongs to more traditional methods than CBT...

However, as I've said, I can understand why your T recommends you a different approach but of course it doesn't mean that I wouldn't feel abandoned by her if it happened to me... I agree with anilam, I would bring it up to the next session and tell T about your fears and feelings... For sure you are not too "ill" for CBT! Your needs might be just different than your current T can fulfill...

[unaluna]

She sounds pretty ethical to me, to be referring you out. If she is in over her head with you and admitting it - instead of trying to fit your square peg into a round hole, she is trying to help you find out where you do fit. She's not the only t in the world - whereas yes those were our only parents. YOU are the one who matters here - not the t. You pay $200 for YOU, not her.

[dark_sweetie]

I'm sorry you are hurting. :c that must be really hard considering your feelings for her and the level of vulnerability you allowed for.

However, I think this is a good opportunity for you to find someone who really understands your issues better. To learn from being vulnerable, you need a good, open, supportive and empathetic therapeutic relationship. Have you read anything about (for example) C-PTSD? Anyway I know how hard it is but in the end it sounds like more than a CBT problem. You are most likely reliving coping mechanisms you developed in your childhood to deal with the stressful world without a proper level of support, validation, protection and guidance. Maybe it is time to find a T who can understand those needs and focus on them to help you learn better ways to cope.

Just some thoughts. Sorry if this is off base. This must be so frustrating. Sending big hugs to you

[SoupDragon]

I fear the same things with T. I am starting to wonder whether "normal" people would not have the same fears and vulnerabilities, that they would not feel abandoned if their treatment provider recommended them to someone else. Like if someone had a physical health problem and was being treated and the treating physician said they could not help them, but knew someone who could - would the patient feel abandoned, hurt?

So maybe the very fact that this prospect does bring up issues, means that there are those issues to work on and the best person to address them is someone who is skilled in that area.

My rational head would totally respect the T for saying this, but I know that damaged emotional bit would find it so very traumatic and would feel all those things. Over-reacting? No I don't think you are, you are purely reacting to something that hits you deeply.


Soup

[HazelGirl]

I totally understand what you are saying. But I agree with the others.

CBT therapy didn't work for me, either. I couldn't convince myself to believe the things I was supposed to believe. I'm currently in psychodynamic therapy and it is working much better. But the sense of betrayal would be very difficult to handle if I was in your position.

I hope things work out for you.

[thestarsaregone]

I'm so sorry

I think your T did the right thing in recommending a different therapeutic method if she believed something would work better for you, but I think she might have been able to express it differently to you (especially considering your own personal fears/triggers). In any event, I think this would be a good opportunity to find a T that is better equipped to work through your issues with you.

I also suffer from depression and personally have my own fears of being too damaged, so I take great care not too reveal too much to others. I struggle with being completely vulnerable with my T (her approach is psychotherapy, btw) and in the last couple of sessions we talked about the idea that I might have romantic feelings for her. This was an extremely uncomfortable session, but it's proving (I hope) to be an important opportunity to really examine my behavior in relationships.

Hang in there

[Petra5ed]

I'll start by warning you I'm not a professional, but I'm well read and opinionated , and I am also overly attached to my therapist. Well, I would have reacted the same as you. My mind already assumes I'll be abandoned, so I would take it right there obviously, proof that my fear is in fact correct. I would be spiraling down a path of terror, dread, grieving... One thing to point out to you though, it sounds like you don't know yet what her comment meant, i.e. was it a suggestion, an order, is she terminating you or merely opining?

I have a very similar problem with intimacy. I cant do it, and I'm not good at emotions either. My first thought reading this was why are you in CBT? I'll post that as a rhetorical, since I'm not sure what your particulars are. The attachment issue stuff isn't tackled at all in CBT that I'm aware of, and attachment disorders are their own animal, they usually trace back to abuse that occurred in childhood. I would suggest only one thing, and that's to discuss your thoughts and fears with your T. For one, it sounds like she might be feeling ineffective with you, by opening up you can demonstrate your level of trust/progress in the therapy. You should also let her know your preference is to remain in therapy, if for nothing else it is good practice to ask for what you want. Finally, you need a clearer picture of what she is saying. She might have just been offering it up as a suggestion, or a possible enhancement to CBT, or maybe a short term thing before you return to her to finish CBT.

