Normalizing vs. Pathologizing

Will respond to a few others later!

What is a MC?

Marriage Counsellor

Yeah, marriage counselor--sorry about that!

I can completely relate. My ex-T. used to point out that I need reassurance. Sometimes even saying "there's that need for reassurance again". But, as my current T. pointed out, the entire point of coming to therapy is to get a reality check - "is this normal or not". We talk to friends and family for reassurance. I agree it's a basic need.

My ex-T. seemed to be almost militant saying I shouldn't seek reassurance/sympathy/validation from others - I should give it all to myself. Well, good luck finding a person who is good at that. we are all human and need each other to survive.

Ex-T. made me feel horrible for wanting the reassurance. She would point out I want it, say she's not that type and then say "when am I not reassuring". I get that one doesn't want to rely on others for every little reality check but when you are digging deep and feeling ways you have never felt before, reassurance/validation is the only way to make it through.

To me she feels a bit uncomfortable in herself and a bit out of her depth doing psycho-dynamic therapy. You mentioned that she was really good with the anxiety disorder stuff in the first couple of years. But she seems to run a bit hot and cold in the relationship department. Maybe her strengths simply lie in more directive therapy modalities.

But she also seems very much embedded in a clinical psych orientation: viewing emotions expressed through behaviors as "normal" or "not normal" through the lens of "illness." It can go hand in hand with a belief that by changing the behaviors, the emotions will follow.

I prefer an orientation more embedded in a counseling psych orientation which views emotions and behaviors as reflective of developmental issues; and that any resulting illness--like depression, etc--derives from developmental gaps (which can also include a biological component.). So whatever led to the gap--unmet needs, etc--is normalized and remedied rather than pathologized.

This isn't to say that all Ts with a clinical psych or counseling psych background conduct therapy in only particular ways, but they are philosophical orientations that infuse their practices.

She acknowledges the need then works with me to come up with a coping strategy and method of homework to challenge it.

Thanks, SoccerMom. I remember your story. I didn't recall your ex-T being so anti-reassurance and validation, so that's interesting... I agree that it's totally human to want validation and reassurance (as does my marriage counselor).

What really got me last week is that, OK, there was this thing a couple years ago where I met with...let's call her a mentor, who I wanted to help me with my job search after grad school. Well, this mentor ended up being very critical of my job search (which I thought had been pretty extensive) and making me cry. I tried to explain to my H when I got home, but he didn't seem particularly sympathetic, saying that maybe the mentor had a point. So I was feeling really bad when I went to see T the next day. She actually said to me, "I know you want validation right now, but I'm not going to give it to you." This was near the end of the appointment. I left and sat in my car in the parking lot sobbing for like a half hour. (Marriage counselor finally gave me some validation the next day.) I told T about this the next session, and how it upset me, and she said that maybe she had handled the situation incorrectly, that she misread what I needed. So it was almost like an apology.

She mentioned this again last week, in the context of my wanting validation/reassurance. And she seemed proud of how she'd refused to give me validation the first time! Which...I thought she had learned from that but apparently not...

I don't know, I'm debating just going to my session tomorrow and saying I either want to take a break or terminate. I could try again to explain why I'm upset, but last week the stuff she said just made me feel worse, since she was so defensive, and it felt like she was turning stuff back on me. MC said I should get angry at her (I struggle with feelings of anger and tend to turn them inward instead of outward). And I have. But it's like, is it even worth expressing my anger to her? I mean, I guess I could practice expressing anger, but I don't see her being like, "Oh, I get it now. I'm sorry."

I just really think she probably thinks everything is OK after last session, since she ended with that whole "I accept you" thing to me. But it's not OK. I'm just not sure she's the right fit for me. She's concerned that letting me e-mail her and stuff isn't helping, but I don't see how her approach is going to work for me. Even without the e-mail, it's just the vibe I'm getting from her. Of course, she mentioned last week how I'm "too perceptive" in my ability to read other people (which she used to say as a complement). OK, I'll stop rambling now. Any advice welcome!

I don't have advice but I do hope it goes well for you and doesn't make you feel worse.

