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  #1  
Old Sep 26, 2017, 09:10 AM
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peaches100 peaches100 is offline
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Whose fault is it if a therapy client repeatedly feels the need to contact their therapist outside regular session time? Wouldn't it depend on the situation? In other words, if the client just misses the t and wants to email or text to maintain a sense of connection, the t may decide it is best for the client to learn to ride through their uncomfortable feelings until they can see their t at their normal therapy time.

But let's say the situation is different. What if the therapy client has dissociative issues and many stressful situations going on in their personal life. On top of this, the therapist has been involving the client in deep trauma work during sessions. Because of this, the client is having a really hard time maintaining their normal adult frame of mind and not getting triggered or dissociated midweek. They are experiencing flashbacks, panic attacks, etc. What should they do?

Usually, the t would discourage them from emailing or calling them for support. Instead, the t would expect them to use the coping and grounding skills they've been taught in sessions to manage their discomfort. Sounds reasonable, right?

But in reality, do we always have that kind of control and presence of mind during a flashback, panic attack, or dissociative episode? I know I don't. There are time when I am so triggered, I can't even think well enough to remember certain coping skills. I don't have the self-control to pull myself out of a dissociative state and back into my normal adult frame of mind so I can calm myself down. What should a therapy client do in this situation?

If we call or email our t, seeking contact and support, they may respond occasionally. But what if it happens more often than the t would like it to? What if it cuts into the t's personal time, and they begin to feel frustrated and angry that the client isn't respecting their boundaries?

Whose fault is it?

Is it the therapy client's fault for not having enough inner strength to use their coping skills to weather the storm on their own? Is it their fault for not having the self-control to put their needs on hold, until time for their next therapy session? Should they be able to routinely pull themselves out of a dissociative state and calm themselves down without help from their t?

Is it the t's fault for expecting the therapy client to do more than they realistically can without assistance? Is it the t's fault for immersing the client in deep trauma work during sessions, knowing that the client will struggle to keep themselves present and avoid being triggered after they leave the office? Is it unreasonable to expect a therapy client to manage all the internal chaos and keep it packed away in a neat little package during the week so as not to transgress the therapist's boundaries or intrude on their time?
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  #2  
Old Sep 26, 2017, 09:16 AM
Anonymous57382
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It's certainly not the client's fault. Ever.
Whether it's possible to ascribe any blame at all is very likely to be dependant on the situation, but a therapist certainly has a responsibility to ensure the therapy is not leaving clients unsafe and retraumatised, and it is good practice to ensure they have appropriate tools such as grounding techniques or a crisis line for when the therapist can't be contacted. If you are feeling unsafe outside session it is important that you discuss this with your therapist so you can work together to ensure you are safe between sessions. If your therapist isn't responding appropriately and helping you, I would consider finding another therapist.
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  #3  
Old Sep 26, 2017, 09:33 AM
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I also think that it is the Therapists responsibility to recognize and determine if those between session contacts mean that the client needs more support than what is currently occurring and assist in finding the correct types of support - more sessions, a second T, a different type of therapy, referred to another T because of skill set/availability... etc.

Or if the client is in the process of learning the skills and learning how to tolerate the stresses... and these intrusions are just a stage in the process.

Overall though, I think there is no one size fits all here and it is the T's job to take care of both the T and to some extent the client.
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  #4  
Old Sep 26, 2017, 09:34 AM
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unaluna unaluna is offline
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Maybe it would help if you could add on another helper? I think i appreciate my t more now that i have added regular chiropractor visits.

It started with a mid back injury that made it painful for me to walk or even roll over in bed; now he is correcting my gait, which ive always had problems with, like since childhood.

Maybe you could get a massage or something once a month? Something for you.

To answer your thread question, i would say, its nobodys fault; life just stinks sometimes. yours sounds particularly hard right now.
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  #5  
Old Sep 26, 2017, 09:35 AM
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LonesomeTonight LonesomeTonight is offline
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I'm not sure it's so much about whose fault it is, but about individual client needs and whether the therapist is willing and able to meet those needs. Having been in situations where I've needed more outside contact--and sometimes gotten it and sometimes not--I understand.

It was difficult for me when my T (T1) was accepting of outside contact (mostly e-mails, though she didn't generally respond), then at one point said they were getting longer and longer, and it was too much. That she only had so much time. And, more recently, that ethically she has to give equal time to all clients (even those who don't take part in outside contact). That felt like she was putting the blame on me, that I was too needy, that I was expecting too much of her. It's part of the reason that I recently started seeing T2.

