Retraumatization and therapist responsibility

In this weeks session, I delved into feelings of shame and terror from CSA. I understand the need to let myself feel all the things that I couldn't let myself feel as a child. But when the session ended, I was still stuck in those emotions. I generally don't keep an eye on the clock so when T told me that we needed to end, I had no time to pull myself together before having to leave the room.

Afterwards, I was unable to shift myself into a better emotional space and...to make a long story short, my night ended with me being taken off a bridge in handcuffs by cops suspecting me of a suicide attempt.

Now that I've had a few days to recover, I am angry at T for letting me leave the room without helping me come to more emotional stability. He knows that I have had suicidal thoughts and gestures when I have difficult emotions. I really think that the bridge incident would not have happened if he had helped me process the feelings rather than just access them. Or at least taken a more active role in getting me more emotionally stable before the end of the session. Or he could have called me later to check on me.

It's made me realize that this experience has been retraumatizing, and that there have been several other examples of me leaving His office feeling retraumatized.

When I talked to him on the phone briefly yesterday, he indicated that maybe it would be best if I stop therapy. This leaves me feeling very vulnerable because I have become attached to him and would feel so rejected if he told me to stop coming. But I'm also wondering where does his responsibility lie in this situation? I feel that I can't see this really clearly right now because of my attachment to him.

I'm sorry you're going through this. Sounds like you're feeling stuck in more than one way.

When I am in an extreme depressive episode, my T always says to me: "Do you need more intensive support at this time?" Originally when she said that I was offended and hurt. But she explained it to me: She wasn't leaving me, but there might be times I need more help than what she is able to provide.

T's are in a sense responsible for their patients. But if for whatever reason they don't know the severity of your situation, they can't be responsible for your actions. They aren't mind readers and they definitely aren't perfect.

Ask yourself if you do require more help than what your T can provide. Are you looking to put responsibility of your own feelings, thought, choices, and actions onto someone else? I think you should address how you feel about the situation with your T. Maybe both of you will gain clarity.

I hope everything works out. Keep safe! You are important

I'm really sorry that you had to go through this...
I had a little bit similar situation (but no SUI attempt) after talking at the session about csa, and for sure after talking too much about it and without any grounding at the end of the session - time was up so I left. Afterwards I was a bit angry at my T that he didn't stop me and eventually I've changed T... My current T says that I was re-traumatized by the previous T and that it could be dangers for me if I stayed with him. However, I do not think that he did it in purpose or that he made a very big mistake - he didn't know me, he could not expect that it could be so bad for me, Ts cannot read in our minds so I would not accuse my T for being unethical or something like that. We just didn't fit...

If I was you, I wouldn't stop the therapy, because for how long? If you come to the same T in a year and talk about the same things, it could end up similarly... And I guess it is something worth to work on... But maybe you could find another T? Who specializes with trauma work?

here in NY (the one in the USA as opposed to other locations) its not the therapists responsibility to make sure their clients walk out the door not act out or attempt suicide after a session. a therapists responsibilities end the moment the client leaves that therapists office...

or like a teacher. a teachers job ends at the end of school its the students responsibility to go home and apply what they have learned, do the homework and such...

or a medical doctor....they see the patient, prescribe the meds/ or other treatment and then its the patients job to follow through with taking care of their self so that they get better...

therapy isnt a situation where a therapist acts like a care taker. they can supply a safe room where you can unload your troubles, learn about yourself, learn how to take care of your problems and then when you have left their office its your responsibility to take care of yourself,

question did you let the therapist know that you did not feel ready to go home yet? therapists are not mind readers. they dont know when you are feeling ok or not, its you that must tell them when you are not feeling "done"

most treatment providers have a waiting room/lobby/reception area where its not just used for waiting for your appointment, its also for if clients are not in a safe mind set, they can take their time, pulling their self together. they can go sit down in the lobby/reception area, read, or write, take some breathing time and then leave the building when they are ready.

before you ended up on the bridge in handcuffs did you call your therapist and say hey, Im feeling suicidal here? again the treatment provider doesnt know what you do or how you feel after you have left their office...

heres an example....

Im a survivor of child sexual abuse... sometimes my therapist and I get to talkng about some pretty heavy stuff... when its times up my therapist must go on to the next client. thats what her job is. shes not my caretaker, I have choices I can make once time is up....

I can tell my therapist Im not feeling so good and ask for some more time if she has any available that day, or in the next few days...

I can leave her office area and sit in the lobby/reception area until I feel I can be safe with myself and others....

I can go home and see if things get better and if not call my therapist or a crisis line, or go to the emergency room.....

I can call a friend and let them know I dont feel like I can be safe with myself or be alone right now can I come over....