Sent from my SM-G900V using Tapatalk

Grrrr! I hate it when I'm upset by something and my partner takes the other person's side. I mean, I do think its worth looking at the situation objectively and all, but surely there is a way to do it that doesn't lead to FURTHER upset and dismay. However, its possible I'm sometimes guilty of the same thing - wanting to assess a situation 'realistically' and being insensitive to the person telling me about it. Even unconsciously taking the other person's side to avoid playing into what I sense the person 'wants' from me.

HOWEVER, I definitely think a therapist SHOULD be able to both give emotional validation and the necessary understanding AND be able to address the objective aspect of the situation. A therapist doesn't have to say you were in the right, but if she can't make you feel understood, and express empathy, then it seems like she can't do her job. And the fact that she look proud of it would just make me want to kick her in the shins. Yes, it's called being withholding... Well done b&*ch

For me - I would have a problem with running the actions of one therapist past a second therapist. That seems a bit muddying the situation to me.
In this specific situation - could it be more difficult with the individual therapist because of how much you like/depend upon/contact the mc?
But if I did not think the therapist was what I needed or that I could not use in some way, I would take a break and try out some new ones.

Interesting...The "counseling psych" definition sounds more like my marriage counselor, since he tends to relate things back to my childhood, talking about schemas and things like that. T has said before that one of MC's things is object relations theory, which, from what I've read, also ties things back to childhood and relationships with caregivers. Which I feel like is addressing the cause rather than the symptoms, which to me would ultimately be more healing. And, yeah, the normalizing and remedying vs. pathologizing thing. He's a Ph.D. though, so probably more trained in clinical, but he was saying last session how he doesn't follow the "blank slate" sort of training he received.

T is a clinical social worker, so I presume her training is a bit different. That came up a bit in session last week, and she said they would have received similar training. I just think she chooses to follow a different approach. And now that I can see those approaches side by side, I can tell which one is helping me. Like, maybe I would need to be temporarily more needy again to process all the childhood stuff, but ultimately, it would help me be independent. I see it sort of as MC fixing the faulty wiring I got in childhood, like he's replacing those more negative messages with more positive ones (while still focusing on current stuff in our marriage and things). While I guess T is trying to focus more on now and how I can handle things cognitively and behaviorally? She's mixed modality rather than CBT though.

Anyway, thanks for giving me your perspective--it's helped me think!

Yeah, I can definitely see that being an issue. I've spent lots of time running stuff with MC past T (because of all the transference, plus giving her his take on stuff going on between H and I). And she's strongly disagreed with a few things he's said/done. (Like at one point a while back, I was saying I felt like the empathy was missing from my H. And MC was saying that one person can't give you everything, so, even though he didn't think H wasn't capable of empathy, maybe it's OK/not the end of the world if he can't provide that for me. T was like, "He actually said that?" Some other stuff too. For the record, she did refer us to him! Though I also wonder at times if there's almost a weird competitive thing, where I feel more connected to him than her, and that bothers her. But...that could totally be a negative maternal transference thing for me, since my mom seemed jealous of my friends that I confided in at times...)

I hadn't really gone the other way much, running stuff with my T past MC. And MC did ask in session last week why I wanted to discuss this with him (said it was fine--and confidential from her--just wanted to know why), and after giving a few other answers, came up with that I thought it was a reality check. Like was I reading too much into what T was saying/doing? Does this often happen after a certain amount of time in therapy with one person? Am I expecting too much from her? Plus he's known her for years, so I wasn't sure if maybe he'd be like, "Yeah, that's just how she operates." (He did refrain from reflecting on what she was thinking.) He was definitely emphasizing how some of how I'm feeling with her might be stuff from my past, specifically my mom. And he was encouraging me to try to work things out with her, because working through it could be helpful to me, rather than just running away.

But I'm just thinking maybe I need to explore other T's, or just take a break from T for a bit and continue with marriage counseling for now (my relationship with H is getting better, too, it's not just about me). Maybe I've just hit a point of diminishing returns with T, I don't know...

Thanks!

I wonder why your MC would recommend getting angry at your therapist over a diagnosis that's associated with emotional dysregulation? It seems like it would just make her feel more satisfied somehow. I'm not saying I wouldn't take issue with her assessment, but I would find a different way to do it, or find a different focus of therapy with her if you decide to continue. And if you feel there's some competition going on, maybe leave out references to your MC. Whatever you do, I'm wishing the best for you. This is hard stuff.