MC (marriage counselor) has never said my e-mailing/texting/phone call requests have been too much. He's said that he can't always read or respond right away--and there have been times it's taken him 3 days or more to read/get back to texts/e-mails. Which can be frustrating at times (and makes me fear he's sick of me), but he's never put it back on me. He's never, like T, suggested I'm taking up too much of his time (though I suspect if I started, like, sending him 10 texts every day for a long period of time, he might say something!) I can deal with that much better than feeling like I'm too needy or demanding--and worrying that I'll be rejected for that (which is how I felt with T1).

Not sure that really answers your question, just giving my perspective.
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  #6  
Old Sep 26, 2017, 09:57 AM
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Argonautomobile Argonautomobile is offline
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I don't know why this is so ****ing difficult for therapists. It's like any other damn profession - if you don't want people to call, don't give out your cellphone number. If you don't want to work on your day off, don't. If you don't want to answer emails after hours, don't open your work email at home. It's not ****ing rocket science.

It takes just a tiny little bit of self-discipline to not work all the time. Just a tiny bit. Maybe they should take a walk mindfully or some **** instead of being frustrated with a client for sending an email they shouldn't have read until Monday.

If this is unacceptable to the client, refer out. For ****'s sake.
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  #7  
Old Sep 26, 2017, 10:30 AM
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AllHeart AllHeart is offline
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I think it's the fault of the therapist when they don't make explicit the rules around outside contact from day 1. Also, their fault when a normally rigid t does not allow for temporary exceptions to be made for a client in distress. Their fault, too, when boundaries are too loose and that winds up creating a client dependency on them. I guess without setting and adjusting outside contact using healthy limits and balance, it's the t's fault.
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  #8  
Old Sep 26, 2017, 10:36 AM
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ScarletPimpernel ScarletPimpernel is offline
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If doing deep trauma work is too triggering for you right now, if you don't have the skills or aren't able to utilize them when you need them, then maybe you shouldn't be doing the deep work right now. I'd tell your T that you can't cope with it.

As far as who's at fault: my opinion is that neither is at fault. It's just the way therapy is sometimes. I don't think placing blame on either side will help solve the problem.
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  #9  
Old Sep 26, 2017, 10:59 AM
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rainbow8 rainbow8 is offline
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I don't think it's anyone's fault, not the T's or the client's. Some clients need more outside support at times, and I think it's up to the client to make their T aware of this need. I think a good T should be able to tell if the client is justified in wanting more contact, and in your case now, Peaches, I think you are going through a hard time and it makes sense that you would want more contact. You have a caring T and an honest discussion of your needs for outside contact would be helpful, if you haven't done so already.

In general, Ts encourage less contact as time goes on. My T has tried to wean me away from depending on her during the times between sessions, but she didn't forbid it. For me, that's what helped. It's taken years, but knowing that I can email her several times in one week if I need it, has gotten me to a place where I don't have to email her as much. But when my H was sick and dying, T knew I needed more contact.

Again, it's no one's fault, unless perhaps the fault of the inventors of the computer, internet, email and texting. It's easier to email than use the phone. I used to call my first T after every session for awhile, but it wasn't as addictive as emailing. I feel bad for you, and hope that you can work this out with your T. I also know you don't want to hear this, but like others have been suggesting, maybe a consultation with another T would be productive. That doesn't mean you are quitting therapy; it means that an outsider's opinion might help. Hugs and wishes for you to feel better about all of this!
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  #10  
Old Sep 26, 2017, 11:44 AM
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Why the focus on "fault"? Not really sure that's the issue.

Having been very dysregulated at times due to trauma and dissociation, there were certainly times when I needed to speak to my therapist between sessions. I simply picked up the phone and called on those occasions. We either talked on the phone, or often, they would ask me to come in for an earlier session if what we needed to discuss was more than really could be handled via phone.

It wasn't often I needed that contact. Some weeks were simply more intense than others, and my therapist had no problem with me contacting him if need be because he knew if I had called him, I had already tried managing on my own using the skills we had worked on and it simply wasn't working this time.

None of my therapist used email or texting for contact and that was best for me. A direct verbal conversation was always more effective and less prone to misinterpretation or delays.

