How does your T deal with this? (Trigger)

My T actually welcomes my requests. He is glad that I feel secure enough in the relationship to take the risk to ask. He also sees it as my learning to identify and voice my needs. Even crazier by most T standards more often than not he happily accommodates my request. Granted it has to “fit” in his office, within our session time and not violate his boundaries but they are pretty open. I am sure Freud is rolling in his grave somewhere but it even seems to be working. Do I always get exactly what I want? No. But it is always a gentle discussion about the need, the feelings, our relationship, his role as my doctor and we have always found a comfortable middle space.

Absolutely it is good to ask for what you need (or think you need). However, the reality is people are not going to respond as the script in our head would like them to.

I say this with love - as someone who also used to do this - but you appear to idolize Dr. T (and had the same pattern with ex-MC) - taking whatever he says as gospel. I used to have someone in my life I treated that way "S says this, S says that" - I emailed S all the time - requested extra sessions, spent a ridiculous amount of time obsessing over what S did or did not say or email to me. It was painful but I walked away and haven't repeated that pattern since (that I'm aware of).

I've been with my current therapist for 10 years and while I love her - I hardly think of her outside the therapy room. It's a healthy growth pattern for me.

In terms of how my T deals with talk about SH/SI she always brings it around to finding out what purpose the urge to SH serves for the whole. Once we identify the purpose (usually to avoid overwhelming emotions) we talk through safe ways to manage the hyperarousal to bring it down to manageable levels. Then, "out in the field" I practise those strategies and later discuss hw it went, and we tweak as necessary.
For me, SH is always about emotional dysregulation/overwhelm in daily life, and we keep working at strategies to help with that. fi now have a pretty good handle on it most of the time, but not always.

The emotional dysregulation and overwhelm is, of course, due to not having needs met in childhood, but that is irrelevant . I didn't learn strategies for self-regulation then, so my task is to learn them now.

This is only somewhat related, but I have found EMDR helpful for emotional regulation. I am incredibly skeptical of EMDR, and yet my brain is becoming an increasingly more calm place as I keep doing it. Kristen Neff's self-compassion stuff has been helpful too. The do yoga/go for a walk type strategies are good for me for regular routine mood maintenance, but they often don't do much for me when I'm in the type of distress where I would spiral into unhelpful old patterns. DBT skills and figuring out what I need and how to provide it to myself in a caring way can more helpful. (DBT coaching is great too! You get support from your therapist and are also slowly building ways to not need that support.)

ex-T was abysmal in regards to helping me curb my SH/SI behaviours because he lacked the competency in how to properly treat complex or developmental trauma. he handled it similar to your T and didn't really say much when i tried to discuss it besides being sorry i had done it or sugesting silly alternative coping mechs, like snapping myself with a rubber band when the urges arose. unfortunately, when i was is in the thick of the emotional dysregulation, snapping an elastic band on my wrist was never going to quite sooth the overwhelming chaos that was being experienced in my body and mind like the endorphin rush i could elicit from the SH i partook in to cope. it wasn't until i found a successful way to start calming the emotional dysregulation with the help of neurofeedback therapy from a T who understood developmental trauma that my urges to SH abated. talking and trying to over analyse from every angle the 'whys' to my SHing and what would or could be the best way to stop doing it was never successful in curbing those urges which often resulted in feelings of frustration and disappointment from the misunderstandings and mis-attunement from my T. in the end, it was incorporating a body centered modality (neuorofeedback) along with the relational/attachment work that was ultimately beneficial for my SH and the healing of my developmental trauma.

How would you describe the ends of the spectrum? If "people pleaser" is one end, what is the other end?

I think this is a pretty common approach for therapists whose practice is informed by a humanistic approach. My therapist sounds very similar.

However, a key part of the work which you describe involves his boundaries, various restrictions and negotiations about the relationship. This is what is missing for LT from the descriptions she provides. LT states her need or want; her therapist can't meet the need (for whatever reason, valid or not), but - and this is the key - he does not seem to have the subtlety or skill to discuss the relational aspect of the interaction. LT is left with unmet needs and confusion about whether it is appropriate for her to articulate her need. It feels like LT is only getting half the story - learning how to state her need/want.

