Is there such a thing as being incompatible with therapy??

I'd say it's about how you know: for instance, how you know that you have internals; how you know that you have an external situation; and how you know that you have (or haven't) a wall.

Wow this is a loaded thread (I say that with positive vibes). I cant speak to all of it but I do have some thoughts. Do you have a mental health disorder or have you been diagnosed with a mental illness? The reason I ask is that personally I feel therapy alone in those circumstances isnt necessarily enough. I believe medication can be a good, possibly life saving adjunct to therapy. Without regurgitating what you have been told or heard from other therapists, what is it you want out of therapy? Its ok to sound fantastical, I am not going to judge. Do you wish to be free of all your flaws and become a more perfect human? Do you wish to let go of your anger? Do you wish to become strong enough to leave your a-hole boyfriend? Do you wish to deal with long buried/childhood issues? Or do you simply want to deal with recent stuff, the here and now? Personally I do not think therapy has to deal with childhood issues, trauma or bad parents and abuse. For some, those issues have been put to rest. Some people need situational therapy like couples counseling. Some people want to make changes in their life but dont know what or how.
Some want to make their relationships better, or at least tolerable. I personally believe in most cases therapy has a shelf life. It can be different for everyone. For me it was 16 years with the same man and we were practically hanging out-yet he got to bill my insurance. There were some brief boundary issues so I ended it. That was 11 years ago and only the last 3 have we been seeing a family therapist. I feel that there are unethical therapists out there who will take advantage of vunerable clients in order to keep them as clients. Therapists can be sick too. I would be willing to bet there are some pretty sick therapists out there. This isnt to say that there arent people who have suffered horrendous trauma and abuse, or have DID and many alters that may need therapy forever. That isnt my call. I think a good therapist knows when the therapy has reached its peak and not very much more growth will happen.

I would be really unhappy if I was labeled in a nasty way like you seemed to have been. BUT I also would turn it over quite a bit in my mind to see if there was any truth in it.

There can be truth in uncomfortable things that therapists and other professionals say but it doesnt mean you are a terrible person. I know there is more I want to add but I need to think about it some more.

Ah well... we just know. It's just how things are. Anyways if we're talking about definitions. Then I would say, "internals" and "wall" and "external situation" and all that, there are a few definitions for each one so I am not sure what you are looking for here.

What I meant was that mindfulness sometimes is described as paying attention to your mind's stuff, thoughts, feelings going around in your mind, and then sometimes as paying attention to outside, though I'm not sure how that's different from grounding oneself when needed (upset, etc, too high arousal of any kind, mental, emotional).

This could be a really interesting thread for me to read, but my gut answer (in my present state of being) to your post question is 'yes, I think there is such a thing as being incompatible with therapy, and I think I am just that'.

Is that the same thing as the saying, "yes, therapy is not for everyone and/or might not 'work' for everyone"?

What do people usually mean by that?

Can anyone give input on this? Thanks much.


***

BTW. One more thing I can think of but that's something else. That's technically incompatibility with *most* therapies (not all). Alexithymic people are incompatible with most. And some other people too. But I'm really looking for what is meant by the saying I bolded above.

No one has been able to diagnose me with any specific "label". So I don't really know.

The closest I received for a label informally (not a formal diagnosis, as this doesn't exist as a psychiatric diagnosis), that I felt kinda fit me, somewhat, so well, that was not a mental illness, but a resemblance to one due to certain circumstances. (Sorry I do not wish to go into details on it) I.e it was not of an internal origin, or mental illness. That's what I was told, that I do not fit that diagnosis because it's not actually that but that my symptoms are because of those certain circumstances unrelated to mental illness.

I don't really know if that covers the whole story but that's what one of the psychiatrists told me. The current one decided to just observe me, which means there is no prescribed medication - other than Xanax on an "as needed" basis (which I requested myself and she agreed).

I would ******ing love medication that actually worked for my symptoms and wasn't addictive. So I'm not really on medication regularly. None worked so far like that. Antidepressants nah, several different antidepressants, I was in the end prescribed three different ones, not a change. I don't have typical depression either, anyhow. The depression tests (questionnaires) I've been given never ended up showing me as really depressed.