If you really need extra contact, perhaps you should consider an actual phone call rather than technology so that you can have a direct dialogue.
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  #11  
Old Sep 26, 2017, 12:09 PM
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Ididitmyway Ididitmyway is offline
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I prefer to understand this type of a situation in terms of cause and effect, not in terms of whose "fault" it is. But, when trying to determine the cause, one will see how to assign responsibility. ( I prefer to use the word "responsibility" because "fault" is too emotionally charged.). So, if I were to put responsibility for the client's needing more and more contact outside sessions, I'd put it on two entities:

1) On a micro level, it's the therapist's responsibility not to confuse the client about how much the therapist is available outside sessions and if the are available at all.

As much as therapists love to talk about "boundaries", many of them, unfortunately, cannot maintain them because they themselves don't understand them clearly and haven't determined what their boundaries with clients will be. I elaborate more on this in this article Therapy Consumer Guide - The Misconception about Professional ?Boundaries?

If I made a decision that I will have no contact outside sessions except for logistical reasons like re-scheduling appointments and such, then this is how it is. If it doesn't work for some clients, I'd refer them to other practitioners who have different policies a.k.a "boundaries" that work better for them. However, I have to understand that with this approach, I would have to conduct therapy differently from how others conduct it. In this case, therapy would be more like a formal educational consultation, as opposed to "working through" the client's transference and attending to their emotions in the moment. If those who practice differently can master different boundaries and to maintain them always without confusing their clients about the nature of their relationship with them, good for them. I cannot do that without confusing clients and, most importantly, confusing myself. Therefore, I will do what helps me remain clear about what I am and what I am not willing to do. If I am clear about that, my clients would be also clear about that.

The fact that many therapists are wishy-washy about boundaries has to do with the fact that they are not clear about how they see their role. When they are confused, their clients get confused as well and don't understand what they can and cannot expect and hope for in therapy. This causes clients a lot of pain and suffering that never gets properly addressed and dealt with because therapists refuse to see how they contributed into that.

2) On a macro-level, the entire system of traditional psychotherapy is responsible for those types of situations because it has failed to develop effective methods to treat various kinds of trauma and traumatic symptoms. There have been books and articles written by professionals on this subject based on research that debunked the notion that leaving people's needs unattended is therapeutic. Emotional needs of people with history of trauma need to be attended to in some manner, otherwise, when therapy triggers them and then leaves them unfulfilled, that causes the person to re-experience trauma instead of healing it. Unfortunately, under the current system, which operates with outdated theories, this can't be done. It is unrealistic and unfair to both, therapists and clients, to put the responsibility of fulfilling all the client's emotional needs on individual therapists. This will never work and will create much more mess than good. The only way to attend to those needs is

a) Through taking a collective rather than an individual approach to administering therapy, when the client, while working with an individual therapist, also is in the relationship with the clinic where the therapist works and can call the clinic any time, day or night, to talk to someone when they need to.

b) Through developing more effective treatment methods based on the objective data derived from research. Many of those methods are body or sensory-motor oriented, as opposed to talk-oriented. Trauma, as the neuroscience has revealed, operates on the deep physiological a.k.a body level and continuing to try to heal it purely through the means of talking and analyzing will continue to fail, because conscious understanding of one's inner process, as helpful as it may be, can only go so far.

c) Through public education and building supportive communities, when people who live with traumatic symptoms get all the compassion and empathy they deserve and stop being cast off as "troubled" and "not normal". Our public is utterly illiterate when it comes to mental health education and, I believe, we won't move forward, as a culture, until and unless it changes.
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  #12  
Old Sep 26, 2017, 12:25 PM
JaneTennison1 JaneTennison1 is offline
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Quote:
Originally Posted by rainbow8 View Post

In general, Ts encourage less contact as time goes on. My T has tried to wean me away from depending on her during the times between sessions, but she didn't forbid it. For me, that's what helped. It's taken years, but knowing that I can email her several times in one week if I need it, has gotten me to a place where I don't have to email her as much.
I wonder, would email be addictive if T didn't reply?

Regardless, I think if the T is going to get "annoyed" in anyway then they should define the boundaries very clearly. I have a current T , she and I discuss texting and run through the boundaries a few times. Just so I am clear. Having had 2 negative experiences I am eager to avoid more. I don't see it as a fault so much as a responsibility. T has a duty to be very clear with you and then you can decide if that works for you.
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  #13  
Old Sep 26, 2017, 01:23 PM
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I agree with most of what was said here.