Sorry to talk about you in the third person, LT!

Ts would mostly be neutral in response to SH. If they show alarm, that might spook clients who may then shut down and never, ever, mention anything SH-related. IF T shows an emotional response, this might be an incentive where clients indulge in more self-harm behaviours because the reward will be T's caring.

As for expressing wants and needs. Ts are not there to satisfy clients' needs. The primary aim is to get clients to be independent and self-sufficient. In other words, find or build the resources within ourselves to satisfy those needs. Another way is to reach out to our environment (people in our 'real' lives). And sometimes we may not even have our needs met... In which case, it is important for us to learn to self-soothe and work past that.

Just like teaching the baby bird to fly. T is a facilitator to help clients fly. They are not supposed to do the flying for you. There is a fine line between enabling and supporting and good Ts ought not to cross said line. I do feel your T messed up by succumbing to your demands. This does not help because you (most clients) would then expect more and more from T and that is not how it ought to be. We need to get what we need, not have it handed to us by T. That can also lead to confusion and/or boundary violations.

Yes! I couldn't put my finger on it, but I think this is it. It's kind of like Dr. T wants LT to somehow know which needs are reasonable and how other people are likely to feel about them, which isn't really possible. In fact that likely exacerbates her anxiety. Then he says no and gets defensive and there is friction between them that eventually gets resolved on the surface, but the underlying process of understanding and validating the need isn't dealt with.

For most therapists, there are certain requests that are likely to be granted (closing the blinds, moving an appointment, talking about this topic and not that topic, etc). There are other requests that should never be granted (marrying the client, adopting the client, any number of increasingly elaborate requests, etc). And in between there are many shades of gray to be negotiated.

I think sometimes the negotiation of the request and getting the therapist to fully understand why it matters to you is often the most important part, regardless of whether the therapist says yes or no. My main therapist (who used to be warm, fuzzy, and relational) has stopped doing this for reasons I don't fully understand, and the effect is devastating. It is hard to accept yourself if your therapist doesn't seem to accept you or care to know why you want what you want.

Acceptance is not necessarily the same thing as acquiescence, by the way. It's about putting all the shameful, irrational desires out there in the light of day and having the T ask you what they mean and show/tell you that it is okay to feel how you feel. That's where I see the recurring ruptures happening (the stone, the standing, probably a few other things I'm missing). You eventually get to yes or no, but his feelings (annoyance, discomfort) get mixed into it before you both can understand and validate your feelings.

I think the thing you keep asking is "Can you meet my needs?" and the answer he keeps giving is "I want to but I don't really know how." It might be an improvement over your parents who maybe weren't always overly concerned about wanting to, but he still might not be able to get you to where you want to go.

The most helpful moment I have had in therapy was when current T had counter transference and started seeing me as his 18 month old granddaughter. Huge breakthrough! T realized that in relationships, the very basics of relationships, his 18month old granddaughter knew far more than the 42 year old woman in front of him. As clients we can’t know what we don’t know and so often T’s assume at least a basic understanding of things that might not be there. So now he gets it on so many more levels. He knows that with it being that young talking isn’t going to work. I have to see things, mirror things, have things modeled for me... THEN he can explain and I slowly start to get it. He gets that sometimes it is going to be over things that would be important to an infant but a 42 y/o “shouldn’t” get worked up over. He has SO much more patience and empathy now because where I am developmentally in a close relationship is where his granddaughter is. He gets sad that this is the first time I have felt safe enough to attempt to go through these basic developmental milestones but he gets it. Some things he asks about (is it OK if I keep my hat on today, I know it makes me look different and that might be upsetting). Sometimes he waits for me to ask (can we sit on the couch because that is the only place right now where I feel safe moving towards and away from you when I need to). It is always “little” things that upset that part of me with unmet needs and leave adult me feeling completely misunderstood or not seen but there is no way for me to explain it other than “the hat bothers me”.

It is so unfortunate that we are left to try to explain these things in logical words when they are often right brain/emotional/timeless/wordless things.