Lol hm well. I don't even know. I just got this extremely strong hunch one day that "IT ALL HAS TO CHANGE". I've been trying to figure out that need to change ever since then. : P

But more specifically, I just want to stop feeling like I am gonna die soon all the time. I want to stop feeling all the horrible internal things. Things like that. I don't mean a panic attack.

Even more specifically, I want to have working, quality relationships. I want to put my life in order enough already, from it having fallen apart (from a crash, long story).



Well yeah, I mean. I answered your question before reading all these options. So I bolded the ones I relate to yeah.

But if I am really honest, I want a quality relationship. Not just tolerable

OK, in a general way. I was looking for emotional connection, really.

What do you mean by shelf life?

Completely true. I've talked to someone who had a therapist like that. She took it to court. She said it was worth it.

I'm not that terribly concerned about personal growth being speeded up artificially all the time. I just want to get rid of the above issues. However much personal growth I'd need for that or if it is something else that I need or whatever.

Thank you, I mean I don't want to turn it over in my mind any minute longer. Had enough of it having spent so much time on that and having felt so horrible about it and everything.

I got that, that is something I figured myself.

Feel free to, I'd be curious.

I don't know if I've the right words, but I relate quite a bit. I was alexithymic, still have difficulty there. I couldn't go deeper until I felt emotionally safe...and feeling emotionally safe was incredibly difficult. Even topics like work, I didn't want to explore deeper.

My therapist respected and still respects the need to feel emotionally safe even if the client doesn't have words for it, or know that's what they need.

It took years with the same therapist because while I felt painfully empty, I was also really emotionally numb and guarded. She didn't rush me to go deep, she respected my defenses. Said tearing down defenses is irresponsible, they're there to protect. That includes emotional numbing.

It still is tough, although I continue to willingly go deeper to be able to achieve my goals on interpersonal relationships, and my relationship with myself and my System (I've DID).

And I don't believe therapy is the only way, although I've benefitted, as I've seen all kinds of emotional damage a pathologising therapist can do. Or "managed care" with unrealistic expectations.

Thanks for your input, this is interesting.

Did you get therapy specifically targeted for alexithymic people? Or did you go to just "standard" therapy (that works for most people with the issue that has them go into therapy)?

I don't understand what you mean by feeling emotionally safe. What was that like for you?

Sounds like your therapist has above-average people reading skills if she was able to figure out what you needed when even you yourself didn't know.

I agree that tearing down walls or other defenses is a stupid thing to do. Even the word usage, "tearing down" will just remind one of the expression "tearing down" a person and not building them up.

So defenses are there to protect, yes. Of course it's not that simple, never that simple.

So like, I don't know if being emotionally numb is necessarily always meant to be there to protect. Maybe temporarily, but if it makes one stay in the same situation without change that was making them emotionally numb in the first place, it becomes a maladaptive response. So more and more numbness to protect and more and more problems and then it's no longer protection but turns into the opposite. Is my understanding.

But it's true that you just can't tear down defenses, whether adaptive or maladaptive ones. It just doesn't work like that.

What are your goals with interpersonal relationships?

I'm just asking because I'm curious, as I kinda had goals about them myself.

Sure, I'm happy to answer questions. Nope, I went to therapy because I needed to get my new (at that time) clinical anxiety under control as it was severely hampering my work performance. I had previously worked in jobs that didn't require a lot of interaction with people, but this new job was different.

So, I had no idea what I was getting into, or what I turned out to need.

I had no idea I was alexithymic, and also had no idea how much I hated myself, as those issues were my normal. I actually expected just 12 Cognitive Behavioural Therapy (CBT) sessions to "fix myself", and expected therapy to be about how I should think positive and quit whining.

I'd say I got immensely lucky as the CBT therapist noticed my deep mistrust and my deep emotional detachment. She would feel there was nothing to connect to, not much sense of me as a person.

Crucially, she didn't see me as incompatible with therapy even when she realised I was incompatible with CBT. She recognised I needed a different kind of therapy and tried several approaches to see what might help. In no way did she blame or shame me, and she recognised her sense of helplessness and other feelings (eg, that there wasn't any connection due to my detachment) as information.

So she tried Schema Therapy, which is a relational therapy (there are others) because it conceptualized detachment as protective and necessary

I had to end work with her as she went on maternity leave, but critically and extremely fortunate for me again...she referred me to a colleague after very careful consideration.