Thanks for the reply and wishes! MC explained the anger part to me a while ago, how if a client is depressed, he'll try to move them first to feel anger. Because depression is a more passive emotion, while anger is an active one. And I have difficulty both with fearing people will be angry with me and feeling/expressing my anger with others--I tend to just turn it inward blame myself. I never really saw my parents get angry with each other, and on the rare occasion they got angry at the other or especially at me, it was a HUGE deal. So this fear of anger was definitely causing problems in my marriage because H felt like he couldn't express anger or frustration with me because it upset me so much, and then I couldn't express it to him either. So we'd avoid conflict and then it would all just spill over at some point. MC has helped us understand we can both express our feelings, good or bad, and it won't be the end of the world/end of the relationship.

So I think in the case with my T, he's kind of doing the same thing, like encouraging me to feel the anger instead of just assuming it's all something I'm doing wrong, like she doesn't care about me anymore because I'm not good enough or something. And I think he figures that if I express anger to her and we work through it, then it will help reinforce the fact that feeling and expressing anger are OK.

Which, yeah, goes against the thing T was talking about with "emotional regulation." But I think she meant more in terms of not wanting or needing reassurance/validation if I'm upset,
But to me, her talking about emotional regulation feels like my mom telling me to stop crying when I was upset. To keep stuff inside instead of expressing it. When I find I do better expressing it, getting it out. Hm, that's probably something to bring up to her tomorrow--why her mentioning emotional regulation last week upset me so much (didn't help that she said it while I was sobbing).

I guess this is the problem with getting some sort of therapy from two different T's, even if one is more for marriage counseling... Getting conflicting messages. I was also getting occasional mixed messages from my p-doc before (though she's since left the practice), where she'd (p-doc) be telling me I needed more medication or, at one point, to go to a day/outpatient program at a hospital, and my T would say she thought I needed less medication and that I didn't need any outside services (well, until she suddenly suggested the hospital out of the blue a few months ago...)

For the record, I have generalized anxiety, panic disorder, some OCD, and recurrent major depression. And now I'm totally rambling Thanks for listening, whoever is reading this.

Your T seems a bit harsh. Not saying she's a bad T but being proud of withholding reassurance?? That's tough.

There's a difference between showing reassurance and enabling someone (or condoning whatever they are doing). Maybe she is equating the two... I mean, what is wrong with providing reassurance and doing some gentle 'shaking'? Dishing out 'tough love' could make one feel...invalidated and rejected. As if she weren't hearing you.

I believe what makes a good T is their ability to adapt their style to the client, not imposing what they feel is right. Otherwise, this could not only undermine any good work but have the completely opposite results to her intent.

I don't know if it's worth terminating with her as it seems quite drastic. I would advise another heart-to-heart (non-confrontational) re how reassurance ≠ acquiescence & how upsetting when it feels she goes into ‘scolding’ mode.

This thread has really helped me understand why therapy with my most recent T was not working - too much pathologizing to the point where I now attribute every negative emotion experienced to my "mental illness". Now, it is not ok for me to be angry even for a valid reason because it's all part of my problem. This T was NOT right for me, and now I can see how and why.

I think you should try and resolve this issue with T, but don't allow her to blame you. She has made mistakes by the sound of it, and in some cases, it seems all too easy for a therapist to blame a client for the therapy not working out without taking their share of the responsibility too.

Yes I think a ts approach will be influenced by their personalities and their life experience. Normalising wouldn't work for me and I find it condescending. Your normal is not my normal so please don't tell me that because you also felt like that it is normal because that's not true, it was normAl for you but not for me. Pathologising is not a good intervention for me either. This is where I like the person centred approach to therapy because it accepts a client for whatever they are without labelling them. I tend to neither normalise or pathologise and to be interested in how it was for the client and they experienced whatever it is they are having issues with. I am glad that you have the two different ts and two different perspectives though lonesome because sometimes a fesh pair of eyes reveals a lot more.

Sent from my iPhone using Tapatalk