I don't think understanding the want or need necessarily means it will be granted. LT, sometimes I get the sense that you think if Dr. T only understood certain things, he would act in the way you want. I don't think that's necessarily the case. And that probably feels invalidating because with that assumption comes the belief that understanding would lead to validation through acquiescence. So you keep trying to force him to understand because you conceptualize understanding as meeting the want or need.

You make some really good points here. There have been minor requests that he's granted without question, like closing the blinds when it's really sunny or adjusting the thermostat slightly if I'm warm. He even agreed to reducing my fee when my insurance coverage changed without much discussion at all (like, I offered a number I thought was fair, he agreed to it, that was that).

But other sorts of requests, yes, he lets his own feelings get in the way at times. He's said that he shares with me what he's thinking and how he's reacting to me more than he does with other clients. Because, as he puts it, he wants to see how other people in my life might be reacting to me (but without telling me). In a way, I get what he's trying to do. It has helped at times.

But it has also led to me stress about things needlessly, like some times he's said he might have reacted in a certain way in my H's place. Or suggested that my H might have "caregiver fatigue" toward me. And then, after feeling really upset by those things, I've asked H about it, and Dr. T has been really off base. Dr. T has even admitted that he doesn't know how other people might feel in reaction to things I say/do. So...I'm not really sure, ultimately, if that approach by him is more helpful or hurtful--as in, increasing anxiety.


I suppose it does get me to check in with people (H, a couple friends) more if I'm concerned about what they may be feeling. But I'm not sure if the anxiety before that is necessarily worth it? I mean, I feel anxiety anyway, but from some of what Dr. T has said, it can make me think, "oh, no, this friend must be so sick of dealing with me." When...they aren't (and these are friends I trust to be completely honest with me, because they have been in the past).

Like Dr. T talking about feeling frustrated with me and "trapped" (into responding) when I emailed him that one Friday night with SUI and desires to SH. (When I told him afterward that I wouldn't have expected him to reply even once, let alone twice, on a Friday night, or if he'd just replied with "I can't help you with this right now, here's the number of a crisis line." He actually made it worse, especially in expressing some of that frustration to me.

So then I was worried about friends (or H) I'd share with--were they frustrated with me, too? Did they feel "trapped" if I told them that I was feeling really bad, like they had to keep talking to me even if they wanted to go to bed, say? The answer was essentially no. (And for the record, I offer the same thing up to those friends, and have done so before, so it's a very reciprocal relationship.)

This line of yours particularly resonated with me: "Acceptance is not necessarily the same thing as acquiescence, by the way. It's about putting all the shameful, irrational desires out there in the light of day and having the T ask you what they mean and show/tell you that it is okay to feel how you feel." That's something that ex-MC was really good at. Being very careful not to shame me and normalizing my feelings and desires.


Dr. T is...not so good at that. For example, it took him a really long time to understand why I felt shamed by the stone thing, like having it come up periodically for months. When you guys on here--who are mostly not trained mental health professionals--got it immediately. He's said he also now understands what significance a transitional object has for me and how I use it, so he's fine with my having one. But when he didn't understand, he shamed me for it. Rather than taking a step back and being like, "OK, this is clearly very important to her. Let me try to understand this before dumping my own negative reaction all over it."

The same with the standing. He didn't even let me really explain what it was all about before he was all like, "I'm not going to sit down and then stand up just to sit back down again." I'm aware that I didn't handle that situation well, like sending him the email afterward, but his intense negative reaction confused me. It could have been a calm, rational discussion, but it wasn't. And it left me afraid to request anything else from him for months because I feared seeming "controlling." (I'm not referring to something like an extra session, because that's different and something he's given me without issue in the past--I mean asking for something from him, like a new stone after I terminated and came back. Took me 2 months to request that, and he happily agreed.)

OK, this is really long, so I'm going to put any further thoughts in a separate post!

That is brilliant, susannah. Thats exactly how i felt about my family. I kept talking to them, hoping someday they would understand and meet the need But they only kept talking to me, hoping that one day i would understand their POV - the opposite - and conform to their way of thinking. I was barking up the wrong tree.

