[Asiablue]

For those of you who have complex ptsd and or attachment difficulties, what kind of agreement do most of you have with your therapists in terms of outside session support? And what works best for you whilst doing trauma work? What kind of support if any do they offer you?

Are you allowed email, texting, phone calls? Or do you have no contact outside of sessions at all? How do you feel about the current agreement you have about access or lack of access to your therapist outside sessions?

I'm conflicted by what I want in a therapist versus what I need. I don't like the idea of having no outside support from them, it feels cold and abandoning. I feel like I don't need to learn to be super independent, I already am that. I have never been over-dependent with anyone, but just having needs makes me feel needy and I do worry about being over-dependent.

But I do need to learn about emotional self-regulation. And I do get overwhelmed with the trauma work at times so I can see the argument for having no contact to a therapist outside of sessions in an attempt to contain it all in the room and not have it spill out across the week.

I'm looking for a new T and wondering what I need.

[guilloche]

Hi AsiaBlue...

I think I have attachment issues (it would make sense with my background, and when I took the online test, I got the "come here - go away!" type... disorganized, I think?) I've given T a copy of the test results, but we haven't talked about it. I don't think he realizes how it is for me at this point, like how I want to quit after every other session

I still feel like we're figuring it out (I've been seeing this T for about 6 months). I'm sure at the beginning he said something about calling him if I needed anything, but I don't - ever. We also haven't really started on any trauma type work yet (and I don't have a formal CPTSD diagnosis, though these days I don't really know which diagnosis-bucket I fall into!)

I do want to say, I relate... I get jealous of people with Ts that emphasize that it's ok to reach out during the week. That sounds SO caring and kind to me, it makes me want to cry. Not just people here, but if you've read any of the "Tales of a Boundary Ninja" blog that gets posted here from time to time - she said that her T really emphasized that's ok, normal, expected for her to call - even if just to make sure he was still there, since he was an "attachment figure".

My T doesn't seem like that.

I don't know, I guess this doesn't help. I think you've been doing therapy for awhile, right? Do you think it's more about the trauma itself (i.e. overwhelmed by trauma stuff and need somebody to help with that) or more about the attachment (like the woman from the blog, needed to know that your "attachment figure" is still there, and still cares?)

[A Red Panda]

I have similar issues - to me, "needing" any form of support goes straight into just a "want" category in my head, and then I tell myself that I should just keep it to myself and not bother anyone - I'm very indepdent. I don't know how to actually rely on and trust someone, because I always think there's an ulterior motive or that there are expectations that I'm unaware of... or simply that they'll bail out quickly.

I know that my T wants to help change that, it's been talked about but it's not THE topic if you get what I mean? He knows that I don't trust and that I don't really share anything. He encourages me to email him as he knows that I don't call. I've actually emailed him on occasion - a few times more as a record so that I couldn't just avoid a topic or lie about it, so it wasn't really reaching out for support or reassurance.

He wants to help me learn to trust and view him as a safe source. He doesn't do anything obivious to earn that, which I appreciate. I did actually find myself emailing him a few times when I was having a meltdown, and I actually even called a left a voice mail once. In those situations, he's gotten back to me very quickly.

I find it reassuring and helpful to know that I can contact him outside of our appointments. The fact that I actually reached out showed me more than anything else that I am actually making progress and am learning to trust him more.

I have attachment issues. I've had a therapist who encouraged out of session contact (email and phone), and she wasn't very good. The one I'm seeing now hasn't said one way or the other, but she never talks about all this boundary stuff I hear everyone else going through. I feel a lot more secure not having between session contact. I think the difference for me is that the one I see now is a very professional, but not at all cold or unfriendly. It just feels good. Not sure how to explain it. You know it when you encounter it.

[junkDNA]

i text and email my T. i see T twice a week. i feel this is good for me. but i want to start working on traumas more. i try to avoid it. he is gentle and doesnt force me to tlk about traumas.

i have ptsd, and i am attached to T. he knows this

[musinglizzy]

I swear my T encourages the attachment (which I HATE having). I can call, Email or text her anytime I wish, and at times she initiates check-ins with me. I see her twice a week, so I really shouldn't need that in-between session contact. She is very open to hugs and touch in therapy, uses "pet" names during sessions, and really does not help me not feel attached to her. I think she's a great T, but I also think I'm more attached than I should be.

[JadeAmethyst]

I have to ask and be specific for my reason to contact my T between sessions. The exception is when I have questions on the worksheets I do for exposure therapy. Our sessions are helpful, and he is patient in helping me stay focused and on task.
As for attachment....nope hasn't happened.

