[MissCharlotte]

Does your T have a treatment plan that he shares with you?

Have you had input into this plan?

Does the plan include goals with specific timetables? Were the goals made by you or T or both?

What is the plan if you don't achieve those goals?

Just wonderng.

My answers are no, no and no. I wish i knew though.

[pachyderm]

> Does your T have a treatment plan that he shares with you?

Yes.

> Have you had input into this plan?

Yes.

> Does the plan include goals with specific timetables?

Yes.

> Were the goals made by you or T or both?

My T works in a public clinic, where I guess "goals" are required. They asked me what my goals were, and I created some. I do not think either he nor I take these goals totally seriously, though since I was allowed to create them, I do want to achieve them. The goals are subject to periodic review by us, for submission to the "authorities" if any, I suppose.

> What is the plan if you don't achieve those goals?

I don't know that there is a plan. Try another therapist?

[chaotic13]

No, and I think that is why I was having some trouble initially. I was too afraid to ask what my actual diagnosis was and what the typical treatment approach will be. I really like a game plan to review and prepare me for what I am about to take on. It would have been really helpful for me to understand how treatment typically progresses, and most recently what some pitfalls might be for me.

I guess I have TRIED not to be a control freak and am working off the assumption that T doesn't necessary work this way.

I often wonder if my T has a structure treatment plan or if it is taken one day at a time.

im the same way mckell.. and each time i ask i dont get a good answer. maybe that the strategy of some Ts to not tell the diagnosis or treatment plan and to focus on a client-centered view of whats important or just not tell us. who knows. it has me all confused.

[sunrise]

Sister, very good questions. Very thought-provoking. I look forward to reading what everyone has to say.

Does your T have a treatment plan that he shares with you?
Not really. Nothing in writing.

Have you had input into this plan?
There is no plan, however, on my very first visit to T, he asked why I was there, so yes, he did seek my input right up front. He suggested that my self-reported "stuckness" was due to past trauma and he invited me to do EMDR to help with this. Since I had never heard of EMDR, I couldn't have known to suggest it. I trusted him on this, did EMDR for some sessions, and we worked to get some of this trauma healed. With that behind us, we turned toward the reason I had come to see him and could work on that more profitably using conventional talk therapy. He also helped cure me of the last remnants of my depression. We never discussed that he should do this or what approach he should take. He just did it, and I was very happy he did! I let him take the lead on therapeutic techniques he uses with me. I never do anything I am uncomfortable with. He is a sensitive guy and he can see for himself when a technique he tries with me is not working, so then he drops that approach. I am not a therapist, so I cannot know what to suggest to him to try. Does that make sense? I can just learn from experience (with my former T and him) what does and does not work for me.

What freaked me out a little bit was the "plan" my T shared for me about working with the family in therapy. After the first time he met with the whole family (me, H, kids), he then told me his "plan" and I wished I didn't know. Squikked me out a bit. There have been no more steps forward with that, but it lurks in the future and fills me with a sense of doom, forboding, etc.

Does the plan include goals with specific timetables?
He asked my goals the first day of therapy. He has told me he does not do longterm therapy, which he defines as over 3 years, so this is always in the back of my mind as a "timetable" of sorts.

Were the goals made by you or T or both?
My T operates on the client-centered model so would always seek the client's input on goals. I had what I wanted to work on when I first met him. But my goals morph, and he is suitably flexible. I think, after some months, once we got decided on the divorce, T swung into his divorce advisor mode and has clear ideas of how I should accomplish X, Y, and Z, and how to help me do that. He's done it with so many couples, that I want to make use of his experience. An important piece he wanted to do, almost from day 1, and that I was strongly resistant to for eons, was to get my H into his office for couples therapy. I finally agreed to this, and it was so helpful in moving us forward. So this is just one example of "T knows best," and I appreciate his patience while waiting for me to be amenable to his unspoken "plan." It was illuminating to me one time when I was meeting with T and my lawyer together, that T said something like "we got you separated" and I realized he took some ownership of the milestones I had accomplished. And here I thought I had accomplished these things! It made me smile; I am happy to allow him that ownership. My fear now is he only wants to work on divorce-related goals. I have a hard time getting him to talk about anything else. I worry that once the divorce is done, he will drop me. Mission accomplished, bye.

What is the plan if you don't achieve those goals?
It is my belief it is up to the client to continually evaluate the efficacy of therapy, speak to the T if things are not moving along as she desires, and to seek another T if she has gotten all the help she can from this particular therapist. There is no shame in exhausting the skill set of a particular therapist and needing something else from someone with different skills. Our needs grow and change. It is OK to outgrow your T. I believe the T should also do a similar evaluation and if things are not working, share with the client advice on trying a new approach or a new provider. The hard thing is, if you need another therapist with different skills, but you have a very strong bond with the current therapist. I think it would be hard to let go of that relationship to seek what one needs with another provider.

