When is it time to start work on trauma?

My old case manager just became my new therapist. We've had three sessions so far (but I've met with her twice prior to that and I've been in Assertive Community Treatment for a few months so she knows my case pretty well) and it's been 30 minutes of DBT and 30 minutes of discussing whatever is on my mind.

I don't discuss my trauma at all with them although it affects me greatly. I am diagnosed with PTSD although if they did diagnose CPTSD at my CMHC I'd probably have that dx (hence the DBT). I really do want to and need to work through what I went through.

Should I wait until we're done with DBT or start working on it during our non-DBT time? I don't think I'd feel comfortable bringing it up yet, but then again I don't think I'll ever really feel comfortable bringing it up so....how to go about this?

Have you asked what they think about it? Personally I never felt comfortable talking about the things that happened to me, but I thought I may not get better unless I opened up. I still find it difficult to talk about. Maybe if you feel the urge to say something about it, just do it and see how you feel afterwards?

What your therapist will provide depends a lot on what he or she regards as important based on their education and preferences.

If you are interested, you might want to read below for an explanation of this. If not, I hope your therapist will provide you with the type of service you desire and which gives the best outcome from your perspective.

I am so very, very sorry that you suffered trauma. That is heartbreaking!

If I remember correctly, there are different schools of psychology and psychotherapy. Some are based on the idea that past traumas exercise a powerful influence on one's life if only unconsciously and that therefore the goal of therapy is to delve into and expose these past traumas to unblock the impediments to living a normal life.

Other schools of psychology and psychotherapy believe that correcting the effects of past traumas, whatever they are, is essential to freeing a person to live a life with some peace of mind and joy of living. These schools of thought often believe that delving into the past is not very productive and often counterproductive.

I am not well informed about DBT, but CBT, its precursor believes that for many reasons, people get stuck in a frame of mind that causes them to view things from a "could be better, but isn't better" perspective. People stuck in this frame of mind view their past, present and future through the lens of could be better, could have been better, probably won't get better.

They view themselves as "I could be better but am not." They view others this way. They view things and events and relationships this way. This way of looking at things is often called "perfectionism"

So one of the main goals of CBT is to teach people how to balance their "could be better but isn't" point of view with its opposite: "could be worse but it isn't worse," a point of view that tends to engender feelings of peace and joy and gratitude and appreciation.

Schools of psychology and psychotherapy like this focus on the present rather than the past. So for therapists who follow these principles, the long exploration of a person's past is not their primary focus.

The focus is on the present.

Of course everyone can say: "My past could have been better, but wasn't better." But it is also true that for most people, their past could have been worse but wasn't worse. The problem is seen as not the past, but on how a person gets stuck in the present viewing their past,

Some of the older schools of psychology viewed human behavior on a kind of hydraulic model. Bad things happen in people's past. They block the memory or details of those bad things. The blockage unfortunately blocks good emotions from getting through, like a blocked pipe blocks all water from flowing.

So the idea of many of these older schools of psychology is to remove the repressed blockage through for example, years and years of psychoanalysis or hypnosis or other methods. The goal is not exactly to help a person to be happy. The goal is to help a person go from being neurotic to normal.

There is a famous quote of Sigmund Freud that reads: "The goal of psychoanalysis is to relieve people of their neurotic unhappiness so that they can be normally unhappy."

CBT [and I think DBT] are different. These are short term therapies. They do not aim at a many year exploration of a person's past. They aim to teach people techniques for dealing current problems.

Insurance companies prefer short-term therapies to long-term therapies to keep down the costs of mental health care.

The doctor/patient relationship is different in long-duration therapies and short duration ones. CBT sees psychotherapy as an educational process. The psychotherapist is a teacher of techniques that have been proven to help people. There is even homework involved.

The patient is more of a student. In a sense, the process is teaching someone how to be their own psychotherapist. The process is experimental. The idea is: try this and see if it helps. If it doesn't help then try this.

The different types of psychotherapy have their fans and their opponents. Some psychotherapist practice a mix of different therapies.

CBT [and DBT I suspect] came from psychologists who were not satisfied with traditional analysis.

One of the fathers of CBT, Aaron T. Beck noticed that unhappiness is often unrelated to circumstances. People growing up in dreadful circumstances and situations and suffering terrible traumas often have an easy going attitude towards life and a genuine joy of living.

At the same time, people who grew up well and in good material and social circumstances are often miserably unhappy. Dr. Beck sought the cause of this.

He teaches that it is the attitudes of people towards their past, present and future that was key to their happiness or unhappiness and that attitude could be changed. The past cannot be changed but one's attitude towards it can, he believes.

I had years of psychoanalysis focused on past trauma and did not find it very helpful although I was greatly helped by CBT. Others have had the opposite experience. People are different and have different psychological needs.

Psychiatric medication is often a game changer in all this. Mental illness has been linked through numerous studies to pathology in the brain for which medication is key.

Of course I could be wrong about all this. I am often wrong about things.

Anyway . . . I hope that whatever treatment modalities you experience will prove helpful to you. It is awful to carry a crushing weight of misery or be unable to experience real peace and joy of living. Those unafflicted with mental illness will never know how heavy this burden is.

I find that if something keeps coming up, whether in your personal life or in therapy, then it's your mind/body telling you you're ready to deal with it. Doesn't mean you have to jump in with both feet. You can tiptoe around to feel your way through.

I think I'd start working on it during the non DBT time. I also think you probably don't have to jump straight in but could tip toe in, feel out how the therapist responds too... (how trustworthy do they seem. at least that would be an issue for me)

We talked a little bit about it. I said it's been on my mind a lot lately. She asked some questions about what happened and I answered. I feel very numb right now.

It's okay to feel numb. It's probably your mind dosing how hard it was for you.