I understand not understanding that. I didn't recognise what it was like until a long time after.

For me, it felt like I could talk about my issues and that I wouldn't be judged negatively like my past experiences. I had the sense that I was seen as a human being (although that was an utterly foreign concept to me), and not a project to be fixed.

I felt that my defenses were respected, and we talked as partners about those defenses. There was warm curiosity about why I had my defenses, which is different from cold curiosity. I would be invited to lower my defenses a little but it was always an invitation, and the rationale was explained.

For example, emotional numbing means I don't feel any positive emotions. I spent my days and nights like a robot who just works.

Possibly. She (current therapist) and my former therapist said to me that they thought all therapists should be like them, though.

I'd tell them about friends who had harmful therapists or my own experiences with a harmful therapist and they'd get quietly angry at those therapists.

Yup, exactly. My own experiences are like what you describe. More and more numbness.

I don't really know how I "thawed" just that my defenses were never torn down or dismantled, but invited to lower them a bit, and that I could shoot up my defenses when I needed to. For example, it was understood that I'd need my defenses due to the environment I was in at work and with my family etc. That it would be harmful if I left the therapy session feeling raw and exposed. So they ended sessions by helping me bring my defenses back up, although I don't remember how.

I wanted to function better at work, as my issues included poor interpersonal skills with colleagues.

Only later were my goals to have genuine friends. I had none, and no acquaintances, when I started therapy. I didn't think such a goal was possible because "who would want to be friends with me?"

Earlier in my post, I mentioned friends. That came later, as I needed help to recognise traits of the kind of people I wanted to have as friends. Such as non judgment.

Some of my friends do have similar emotional detachment and feelings of being a hollow shell. That's alright with me, they and I are humans with defenses. And crucially for me and them, at least, we respect each other's defenses.

Can I ask how long you've been in therapy for, @Quietmind 2? Just curious, as what you write about sounds like a long, tedious, but worthwhile process. Glad you have had such good experiences

Thanks!, this was very informative. A couple more questions, if you don't mind. I might add more comments on my own experiences later as you got me thinking, too.

Ahh alright what I meant to ask was whether the therapy was therapy specifically adjusted to alexithymic people. Not that you went into therapy due to having alexithymia.

Are you able to clarify for me on this point? Was it standard schema therapy, or did they have access to methods for a version specifically adjusted for alexithymic people?

I am asking because what I've read is that there are a few kinds of people who are incompatible with standard therapies and alexithymia is a good example of that.

So just curious if these therapists were able to work you even if they had no previously working therapy methods or frameworks for alexithymic people and/or experience with alexithymia before.

I'm glad that you did not feel judged by being told all that about no connection or personality being sensed there.

Did she explain to you that she doesn't think you actually don't have a person but just that she is unable to reach it due to the detachment?

Also if you don't mind me asking, did she actually share with you that she felt helpless on the spot? Or just more like, share it with you later in retrospect when somehow relevant for a discussion?

Yes. I mention the Detached Protector and Schema therapy right in my first post in this thread. I've been given Schema therapy too, was a disaster.

This is very interesting to me. I like your wording.

I've not often seen true warm curiosity from therapists, I've seen some try and do fake warmth though.

As far as emotional safety, I feel your description of it is part of being accepted & loved in a relationship.

Where I have had issues is getting to feel loved in close relationships, BTW. And I can't do a fake therapeutic relationship and transference for that, I've not the strong imagination for that.

Frankly, for me younger therapists have been better with real emotional interest, rather than fake it all with a competent therapist image.

That sounds like anhedonia to me.

Did you mean that type of emotional numbing then?

Why should all therapists be like them? Like, in what way? Mind clarifying a bit for me?

Frankly, yes, my overall opinion on the administration of therapies is that it's a mess. There is too much psychological power there that's not regulated properly. Very unethical in my mind.

Sure I am aware that a lot of people have still benefited from therapy, and that in some cases there may be naturally issues with getting benefit from standard therapies. Is why I made the thread.

Like you said, you got lucky. A lot of other people may have also got lucky and benefited from the therapy process but too many people have got unlucky. I still don't know if I am just in that category, myself.

Or if therapy just isn't for me. It's not supposed to be for everyone but again I don't know what that means ???