[chaotic13]

This thread as well as my recent meltdown has really got me thinking what's next. I'm kind of at the point where some issues are on the table and now I'm asking, how do I go about fixing them? I had such a hard time getting certain things out, is the hard part over? Is it just beginning? Is there some technique or mental exercise that I am going I have to do to overcome these issues? It is obvious this week that simply remembering and disclosing stuff hasn't solved any of the issues. This is where I'd like to refer to some type of general treatment protocol. So I could see where I am in the overall process. I have no idea what to expect in my next session. I'm a bit freaked because I have no way of preparing myself for it. I'd like to be able to predict somewhat how my T might likely respond with the information she now has on me.

[sunrise]

sister, I've been wondering why you are asking these questions about treatment plans right now. I know you are in the middle of a rupture. I wondered if maybe you feel you should have a treatment plan and you don't?

Then I thought the opposite--maybe T shared a treatment plan with you that you had not known he had until now. I'm wondering how I would feel if my T suddenly told me he had a treatment plan for me but had never shared it. And it had a bunch of goals on it that were not my goals. And a timetable that was not my timetable. I think I would feel betrayed.

Please excuse my meanderings. I have found your post very thought-provoking.

I hope you are OK.

[MissCharlotte]

((Sunny))

Thanks -- I am barely ok.

Someone else asked me the same questions in PM. No, i don't wish I had a plan and no he didn't suddenly share one with me. The one thing I know about myself is that if my therapy is not self directed it won't work.

I was really just curious and the curiosity was prompted by certain things that he said to me, (that made me think he was changing gears) so I began to wonder.

This rupture has taken its toll and although I suspect we will repair, at this moment I truly don't know. I am working through a tremendous amount of past trauma/abandonment. It is very painful and sometimes T is a bumbling idiot in his efforts and it begins to feel like abuse.

I am in a lot of pain right now, but I plan to keep posting about the rupture. (I'm sure there will be something tonight if I can manage it....)

Thank you for asking.

Peace

[Mouse_]

Sister, Yes keep on posting.

[pachyderm]

> sometimes T is a bumbling idiot in his efforts and it begins to feel like abuse...

I have exactly the same reaction. Sometimes I feel that they do not care enough to be sensitive. Their lives are OK, why should they worry?

in schema therapy it is very clear that the T is supposed to be open, overt and above board with every aspect of therapy.. nothing hidden at all. The client is strongly encouraged to learn as much as possible about the process.

all sounds great... unless the client plugs her ears.

my T wants to have a treatment plan. He wants to structure stuff, to a degree - ie not as much as in CBT but more than psychodynamic. He wants a lot of stuff that i ain't giving him.

it's not that i don't want to fix things, it's that talking about goals, etc gives me a particular trigger that is hard to explain. i guess in essence, i need a goal about goals.

i have goals, i just cannot lay them out for him yet. i give him bits and pieces here and there. He says he is working blind and i laugh at him.

the way i look at it is this... i work hard at this.. very hard. i take it very seriously. i have things i want to accomplish. So... i'm not going to piddle around and waste my time or my money. i take what he says deeply into consideration.. i try to apply what he says... we do work on concrete things as well as more abstract things. So, it's like my grades at school, i don't go get them.. i know i am doing my best. Same thing with T.. i may lie to myself sometimes, i may get things wrong and i may even behave poorly.. but overall i am doing my best at this. i don't feel i need a big picture map right now. i don't feel like we're spinning our wheels.

i'm curious about the ideas of "diagnosis" and "treatment." i dunno, i mean they are appropriate terms, but it doesn't feel right. i feel i have issues to work on.. but i don't feel like it's an illness. i have been dx'd BPII but we don't go near and bipolar issues, we work on things like my confidence problems. i see myself as having no more or no less issues than anyone else on the bus you know? We all have issues and histories, i'm just trying to do something about the problematic ones and a lot of people don't. How can someone dx the human condition? It's not abnormal to have problems. Curious-er and curious-er.

[chaotic13]

Jello,
In your school comparison, if you are struggling in a class do you ever go to the professor to seek their input on how you might better approach the content? I am very much an independent learning, at this point I know how I learn and acquire new information. If I know what it is I need to learn, I can usually, despite what the teacher does, map out a course of action that will meet the learning objective. I can do this because I know this part of myself and I am an educator and know different approaches to use.