Anyways, the other thing I wanted to point out is the way you wrote your post I think that deep down you know that avoiding being vulnerable etc. is an irrational way to live. I do the same thing. It becomes engrained habit after you are burned by enough people, but after a short while it becomes very isolating. I'm now without almost any intimate relationship, except for with my T, so imagine how much strain that places on the one freaking relationship! If you never open up you end up living your worse fear, you might not be abandoned technically, but you end up alone regardless.

[missbella]

Reading your account, I was angered on your behalf that your therapist would name call and label you for what she apparently sees as an ineffective treatment. As I read, it seems like she's blaming you for her modality and her shortcomings. This isn't working, so it must be the client's defects.

I don't know who decides what's normal and what is defective to start with. We are dependent, interdependent and social creatures. I assume most people on the planet have hurts, yearnings and needs. If attachments didn't make us crazy there wouldn't be all those love songs, and everyone else wouldn't need to listen to them. Relationships sometimes can be difficult and complicated. So who determines what is too deep an "attachment issue"?

In recovering from my therapist's bullying, it was helpful for me to see him for what he was, not a judge, not an authority of anything, but a vulnerable man who went to graduate school, learned a lot of terms and protocol, then hung a shingle claiming he suddenly had the power to heal other people's lives. (Though I found nothing but regression in therapy, I found growth in other ways, including time and experience.)

I'm angry when someone pins labels on me. It's not constructive, and it's tactless. It doesn't teach me or help my growth. That would be exponential if I had opened myself up to someone, thinking them an authority figure. A professional is acting like a mean kid in third grade who doesn't know better.

If I were in your position, I'd try to assess whether it would be constructive to talk about the rupture. Therapists ideally advise to do that. Some can handle it, some can't though. In my case, the therapist continued to pin the blame on me, and trying to talk to him was like poking a rattlesnake. Other therapy clients had a "you hurt me" conversation, the therapist admitted the error, and both went forward strengthened.

There's the dating cliche, it's not you; it's me. Reading your account I thought that's what she should have admitted.

[Asiablue]

I would have thought schema therapy was perfect for someone with abandonment issues. However the CBT side of things really isn't suited to the relational side of things. There's nothing to say you couldn't try psychodynamic and go back to her later.

Also don't put too much weight on what she said about not thinking highly of psychodynamic therapies, i think most T's have a bias towards their own type of therapy and it's a bit of a competitive thing with some therapists but not taken seriously.

[Littlemeinside]

Schema Therapy also has a psychodynamic approach= object relations/attachment ect. and works with the T´s and clients (counter)-tranference. They just phrased it as the T being aware of their own schemas as well as the clients.

Maybe she isn´t a "fullblown" Schema Therapist?

I am curious as to why you can be to intelligent to do this sort of work?

Sounds like something is up with the T that may not be related to you? Who knows.

Sorry this happend to you. I know from personal experience what it´s like, having to pay (!!??), to be abandoned and treated the way you were in childhood, all over again.

[grimtopaz]

I want to thank everyone for your feedback since I need the support right now. It meant a LOT to me to wake up this morning and read your support.

To answer some of your questions. The reason I went to see a CBT therapist is that initially I thought I was just dealing with Major Depressive Disorder and anxiety, and my understanding is that for those diagnoses, CBT has been shown to be most effective. I was unaware that the core of my problems was attachment issues and relationship issues.

I am not sure how being "intelligent" is being held against me. I *think* that she might have said at some point that smarter folks can talk their way out of CBT logic, and also build much more elaborate defenses. But I can't help but wonder if it has more to do with he, since she has mentioned in passing that I'm smarter than her and know as much as she does (which I think is ridiculous). She has also told me that when she talks to me she feels like she is talking to another professional/peer rather than a patient (I don't see why I can't be a professional AND a patient!)

