[MuddyBoots]

My therapist keeps asking me how she can help me out better. We were doing DBT for half the session and a general check-in the other half which was helping, but now I'm in a dbt group so she doesn't want to go over the same stuff I'm learning in the group.

I find it hard to open up unless I'm inebriated or manic so that's a big obstacle. Some things I want to work on are shame, trust issues, fear of abandonment, self-destructive behaviors (drug use, self-harm, stopping my meds, bulimia, jumping into and out of and back into abusive or at the very least unhealthy relationships), and impulsivity. I just don't know HOW she can best help me out here, and she doesn't know either because I have a really hard time bringing these topics up (shame) and I can't show up drunk again because I have a conditional discharge that says no substance abuse.

She doesn't do email or texting and phone calls are strictly for scheduling purposes btw.

So, how should I try to ask my therapy to be structured? Right now she just sorta asks what's been going on and about my symptoms/behaviors/relations with others and that takes up about 15 minutes because I don't elaborate and then there's really nothing left to say that I don't want her to say "well, she's a hopeless case."

I'm stupid when it comes to therapy. I grew up "if you have bad thoughts, drink a beer and forget it." I don't know how to just say "I'm suffering. I need help," on the spot.

I want to get better. How do you do therapy?

[amandalouise]

Originally Posted by MuddyBoots

My therapist keeps asking me how she can help me out better. We were doing DBT for half the session and a general check-in the other half which was helping, but now I'm in a dbt group so she doesn't want to go over the same stuff I'm learning in the group.

I find it hard to open up unless I'm inebriated or manic so that's a big obstacle. Some things I want to work on are shame, trust issues, fear of abandonment, self-destructive behaviors (drug use, self-harm, stopping my meds, bulimia, jumping into and out of and back into abusive or at the very least unhealthy relationships), and impulsivity. I just don't know HOW she can best help me out here, and she doesn't know either because I have a really hard time bringing these topics up (shame) and I can't show up drunk again because I have a conditional discharge that says no substance abuse.

She doesn't do email or texting and phone calls are strictly for scheduling purposes btw.

So, how should I try to ask my therapy to be structured? Right now she just sorta asks what's been going on and about my symptoms/behaviors/relations with others and that takes up about 15 minutes because I don't elaborate and then there's really nothing left to say that I don't want her to say "well, she's a hopeless case."

I'm stupid when it comes to therapy. I grew up "if you have bad thoughts, drink a beer and forget it." I don't know how to just say "I'm suffering. I need help," on the spot.

I want to get better. How do you do therapy?

my own therapist does allow emailing,, texting, video calling and so on as well as in person.

now that the worst of the covid "stuff" is over and mental health agencies in my location have re-opened their in person appointments schedules, sometimes I do find it challenging to sit there in person and talk about myself and my problems / issues.

I have learned to overcome this covid shutdowns shyness and uncomfortable feelings by continuing to keep a daily journal.

in my daily journal I detail my day and any problem areas / challenges, if I managed to overcome them or need help with them, along with how I have managed to use in my daily life, the therapy approaches my treatment provider was teaching me. therapy techniques are not just for the classroom or the therapy room, so I make a point of incorporating those skills I learn, into my outside of therapy life.

then on therapy day I take my journal with me to my in-person sessions and share it with my therapist. doing this has "broke the ice" many a time on things like not sure what to say, not sure what to work on, or those sometimes-uncomfortable silences.

I know that it may be strange to you that your treatment provider now is waiting for you to lead the way instead of their structuring the sessions. they do this because they

1. feel you are ready to take a more proactive role in your treatment plans then just the therapist constantly leading you on how to "do" therapy. especially if you have been in therapy with them for a while. they figure you understand what and how your sessions run and you know you best, on what you want to work on.

2. because they cant be in your life 24/7 leading your life for you. they are not there from the moment you wake up to round the clock making your life outside of therapy decisions. they trust that you will take what you are learning in therapy and in your group to make your life outside the therapy sessions and group better.

3 the new mental health system went into effect march 2022. treatment providers have a deadline of leading their clients into a more individualized therapy program where the client and the therapist work on the deeper individualized problems instead of doing the carbon copy style therapy work. to do this it requires less leadership on the treatment providers and more proactive hands on approach with the client where the client tells the therapist what their problems are, what they want to work on, instead of the therapist planning out questions to ask you and leading you through your life issues.

in other words your therapist and the mental health system in place is now trusting you to come to therapy and be proactive in what you want to discuss and what you want to work on. you are the one in therapy and you and your insurance if you have any are the ones paying for the sessions, so who better to decide what you want to talk about and work on in therapy right.

anyway maybe though my situation is different for I'm not doing DBT, maybe what I do with keeping a daily journal and sharing it with my therapist, will also help you with this transition into being the "leader" of your therapy sessions.

[DigitalDarkroom]

Does it help you to write things down? (Your post would be perfect to show her!) I draw or write things out for my T when I can’t speak (which happens a lot). What has she tried so far to help you open up?