I think sometimes it's just that I want him to understand. I don't believe he'll give me anything if he just understands why I want it. Like I know he absolutely would never give me a hug or, say, hold my hand if I'm really upset. But I want to be able to talk about why I might want those things, even knowing I can't have them. But I feel like trying to do that with him would just turn into his saying he won't give me that, when it's not my point.

Or even with the empathy for SH thing, part of me wants to be able to go in there today and be like, "Damn it, I really hate that you won't express sadness toward me about that." And that he could validate those feelings of wanting that, even if he won't give it. Like, "It makes sense to feel that way, and I get how it could be painful." Because he'll do that about a lot of other stuff, and I find that to be very helpful.

Understanding and validation were things I felt I often missed from my parents (even now), so it can feel very healing to get it now. There are topics with Dr. T where I can feel very heard and validated, stuff about my D being a major one. Or about how my intense anxiety as a child could be considered a form of trauma. Uh...now I lost what my point was here. I guess that validation and understanding can go a long way with me, even if it's not something that he can do anything about or offer.

Hm...maybe that's something worth talking about with him. How sometimes I'm expressing a need or want to him because I sort of want that desire to be validated, even he can't or won't meet it (whether by choice or reality, like he can't go back in time and affect my childhood).

This is a really dumb, minor recent example with my mom, but yesterday I was telling her how intrusive the service was at the restaurant H and I had gone to the night before, like the waiter and busser were basically staring at our table, and the second we cleared a dish, they'd grab it. Which was many times throughout the meal (we had some appetizers). And my mom was like, "Well, I think in places like that, they consider it to be good service." (she was referring to places of a certain ethnicity, incidentally...). Where a "Yeah, that sounds annoying!" would have been great. Not that I'm expecting everyone to agree with me! It's more a consistent pattern of how my mom has reacted all throughout my life. Of invalidating feelings and emotions.

A much bigger recent example is when I'm trying to deal with D sobbing and clinging to me as soon as I arrived to pick her up, and my parents both kinda laughing rather than seeming at all empathetic. And any time, especially when she was younger, when I'd express distress or frustration over something with her, it was like, "Welcome to parenthood!" and/or laughter instead of "Yeah, being sleep-deprived can be really tough."

One of the biggest ones from teen years was my telling her I was depressed and wanted to see a therapist, and she said, "What do you have to be depressed about?"

I don't get the impression he's the type of therapist who sees all wants as valid. For example, it seemed like he sent the message that your want for him to say something to make you feel better wasn't valid that time you sent an email right before you temporarily terminated. I think he said something along the lines of it being an unrealistic expectation and something you shouldn't expect from other people? That to me says the want was not valid in his eyes. Maybe you have fundamentally different views on the subject of the inherent validity of wants and the feelings underlying them.

I agree with this. He seems to want to mould your needs/wants into a form which he finds palatable. Your therapy seems to settle when you are "behaving" and expressing the kinds of desires which he thinks are appropriate.

Family is so much more difficult. I am struggling with H currently because of what I experience from T. Yesterday H got home from work and asked how my day was. I dodged the question because it had been an aweful day and I knew Hs reply would just make it worse. But, H persisted so finally I told him it had been a really difficult day for me and that the snafoo we had on Saturday was really upsetting for me too. His reply was “It’s Sunday”. What does that have to do with what happened Saturday night? You are always bad on Sunday. You are always bad on days ending in Y. So... backed with what I am learning from T I gently confronted him that I really needed support right now and his comment felt really dismissive and hurtful. And... I got back “I can’t do compassion”. Sadly he is my H and not my T and while he was more compassionate before we were married it was never T compassionate. As much as I want more from H I have to realize that H is not my T, our relationship isn’t all about me and, hardest of all, I can’t change him. Even if I tell him what I need to hear he will no do it.
So... back to T... I go to T and ask for what I really needed and I get it (most of the time, if I am being reasonable). Each time T gives me what I really need that huge emptiness gets one tiny drop smaller... after a year it is just barely starting to get noticeably smaller. As it does I have more compassion for H and I am far less likely to fly back at him out of my own hurt and start a rip roaring fight. But it is slow.

Edited to change seafood back to snafoo... spell check hates me.

