[muffyvanderbear]

I've been seeing therapists off and on for over 20 years now. I would usually see them once a week in the beginning, but then shortly after it would be every 2 weeks or even every month.

This past November, after 5 weeks in the hospital, I was dx'd Borderline Personaliy Disorder and Depersonalization Disorder. Previously I was dxd Bipolar 1.

I found a new T who does Psychodynamic Therapy. He wants to see me twice a week for an indefinate period of time.

How often do you see your T?

Muffy

[sunrise]

Current Therapist (humanist/eclectic): 1 time per week

Former Counselor (CBT): as often as 1 time per week, but sometimes every 2-3 weeks or longer, including a break of 4 months. I had a hard time committing to therapy with her and was very flaky about setting up appointments. At the beginning, I think I saw her 2 times per week a few times because I was such a basket case.

Hi Muffy.

I see my T once per week. I wish it was more. I wish I could tell him that I want to see him more, but I don't know if I really need to, or it's just me.... well, being me. Just last week I began to finally let on just how much I need him... I feel like to admit that I wish I could see him more than once per week would be the ultimate embarassment for me. I can barely call him without wanting to hide under the table. I have only called a few times (for reasons other than appointment related). Even though he told me I shoud call if things get bad, I still feel like an idiot.

Oh, and my former therapist in NY. I used to see her two times per week right after I came out of the hospital (when I was dx borderline, as well!) I liked going to therapy more than once per week.

Anyway, that was the long winded answer. Sorry. But that's what's great about this forum. So many times a simple questions like "how often do you see your T?" can really get you thinking.

I see him Tuesdays, to be exact. (Yay, tomorrow!)

CBT therapy: once per week.
DBT therapy: once per week plus group therapy once per week.
supportive psychodynamic: once every fortnight (mostly because of time constraints, i think)

now i'm seeing my t every friday and every second tuesday. he said twice a week would be optimal but i said something about how it might be better or it might be worse and so he offered me this comprimise and we can see how it goes.

i think that twice a week is optimal for personality disorder type stuff. it can take a while to build up trust and while you can't circumvent that by seeing each other every day or whatever you can certainly help it along by seeing each other twice a week rather than less often. it also helps the day to day stuff not take over the sessions.

[withit]

I initially saw my t once a week and after a few weeks I told her that I feel I need to see her at least twice a week, but that I could not afford it financially, and would she be able to lower the fee so I could see her twice. She so generously reduced her fee to a ridiculous amount but I venture to say she would not have done it had she not felt I needed the twice weekly.
At the time I was a 'borderline' case. After three years of twice-weekly sessions she said she could no longer afford to see me at the very low fee, and since I was not able to pay full price, I just continued to see her once a week. It worked out just fine. I learned to make full use of the once-weekly session. She did allow for between-session calls.
After five satisfying years, I terminated treatment with her, (long story). I am a recovered borderline, hurray. Still have some issues I want to work through, have begun seeing a new t, and I did ask to see her twice a week. I told her that once I internalized a positive transference of her I would be able to manage with once a week.

that is great withit :-)

i am a recovered borderline too :-)

though... i still have this other matter to deal with (past t's never dealt with the dissociation).

but i no longer meet criteria for BPD :-)

though i still consider i have borderline 'traits' (fear and longing for intimacy, trouble with emotion regulation especially when stressed, some PTSD symptoms).

but yeah, there surely is hope :-)

i've never had twice weekly therapy. i always wanted to see someone psychodynamic but that was never really an option. aside from seeing p-docs fortnightly and they always moved on after 3 or 6 months or a year. they were meant to be medication prescribers and some of them got in trouble for seeing me more than monthly, i think. but i always wanted to see someone psychodynamic twice a week. but now i'm seeing my t and the transference is starting to feel pretty intense i'm worried that seeing him more could make things worse (intensify it further) though it is possible it will make it better (by helping me internalise that image). we will see, i guess.

i think it is really nice that he comprimised with the once per week and an extra session every fortnight. back to idealising. sigh.