[martamiriam]

Originally Posted by Asiablue

For those of you who have complex ptsd and or attachment difficulties, what kind of agreement do most of you have with your therapists in terms of outside session support? And what works best for you whilst doing trauma work? What kind of support if any do they offer you?

Are you allowed email, texting, phone calls? Or do you have no contact outside of sessions at all? How do you feel about the current agreement you have about access or lack of access to your therapist outside sessions?

I'm conflicted by what I want in a therapist versus what I need. I don't like the idea of having no outside support from them, it feels cold and abandoning. I feel like I don't need to learn to be super independent, I already am that. I have never been over-dependent with anyone, but just having needs makes me feel needy and I do worry about being over-dependent.

But I do need to learn about emotional self-regulation. And I do get overwhelmed with the trauma work at times so I can see the argument for having no contact to a therapist outside of sessions in an attempt to contain it all in the room and not have it spill out across the week.

I'm looking for a new T and wondering what I need.

I had a spiritual or what you might call a "Christian" who was trained in DID which helped me to integrate but never heard of not being allowed outside of sessions support. At the same time I was seeing an M.S. trained counselor at a local clinic with the same belief system I did and I found that it is hard not to let it spill out across the week no matter what you do...I am uncertain as to why your therapist wanted that kind of control...with trauma work there is no telling at least in my own personal trauma work when or where it will hit...it just does when it is ready to and so trying to contain it seems a bit off to me...Personally I would try to find a therapist who fitst your needs not the reverse..am just saying...

[Asiablue]

I think I'm having a bit of a lightbulb moment right now.

I've been going to therapy with the intention of tackling the complex ptsd stuff but the relationship stuff always gets in the way, my fear of attaching, bonding, trusting my therapists triggers huge reactions in me. The work of dealing with the actual trauma memories slows down because of it.
So.... I wonder if when I go interview therapists that I explain that to them it might make them better informed in how to help me??? hmmmm

[feralkittymom]

I think it is potentially misleading to characterize the attachment issue as dependent vs independent. One being bad and one being good. Or one being too much and one being not enough. Feast or famine.

The goal is interdependence, and developing the "feel" of that requires consistency and constancy from a T. Contact between sessions on a "call me if you need me" basis can be problematic because it isn't constant--the conditions surrounding it vary, and that creates emotional confusion. Often this seems to evolve into an issue of boundaries, with "privileges" of limitless contact becoming restricted, and that action can activate feelings of abandonment.

The other issue with between session contact is that many Ts can't maintain consistency when contact is irregular, whether it's because of between session contact or because of differences in scheduled contact. Or the mix of the two. So the risk to a client is getting a response--or not--different from what was expected, and that can also activate feelings of abandonment.

Any of these situations can also increase anxiety about attachment which then gets expressed by increased emotional dysregulation. This doesn't mean that there can't be an arrangement about out of session contact for emergencies--but what constitutes an emergency needs to be spelled out clearly so that the client isn't left wondering whether they "should" or "shouldn't" call.

I'm allowed email contact. It has helped me a great deal.

[ThingWithFeathers]

I have complex ptsd and an avoidant attachment style. I see my t once per week for an hour. There's no ability to see her more frequently as it's a free service and that's what they can (generously) offer. I am allowed email contact, and during business hours can call. Texting has only ever been initiated by my t and are always session time related (text messages go through the organisation's central office system, so are not private between clients and ts).

The biggest thing my t has done to help me in this regard is to be consistent in replying. She always responds to my requests for help.

It's really hard for me to reach out for help, so her consistent approach, reminders that it's okay to contact her and her encouragement to do so helps me feel more comfortable in my relationship with her.

[Asiablue]

Originally Posted by feralkittymom

I think it is potentially misleading to characterize the attachment issue as dependent vs independent. One being bad and one being good. Or one being too much and one being not enough. Feast or famine.

The goal is interdependence, and developing the "feel" of that requires consistency and constancy from a T. Contact between sessions on a "call me if you need me" basis can be problematic because it isn't constant--the conditions surrounding it vary, and that creates emotional confusion. Often this seems to evolve into an issue of boundaries, with "privileges" of limitless contact becoming restricted, and that action can activate feelings of abandonment.

The other issue with between session contact is that many Ts can't maintain consistency when contact is irregular, whether it's because of between session contact or because of differences in scheduled contact. Or the mix of the two. So the risk to a client is getting a response--or not--different from what was expected, and that can also activate feelings of abandonment.