However, with therapy I feel totally lost. I can't seem to see the overall process nor figure out where I am relative to it. (Am on on chapter 1 of 5, 3 of 10, etc?). All I know is that I was once relatively happy with my life, now I am unhappy and I can't figure out how to undo the mess I've created. I am also the type of freak that has trouble simply letting go, trusting that someone knows what is best for me, and just relaxing and following her lead.

well, part of the issue is that she isn't in the lead, nor should she be. i do not want nor mean to be oppositional, but i have to ask why did you go to therapy? What did you want or hope to do? What is it you want now? What end results do you hope for? Why do you have trouble letting go? What would you like to be able to do instead? Why does not being in control worry you? What might happen? What might not? Why do you think you're a freak? WHat is your definition of freak? How did you develop those feelings? If you answer these questions for yourself then that is your lesson plan.

i don't think you're a freak. i do think you're right about the letting go and trust and stuff... i think not feeling "smart enough" to just figure it all out or think your way out of it is in there too right? Knowing something intellectually doesn't necessarily mean you can just fix it. That part takes time.. a lot of it sometimes.. it takes patience and trust, not in the T but in yourself. You have to believe change is possible and that you deserve to be as happy as anyone else.

we lie to ourselves.. in defense against pain usually. We trip ourselves up. A T can help that part... to help you see the lie vs reality, or how a pattern is present and maladaptive to your current life. They can try to help us learn new methods of doing things and support those efforts until we have them mastered.

THOSE are the things to relate yourself to... The unhappiness now, that lost feeling.. of course you are going to feel that doing this was a bad idea, etc. i never ever ever tell anyone to go into therapy. i also never tell anyone that they made a mistake by doing so. When we work on ourselves our T's are kind of like a truth mirror.. when we are lying to ourselves they are supposed to help us see that.. and not by just saying it to us, we need to be gently prodded around to finding that nugget ourselves.. cuz for whatever reason one design flaw of humanity is that we don't engrain anything of that nature that we don't discover ourselves.

a lot of us end up feeling unhappy or unsure or both, and for an extended period... we wade into internal waters that we aren't familiar with and we don't like what we learn about ourselves. i don't like finding out that i'm not the independent, in control person i imagined.. i found out i jump from person to person hoping to find approval that i didn't get when it was crucial. Sad eh?

thing is, it isn't the therapy that is the source of unhappiness IMO, it's what we learn about our world/self view. It's like having to feel pain to have a broken bone reset.. i would imagine that when the doctor is moving that bone around the patient might wish he/she had not chosen to have it seen to.

ignorance is bliss.. or it was.. can't undo what you discovered about yourself and others around you. You can be happy again tho.. and as idiotic, trite and off-handed as it sounds, all i think you have to do is to stop trying to have every detail worked out before you get there. i know.. easy to say. Once you have the process all figured out... you'll be there. i think therapy is a mystery insofar as we are mysteries to ourselves.

(again Mckell, no intention of being pushy or anything k?)

forgot to address this... about the school analogy.. i do go to my profs, about the material, but not about approach. i go and i say "i do *not* understand what Baudilaire is saying, i'm over my head..." i don't wish i'd not gone to school, just to stick with the analogy. And since we're there... are you asking that teacher about what you are struggling with? Are you saying clearly and directly that you don't understand the lesson plan? If it is something that is deeply important to you, especially in making you feel more stabilized in doing this... then ask. Direct. What could happen?

[pachyderm]

> ask. Direct. What could happen?

Some of us (well, me anyway) learned as children NOT to ask anything that could be taken as a criticism. And just about anything could be so taken. What could happen? Threat to life?

You say, it is now, not then. But the lesson was learned very thoroughly. Are you SURE it won't happen this time? What are the guarantees?

Maybe you get some idea what some of us struggle with.

i'm sorry pachyderm.. for two things, one and most importantly, that something like that happened to you at all.. the other is for my wording. i know all too well just what reasons there might be for not asking..

It was more of an internal questioning i was getting at.. and in this one case Mckell raised the issue of going to a "teacher" first, so i continued with it in that vein. i assume she had no historical physical fear of the teacher in question.

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You say, it is now, not then.

</div></font></blockquote><font class="post">

um.. no? never have i, nor will i, ever tell someone such a thing. That would be a pretty big failing in understanding. i don't think many kind things about myself, but i'd like to think that i try to be helpful and supportive most of the time. No one is perfect.

[chaotic13]

Mz jellfluff said:
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You can be happy again tho.. and as idiotic, trite and off-handed as it sounds, all i think you have to do is to stop trying to have every detail worked out before you get there. i know.. easy to say. Once you have the process all figured out... you'll be there. i think therapy is a mystery insofar as we are mysteries to ourselves.

</div></font></blockquote><font class="post">
I get what you are saying here. If I could relax and go with the flow. I would be doing a lot better in Therapy and enjoying life a lot more.
I just can't figure out how to do it. Quaalude's may work :-)

As for let a T lead, what I meant was, I need to stop focusing on the process and what she is doing and accept that she is more knowledgeable about some things and I should trust her suggestions even if I don't understand it yet.

[MissCharlotte]

Hi everyone,

Wow, there's been a lot of action here on this thread today!