[ScarletPimpernel]

When I'm not able to open up, it's usually because I'm not in my window of tolerance. So L and I do grounding techniques: breathing exercises, holding hands, talking about my dogs, pick your poison questions, other questions we printed out, etc. That usually helps a lot. If we need to, we'll do something more than once. And some days are just bonding days where we do games or arts and crafts. That helps me overall feel comfortable with her so I can be more open. And then there's just time. I've been with L for over 4 years now. I trust her and feel safe and comfortable with her. So I'm extremely open with her now.

[FooZe]

Originally Posted by MuddyBoots

... I have a really hard time bringing these topics up (shame)

What would you expect to happen if you told her you'd been wanting to work on topics A, B, and C but shame kept getting in the way -- so how about if you worked on shame?

[MuddyBoots]

Originally Posted by FooZe

What would you expect to happen if you told her you'd been wanting to work on topics A, B, and C but shame kept getting in the way -- so how about if you worked on shame?

I've told her I want to work on shame (and the other topics), but she wants to know how I want to work on shame, and going into specifics in thought, writing, or talking just makes me feel like a failure as a person

But writing things I want to discuss down I think would be really helpful. I've already started making a list. I'll spend the week pondering them so I don't freeze up when she asks questions.

[DigitalDarkroom]

Originally Posted by MuddyBoots

I've told her I want to work on shame (and the other topics), but she wants to know how I want to work on shame, and going into specifics in thought, writing, or talking just makes me feel like a failure as a person

But writing things I want to discuss down I think would be really helpful. I've already started making a list. I'll spend the week pondering them so I don't freeze up when she asks questions.

First, you are not a failure as a person! Therapy is hard and talking specifics is really hard. Please be gentle with yourself.

I think you should tell her that you are worried about freezing when she asks questions. She needs to know so she can meet you where you’re at. She needs to go slow and do things at your pace. And, she should be coming up with ways to help you -therapy is a collaboration!

[LonesomeTonight]

Originally Posted by MuddyBoots

I've told her I want to work on shame (and the other topics), but she wants to know how I want to work on shame, and going into specifics in thought, writing, or talking just makes me feel like a failure as a person

But writing things I want to discuss down I think would be really helpful. I've already started making a list. I'll spend the week pondering them so I don't freeze up when she asks questions.

Agreed that you're not a failure as a person! It seems like she should be able to guide you in terms of working on shame. One thing you could do is ask how she's worked with other clients on shame or similar topics. I mean, not to be specific about those clients, but maybe something like, "We talked about when they first felt shame, what leads them to feel shame now, etc."

I agree with suggestions to write things down. My T does allow email, but I still have handed him something at the start of session to read before.

Maybe it would help to *not* start a session by talking about what's been going on, as you said you tend to do. Sometimes that's helpful (and I do that), but I also find at times that then I can spend a long time just recapping, say, something that happened over the weekend, my reactions to that, etc. Then suddenly we only have 20 minutes left.

So if there's something specific I want to focus on, I might let my T know right at the start of session. If you want to be working on shame, for example, you could tell your T that you want to focus on that. That you might need help feeling safe opening up about it. You might need her to ask specific questions, if that helps you. Or to just sit in silence for a bit.

My T's backup therapist who I work with when he's away uses some different techniques. If I mention feeling an emotion, she may ask where I feel it in my body (which can be difficult at times). And when the first time I can remember feeling that, or at least some other time when I was younger. And then we discuss that some more to try to get to the root of what's going on. So those are some techniques, too. (My regular T just tends to ask other sorts of questions and inject his own thoughts.)

If you're making a list, you could give that to her, then figure out what order you want to work on things. Maybe "shame" is too much to work on right now, so you need to start smaller and work your way there, for example.

Also, think about whether there's something that might make it easier to open up. Do you not want your T to look at you, for example? Might it help to sit on the floor? To hold a stuffed animal or fidget toy or something else to focus on? Just a few thoughts.

[FooZe]

Originally Posted by MuddyBoots

I've told her I want to work on shame (and the other topics), but she wants to know how I want to work on shame...

How about: in whatever way will get you past it or through it most gracefully so you can move on to what else is important to you?

But writing things I want to discuss down I think would be really helpful. I've already started making a list. I'll spend the week pondering them so I don't freeze up when she asks questions.

Sounds promising. At one time, something I would have worried about if I were making a list like that might have been, "What if I make the list and bring it with me, and then find myself wondering for every single item, 'What could I possibly have been thinking when I wrote that one?'"

By now, I know that's sure to come up anyway so I no longer bother to worry about it.

I agree with the others who said about writing stuff down to show the therapist.

Some things, in my experience, are too hard to say out loud

[MuddyBoots]

Writing things down was really helpful.

She asked me how I was doing and I said I was doing great (because I had just gotten back from the riverwalk), but then I looked at the list and I realized there was a lot to talk about. She realized I'm in a really fragile place right now especially due to the topics we're discussing, and since she's going to be out this week, she's going to set me up with peer support to at least have someone to check in with.

[ECHOES]

I don't think it's a fair question to you.
It's more fair to ask HER how she can help.