Any of these situations can also increase anxiety about attachment which then gets expressed by increased emotional dysregulation. This doesn't mean that there can't be an arrangement about out of session contact for emergencies--but what constitutes an emergency needs to be spelled out clearly so that the client isn't left wondering whether they "should" or "shouldn't" call.

Nailed it! ^^^^^^^

Ty FKM

I think has been some of the problem that I've encountered in my therapies surrounding contact. The outside contact IS a great thing for me but there needs to be clear boundaries surrounding it to protect both me and the therapist and to provide that sense of containment.

[Tongalee]

Originally Posted by Asiablue

I think I'm having a bit of a lightbulb moment right now.

I've been going to therapy with the intention of tackling the complex ptsd stuff but the relationship stuff always gets in the way, my fear of attaching, bonding, trusting my therapists triggers huge reactions in me. The work of dealing with the actual trauma memories slows down because of it.
So.... I wonder if when I go interview therapists that I explain that to them it might make them better informed in how to help me??? hmmmm

I think its great that you are realizing what is getting in the way of your trauma work with your therapist, but I think that it is a mistake to consider your trauma work and your work on being able to express your needs and attachment as different things, where one is capable of hindering the other. I too have C-PTSD and am having a difficult time being attached to my therapist. It is something that has been quite on topic since the holidays have started. One thing that has been pointed out to me multiple times is that these two issues are not separate. My unwillingness to admit my attachment to both my therapist and myself, my relentless standoff from my emotional needs, comes from my disturbing trauma history. One seems to interfere with the process of therapy because it is stirred up every time we begin to discuss trauma things. Ex. We start to talk about nightmares, and within the bad dreams I have a comforting thought about my therapist putting me to bed, warding off the monsters if you will. The trauma stuff is set to the side because I retreat due to my discomfort about the attachment dream. These two things seem separate, but they are connected. The fact is it was not safe to trust adults when I was little, and that worry and fear is still carried with me today. The idea of letting this adult into my life, my comfort zone, and my issues ignites that panic from when I was little. To start the trauma work, to be able to talk with her about what happened, I need to trust she won't hurt me. I need to let myself attach to her to learn what it feels like to depend and trust an adult, to know they won't hurt me. I hope that this makes sense, but I guess my bottom-line point would be that everything is connected and attachment issues is just as much the work of therapy as the trauma processing.

[Asiablue]

Originally Posted by Tongalee

I think its great that you are realizing what is getting in the way of your trauma work with your therapist, but I think that it is a mistake to consider your trauma work and your work on being able to express your needs and attachment as different things, where one is capable of hindering the other. I too have C-PTSD and am having a difficult time being attached to my therapist. It is something that has been quite on topic since the holidays have started. One thing that has been pointed out to me multiple times is that these two issues are not separate. My unwillingness to admit my attachment to both my therapist and myself, my relentless standoff from my emotional needs, comes from my disturbing trauma history. One seems to interfere with the process of therapy because it is stirred up every time we begin to discuss trauma things. Ex. We start to talk about nightmares, and within the bad dreams I have a comforting thought about my therapist putting me to bed, warding off the monsters if you will. The trauma stuff is set to the side because I retreat due to my discomfort about the attachment dream. These two things seem separate, but they are connected. The fact is it was not safe to trust adults when I was little, and that worry and fear is still carried with me today. The idea of letting this adult into my life, my comfort zone, and my issues ignites that panic from when I was little. To start the trauma work, to be able to talk with her about what happened, I need to trust she won't hurt me. I need to let myself attach to her to learn what it feels like to depend and trust an adult, to know they won't hurt me. I hope that this makes sense, but I guess my bottom-line point would be that everything is connected and attachment issues is just as much the work of therapy as the trauma processing.

You're right, the two things are intertwined. It's because of past prolonged trauma in childhood that I have ptsd and trust issues, but also the way I attached to my parents (not securely) in infancy/childhood that have caused difficulties in some relationships. The therapy relationship just seems to amplify the difficulties I have with understand the dynamics of relationships.

I just need to find a therapist who really understands this and can help me through it.

[angelicgoldfish05]

Originally Posted by Asiablue

For those of you who have complex ptsd and or attachment difficulties, what kind of agreement do most of you have with your therapists in terms of outside session support? And what works best for you whilst doing trauma work? What kind of support if any do they offer you?

Are you allowed email, texting, phone calls? Or do you have no contact outside of sessions at all? How do you feel about the current agreement you have about access or lack of access to your therapist outside sessions?