In my view, it seems to come down to 2 things:

-therapist competency
-therapy frequency

There's so much a therapist can do to manage the treatment and/or transference. Trauma exploration is not usually a good thing to do when someone has too many life stressors, like caring for loved ones, deaths in families, job loss, health problems. You can take a break from therapy, build your defenses. Do crafts together, play games. Just be more supportive. This all can be therapeutic.

A therapist can give transitional objects, commit to a pre-scheduled 5 minute phone call once a week, make a voice recording, etc. Adjusting technique-being more validating, avoiding confrontation. The 5 minute check in would be discussed an agreed upon by the client and therapist. Not 'boundaries' authoritatively imposed by a therapist. There are endless things.

When a therapist is overly rigid and has no flexibility, problem solving skills, or solutions, then that reflects on their competency. And through the initial intakes, they know what they are getting into when they take on trauma clients. I suspect some will take clients because they need the money, regardless if they can best serve them.

To my second point, people with certain histories in this kind of therapy seem to need more than once a week treatment or connection. In another thread, I mentioned need vs. therapeutic need. A weekly 5 minute check-in with a therapist might be a therapeutic need and part of the treatment. I do like what IDIMY said about the macro level. And van der Kolk's work.

And..people need containment!
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  #14  
Old Sep 26, 2017, 05:14 PM
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Anastasia~ Anastasia~ is offline
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Taking away thing like email privilege says to me, You're too needy. Ts need to spend a lot of time contemplating if they can handle this or not. If they are any bit sensitive to this, they need to explicitly spell out what is ok and what is not from the beginning. Otherwise, they are setting the client up for failure.
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Old Sep 26, 2017, 05:45 PM
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Sadly, I think that many therapists fail to clearly and definitively define their OWN professional boundaries; in other words, she hasn't determined what she is emotionally capable of maintaining through out the course of therapy. So, what happens is, the therapist greets the new client and want to encourage the client's connection to her. She gives the client her email and/or cell number (sometimes right off the bat, but often only after she thinks she's determined that the client needs some sign of her commitment to the relationship) and she encourages the client to call, text or email when she needs to.

In some or a lot of cases, the client takes the therapist up on her offer of outside contact and uses what has been "freely" offered. Things go okay for a while, but then, when the client doesn't "get better" or doesn't show the degree of self-soothing/independence/acceptance of outside support (based on the therapist's time table or determination of when that should happen), or the therapist's professional or personal life gets a bit busy and she begins to feel "put upon", the therapist decides to have that conversation about boundaries with the client. This usually happens AFTER the therapist has begun to really experience frustration or anger, and the conversation doesn't go well.

From what I've seen on here, the conversation often explodes things into pieces and the resulting anguish and anger from the client is handled poorly by the therapist. From what I've seen and read on here, the therapist gets defensive but puts the blame (often without stating it that way) on the client's neediness. But the client gets the message-You're too much for me! Results: shame, guilt, hurt and re-enactment of early trauma and a severe feeling of betrayal of trust in the therapeutic relationship. Not helpful!

I really don't understand why therapist aren't more personally aware and responsible for determining AHEAD of time their boundaries. They don't even seem to get how much damage they do with not getting this part of therapy right. They talk about attachment disorders but they don't GET their impact on clients in the therapy room due to their inability to get this part of their job right. Very sad and just hurtful for a lot of clients . . . and the profession really isn't doing anything to get this right.
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  #16  
Old Sep 26, 2017, 06:23 PM
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Quote:
Originally Posted by itisnt View Post
Sadly, I think that many therapists fail to clearly and definitively define their OWN professional boundaries; in other words, she hasn't determined what she is emotionally capable of maintaining through out the course of therapy. So, what happens is, the therapist greets the new client and want to encourage the client's connection to her. She gives the client her email and/or cell number (sometimes right off the bat, but often only after she thinks she's determined that the client needs some sign of her commitment to the relationship) and she encourages the client to call, text or email when she needs to.

In some or a lot of cases, the client takes the therapist up on her offer of outside contact and uses what has been "freely" offered. Things go okay for a while, but then, when the client doesn't "get better" or doesn't show the degree of self-soothing/independence/acceptance of outside support (based on the therapist's time table or determination of when that should happen), or the therapist's professional or personal life gets a bit busy and she begins to feel "put upon", the therapist decides to have that conversation about boundaries with the client. This usually happens AFTER the therapist has begun to really experience frustration or anger, and the conversation doesn't go well.

