Do you know your T's expectations of you?

puzzle_bug, that's an ultimatum and a demand. It's wrong.

I just can't understand what I did or didn't do that caused him to issue that demand. I don't honestly know. I guess I'll never know.

Some of them are just awful and should not be therapists. I told my current therapist about one that terminated me, and that it was my fault, and she was incredulous that I took responsibility for it. She said no client is at fault for something like that. I, like you, had been wondering what I had done wrong. Turns out...nothing.

puzzle_bug, that was wrong and unfair and unethical. I am furious at that T. So inappropriate. You did nothing wrong.

mine and stopdog's views of therapy are often divergent but in this case I have to agree emphatically.

A few sessions in my T actually made me sign a contract which included:

- stay in therapy for at least one year
- contacting her before I harm myself in any way
- no contact allowed for a 24 hour period after I have harmed myself in any way
- no admission to a hospital without talking to her first
- any suicide attempt would result in immediate termination
- no termination is allowed without talking it through with her

I know this can seem a little harsh, but it really helped me as I had an history of quitting therapy without notice and of SIing before sessions to justify my need for help. When I did that my Si was actually rewarded with a session, which was not helpful, in this scenario I was rewarded with the session if I didn't harm myself.

I guess my t expects me to show (though that is a loose expectation), to be as honest as I can, to tell her if something really is not working, to keep myself safe, to do the "work" of therapy (since I am there to address specific things), and to respect the boundaries set up by us and the agency. I'm not sure there are many other expectations that actually mean anything to me. I may be expected to move forward, but I'm not totally sure what that looks like on her end (I know what my own expectations are around that). I guess I'm also expected to adhere to agency guidelines for safety... but yeah, not sure what else. I think if I was paying for a private practice clinician, the only expectation would be to show up and pay for services utilized. Being at a grant-funded agency, the expectations are a bit more. Oh, and I'm expected to be honest about why I'm there and hopefully stick to the treatment plan... they may have an expectation of improvement, but if that doesn't happen, then the treatment plan and therapist fit are reexamined, as is the appropriateness of receiving services at the agency.

Interesting. I would not be able to agree to that... I am glad it helped you, but it would definitely not fit for me.

If it is okay with you, then good. It would not work at all under any circumstances for me. Plus - what happens if you quit without talking it over? They can't come grab you and make you go to the therapist. They might could try to collect money from you or not take you back if you changed your mind, but other than that - it is a bit of a mind thing - not a realistic enforcement thing. Or why not just SI and not tell the therapist? This sort of thing, for me, would not stop SI, it would just stop one from talking to the therapist.

to not flush my meds down the toilet anymore

We actually spent two sessions talking about the contract and discussed all of this and I gave T the permission to call and pester me until I went for one last session. It never happened but I'm sure she'd do it.
And yes I could have lied, but that would not have been helpful in the long run. I don't remember everything but a lot of loopholes were closed during those two sessions. I mainly remember being terrified because I admitted all my usual therapy tricks and felt really vulnerable.

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If it works for you, then great. I don't see where any of it would be lying or not lying but if such a thing helps you mentally do therapy the way you want to do it - super

Thanks... and sorry for taking so long to get back. Today was a little crazy, and I have therapy tomorrow and am kind of exhausted already.

Thanks for all the feedback! It's interesting to see how differently we can all interpret this, and what our Ts have asked of us... Thanks!

Striking, thanks for the suggestion for the 3rd person view. I may try that. I probably need to talk to him about all this stuff anyway, but you're right, I'm not eager (or good at!) diving into all the emotional stuff. I'm better at ignoring it, but pretending to be magically great

ScarletPimpernel, thanks... and good question (re: why did I go back to therapy). I am kind of getting lost with the therapy, and not sure anymore. I think I had concrete goals when I started (dealing with my crazy mom, dealing with a work trip that made me want to jump in front of a bus, and figuring out what to do with my life!). But all that has kind of gone *whoosh* and I just feel... ugh, more crazy, with all my stuff laid out in front of us, you know? I think if it weren't just so incredibly expensive, it might be a bit easier to swallow, but I'm having budget-anxiety!

Thanks for posting about how you were "fine" when you weren't really living your life, I very much relate to that. I'm not totally hiding out in my house, but, I'm not really doing a whole lot either (haven't dated in like... since college, a very long time, don't have a lot of friends, and kind of stuck in a rut). I do want things to be better, but sometimes it's really hard to see how therapy is going to get me there!

re: The expectations around telling about SI... I think I'm just confused? So, we talked about it once, I did let him know that it had been a problem in the past, and that it had started back up again. And, he gave me his alternative (hand in a bucket of ice). I was pretty shut down and not very talkative, I think. But, there wasn't really any discussion or indication of whether I should be bringing it back up when it happened or talking about it, so I guess I kind of feel like he might not want to hear it (he may say, "why did you do that? Did you try the bucket of ice thing? Go do that instead!")