<blush>

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withit said:
I initially saw my t once a week and after a few weeks I told her that I feel I need to see her at least twice a week, but that I could not afford it financially, and would she be able to lower the fee so I could see her twice. She so generously reduced her fee to a ridiculous amount but I venture to say she would not have done it had she not felt I needed the twice weekly.
At the time I was a 'borderline' case. After three years of twice-weekly sessions she said she could no longer afford to see me at the very low fee, and since I was not able to pay full price, I just continued to see her once a week. It worked out just fine. I learned to make full use of the once-weekly session. She did allow for between-session calls.
After five satisfying years, I terminated treatment with her, (long story). I am a recovered borderline, hurray. Still have some issues I want to work through, have begun seeing a new t, and I did ask to see her twice a week. I told her that once I internalized a positive transference of her I would be able to manage with once a week.

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That's really cool that you reached that stage of therapy (internalizing pos. transference). I hope I will get there someday. For now, I cannot internalize my T in a positive manner. The separation during the week is actually quite painful at this point. It's like I have to see him in front of me to know he's there.

[sunrise]

What does "internalizing positive transference" mean?

i think the idea is that in positive transference you have this image or idea of the therapist as a benevolent and powerful other. so when you are in their presence they are able to soothe you and make you feel cared about and worthy and cared for etc.

i have trouble with object constancy. object constancy is being able to conjure up the image or idea of the therapist (and feel soothed by that) even when the therapist is not present. when my therapist is not present i have significant difficulty remembering what he looks like or what his voice sounds like or what sort of thing he would say to me... hence i have trouble with object constancy. i actually need him to be present in order for his image to help me (because it is transference it is more about my image of him rather than who he really is).

internalising the image is being able to summon the image in the absense of the object. and the transference... is what gives the image its power.

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alexandra_k said:
i think the idea is that in positive transference you have this image or idea of the therapist as a benevolent and powerful other. so when you are in their presence they are able to soothe you and make you feel cared about and worthy and cared for etc.

i have trouble with object constancy. object constancy is being able to conjure up the image or idea of the therapist (and feel soothed by that) even when the therapist is not present. when my therapist is not present i have significant difficulty remembering what he looks like or what his voice sounds like or what sort of thing he would say to me... hence i have trouble with object constancy. i actually need him to be present in order for his image to help me (because it is transference it is more about my image of him rather than who he really is).

internalising the image is being able to summon the image in the absense of the object. and the transference... is what gives the image its power.

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Excellent explanation, Alexandra....

I am the same way... He even suggested having phone sessions at times when I need him more, but I have trouble with that because like I said before... I need him right there to know he exists.

To internalize your T in a positive manner, you can transfer the positive aspects of therapy out of therapy, even when your T isn't present.

Can't do that yet. Not even close. Which is probably why that one hour per week is so crucial to me.

[sunrise]

Thank you for the clear explanation, alexandra. What you wrote makes me think that maybe I have internalized my T. I dream about him a lot and think about him. I can picture him and hear his voice in my head. Sometimes when I am faced with dilemmas, I think "what would T do?" and it helps me surmount the obstacle. I don't think I would describe it as "soothing" but I am definitely able to feel his presence when he is not physically with me, and I have an internal certainty that he still exists when we are not in session. Does it sound like I have internalized him?

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sunrise said:
Thank you for the clear explanation, alexandra. What you wrote makes me think that maybe I have internalized my T. I dream about him a lot and think about him. I can picture him and hear his voice in my head. Sometimes when I am faced with dilemmas, I think "what would T do?" and it helps me surmount the obstacle. I don't think I would describe it as "soothing" but I am definitely able to feel his presence when he is not physically with me, and I have an internal certainty that he still exists when we are not in session. Does it sound like I have internalized him?

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That is definitely internalization. Your T's interaction with you extends beyond the T room.