From what I've seen on here, the conversation often explodes things into pieces and the resulting anguish and anger from the client is handled poorly by the therapist. From what I've seen and read on here, the therapist gets defensive but puts the blame (often without stating it that way) on the client's neediness. But the client gets the message-You're too much for me! Results: shame, guilt, hurt and re-enactment of early trauma and a severe feeling of betrayal of trust in the therapeutic relationship. Not helpful!

I really don't understand why therapist aren't more personally aware and responsible for determining AHEAD of time their boundaries. They don't even seem to get how much damage they do with not getting this part of therapy right. They talk about attachment disorders but they don't GET their impact on clients in the therapy room due to their inability to get this part of their job right. Very sad and just hurtful for a lot of clients . . . and the profession really isn't doing anything to get this right.
Yep, this sounds quite a bit like my experience with T1. The outside contact is OK until...suddenly it isn't. And she made me feel like I was expecting too much of her, that I was being needy. When, if she had let me know it was getting to be too frequent before she got to that point, things might have gone better.

T2, who I just started seeing, has a policy where if it would take him more than 15 minutes to read/respond to an e-mail, then he'll charge for every 15 minutes beyond that. Though he said if those longer e-mails were just every couple months, that would be OK, no charge. And he'd let me know if an e-mail was at the level where he'd normally charge, just so I can decide whether to send one like that in the future (knowing he'd charge beyond the 15 minutes). Shorter e-mails or those needing no response (and of course scheduling e-mails/texts) are fine. (And I could opt to schedule an extra session or phone call.)

When he first told me about this last session, it bothered me a bit. But now, after asking him more about it today, I'm thinking it could be a good thing, because he's saying more generally what his boundaries are, before he starts charging for his time. I mean, sure, there's potential room for conflict over, say, is this a 15-minute e-mail (no charge) or a 20-minute one. But at least he seems to have a sense of what his boundaries are. Which is encouraging to me.

Last edited by LonesomeTonight; Sep 26, 2017 at 06:58 PM.
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  #17  
Old Sep 26, 2017, 06:31 PM
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What I have learned from several therapist is to not wait to make contact when I am ready to fall apart. It was okay to reach out when the toddler, five-year-old, and now the adult needs to touch base to know that I matter to someone.

It is really disconcerting to hear of all the suffering so many on PC go through because of the taboos that the therapist and/or the client has placed on reaching out outside of sessions.

I sent close to 1,200 emails in 18 months and ~2/3 were answered. The set up was I could send as many as I wanted (28 one day) but she did not promise to answer unless I stated I needed/wanted a response. Many of them were comics, stuff on PC, or things I found interesting on the internet. I also had access to unlimited phone calls and extra sessions. She would get back to me as soon as she could. She did not take phone calls in the middle of the night or if she was out. She chooses not to own a cell phone. She made sure she took care of herself.

I don't think she could have even initiated this kind of therapy if she had more family responsibilities.

In my opinion it is not about fault, both the therapist and the client both have needs and wants in order to get through the day, as much as the therapist putting pressure on themselves. Then things change for them, and they cannot deliver, so they place blame on the client's needs/wants when things go down hill.

We both survived.

Last edited by Anonymous52723; Sep 26, 2017 at 06:55 PM. Reason: word changed & subtracted
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  #18  
Old Sep 26, 2017, 06:48 PM
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does it have to be someones fault?
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  #19  
Old Sep 26, 2017, 09:28 PM
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Quote:
Originally Posted by peaches100 View Post
If we call or email our t, seeking contact and support, they may respond occasionally. But what if it happens more often than the t would like it to? What if it cuts into the t's personal time, and they begin to feel frustrated and angry that the client isn't respecting their boundaries?
If I've learned nothing else in therapy so far, it's that people are responsible for maintaining their own boundaries. That's hard and painful and why a lot of people are in therapy. Clients are going to push those boundaries, especially when they're in pain. Therapists need to maintain their boundaries for their own sanity and to best help their clients. If they're having trouble doing that, then they need to seek the support to restart and maintain those boundaries, whether that's self-care or therapy themselves.