I see. You mentioned you still have to go deeper in therapy. Why, if I can ask? Because of the DID?

Ahh ok. For me the "goal" (unwilling to use that word anymore for relationships) would be having more quality, close relationships. I've had some close relationships, but just not quality enough and I did not ever feel loved enough.

I'm good with having acquaintances, buddies and loose friends but close relationships......it "worked" for a long time but then was a disaster in the end. As this stuff didn't really actually work.

I'll admit I haven't read this whole thread, but will just share my personal experience.

I tried individual therapy for years, and never got much out of it. When I switched to peer support groups (where the facilitator as well as all the group members have mental illness), I found they were much more effective. I really feel understood in support groups, and I enjoy listening to and helping others.

As far as affecting real changes in my life, the 12 steps are what did that for me. I did them as part of Overeaters Anonymous, but there are many programs that do them, including Emotions Anonymous, which is specifically for people with mental illness, whether or not they have an addiction.

I know this pandemic has made in person groups difficult, but there are may available online and free of cost.

Several years. Around 155 sessions.

I never went weekly consistently frequency of therapy varied (hence calculating by session number), given constraints of public healthcare and my job.

When my T went into private practice (with a sliding scale) she took a lot of her public healthcare clients with her. Including me.

Yeah, it's been worthwhile for me because when I was eventually diagnosed with DID recently, I already had a solid therapeutic alliance with my T.

And I do respect that therapy isn't for everyone, and there are a lot of harmful therapists.

Thanks. Yeah, as far as groups, I found two that I liked, yeah, online because of the pandemic. But I don't often go, I just don't often feel the need, and not often able to, because when I go I always go when I'm at the point where I really feel like talking to others like that. If I were to try to go when I don't FEEL that way spontaneously, then a group talk would for sure be a disaster. ....And most of the time I don't feel it, so I have to do it all alone.

EDIT: What I mean, an online group talk is what would be a disaster. Offline it was just fine when I went even when not feeling particularly spontaneous. But these aren't really available for the topics I'm interested in, when I tried was just to see what a group talk is like. But again, in my country they are available for certain topics and I can't relate to any of them.

So these two online ones are great when I do FEEL like going to them. Like 1-2 times every two weeks or something.

Firstly, I'd say I don't think therapy is for everyone and I don't like how people are blamed for not finding therapy useful. I've seen that sometimes on this forum and I don't want to talk like therapy can help everyone and everything.

I'm not good at explaining why I think so. I think it's because maybe therapy is pushed a lot in some countries or cultures.

In my culture, a lot of people don't want therapy even if they can access it through public healthcare because they prefer clergy or talking to friends.

I got incredibly lucky, and there are also stuff therapy can't "fix", like systemic issues in society which affect many people's lives.

I think it was standard Schema Therapy foe Ex T, however, for my current T, she quickly realised it's not so simple as asking my Detached Protector to "step aside", and that I'm alexithymic... so I believe she modified it very heavily.

How heavily, I don't know. I've read the clinician books and they claim the hallmark of Schema Therapy is flexibility, so to her, it's "I'm just doing Schema Therapy."

I have to say that during times of high chronic stress, I do lose my ability to feel and name my emotions.

I think I also benefited from this book by Robert T Muller titled "trauma and the avoidant client".

I think these days we're not doing Schema Therapy since my DID become apparent. Some alters don't like the concept of being just "modes".

I honestly believe they either had some training or sought out training. And then gained experience. Not sure how to describe my gut feeling. Like, there might not be a therapy training workshop or book titled "working with alexithymic people", but there's literature out there these days.

Developing Emotional Skills and the Therapeutic Alliance in Clients with Alexithymia: Intervention Guidelines - FullText - Psychopathology 2021, Vol. 54, No. 6 - Karger Publishers

Ex T said she was unable to reach me due to my detachment yeah. Said it in the session, and it took me by surprise. She did make it clear that she understood it as a defence, and that she would like to connect in order to be a more effective therapist for me. I remember asking why would she want to connect, and how it would help our work be more effective.

Though I don't remember the answers although I too also asked current T a lot of those same questions.

Hmm, Ex T shared her feelings of helplessness later. On the spot, I did notice (as I'm hypervigilant), but thought it was frustration at me. Therefore I only asked later, when I myself felt frustrated with my progress.