I can talk with my wife and let her know Im not feeling so hot right now, please hold me....

my point is its not my therapists responsibility to see that I dont self harm, try to kill myself, or other ways I may feel like acting out after therapy...its my responsibility to take care of me and make sure that Im safe with myself and others.

for situations where I cant be safe with myself and others thats when I am under inpatient care...thats where mental health treatment providers watch me and keep me safe when I cant do that for myself.

here in America we have the freedom to make our own choices unless we have whats called a guardian....thats when a court makes the decision that an adult is unable to make their own decisions, someone is appointed to watch over the person and make their physical and mental health decisions for them.

there are some treatment providers that will check in with the client to see whether that person is ok but its not one of their job requirements.

my suggestion if you would like your treatment provider to check in with you about how you are doing before you leave their office you can ask them to do so. they will tell you whether they can do that...though it may mean you have less time with your treatment provider for discussing your problems because most mental health agencies in america run on the policy that each client gets an hour. so when the hour is up its the next clients turn. how that computes with after session check ins you and your treatment provider may decide to stop your sessions at for example 40 minutes so that you have 10-15 minutes to discuss how you felt the session went and whether you feel like self harming or suicidal... and then of course you need to look at what the agency rules are that your therapist will have to follow should you be in a self harming or suicidal state of mind...if its like my treatment provider being suicidal or in self injury state of mind after therapy means inpatient care and stopping therapy until the hospital says Im stable and able to handle talking about the trauma and abuse without being a danger to myself or others.

What's your T's training and experience with trauma treatment? If you've struggled with SI and gestures, and he's known this, then his handling of your treatment sounds quite inappropriate to me.

You need to share with him what happens to you when you re-experience those feelings: do you dissociate? Go silent? Shake? He needs to be able to read your signs in the moment.

There are a number of approaches to trauma treatment, but if he's encouraging you to re-experience traumatic feelings, then he's got to build in safeguards. It is irresponsible to not do so. It also needs to be assessed whether you can pursue such work safely in an out patient setting. His suggestion that you stop therapy with him makes me wonder if he's thinking you may need more containment than he can provide in order to do the work, or questioning his own ability to conduct the therapy. Either way, you need to know.

My T is VERY careful about exploring trauma because he absolutely is careful that it is not retraumatizing. He does not agree with the therapy train of thought that trauma survivors have to process every trauma event in detail and "re-experience" the trauma in order to heal. He says that approach used to be the belief but most therapists learned it is a mistake to do so and can be incredibly re-traumatizing, making healing much slower and difficult.

We do at times have to go into detail, but he limits how much we do, he monitors me carefully for my responses, and doesn't hesitate to stop and ground me at any point that I am not doing well. He always makes sure there is time to find clear closure in those sessions and checks with me about my safety to drive, etc.

Any therapist should be doing those things with their clients if the are working with trauma. That absolutely is their responsibility.

I have to agree with 1914sierra. My T proceeds with great caution and even emphasizes that she cannot and will not push me if she sees me becoming too distressed. It is so dangerous to be retraumatized! I know some T's actually do this on purpose and believe it to be effective but I personally do not see how any good can come from it.

I am also curious if your T has experience working with trauma. Can you ask him? When I was unsure of specific qualifications of my T and whether or not she was competent in the specific area we were working on I was completely blunt and asked her if she had the training and felt comfortable with it. I see therapists as any other healthcare providers when it comes to specializing in specific work and experience level. It can be dangerous to seek help from the wrong type of professional when it comes to certain issues.

During those sessions where trauma is addressed it really is necessary and very important for our Therapists to ground us and make sure we will not die once we leave the session! I don't know how many times my T has called someone to come and get me, let me stay in another room for a while so she can check on me occasionally, or sat with me for a while longer to make sure I was okay. Again, like 1914sierra stated, she monitors my reactions closely and puts the breaks on it when I become overwhelmed. The way I see it...the Therapist is completely to blame if they do not follow through with these responsibilities if something happens to the client after the session.

I'm really sorry you had this experience. It makes me mad at your therapist for handling this so poorly and I really hope you are able to resolve the issue with him or find someone more competent to help you through that stuff.

My T is also pretty careful. She allows me to be in charge of how much I share, or to say that I can or can't talk about certain topics. There have been a few times where I haven't been communicating well and my T wasn't aware of how I was feeling and I have left feeling terrible. But those are rare (maybe 2 or 3 times in 2 years?). It's normal for trauma to come up between sessions, so if things were resolved in session, that doesn't mean that the next few days won't be hard. But that doesn't sound like what happened in this case. It sounds like you needed extra time to process and ground yourself before leaving, and your T did not do that. The ending techniques are very important because they help you get on an even keel before leaving and trying to handle the rest of your world.