Pachy, I suspect we have a lot in common, both with the experience of sometimes bumbling T's and the experience of trying to have our needs met and being bashed for that. (Which probably makes it even more difficult to ask for help from T.)

Jello,

Whoa. If anyone mentions goals I'd be running in the opposite direction. Don't fence me in. My original goal in seeking therapy was for help in coping because I felt like I was losing my mind so my goal was to remain in one piece...

McKell,

I'm a teacher too. Maybe you can think of it this way. I have lesson plans but I keep them flexible. Today, for example, the kids were antsy (too much indoor time). So, we played vocabulary ball. We tossed a rubber band ball around the room and worked on vocab for the novel we are reading. Of course, they wanted to play vocab dodge ball but I had to draw the line! So, I guess what I am saying is lay out a flexible plan for yourself but be flexible with it the same way you would for your students. And, no I do not believe you have to trust anyone until you feel they have earned your trust and you feel safe. Then you will be able to give of yourself willingly without looking over your shoulder and accept T's offerings with your heart. Take your time, it's okay.

Peace

[chaotic13]

I liked your teaching analogy. In other words you as an expert are able to respond to your students and adjust the task as needed. Because you are an expert you have several ways to work on vocabulary skills, so you are able to change your plans and still achieve your overall goal.

Unfortunately, I tend to be that pain in the butt student who may be preoccupied with what you are doing and with what I am doing, that I miss the point of the lesson.

Honestly, I am also the student who is very good at hiding in the back of the room, not drawing direct attention, appearing understand what is going on, but in reality being totally lost and hating school.

[chaotic13]

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sister said:

Pachy, I suspect we have a lot in common, both with the experience of sometimes bumbling T's and the experience of trying to have our needs met and being bashed for that. (Which probably makes it even more difficult to ask for help from T.)

</div></font></blockquote><font class="post">

I can see both your points here. When past experiences condition you to alway expect that every question asked or weakness displayed will leave you open for attack-- you tend not ask the questions or show your weaknesses. The skill of the T becomes really important.

[sunrise]

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MzJelloFluff said:
i'm curious about the ideas of "diagnosis" and "treatment." i dunno, i mean they are appropriate terms, but it doesn't feel right. i feel i have issues to work on.. but i don't feel like it's an illness. i have been dx'd BPII but we don't go near and bipolar issues, we work on things like my confidence problems. i see myself as having no more or no less issues than anyone else on the bus you know? We all have issues and histories, i'm just trying to do something about the problematic ones and a lot of people don't. How can someone dx the human condition? It's not abnormal to have problems. Curious-er and curious-er.

</div></font></blockquote><font class="post">JelloFluff, I agree completely with this. The words "diagnosis" and "treatment" are not part of my thought process, and when I see them used, they seem alien to me! Neither T nor I ever use these words with each other. The only need I had for a diagnosis was when I first started to see T, I tried to get reimbursed for my visits, and T had to give a diagnosis to the insurance company. We went over it together and he put down the least "serious" one he could that he said would get reimbursed. We went over this together and he made sure I understood he was just putting down this diagnosis for insurance purposes, not because it had any meaning for our therapy. It was just a bureaucratic hoop to jump through and he made sure to get my "OK" on it before writing it down (it was depression). (Turns out he only had to do this once, since my insurance would not reimburse for his services.)

My T does therapy from a perspective of health rather than pathology, and I really like that. I don't want to have labels applied to me. I mean, how would they help me? Let's just work on my problems, not engage in the exercise of trying to fit my quirks into a box in the DSM.

My daughter's therapist has also never offered a diagnosis, and we haven't asked for one. She just works on the issues. Lately, I have been wondering if my daughter has Asperger's Syndrome. And I have wondered too why I am having these thoughts and want to label her? Would the label be helpful to her? To her therapy? Or do I want the label for me? To make me feel "better" ("it's not my fault she's this way--she has Aspergers")? Would it help me know how to approach and interact with her better? Maybe. I am conflicted on this! Plus, I would feel really bad approaching her therapist and saying, "do you think she has Aspergers?" Like I was trying to label her and box her in. My own T said to me in our last session, regarding my daughter, "I think she's one of us."

[MissCharlotte]

((Sunny))

Having a dx of Aspberger's would be helpful for your daughter as far as getting her the help she may need.

As a teacher and mother, I am in agreement with you about not wanting to label children. I think it often does more harm than good. However, I also see some students who are not getting all they need to be successful. And that makes me sad. I have one student who has Aspberger's and has difficulty self regulating. He is always in trouble wit his teachers and he would so benefit from social skills classes where he could learn more techniques for self-help.

So, I would look at my child and if there are areas where he/she is not as successful as I thought she should be then I would consider the dx if it would get her the help she needs.

Peace