With my current therapist, I'm working on asking "I feel like you're frustrated/angry/bored with me, are you?" quicker in the session itself. It's gone from several sessions before I voice something, to around 10 minutes.

I have a friend whose Schema Therapy was a disaster, and he doesn't do well with relational therapies.

I think one major problem was that the therapists were not respecting his detachment as a necessary defense. Or if they did, they were impatient with this forced "goal" and imposing their own agenda on him.

Ultimately they were trying to fit him into this box and for him to conform to Schema Therapy ideas, instead of adapting to who he is.
I've felt fake warmth, and true warm curiosity, yeah. I definitely accused my current T a lot (almost every session for a long time) about if she's faking care, faking interest, that I don't tolerate warmth because it's a trap.

In hindsight, (thanks to your words prompting self reflection) she titrated her warmth. She wasn't as warm in the beginning.

One thing current T would tell me is that there's no way she can BS clients with fake warmth. She would say she understands why people are guarded, and that she had to earn trust. Mistrust is not the fault of the client.

Oh yeah, I'd agree. I don't quite feel loved in close relationships except for a few very special people. Other friends, yes I value them and care, but there's a certain inner distance I hold, if that makes sense?

For transference in therapy, it helped me to work with it... because Current T does care and has proven that (though maybe other therapists might be horrified) but that's not for everyone.

I don't really know how to explain how I know its real, and it's different from my loved ones. Other than saying I don't think every therapist has that quality. On this forum, there's also been many threads on if therapists really care or does the care stop when the client can't pay anymore... which I definitely relate to.

Have had many debates with my therapist and currently I see her for free or a token amount due to major external mishaps I'm still recovering from.

I believe the ability to detect sincerity that you describe is something important and to be respected.

I'm not sure as I wasn't aware of that word.

For me, it's zero emotions. Not just positive feelings, but negative ones too. Simply nothing at all.

Feeling numb: Symptoms, causes, and treatment

Sure. They meant the stance of not blaming clients, being flexible to what the client needs, being open to feedback, and not pathologising defenses.

Yeah, I agree on the very skewed power dynamics. Which is why I'm staunchly of the view there's not enough regulation on therapists globally.

I should clarify, I apologise for being unclear.

I don't believe therapy is the solution/cure or whatever for all kinds of issues because therapy is very individual focused. Many problems aren't within the individual, and for those, I view therapy as supportive in nature if there's a good match.

Take depression for example, yes for some it's due to their thinking, but depression due to poverty or racism (for example) isn't going to resolve with just free or low cost therapy.

My therapy won't lift me out of my current state of being working poor, but it's a place I can go to get support when I'm feeling hopeless about my situation.

Where I can work on articulating my needs for later when I see my social worker, and work on self advocacy even in a dehumanising system.

And I believe some people don't benefit from therapy because not everyone wants to have 1 to 1 appointments with a stranger who can be like an authority figure.

Some benefit a lot more from peers having similar struggles and a more casual scenario like that of a Meetup group. It doesn't have to be "sit down in a circle and talk" style. I've enjoyed boardgames in a group when pandemic restrictions lifted somewhat in my country.

For me, I wanted therapy so I could learn to form and maintain friendships.

Yes, because of the DID.

I perhaps shouldn't have used the word goal, apologies. Yes, I mean quality friendships.

And to be clearer too, I'm not intending my posts to be saying I'm right and others are wrong.

I do believe I got very fortunate with therapy and that my work there also involves improving my interpersonal relationships, including close friends.

I do have acquaintances and casual friends as well, and maybe some will become closer, and some will be less close.

I guess I also work on identifying what attracts me to want to have a closer friendship among my acquaintances?

As emotional numbing, depression, some degree of alexithymia can affect matters, for sure.

Thank you, that was actually a summary that I found helpful for myself. And yes I agree that people should not be blamed for not finding therapy helpful.

Thanks much for the book tip too. I downloaded it and while written by a clearly competent therapist, it convinced me that I will never try therapy again. It's simply not for me. The way it describes how much drama can be ongoing in therapy, because of countertransference, the way it describes so-called premature termination reasons and so on, all that drama is just.... not something I will be exposing myself to in future. I've had enough of it in therapy previously. I'm not the person that wants to get engaged in bad drama that plain goes nowhere, especially if I'm trying to open up to someone about my most sensitive emotional issues.