You know what's funny? I am going to school to be a T and when we practice by role playing, and I am being the T, I think, "What would my T do? What would he tell this person?" So I can internalize him when it comes to my work, but not my own life yet.

yeah, it sounds like you have internalised him. to a certain extent at least :-)

the notion is that when we are infants (going on about Schore now) we lack the ability to regulate our emotions. the (m)other acts as an external regulator of the infants emotions (when all goes well) and regulated the infant out of a negative state into a positive state or out of a very excited positive state into a calmer positive state. the infants neurology then develops (by proliferating neural connections and then pruning neural connections) to 'mirror' the (m)others regulatory function. the infant is then able to hold the (m)others image in mind and thereby self soothe (to a certain extent).

sometimes the (m)other isn't able to regulate as much as the infant needs (could be because of infants sickness / distress or because (m)other doesn't know how or whatever). thus the infant is unable to have this (m)other image in mind in order to regulate their emotions / self soothe. Schore says that therapy works (well some varieties do) by providing the experiences that were lacking so that the adult gets to internalise the positive image. but it takes time, yeah.

:-)

have you tried the phone calls? i ask because i'm not really one for looking at my t. i don't really look at him. hence, i guess it will take me a very long time before i can picture the way he looks when he isn't present. mostly it is his voice that is important to me. his (vague) physical presence, sure, but mostly his voice. the tone. and (admittedly to a lesser extent) the things he says.

i have trouble visualising his appearance the most. the things he would likely say next. i can visualise his tone of voice to a certain extent, however. and sometimes i can visualise his physical presence in such a way that i feel held even though he is across the room (or even city) from me. and... i don't desire that he be any closer.

sometimes...

partly it is about practice, i think. trying to conjure up the image and the feeling of being emotionally held. it is a way of self soothing. eventually... i think the idea is that you can get those experiences from a variety of people IRL and more in particular from emotionally significant others IRL. but i guess it starts with (m)other and then father to a certain extent (more or less depending on (m)other) and then friends and peers and then romantic attachments... but when parents were unable... therapist can help...

perhaps.

but if it is his tone of voice and / or the things he says that is most important then a phone call might be able to help. though... sometimes people can sound a little bit alien over the phone so it might take a little while to get used to it.

[sunrise]

Hmmmm, I don't think I am quite there yet then with internalizing the T.

One thing I do have a bit of trouble accepting is that T and I have a "real" relationship. I don't feel we do. But he says that what we have is "real." It doesn't feel real to me because I pay him to have this relationship with me. He is doing it because he is paid and it is his job. It isn't truly authentic or real because of the payment/job aspect. It's like he isn't engaging with me because he wants to of his own free will, but because I am forking over the cash. But yet, I do feel warmth and affection and love toward him, and I feel the warmth and affection he projects to me. But yet it is not real. He is paid. I have bigtime problems with this paradox.

i think a lot of people have significant difficulty with that paradox.

i guess that t decided to be a t (hopefully) for benevolent reasons of wanting to help people. i figure he doesn't agree to work with just anybody who comes in to see about working with him, and hence he works with people who he feels he can help. i bet he gets something out of that. otherwise he wouldn't be doing it. it might make him feel more competent and effectual and feel good about himself that he can help you and it might give him a sense of mastery / control over forces that he struggled with as a kid (pain and the like). i'm saying all this by way of trying to convey that i'm sure he gets something from seeing you too - or he simply wouldn't see you. he would refer you on to someone else, or whatever.

i think the relationship is real, but it is certainly different from most IRL relationships. i guess it is most similar to the (m)other / infant relationship. (m)others do indeed decide that they want to have a kid (just like your therapist did indeed decide that he wanted to be a therapist) but (m)others typically don't have any say in what kid they get. they just have one. they might get to select half the genes, but they don't get to select that particular kid ;-) whereas... t got to pick YOU. i'm not sure if this bears on the reality of the relationship...

i guess that with respect to the job / payment aspect... one has gotta make a living. your t couldn't afford to spend time with you for free because he would need to have a job in order to survive and support his family or whatever.

but yeah, i do understand about the power differential in the relationship. while i imagine they probably DO think of us outside the session i'm pretty sure they don't think of us as much as we think of them. i'm also pretty sure that for us attached peoples... we need them one hell of a lot more than they need us.

sigh.