My t always asks, how things are if there are any stressors in my life,and then theres always time for grounding before I leave, and I can always call, and I have crisis numbers in place, I havent fully started yet, but she is qualified. I know when to say stop, and she knows my body language when to ground and when to say enough, so I am not worried.

Thanks everyone, for your responses.

I definitely take responsibility for my actions - I'm the one who made decisions that led to the handcuffs.

But T knows enough about me to reasonably anticipate that I was at risk afterwards. At the end of the session I was still curled in a ball facing away from him and crying. T knows that when I am deeply distressed, sometimes something "switches" in my brain and I become self destructive. I have also told him several times that when I am in this state is when I am LEAST likely to reach out for help.

I have become so attached to him that I feel it would be devastating to end the relationship with him at this point.

He has a transpersonal orientation, and I've never asked him if he specifically has experience with trauma. I asked him once, fairly early on, if he has ever had suicidal clients and he said yes. He also told me at another point that he worked with a family around csa. He has over 20 years of experience and is overall a very competent T (I've seen some less competent ones before finding him!) but i do feel he dropped the ball by not helping me ground and regroup before leaving the session.

So yeah, I'm angry with him, but I'm also afraid by the idea of stopping seeing him. I've invested so much - time, energy, money, emotion, vulnerability - in seeing him, and he has helped me in so many ways. But I can't have this happen again. And I need him to reach out to me more. I'm starting to wonder if he truly CARES about me, not just that he is concerned about me.

Sometimes I wonder if maybe I didn't go to the bridge because I wanted his attention? Because I wanted someone to save me? I hate saying that because it is so embarrassing and I don't think that is completely true, but maybe there is some truth to it.

Instead of seeing it as "now I have to leave because he did something wrong" what about talking to him about it? Can you bring it up and together create a better plan to help you? Maybe spending the last 10-15 minutes grounding and bringing you back to reality, and if you still look like you're struggling, him agreeing to call you that evening?

yea suicidal for attention been there done that. its a hard thing to fall into and know thats what we are doing and once we know it its hard to break that cycle.

not reaching out when you know you really need it. again been there done that...

expecting or wanting the therapist to swoop in and be the savior...again been there done that....

It was a long road but I learned the attention from suicide was negative attention (lectures, long sessions on reviewing what to do when I got this way, slowing down or stopping sessions, inpatient care....) was not the kind of attention I wanted...

what I wanted was more time with my therapist, my therapist to comfort me, my therapist to be my shoulder to cry on, share a laugh or two....

I learned that the only way I was going to get the positive attention I was looking for was to ask for it.

heres an idea that helped me....

I started asking for the attention during times when I wasnt in crisis....

T...how are things going today?

me...great I accomplished so much this week...this is what went on today and this week...I feel so good today I feel like I need someone to give me a hug and say great job today. would you be that person please?

therapist laughing...sure I can and I would also like to congratulate you on asking for something you need. do you realize this is the first time you have asked for what you need in here? then she proceeded to tell me how proud she was of me and my accomplishments..

walking out of her office that day I was walking on air because I got a hug, recognition and was listened to.

the more I asked for the positive attention during non crisis times made it so much easier to ask for the positive attention when I was in crisis.

it worked for me maybe this will work for you.

Yes, I am going to talk with him later today. I'm scared about how the conversation will go. He said over email that his concern is how to "proceed in a way that is genuinely workable, taking into account the way things actually are and both of our concerns about your welfare". My last T terminated me via letter for suicidal thoughts so I've got lots of fears about abandonment that are up for me right now.

But what you suggest HazelGirl sounds much more reasonable and I am sure that I coming up with a plan is what T meant in his email. Wow, this is just touching all the most hurt parts of myself and it is really scary!

I am really sorry that happened. It sounds horrible. I do hold your therapist partly responsible and it makes me mad. My ex t did that quite a few times, and my new t says that it was ex t's fault, she should have done more to make sure i was ok before i left the session, should have never let me leave so upset.new t is an expert on trauma, so i guess she knows what she is talking about.
Ex t would cut me off at the end of session with no warning and get me out of the door, not really caring if i was still a mess or crying,not asking how i was feeling, knowing i was often suicidal, and several times i would attempt suicide. When she found out about it later she got mat at me.

I am very sorry that that happened to you this week... I really hope you can resolve this issue with your t

One of the major reasons I don't really like getting too deep into what caused my PTSD in therapy is because I am afraid it would be re-traumatizing and I don't think my therapist would know how to deal with that and it likely would not be a very safe situation for either. Perhaps your therapist just doesn't quite have the qualifications to help you work through those things in a safe way that doesn't leave you feeling overwhelmed and suicidal when you leave the office.