So, for me the equation is just as simple as that. Thank you just once more for providing me such a great resource on this topic.


That also sounds like a decent article. I found it quite interesting and possibly useful how it listed alternatives to therapy (I know the article was about alexithymic people specifically but I just like to hear about any alternatives to therapy).

What I also liked in it was the honesty - it mentions that some of the things are still just theory and have never been actually tried on alexithymic people. Which is in line with my other observations: therapies do rely on theory too much for my liking, as in, my personal preference. And that adds to my equation and calculations above:

Random drama played out on my most sensitive emotions + unproven theory and mental experimentation = no therapy for me.


Oh, yes. Often the therapy process itself is pretty much about the emotional connection, some therapies (such as EFT) even work on the emotions themselves. Or in other words, much of the therapy material is emotions themselves in these cases.

Of course, CBT and related therapies will only work on emotions in the indirect way.

(Will admit, I don't see why for CBT a therapist would need to feel a connection with the client. Other than simply paying attention and using cognitive empathy.)

I find that very interesting. Would like to say more on it later if I can. For now, I'll just quickly add, so it sounds like your emotional awareness is increasing, which is a good thing.

I asked about when your Ex T shared her feelings because I think if she had done it on the spot, it would not have been professional. Just my personal opinion and gut feeling, tho. So yeah, that sounds fine to me.


Could you say more on how T proved he/she cares?

This is a very interesting topic. How is it different from the care you feel from your loved ones?

Ahh ok, then yeah that's complete emotional disconnection/numbness, both for positive and negative feelings. Anhedonia refers to lack of positive emotions/pleasure. Ie. the numbing of those.

Interested in my little vision for how to do regulation?

Yes, thank you again, more of a great summary there, including alternatives to one-on-one therapy.

I think I originally went in because I saw I had some psychological symptoms, I wanted change, I wanted to not see the future as hopeless. My interest in making my relationships more quality and to be able to receive emotional connection better only came after some of the psychoeducation was already ongoing for me, as I was not going to realise that kind of issue until then.

Don't worry. No need to apologise for anything at all I'm not the kind of person that easily gets offended or anything like that.

Oh yeah I'd still like to do all that myself. Really interesting stuff about understanding and emotionally experiencing all that, a conscious understanding about attraction and emotional needs and then expressing those and so on.

But I do not believe one-on-one therapy would help me do any of that. Seems like more harmful than helpful for me. The equation I made above is loud and clear to me. So, I guess, I'm not one of those people therapy is for.

PS. I will want to go back to some of the things you've said here, and some things I wanted to say earlier, but it's getting late here right now. May need 1-2 more days before I can put it together properly.

I do want to reply to you too. I've also been doing the "long, tedious ..... process". Maybe worthwhile, yeah, I don't want to claim anything prematurely. I don't mean therapy specifically, I mean all my dealings with psychological and emotional things that I've tried to get myself into. Not an easy case either here, clearly.

I responded to this post before....but I want to add a new thought. I realise that I DO think that approaching issues from a stance with anger rather than from a depressed, low, passive state is better, and means more strength, yes. I don't think I was indicating more than that, though. Because, what I wrote in my OP was, wanting to come at the negative from a place of strength. And that currently - most of the time anyway - I can only use anger (or alternatively, rational detachment) for that, but I do not view anger as the only option for strength. It's only one way of expression or attitude (with many possible nuances to it actually), and there are other ones too, or I wouldn't have asked about this topic in the first place.

Could it be that you do in fact often have anger come up associated with certain issues, and that you've found that finding constructive ways to express it often works better for you than trying to avoid it or hide it and pretend it's not there?

If you were to find yourself in a place where anger wasn't coming up for you so much, you might not want to get stuck working at dredging up anger from somewhere just so that you'd have something to express.

If you meant, expressing anger in constructive ways works better than trying to hide it, yeah I agree with that. I don't really try to dredge up anger, I either have access to it or not in a given moment, but sooner or later I do decide it's time to try to access it, and the purpose of anger for me is usually not emotional expression per se, I usually channel it into action to get to a goal, to keep up the fight, to not give up, and so on, and that's what I mainly meant by going at it from a place of strength when it comes to anger vs being low.