Am I wasting my time and T's...?

Am still in the very early stages of Schema Therapy, building the relationship with T, trying to build trust etc...

But my head can't get past the belief that one hour a week (with no outside contact) is not going to cut it. I just don't see how it is possible to not only build the relationship & trust and also work through all the crap I need to deal with, in the time given.

This is a kind of block for me, because I'm already thinking it's not going to work, why bother trying.

I've understood that once a week psychotherapy is standard and many people consider the higher frequency acceptable only during crisis.

I personally have never gone that infrequently. The lowest frequency I have had is 2xweek and the normal frequency for me is 4xweek (psychoanalysis) and this without any ongoing crisis. I couldn't imagine that I could have gotten where I am right now by just going once a week - I think many deeper stuff would have remained quite inaccessible, or if it would have become accessible, the one week gap between the sessions would have made approaching this material too painful and thus perhaps impossible.

I realise that 4xweek is really out of the norm nowadays and many people could not afford it both time and money wise. However, I think that 2-3 sessions per week would be useful for many people to proceed more quickly in their therapy.

Could you ask your T to have more sessions per week?

If it were private therapy yes this might be possible, but it is being offered through secondary MH services on the NHS (UK) so not an option unfortunately.

In the schema therapy clinician books, the therapist is heavily encouraged to offer out of session contact.

Maybe ask your T? I only got out of session contact with T when I...um...sought forgiveness rather than permission.

I'm in secondary services of my country's public health care services which is quite similar to the NHS.

I am with QuietMind in wondering about outside contact if you're doing schema therapy. I am not doing schema therapy, but there are some similar elements in my therapy, and my T allows as much outside contact as I need. But we didn't start out that way, and I think the outside contact rules (or lack thereof) only became formulated once my T knew more about how I operate, what my boudaries are like, how much support I have in my life, etc. Otherwise I think she would be worried about whether she could accomodate the degree of outside contact I am likely to need on an ongoing basis (which has turned out to be a medium-low amount, in typical circumstances).

Have you asked about outside contact, or are you just assuming it isn't going to be offered? I think it's perfectly fine to describe your needs to your T and see what they say. I do agree that outside contact can be important for dealing with certain things, and I hope you are able to get the help that you need, in whatever form that ends up taking.

My pdoc is very firm about boundaries, most NHS drs are, mine deals with a particularly volatile bunch though.
Once we settled in once a week was plenty for me personally, but then I only turn up because I 'have' to otherwise I probably wouldn't make that.
Give it a chance, sometimes appointments just means you fill the time with more minor stresses than focusing on the things you really need to.

However if your on the standard 12 week block that is usually provided you will really need to focus on just what you want out of it.

All the best.

I do not believe one can waste the time of the therapist. The therapist is paid to sit there. The client is the only one who can have their time wasted.

What does this mean? Forgiveness for what?

I found it completely absurd. Everything must be stuffed into a one hour window. It's arranged for the convenience of the therapist and the client must schedule their needs accordingly, then switch off when the hour is up. Even with between session email it was hideously out of control.

Yes exactly!
It's impossible to just turn off feelings like a tap once they've been brought up, then you have to go off to wherever, often in a highly emotional state and be 'normal' again. I've tried therapy at both ends of the day and neither is ideal when there is somewhere else you need to be afterwards.
Apart from breathing exercises, they don't seem to teach you how to deal with the fallout from all the crap you're left with at the end of the session.

This is why I'm even more surprised that this particular type of therapy has been offered; I have no outside support system. Psychologist wouldn't be able to accommodate the degree of contact I would need on an ongoing basis - she only works there 2 days a week and that time is taken up with seeing clients; the other 3 days she trains and lectures.

She has already said that she can't be available in a care coordinator role - whilst I appreciate she has been upfront about this, it doesn't help me. I do have a care coordinator but she isn't available on the day I see the therapist, so it's not even as though I can ring her afterwards.

I found her public instagram and sent her a private message (she'd mentioned some clients finding her email but I didn't have out of session contact), then i freaked out and had a panic attack the next session because I was sorry I messaged her. Then she allowed me out of session contact. Her boundary is she won't reply to anything I send and we'll discuss in session if I'm messaging her "too much".

Not saying I did the right thing. I didn't.