Your parents don't get it LT and perhaps never will. Maybe explainignto Dr T is you trying to have him understand like you want them to. That's just my armchair therapist talking lol

In reality they are not going to get it and neither is he, so what do you do? keep butting heads? Look elsewhere to get what you need? Put in the fight you have towards healing this need? It's all your choice.

I am also somebody who doesn't view all wants and feelings as valid. I am not saying that as a comment on anything in this thread, though, as I don't really have an opinion to be honest and it's not really my business to evaluate the validity of wants I'm not being asked to fulfill. The reason I don't think wants and feelings are inherently valid is because the definition of valid (sound; just; well-founded) is often so at odds with wants and feelings. If I'm honest, I want the therapist to be at my beck and call and to never go on vacation, but there's nothing valid about that. I'm not an infant and she's not my mother. It's not sound, just, or well reasoned to have these feelings of dependence and feel the anger and panic of a small child whose caregiver has abandoned it when she goes on vacation. It may make sense that I feel that way due to my early experiences, but I don't think that makes it valid. It is not a way I should feel. I guess you could say I was given invalid care as a child and that has predictably led to me having invalid feelings and wants at times.

It's not valid for someone to want to sexually assault someone else. They may have feelings that they want to dominate and terrorize someone, but their feelings about that aren't valid. It's not valid for misogynists to think women are inferior or feel contempt, hatred, etc. towards women. It's not valid for a racist or xenophobic person to fear someone just because they are Muslim, or think that someone of another race must be any certain way. I could go on forever about this. Yes, these are some extreme examples, but it goes to the argument that not all feelings are valid just because we feel them.

I also think this belief can be harmful. I feel a lot of self hatred and shame. Is that valid? I want to hurt myself sometimes. Is that a valid want? I have a lot of self destructive wants, and not all of them are clear cut or obviously bad for me.

Not all wants/needs are valid as desires which can be met, validated, or which are acceptable, but all wants/desires are valid as therapeutic material.

Fair point. But does that necessarily equal Dr. T validating them?

Whoa! In a weird coincidence, I was just listening to a podcast this morning, and it perfectly explained the thing Dr. T said about how "most people's" memories get happy and fuzzy over time but yours sometimes don't (On Being with Krista Tippett where she interviews Bessel van der Kolk). Apparently the memory thing is a consequence of trauma! (I am talking specifically about the section where he talks about people who are interviewed right after the war and again thirty years later. The people who didn't get PTSD had romanticized their experience, but the people who had gotten PTSD told the exact same story both times.) So Dr. T is seeing something important about your mental process and then saying, "So... what's up with that?!" which probably makes you feel like a space alien. But actually he is noticing a consequence of trauma and then kind of throwing up his hands because he doesn't know what to do with it.

If you have been chronically invalidated, it's easy to keep invalidating yourself. I think it is encouraging that you are referring to your childhood experiences as trauma because they absolutely are. And I think sometimes when we or Dr. T try to parse what is a reasonable request or a valid feeling or whatever, it is likely continuing the cycle of invalidation for you. I am wondering if adding another therapist for EMDR/trauma work specifically could help you. Liz is fine with me seeing Amy at the same time (even though Liz is usually dead-set against people seeing two therapists at once) because Amy has specific techniques that Liz doesn't. I really, really think you could benefit from trauma work at this stage, and it would resolve some of these things you are wrestling with in your sessions with Dr. T. You may find that once you get some of the trauma work done, your sessions with Dr. T will become more productive because you can take the good things he has to offer (like all the marriage and the parenting stuff) without being occasionally blindsided by the trauma responses you have when he doesn't get what you need him to get. By this I mean that you will get you, and you will see Dr. T more clearly and be able to deal with his blindspots without being blown off course. (This will likely extend to understanding your H and other people too, obviously.) It's hard to work on relationships when you still have work to do on your self.

Oh that's a weird coincidence, EM! Thanks for sharing the link--will listen later today.

The EMDR suggestion is something to consider. The backup T I saw a few times, R, actually does EMDR, but not sure if it would be better to see someone with no connection to Dr. T if I went that route. I saw someone above mention hypnotherapy, too. Could be worth asking Dr. T if he'd be open to my, say, seeing him once a week and doing EMDR once a week. Or possibly DBT, I don't know.