(((((sunrise)))))

Wow, i don't even know what all this "transference" stuff is. When I was in therapy before getting on the right meds I just cried the whole time & was not functioning well. Now I'm doing pretty well on my meds, but I don't know what I'm supposed to be doing in therapy. I see her every 2-3 weeks. Even after an OD in Aug. I can't pinpoint a goal in therapy.--Suzy

[sidony]

Okay I haven't read every word of the thread yet, but I'll go ahead and answer the main question: I see my therapist for individual therapy once a week on Tuesdays (yay, tomorrow!). I also see him on Monday nights when I'm in group therapy though obviously it's a different kind of interaction.

I wish I could see my therapist more often too, but it helps me to have a week to figure out what I really want to talk about! I have no intention of going less than weekly. (I've been seeing him once a week for just over a year now, and I have no desire to lessen the frequency!)

Sidony

sounds like you are doing some kind of supportive therapy so they can keep an eye on you to check that you are ticking along okay.

transference doesn't usually emerge (not in an intense form anyway) when sessions are every 2-3 weeks.

[WinterRose]

How do you manage seeing a therapist so regularly with healthcare? Is it very expensive for those of you who do? My plan only allows 30 visits a year.

Right now I see my therapist every other week and my psychiatrist monthly. My therapist would really like to see me weekly and it's really hard seeing the psychiatrist only monthly because he contributes to my therapy too. Sometimes the breaks make things really disjointed. Sometimes they work well for internalizing things. I understand that it is usually beneficial to see a therapist once or twice a week.

sometimes therapists have sliding scales (where they will see you for reduced rates if you really can't afford to pay more). depends on the therapist though. if they work for some kind of agency they might not be able to do that. or if they don't have enough full fee paying clients they might not be in the financial position to do that.

30 visits a year isn't very many :-(

could you ask your therapist if there is any way you could see them more?

[Hopefull]

I see T ones every other week. Due to scheduling issues, it is now down to ones every three weeks for our last session and the next session. I am considering keeping it at one's every three weeks because I am getting lower on stuff to discuss with her. Besides, it might help me save some sessions for future use (I'm allowed 30 sessions per year). I doubt that I will have a problem keeping it below that.
As for internalization, I have never heard of that. But, it seems to be a description of when I "obsess" about my T. I fantasized about her following me at work and pointing out when I did something good. It was a strange sensation to feel at work. I now just think about her words more than any thing else. I can see her in my mind and sometimes imagine her there.
AS for needing her, I still need her. I am studying to become an addiction counselor and I just can't imagine someone needing me like I need my T at times. I just need her positive thinking at times. She helps me to get out of the black and white thinking mode and into the gray zone.

[WinterRose]

Well - my therapist is self-employeed. Last year she did see me and charged me the fee that the insurance company collects instead of the full fee until it got to be too stressful for me. When she saw that she took me down to what my co-pay was. I feel bad about it though. My psychiatrist says I could see him off the books sometime, but he's so busy I don't know what he's thinking! Perhaps it's my pride - I feel like I'm taking advantage or something. The psychiatrist says to call him if I need to, but I don't because I can't figure out if I need to or not when I want to. He's so busy.

The insurance company says I could try a clinic or something, but that's just out of the question - how can you switch like that - you'd have to start all over.

I'm not going to worry about it until I get closer to the end of my 30. Just wanted to know how you all did it.

[WinterRose]

Interesting thoughts about internalization (which I hadn't heard of before either). I've never thought about my therapist much between sessions - I guess my connection with her isn't of that sort. There seems to be a little bit of distance between us that I don't know how to describe - boundaries maybe? It's not that she isn't kind or supportive. Still I can't see leaving her for a while. I'm not ready yet. Now my psychiatrist on the other hand - I feel kind of needy about him - but there is a lot of transference going on in that relationship.

My insurance pays for twenty visits a year, that includes both T and P-doc.

The rest of the time I pay out of pocket full price.

I see T twice a month a P-doc once a month.