When I started bringing up attachment issues, she mentioned Schema Therapy, which I thought was a perfect fit for me. But perhaps she is not a "full blown" Schema Therapist or is not trained to deal with whatever I have.

My "reasonable" mind keeps saying that she is being an ethical professional and is doing what she thinks is best for me. I agree that it would be easy for her to just chat about the weather and keep taking my money. My "emotional mind" just sees it as "no one will put up with me even if I pay them!" and I see this as more evidence of my greatest fear.

I did think she made a very poor call in just bringing this all up the last 10 minutes of session. I know she had to let me walk out of her office kind of a mess because she had a patient waiting. She was also very nonchalant about the whole thing, and her tone hurt. I know at some point she was trying to explain things to me rationally, but I felt like I couldn't process the information.

When I think about what I want to say to her, I just break down crying - this lack of control is so scary for me. I think I'm going to write down an outline of what I want to say and take it to session. I'll let her know how I am feeling and why. Ultimately she is in charge of treatment decisions.

Part of me wants to terminate and say things that will hurt her as much as I feel hurt (I know this is very irrational and I won't do it), and another part of me wants to shut down and be purely intellectual (my usual style). I need to find the happy medium.

[HazelGirl]

Ultimately, YOU are in charge of treatment decisions. Not her. She may feel inexperienced (maybe she's new?), and not educated enough to handle your case. That sounds like what is going on to me.

[Fuzzybear]

So she thinks only "dumber" people are helped by CBT? Wow. What a horrible thing for a therapist to think about her clients. I would not want to see someone like that.

[grimtopaz]

Originally Posted by HazelGirl

Ultimately, YOU are in charge of treatment decisions. Not her. She may feel inexperienced (maybe she's new?), and not educated enough to handle your case. That sounds like what is going on to me.

She is about 40 years-old (I'm 32) and she graduated about 10 years ago from her Ph.D. One of the reasons I chose her is that she has a lot experience training interns, and is in charge of training psychology postdoctoral fellows and psychiatry residents at a "fancy" medical school.

I know that lots of letters after someone's name doesn't make someone more competent, but I wanted her to have experience and a solid academic background.

I will very politely/respectfully ask if there is something about me (that is not my fault) that makes her uncomfortable/feel ineffective. Aka are there countertransference issues/do I trigger any of her schemas? She tends to be quite good about not getting defensive so perhaps there is something there.

[HazelGirl]

Originally Posted by puzzle_bug1987

So she thinks only "dumber" people are helped by CBT? Wow. What a horrible thing for a therapist to think about her clients. I would not want to see someone like that.

I don't think she worded it well, but I know what she was trying to say. Some people are more self-assured about their knowledge. They trust their own knowledge more. Because of this, they often don't respond as well to the outside interventions coming from the T who is doing the CBT. I have this issue, where I believe my own irrational and blown out of proportions beliefs over the stuff I am "supposed" to believe.

[someone321]

Originally Posted by grimtopaz

I want to thank everyone for your feedback since I need the support right now. It meant a LOT to me to wake up this morning and read your support.

To answer some of your questions. The reason I went to see a CBT therapist is that initially I thought I was just dealing with Major Depressive Disorder and anxiety, and my understanding is that for those diagnoses, CBT has been shown to be most effective. I was unaware that the core of my problems was attachment issues and relationship issues.

I am not sure how being "intelligent" is being held against me. I *think* that she might have said at some point that smarter folks can talk their way out of CBT logic, and also build much more elaborate defenses. But I can't help but wonder if it has more to do with he, since she has mentioned in passing that I'm smarter than her and know as much as she does (which I think is ridiculous). She has also told me that when she talks to me she feels like she is talking to another professional/peer rather than a patient (I don't see why I can't be a professional AND a patient!)

When I started bringing up attachment issues, she mentioned Schema Therapy, which I thought was a perfect fit for me. But perhaps she is not a "full blown" Schema Therapist or is not trained to deal with whatever I have.

My "reasonable" mind keeps saying that she is being an ethical professional and is doing what she thinks is best for me. I agree that it would be easy for her to just chat about the weather and keep taking my money. My "emotional mind" just sees it as "no one will put up with me even if I pay them!" and I see this as more evidence of my greatest fear.