I see T once a fortnight. For about a year due to scheduling issues and my work, I could only see her once a month. She then offered that I could call at the two week mark if I needed it.

Wow, yep I'm surprised you're being offered this kind of therapy when your T only sees clients two days a week. Schema therapy requires the therapist to be quite involved.

East17, when I started schema therapy we spent a while (I think about a month initially) working on ways of calming down, self soothing, managing emotions etc. Otherwise you are right, it would seem that you would open up all these potentially overwhelming emotions and then be left hanging.
I also had out of session contact. It's a shame your T can't offer that.

Do you know how long you have for doing schema therapy? I wonder if your T has a limited number of sessions and so is kind of rushing into things. It doesn't seem like a good idea though because in the end of the day it needs to be helpful to you, not harmful to you!

So have you actually talked to T about your situations. What are her suggestions? Does she have any suggestions at all? If not then could you talk about it with your care coordinator? Does she have any suggestions?

I mean, I would hope that someone in this NHS system would have to think about your situation and offer some solution that make the therapy workable for you. However, I'm afraid that it might not be the case - I have heard some most absurd stories about the mental health care through NHS that it makes me wonder if people organising and working in this system have any clue at all what they are doing or are they merely pretending.

Anyway, I suggest not to suffer in silence but ask from your therapist and from your care coordinator for solutions. Either the T or the care coordinator finds a way to be more available to you, or they find another more available T to you, or in the worst case they have to admit that they offer you something that they really haven't thought through at all. But at least then you know.

Yep. it's completely incongruent -- digging deep into sensitive stuff on a tight schedule and in small doses. Even a layperson could surmise that a bunch of catharsis, followed by an abrupt ending, followed by a few days or a week of separation, is going to lead to problems. There shouldn't be a need to deal with the fallout from a session, in my opinion. It means something is wrong. A healthy intervention should not leave the client/patient scrambling to recover their equilibrium.

I absolutely can't agree with that. If someone has emotional problems then the only way to make any changes is to shake the equilibrium off the balance, which then will necessitate searching for new balance. Otherwise you will just stay stuck where you are and then the whole therapy is just pointless.

Of course, the whole treatment environment must somehow support this process of repeatedly shaking the equilibrium and finding a new balance - either the sessions must be frequent enough or some other support systems must be in place. Once per week therapy without any possibility of intermediate contact is in many cases not enough though.

If money were not an issue, in your view, what do you think is the minimum amount of sessions, including session length that should be okay per week, and the amount of out of session contact through the different forms of communication (e.g email, phone, etc)? This is just setting industry parameters for clients that feel they need more than what you describe above that they get. If this could be done would you see therapy has having some merit? This would be a seperate issue from the different types of therapy or having proper therapists that knows what the heck they are doing.

It could be pointless regardless. Or damaging. If one assumes many people enter therapy in some sort of crisis, then a process that is inherently destabilizing does not make a lot of sense. Unless you like russian roulette.

I have no idea.

If we assume 112 waking hours per week, even 4 therapy sessions per week means the client is with the therapist only 3.5% of the time. From what I've seen, many people spend the other 96-99% of the time fixated on therapy, which seems to indicate a problem.

I found that increasing to 2x per week solved nothing. It wasn't the frequency of sessions or the nature or frequency of outside contact. It was trying to have some sort of emotional relationship based on distance (plus all the other problems).

I agree with that. You can't do discovery work in psychotherapy with someone who is in acute crisis. It truly would be pointless and most probably damaging.

I suppose schema therapy is something that is indicated for people who are not in immediate crisis though.

You're right. It's crisis stabilisation first then the deeper work with schema therapy.

I think any type of therapy can be destabilizing for someone in crisis, and not just acute crisis.

Personally I don't put much stock in different types or modalities of therapy.

I don't think it's the modality that causes the distress, it's the basic nature of the relationship... you have exactly one hour to express everything that plagues you in your life, and then adios. It's too much catharsis in too little time with not enough consideration for what happens after. If you have a problem with that, it's interpreted as evidence of your "disorder". Everything OP said seems relevant to all types of therapy.

Every time I've apologized for wasting her time, my t has said something along the lines of "You're wasting YOUR time, not mine." Kinda an ouch, that she's so blunt about it, but it's the truth. She's being paid to be there whether I talk or not. Although I do think that most of the time she does more than just sit there, I understand that there are differing opinions on that!