I would say it's less about fault and more about poor communication and expectations.
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  #20  
Old Sep 27, 2017, 12:36 AM
Amyjay Amyjay is offline
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I don't think that it needs to be anyone's fault either. A client is not "wrong" for being overwhelmed and needing support and a therapist is not "wrong" in setting boundaries around what they can an cant do.
But when there is a real need the client and the therapist still have the therapeutic work of finding ways to meet that need. That still doesn't mean the therapist has to be the one to meet that need outside of session time and that still doesn't mean the client is "wrong " or "bad" for having that need. But if the need is there and the therapist has determined they are not able to fill that need in that way then that is just how it is and the work needs to shift to finding other ways to get those needs met.
That could be finding other support people, temporarily increasing sessions (if both agree on terms), developing self support skills like containment, mindfulness, grounding skills, there are so many ways to get support other than the therapist doing something they are not able to do.
Possible DID could even be a big help here because the more you work with inner parts in therapy and develop those internal relationships the more support you will be able to give each other.
There are so many ways you can support all parts of yourself and your t will be abl to help you with this.
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  #21  
Old Sep 27, 2017, 12:48 AM
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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.
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  #22  
Old Sep 27, 2017, 12:52 AM
feileacan feileacan is offline
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I don't find it constructive to think whose fault it is. I think it would be more constructive for the client/patient to think what kind of treatment he/she needs and then look for such a treatment.

I have 4 regular weekly sessions and on top of that I have emailed or called during the times I've been very regressed due to trauma work. It has never been a problem to my T because he has understood that I contact him when I *need* to do that, not just because I would like to chat with him.

He told me though that he prefers not to respond to emails and he generally doesn't, unless I explicitly ask for a response and also then the response is very short, just acknowledging my email. He has almost always picked up his cell when I've called or he has called me back, unless I've tried to call him really late at night.

We have had no clear rules. It all has evolved as part of our work and what I feel I need. He has always respected my need and I think this is one of the reasons why I think this therapy has been immensely helpful to me.
Thanks for this!
LonesomeTonight
  #23  
Old Sep 27, 2017, 03:28 AM
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koru_kiwi koru_kiwi is offline
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Quote:
Originally Posted by Ididitmyway View Post
On a macro-level, the entire system of traditional psychotherapy is responsible for those types of situations because it has failed to develop effective methods to treat various kinds of trauma and traumatic symptoms. There have been books and articles written by professionals on this subject based on research that debunked the notion that leaving people's needs unattended is therapeutic. Emotional needs of people with history of trauma need to be attended to in some manner, otherwise, when therapy triggers them and then leaves them unfulfilled, that causes the person to re-experience trauma instead of healing it. Unfortunately, under the current system, which operates with outdated theories, this can't be done. It is unrealistic and unfair to both, therapists and clients, to put the responsibility of fulfilling all the client's emotional needs on individual therapists. This will never work and will create much more mess than good. The only way to attend to those needs is

a) Through taking a collective rather than an individual approach to administering therapy, when the client, while working with an individual therapist, also is in the relationship with the clinic where the therapist works and can call the clinic any time, day or night, to talk to someone when they need to.

b) Through developing more effective treatment methods based on the objective data derived from research. Many of those methods are body or sensory-motor oriented, as opposed to talk-oriented. Trauma, as the neuroscience has revealed, operates on the deep physiological a.k.a body level and continuing to try to heal it purely through the means of talking and analyzing will continue to fail, because conscious understanding of one's inner process, as helpful as it may be, can only go so far.

c) Through public education and building supportive communities, when people who live with traumatic symptoms get all the compassion and empathy they deserve and stop being cast off as "troubled" and "not normal". Our public is utterly illiterate when it comes to mental health education and, I believe, we won't move forward, as a culture, until and unless it changes.


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.
Thanks for this!
Amyjay
  #24  
Old Sep 27, 2017, 04:04 AM
Amyjay Amyjay is offline
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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.
Thanks for this!
moonraingirl, rainbow8
  #25  
Old Sep 27, 2017, 04:15 AM
Amyjay Amyjay is offline
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Quote:
Originally Posted by peaches100 View Post

But let's say the situation is different. What if the therapy client has dissociative issues and many stressful situations going on in their personal life. On top of this, the therapist has been involving the client in deep trauma work during sessions. Because of this, the client is having a really hard time maintaining their normal adult frame of mind and not getting triggered or dissociated midweek. They are experiencing flashbacks, panic attacks, etc. What should they do?

Usually, the t would discourage them from emailing or calling them for support. Instead, the t would expect them to use the coping and grounding skills they've been taught in sessions to manage their discomfort. Sounds reasonable, right?
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!!
Thanks for this!
LonesomeTonight
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