I did think she made a very poor call in just bringing this all up the last 10 minutes of session. I know she had to let me walk out of her office kind of a mess because she had a patient waiting. She was also very nonchalant about the whole thing, and her tone hurt. I know at some point she was trying to explain things to me rationally, but I felt like I couldn't process the information.

When I think about what I want to say to her, I just break down crying - this lack of control is so scary for me. I think I'm going to write down an outline of what I want to say and take it to session. I'll let her know how I am feeling and why. Ultimately she is in charge of treatment decisions.

Part of me wants to terminate and say things that will hurt her as much as I feel hurt (I know this is very irrational and I won't do it), and another part of me wants to shut down and be purely intellectual (my usual style). I need to find the happy medium.

Hmmm... I'm not sure if I get your T's point... Why can she think that someone is too smart for a therapy and actually she uses that"against" you... That's weird... i also have a PhD from blah blah blah (doesn't matter) but in my opinion I just got lucky, got good brain but I'm absolutely not too smart for anything... Some people are great in music, some in art, others in social skills and I'm not bad in science that's all... But actually I can agree that "intelligence" might not be so cool in therapy at my case at least... Because I simply overthink... For me the therapy is like a chess game, I think about the impact of my words/moves on T, his possible reactions and their impact on me etc, etc, etc... So my "intelligence" makes me so stupid that I think instead of feel...

[minneymouse]

I agree with the others who have identified that this is an issue with your T as a therapist, and not you as a client or schema therapy as a modality. I have very strong attachment issues (so strong that I tipped my T off even before we started working together that she wouldn't be able to cope) and schema therapy takes those into account. However, schema therapy is only as healing as the therapist is willing to fully deliver it. It sounds like your T is quite structured and rigid, and perhaps is uncomfortable with some aspects of the therapy. She may be clinging onto the cognitive restructuring aspect, because that suits her personality and approach, but is holding out on the experiential elements (e.g. imagery rescripting), and on reparenting, which is core in schema therapy.

Schema therapy only works for me because my T is willing and able to deliver *all* aspects of it. However, she's only able to do that because of her natural tendencies and abilities as a person and a therapist. She is high in warmth, tends towards flexibility, and is willing to reparent. She isn't wary or afraid of my feelings, or of her own. She is willing to love me within the frame of therapy because she knows that is what heals.

I'm so sorry the T you love and trust has hurt you. I know what that is like. This is not about your limitations but hers. I hope you can find a T who isn't afraid to be what you need her to be.

[CantExplain]

I've thought about this a bit more.

For a doctor to refer you to a specialist is right and proper.
For a parent to refer you out is abandoment and betrayal.

And of course a therapist plays both roles, whether they like it or not. Doctor and parent pull in different directions and they need to be sensitive about that.

[SoupDragon]

Originally Posted by grimtopaz

My "emotional mind" just sees it as "no one will put up with me even if I pay them!".

Yes l often think this too.

[grimtopaz]

Again, thank you so much for your feedback. I appreciate everyone's input and support.

Since I was very distressed, I ended up writing my T an email (which I'd never done before, other than to ask technical questions).

The first part of the email was me making an argument in favor of Schema Therapy for my issues (the intellectual approach). Then, when I realized what I was doing, so I just straight out said that I'm in a lot of pain and I don't want her to give up on me. It was incredibly difficult to make myself that vulnerable, but the fact that is was through email, helped. I don't like feeling like I'm begging for help - but there it was.

She wrote back saying that she is nowhere nearly giving up on me yet (the world "yet" kind of unnerved me, but I'm very sensitive at the moment), and that she is sorry if in any way she communicated that. She wrote that she wants me to get better so she is considering alternative treatment options. She stated that Schema Therapy might be helpful and recommended I buy "Reinventing Your Life" by Jeffrey Young. She also wrote that we can speak before our session if I would like. (I feel no need to, but I appreciated the offer).

Her email made me feel much better. It's scary to realize how much power she has over me. But I feel like I can trust her.