But I also feel like part of it is... I don't know if he wants the information as a way to see how I'm doing, because I don't know that I want to "work on" that. I don't think it's helpful to come up with alternative ways to hurt myself - I'd SO MUCH RATHER figure out how to deal with the things that are overwhelmingly stressful in a healthy way, not with ice or rubber bands. Does that make sense? But I'm afraid it's going to come across as... "hey, I'm doing this bad thing that is going to freak you out and by the way, I want to tell you and get attention, but I don't want to work on fixing it."

I guess that's part of it, I don't want to be "attention seeking" - and I think telling him, especially if it's followed up with "I don't want to look at alternatives" feels attention seeking to me.

Hm. Thanks, this is actually interesting to think through, I appreciate you asking about it!

Stopdog - thanks, it's always interesting to hear your take on all this. When you say, "I think a client can be insistent that is what is useful for them and find a therapist who will not object." - I think you're lucky that you're very clear on what you want, and what is helpful to you (I think?). Part of what is making me feel so crazy is the sense of... fogginess? The inability to pin down anything. You know what I mean? Sorry, it's frustrating (i.e. I'm frustrated with myself for not having a good, clear sense of what's going on inside of me! Not frustrated at you!)

Puzzle-Bug - I'm so sorry that your therapist gave you an ultimatum like that, which seems hugely inappropriate, and that therapy ended because of that!!!

Jordy - Oh wow! That's really interesting! You know, it does seem kind of like a LOT to ask of a client, but, I bet in a way, it felt good (and safe, maybe?) to have it spelled out and that type of structure to work with? Thanks for posting that, I'm glad it's working for you!

Thanks!

My T expects me to show up for our sessions, pay him, do my best to be my authentic self, and reach out if I need him.

Guilloche -
I know for me, the problem with wanting to get better is: what does "better" actually mean? I often compare myself to other people my age. I didn't finish college, I don't have a job, I don't even have my own means of transportation, I'm not married, I don't have kids, I don't own a house, I'm not financially independent, etc. And when I compare myself to my T (because she's one year younger)... geez I feel like a loser. But my T reminds me that she didn't go through the things I have gone through, and if she had, her life would be different. So I have to figure out what "better" and "successful" means to me. That's difficult when there is no defined course or examples or goals. So I can relate to feeling kinda lost in therapy.

About the typical coping methods for SI: they irritate me so much! Stick your hand in a buck of ice, snap a rubber band, draw on yourself with a red marker, etc. Yeah. Been there, done that. It's not the same. And just like any other addiction, you won't quit until you decide to for yourself. And when you do decided, you will have coping skills that are tailored to meet your needs. My coping skills for SI are the same coping skills I use for everything else. None of it is simulated SI. The only coping skill I use specifically for SI is tattooing, but again it's not simulating SI... it's a visual deterrent.

I will never condone or condemn SI. I do think it can be dangerous and at some point needs to stop. But telling someone to quit doesn’t help. And I know from personal experience, a coping skill even if unhealthy, is better than no coping skill. It isn't something anyone should be ashamed about. It has helped you survive. But it isn't helping you improve your life.

My T actually told me something interesting: another perspective. People normal think that you have to get your life "better" and then you will give up the SI (or other addiction). But by practicing these unhealthy coping skills you are causing yourself to live an unhealthy life. You are punishing yourself, hurting yourself, and holding yourself back. She said it much better than what I wrote, so I hope the point comes across right.

Actually, totally side topic, but related. It was always believed that you had to get the homeless to be healthy before they would be able to live a healthy life off the streets. But Utah did it backwards: they gave the homeless homes Give the Homeless Homes

If you don't want to work on the SI, then you don't have to tell your T about it. It's not a "requirement" for treatment. Well, maybe it is for your T, but it doesn't have to be for you. When I first lived at a board and care, they told me no more SI. Well, I didn't listen. When they found out, I got sent to a crisis house. They let me come back, but told me if I did it again, I would be kicked out. Did I listen? Nope. I just got more creative It is an expectation that I tell my T if I SI, but it's because we made a deal that we would both be open and honest. There is also an expectation that I don't SI anymore, and that was because last time it turned into SUI attempt. It's too dangerous for me to do it anymore.

If you do decided to tell your T, even if you don't want to stop, it doesn't mean you're attention seeking. You are just being honest. Attention seeking would be doing it in front of him or doing it to cause a reaction. Which btw wouldn't be considered true SI at that point. SI is done in private, not in front of anyone. And SI is done to make you feel better, not to manipulate anyone. So by telling anyone about it doesn't mean you're attention seeking. In fact, here a perfect example: Is you or anyone else on this forum who say they SI seeking attention? Or are you/they seeking support and help? It might not be support to quit, but support for the underlying pain and suffering. True? You should be allowed to tell your T anything or nothing. It's your therapy. My only advice is to make sure that your decision is made in your best interest.