I'm conflicted by what I want in a therapist versus what I need. I don't like the idea of having no outside support from them, it feels cold and abandoning. I feel like I don't need to learn to be super independent, I already am that. I have never been over-dependent with anyone, but just having needs makes me feel needy and I do worry about being over-dependent.

But I do need to learn about emotional self-regulation. And I do get overwhelmed with the trauma work at times so I can see the argument for having no contact to a therapist outside of sessions in an attempt to contain it all in the room and not have it spill out across the week.

I'm looking for a new T and wondering what I need.

Sorry I have not read everyone else's replies yet, but do you know if there are any support groups in your area? I went to an emotional regulation/distress tolerance group once and found it to be very helpful. It was also geared towards low-income participants so I was able to afford it. Home | SAMHSA might have some resources you could check out.... just thought of that because you said something about wanting to learn emotional regulation...

But to answer the question, I find it would be good to have the options to get in touch with a T outside of session in emergencies. When I was a caseworker, I let myself be available on an as-need basis and don't know if this was helpful or not. On the one hand, you may be able to help someone through a difficult time. On the other hand, if you have many clients and need to prioritize with self-care, and also the many clients, you will start having to assess and prioritize. This could unintentionally "reward" those in more crisis/need with the assistance. However, if the need is there, it needs to get met somehow, so I don't know.

I also don't know your situation and what supports you have in place working with the therapist and therapy. So it is really up to you and the therapist to talk through and work out. You may also want to list the strengths you find in the therapist (the positives) and weigh them against the therapists out-of-session contact policy if they do have one and then decide. Good luck!

[Tongalee]

Originally Posted by Asiablue

You're right, the two things are intertwined. It's because of past prolonged trauma in childhood that I have ptsd and trust issues, but also the way I attached to my parents (not securely) in infancy/childhood that have caused difficulties in some relationships. The therapy relationship just seems to amplify the difficulties I have with understand the dynamics of relationships.

I just need to find a therapist who really understands this and can help me through it.

I think you're exactly right, therapy is set up to amplify the issues you carry with you on a multitude of things. Therapists are trained to get these reactions and emotional responses out of you to promote growth and understanding. I hope that you are able to find someone with whom you can work well, and perhaps cone to a better understanding of yourself and your ability to connect with others.

[archipelago]

Increasing contact during trauma work seems to be quite common. For me this has meant extra sessions, but it has also included more between session contact as well. I didn't see this as creating a problem. The opposite. It made the work go faster and smoothed the edges, which helped me not just get through it, but also internalize modes of relief and soothing that then I could use without making contact.

The connection between attachment and trauma is primarily that when that trauma alert goes off our attachment system goes off almost before our fight or flight. It is normal and healthy to seek out someone. Attachment is what allows us to learn affect regulation. If we have a faulty attachment or affect regulation reinforcing these makes perfect sense. And it is not an endless pit of devouring someone else's energy. There is a point when that regulation can be established and then self-regulation can happen.

[ThisWayOut]

(this is me kinda thinking out loud, so sorry if it doens't make sense)

I've kinda been thinking about this myself this past week because i am starting work with a new T, and need to figure out what is best to help keep me on track with things.
Would it be helpful for you to find a T that offers outside contact in the form of an agency-run or T-affiliated crisis line? I ask because the T I see now works at an agency that also has an in-house crisis line. My gut reaction is not to want to talk to strangers when in crisis, least of all over the phone (I really struggle with being able to speak about things, and it's harder to understand I'm struggling with saying things over the phone than to just think I'm being silent because I have nothing to say). When T again offered that I call the crisis line if I need anything between sessions, I cringed. But now I'm wondering if that's not a good way to mediate some of the contact boundaries. I know T will only check her vm when she is in the office. I know there's no way to contact her if she is not physically at work. I'm sure this helps them maintain boundaries and keep from getting overwhelmed (they exclusively work with trauma clients. Because it's a grant-funded & state-run agency, they have limited staff with huge case-laods). I think it also might help clients spread the attachement/trust out a bit. As archipelago mentioned, there really isn't a way to predict or schedule trauma reactions. For me, there's a measure of self-regulation going on because of the hesitation around contacting a crisis line about "stupid" things (though I categorize most of my desires to reach out as "stupid"). But if I do contact them, T will get an update and we can work on that in session too. It keeps me from wearing T thin on my neediness, but also still allows me to reach out... I think. This is all just me thingking out loud, and may not make any sense or fit your situation. I also know that things where you live are run differently, so I'm not sure this is even an option... but wanted to throw it out there for ya.

