Outside Contact: Whose Fault?

in the last couple years there has been a lot of research and a much greater awareness of complex trauma and especially how it affects the brain and this is slowly changing trauma therapy. if anyone has a history of complex trauma (especially trauma and attachment trauma during early and middle childhood) it is really important to find a therapist who has really up to date training and knowledge in this area.
It is now known that talk therapy on its own doesn't work for complex trauma. It is more than a psychological issue, complex trauma changes the normal course of brain development and is a neurobiological issue and it requires a different approach by a t that knows the heck what they are doing.

I read the book for therapists called "Schema therapy: a practitioner's guide". (I wanted to find out as much as possible about the therapy I was doing).

Talking about outside contact for people with borderline personality disorder, the author said something like this: People with borderline personality disorder are going to need more support than the therapist is able to give. That is not their fault, it is the nature of their difficulties and they didn't choose to have those difficulties. On the other hand, the therapist also has a private life and family life and cannot constantly support clients 24/7. So the idea of it being anyone's fault is not helpful. The therapist and client both realise that the situation is not perfect, but they work out what they are able to do so that the client feels supported as much as possible, and the therapist does not feel burnt out and resentful.

He goes on to explain that the most important thing is for the therapist to have self knowledge and b aware of what they are able to do and not able to do, and that the highest priority is consistency so that everyone knows where they are. He says about how damaging it is to the client, when a therapist is trying to meet all their needs and doing a lot, but it turns out to be too much and the therapist suddenly changes. I know some people here have experienced that. It sounds incredibly painful.

I've been so fortunate in my T. We've had a few ruptures over him not replying to a text straight away or something like that. But on the whole he has been incredibly patient and very consistent, for many years.

I'm not into assigning fault, just responding to this. ^

The treatment I need doesn't exist. You go 4 times I week. That would really help me, but I couldn't afford it and my T had no flexibility. At all. I couldn't even afford a tapered ending and was cut off abruptly when I fell ill.

Going once a week often felt like I was being traumatized.

But therapists have no business treating trauma clients if they can't make themselves reasonably available in between sessions. I can't just not take a call from my boss or client because it's my 'boundary' and I need to take care of myself when a critical decision needs to be made. A police officer can't just say "I don't want to go to that part of town" because it's her boundary and she's taking care of herself.

We all have stressful jobs and obligations to those we work for. It's about respect, too.

I agree with you. I feel lucky that I can afford (fully out of pocket) my treatment.

However, I still think we have the option to decide whether we accept the treatment that is inefficient or harmful for us or not. Perhaps no treatment is much better than an unsuitable treatment. Although I acknowledge that making such a decision can be very difficult and part of the whole problem for some people, it is really non-constructive to try to evade that personal responsibility and push it to someone else (a particular therapist or the whole field on psychotherapy in general, for instance).

i too believe it is a failure of the 'system' not being able to fully meet the needs of those with such complex traumatic histories. thank you for explaining this in such detail.

in this case it would be detrimental to continue with deep trauma work. Safety and grounding need to come before anything else, and especially before any deep work is done. Trauma work should only proceed when it can be safely managed by the client between sessions. Safety must always come first.
Trauma work is only safe to do when the client has safety in day to day life (eg no major life stressors) and has developed adequate grounding and containment skills. in DID therapy its divided up into stages - stage 1 is working on current safety, developing inner resources, grounding skills containment etc. once that i all well established it is SAFE to go on to trauma work. If the client destabilizes at any time you go back to stage 1 work to revise and create safety again. It goes back and forth between stage 1 and 2, reverting to stage 1 whenever things become too overwhelming. Even trauma therapy shouldn't be overwhelming your coping skills. Coping skills must come first.
This is where traditional talk therapy failed complex trauma clients. Therapists encouraged clients to talk about their traumas over and over and all it did was retraumatize people. Therapy is supposed to help, not harm. If it is harming it is definitely not helping!!

I'm not into assigning fault, just responding to this. ^

The treatment I need doesn't exist. You go 4 times I week. That would really help me, but I couldn't afford it and my T had no flexibility. At all. I couldn't even afford a tapered ending and was cut off abruptly when I fell ill.

Going once a week often felt like I was being traumatized.

But therapists have no business treating trauma clients if they can't make themselves reasonably available in between sessions. I can't just not take a call from my boss or client because it's my 'boundary' and I need to take care of myself when a critical decision needs to be made. A police officer can't just say "I don't want to go to that part of town" because it's her boundary and she's taking care of herself.

We all have stressful jobs and obligations to those we work for. It's about respect, too.

THIS!!

I can't tell you how many times my therapist essentially explained this very thing to me over and over again. He railed against therapists who seemed to know nothing about working with trauma except "have them talk about it over and over again until they feel better." He said it is incompetent, retraumatizing, and causes lasting damage; it was clearly a hot-button issue for him.

I was SO fortunate to find a therapist who did exactly what you outline here. Safety and grounding skills ALWAYS came first and we returned to them whenever needed. We delved into history only with a very specific purpose in mind, in small doses, and never as just an exercise in self-flagellation by repeatedly going over the gorey details. Thus, rarely was I so dysregulated by a session that I needed a great deal of contact between sessions. It still happened on occasion; trauma is a beast that way no matter how careful the therapist is. But it wasn't constantly an issue, and we were able to handle those occasions as they occurred with extra sessions, or a quick phone contact between sessions, restabilize and then move forward again.

It was a slow process, but I came out on the other side.

Therapists are responsible. They orchestrate the whole thing. Their job is to avoid client harm as first priority. If a client is flailing around in an impaired and destabilized state and feels an overpowering need for contact, then they are in harm's way and the therapist has failed.

Or if the client does have trouble containing emotions as a general problem, then a plan should be in place BEFORE the client goes haywire between sessions. Or perhaps therapists ought to reconsider this dangerous game they are playing.

Therapists are masters of accountability evasion. Their obsessive blathering about boundaries is a convenient means for transferring fault to the client. The client has "boundary issues". No, you just manipulated their emotional state by acting like their new mommy/friend/lover/savior, and now predictably they are tweaking heavily after being chased out of the room at the end of the hour, with nothing but superficial reassurances about coping.

Lolagrace,

How long were you in therapy?