Is the fear of being seen as "attention seeking" because of the stigma of SI, or because you happen to SI and also want attention/to feel cared about? Again, SI and attention seeking are two different things. But I understand the fear of stigmas. With my BPD, I always fear people seeing me as manipulative, a liar, having poor boundaries, anger problems, having to "walk on eggshells". I spend way too much time worrying about avoiding the stigma that I deny myself the freedom to seek the support I need and wind up not being able to fully express myself (as in the current situation with my Pdoc).

And wanting support is a good thing. Reaching out for support is a good thing. Neither of these are attention seeking. Manipulation in order to get support is. I don't think that's you at all because of all your posts I've read and by the mere fact you are concerned about being perceived as such.

I hope that helps some I know things are easier said than done and often times emotions override logic. But maybe even just knowing that you're not alone and not "crazy" () helps?

I never asked because I never felt or thought that therapists should have any expectations of me. I don't see expectations as part of a therapy process.

However, I do think it's important for therapist and client to have an agreement about responsibilities of each party. Therapy is a mutual work and so each party has their responsibility in this process. But I do separate responsibilities from expectations. To me those are two different concepts.

Growing up I had a lot of expectations placed on me to "perform" - or at least to be prepared to act or behave in whatever manner my Mother required of me at any given time, so that she could garner attention for herself or fulfill her own emotional needs. My Pdoc knows this, and he also knows the negative impact it had on me, so aside from just asking that I at least be open to considering new ideas and suggestions he doesn't really place any sort of expectations on me.

Thanks everyone. Therapy in about an hour and a half, so I'm getting a bit fuzzy-brained.

ScarletPimpernel - thanks! That made a lot of sense! Both what you said about not knowing what "better" means for you (yup!) and that sometimes using a bad coping method prevents you from getting to better. It probably doesn't help that previous (not great) T sort of jumped up and yelled about the SI stuff at one point when I was trying to talk about it. I guess it just comes down to: does he want to know (i.e. as an indicator of how I'm doing), and is he ok with me talking about it even if I'm not looking for an alternative. I don't know though, I don't think I feel a huge urge to discuss it... I just don't want to feel like I'm *supposed to* and am not, you know? That, "well, why didn't you tell me?!" kind of response...

Reaching out for support... I'm not even sure how that works. I still can't fathom under what circumstances I'd want to call my T. (I had a dream where I had killed someone (!) and was going to jail, and thought - "ok, this is probably big enough that it's appropriate to call my T!" - I guess I just don't know what T can actually do to help, so, what's the point? Especially when it's fuzzy...

re: The fear of being attention seeking... hmmm... I don't know. I don't think it's the stigma, I think it's the repercussions, like... it won't be taken seriously, since it's "only" attention seeking, you know? Or like... obviously if you're SI-ing to get attention, the appropriate therapeutic intervention is to not positively reinforce it, so it pay less attention - which feels a bit like abandonment!? Maybe... because it feels like the only thing worse than having to talk about it is talking about it, and getting a response like, "That's not really that big of a deal, what else do you want to talk about?" - which brings me back to feeling like I'm attention-seeking.

Oh! And I think part of it is... I feel like if I talk about it, I *should* be showing guilt/remorse, like "this is so awful and I want to fix it". But, I don't. Not right now, anyway... so there's some weird mismatch there.

"Not crazy"... Thanks!

When there was si that I didn't particularly want to change or stop at the moment but figured t might want to know, I told her that it was there, and the only reason I was telling her was because she may want to know it was going on, but that I wasn't really in the mood to talk about it, and I wasn't ready to give it up at the moment. I also assured her I would tell her if it became concerning (hit a level of severity or frequency that might lead to more issues).
Though, this was only after t and I had already established that si was in my history, and that I knew she wasn't going to freak out on me about it...

Good luck today either way.

Thanks ThisWayOut... that makes sense.

I'm back from therapy, and a little shaken up. He was fine, and we talked a little about this and a little about the SI, and a little about goals for therapy... I was having a hard time articulating much, but got through.

He's suggesting a DBT class as an adjunct to therapy. I'm supposed to call two people that he recommends this week to find out about classes/prices/etc. So, I feel more crazy now I think it could be good... I've seen how much DBT has helped some other people here, and had looked into it on my own, but right this second it feels a little overwhelming to think about!

Oh and he said "yes" - if something happens, like SI, or like me spending the weekend in bed b/c I don't have the energy to get up, then he wants me to "report" that, even if I think it's one-off weird thing. I feel really weird about this - didn't get into the weirdness, b/c I wasn't processing that well, but I guess now I know. It's hard though, b/c if something happens on Saturday, it tends to feel "unreal" by Monday/Tuesday. *sigh*.

*thanks* lots to think about, as always...