I think when we go from having to be totally self-reliant, to learning that it's ok to need from others, there's a point of disarray and swinging wildly to the other extreme of total helplessness before we settle back in the middle-ground. And it can take a long time, especially if T's change and boundaries change. I know I've been struggling with this concept of "reaching out" for going on 5 years... but it came after 30 years of having learned to not trust anyone else and not reach out. I guess 5 years in the grand scheme of things isn't all that long.

[precaryous]

My T is a lot like musinglizzy's. I think my T also encourages the attachment by asking me to call anytime, email anytime. She also hugs her patients- but not me, yet. Touch is an issue we have to work out. She has also initiated contact with me once just to check in.

I was very worried about attachment stuff in the beginning because I had become very attached to PrevT. It hurt to lose her. I paid close attention with this T...wondering if I had the power to control attachment or not. I think if I had been hard-headed about it, I could have rejected her...but it ended up feeling like it happened naturally.

I don't worry much about whether attachment is healthy or not...right or wrong. I feel I am doing better with my attachment where it is..I like my T very much. The Well once wrote that it's a need being fulfilled and as long as we have it, we can't make it go away. He also said that it will settle down as we get emotionally healthier.

i have complex PTSD and we text between sessions.

[MoxieDoxie]

I can email and skype message him. He will respond if he can and if he feels it is something that can not be resolved quickly with a few messages then he will try and fit in an extra session. His is swamped with clients and I am sure I am not his only difficult energy sucking client on his case load and he has to do some self care and not be open 24/7 for business.

[Virginia1991]

I get to text/email/call whenever I want. I don't call because I don't like to talk on the phone but I do text/email. Some weeks more then others. She always responds. I really appreciate it and it has helped me tremendously as I have difficulty "saying things in person". I have PTSD and I would say I have attachment issues as well.

[boredporcupine]

The main thing, in my opinion, is whether between the two of you, you can work out a consistent system that will work for both of you.

Stuff happens during the week that may trigger us or stress us out, even if it's just thoughts we're having. When humans are stressed or triggered, our attachment system fires up, whether we are aware of that or not. What happens next determines the outcome.

Basically, the question is, do we respond to the distress and the activation of the attachment system in a way that regulates the distress or in a way that makes it worse?

If you can reach out to someone when distressed, whether that is your T, another person in your life, or an internalized version of a positive attachment figure (like picturing getting a hug from someone in your mind), and the contact whether real or imagined soothes your distress, then that is the ideal situation.

Sometimes reaching out to someone when distressed is so fraught for people with trauma histories that they have to learn other ways of handling distress first. That's where self-soothing skills come in. Even though part of you may want to reach out to your T or someone else, another part of you may be terrified to do that. So instead, maybe you listen to a guided meditation or go for a walk or whatever you have learned to do that can settle your nervous system. It's not ideal (in that this type of self-regulation will probably never be as effective as being able to rely on an attachment figure) but it still solves the problem in the moment.

In the worst case scenario, maybe you want to reach out but then you're afraid you're not supposed to. Now you have an internal conflict which is increasing your distress even more. Or maybe you do reach out but don't get a response or get a different response than what you wanted. Now maybe you feel abandoned on top of distressed, or you may feel shame and anger. So your distress again is amplified instead of settled.

Basically you should have a system between you and your T that when you are distressed, you can settle it consistently (if not 100% of the time, at least a majority of the time) without making it worse. If email can work for that, great. If phone calls work, great. If having someone besides your T to contact works, great. If self-soothing strategies work for you, great. If having a recorded message from your T works, awesome. I have used combinations of all of those things at different points in my own therapy. They worked most of the time because it felt like a collaboration and because T was fairly consistent with how she responded to emails and phone calls. If they know they can't be consistent with one method, it may be best to rely on a different one.

[Seeker101]

My T said it was fine to call anytime. She also asked that I have a go-to person who could be available 24/7. Well, my Go-to can't be available 24/7, and I do call her when I know it's ok, like between 9-9. Otherwise, my T is affiliated with a 24/7 crisis line, and I have called that line when needed.

My T has always been good about calling me back within an hour of my leaving a voice mail. Granted, I've only had opportunity to call during business hours. The most recent call I made prompted her to staff my case, and as a result, I've been accepted as a patient, assigned to a psychiatrist, and will be undergoing DBT.

Long story short, I make contact between sessions as things come up and I start spiraling, whether that be my T, my friend, or the crisis hotline.