[darkrunner]

I brought this up in a chat last night and it felt ok, so I thought I'd take a chance and post it here to get some other ideas....

What kind of response should I expect to get from my T when I tell him about self-destructive thoughts/behaviors?

I feel like when I talk about these things he doesn't seem to care....he seems to brush it aside or avoid it. He either stays silent, changes the subject, or picks up on some other thing I've said and talks about that.

I have to admit I really don't know much about therapy. I've only been seeing him for about 2 months and for about half of that it was only every 2 weeks because of his vacations and mine.

I am so afraid to bring this up to him because I don't want him to think I am telling him how to do his job or that I am being critical. I thought maybe he is avoiding it because he doesn't want to encourage it? Or maybe he thinks I am just trying to get attention? Or maybe he really doesn't care what I do. I don't know. I feel like I need help in dealing with these self destructive impulses.
Is it normal to expect this from him?
Will he be angry if I bring it up to him?

kt

[winterbaby]

It depends on the t's orientation, some of them depending on their treatment orientation, do not focus on it too much or want to make it the central focus of the therapy. You could ask him how he would work with these thoughts, etc and see if he works the right way for you. It's not being critical it's being a knowledgeable therapy consumer to find someone whocan work with you the way you need them to.

[Mouse_]

My T tends to do as yours does. Its not that they brush it aside, but I think that they see it as old ways of coping and no that they cannot change that by telling us not too and have faith that with time the urge to cope in these ways will lesson and I've found that to be true.

[skeksi]

It might be helpful if you discuss with him what kind of response you feel you need. He may not realized that you feel he's brushing it aside.

[darkrunner]

Thx for your replies and advice, winterbaby, Mouse, and skeksi....

I am afraid to bring it up to him, but I am thinking about it.

[sunrise]

ktgirl, I have heard of therapists trying to extinguish a behavior by refusing to talk about it. Could it be your T is doing that? I personally don't approve of such tactics unless they notify you of what they will doing up front. For example, telling the client at the outset of therapy, "if you choose to bring up self injury, I will not respond or will change the subject, because I believe talking about SI only encourages it," or something like that. If that is the therapeutic strategy your T is taking and hasn't informed you of it, it bears discussion and you will have the opportunity to ask for greater transparency from him RE his therapeutic strategies. If you don't like his strategies and he won't adjust to something more in line with what you want, then you can change therapists.

I'm sorry you are so hurt by this. I can imagine how hard it must be to finally acknowledge you need help, go to a therapist, and have them unwilling to discuss the areas you need help on. That said, a lot of times in therapy there are misunderstandings, and maybe your perception that he is avoiding this topic is not correct. I think he deserves a chance to hear your concerns and address them.

I remember in my therapy, I had this one instance where I told my T he always seemed to ignore a certain topic I brought up and it kind of pissed me off. He told me yes I had brought this topic up obliquely a number of times and he hadn't deliberately tried to not address it, but he said you just have to invite me. He had been getting some vibe from me that I was very tentative or vulnerable around this topic so wanted me to retain control. So now I know that if I want to talk about this, I can, I just have to be more direct about it.

My T reacts in a similar way. The first time I told him about my SI, he asked a lot of questions, lots of details, etc. Now we don't really talk about it, even if I mention it. And when I've had suicidal ideation, we discuss it, but he definitely doesn't freak out or focus on it or anything. His way of handling it feels fine to me, and when I need to talk more about it, I do let him know.

There have been other issues, however, that I've felt I really needed him to address with me, that I didn't feel like he was giving enough attention to. It bothered me for quite a while - and finally I told him in session one day that I thought he was ignoring something that was really important to me. He totally heard me, and got it, and it really shifted the direction of my therapy in a major way.

So, if it feels important to you that this be addressed, I definitely think you should let him know. What feels scary about bringing it up with him?

[darkrunner]

thanks sunrise. You have such a good way of putting things. It is possible that he is trying to extinguish a behavior, but I think you're right that he should tell me if that is what he is doing.

And I also like how you said that he "deserves a chance to hear my concerns and address them." I never thought about it that way. I do believe that he truly wants to help me so it is only right to give him that chance to address my concerns.

This has been hard - I am literally scared of myself so much of the time because I never know what crazy impulse will come over me next and if I will be able to control it. I feel like I am dealing with it all alone....like no one else wants to hear about it, even my T.

[darkrunner]

My T never asked any questions. When I told him about the SI he barely acknowledged it. When I told him about being suicidal he gave me a card with a crisis hotline number on it and didn't say much else. I wouldn't expect him to freak out or anything, but he doesn't even seem interested.

earthmama - How wonderful that you are comfortable addressing your concerns with your T. There are a couple of reasons why it is scary to me - I'm afraid he might:
-- admit he really doesn't care.
-- think I'm criticizing him and get angry
-- decide not to work with me anymore and refer me to someone else.

</font><blockquote><div id="quote"><font class="small">Quote:</font>
ktgirl said:
I'm afraid he might:
-- admit he really doesn't care.
-- think I'm criticizing him and get angry
-- decide not to work with me anymore and refer me to someone else.

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

I've had all of those fears at one time or another! This list looks SO familiar to me

Maybe you could start out by telling him that you want to talk to him about something, but you're scared. You can tell him the things you're scared of. Maybe he will be able to reassure you enough that you will be able to then talk to him about how you're feeling about the SI.

I had to spend a LONG, LONG time learning that T was not going to refer me before I could open up about some things. I don't know why I was so scared of that, but I was. Even now that I'm over that fear, T will sometimes throw out "...and I'm not going to refer you!!" because we spent so much time going over that and over that

(((((((((((((((((((((((( ktgirl ))))))))))))))))))))))

I think what you are going through is one of the big learning experiences of therapy - realizing we have needs, and struggling to get them met. It's hard....but it will get easier.

[(JD)]

to all.

Therapists don't generally focus on symptoms, but on causes. If you had headaches because of stress, it would only do to give headaches a small amount of attention (as in what to take or do when you have one) and use good therapy time to work on the stress reaction that is causing them.

Seasoned therapists are not shocked, nor moved to termination, by the disclosure by patients. You're in therapy for help, they don't send people who need help away.

Sometimes, I think, patients need to discuss such activity with their doctors so that they, themselves are sure that the doctor really understands how much they, the patient, are hurting. Once a patient knows the T cares, and remembers what is "going on behind the scenes" then the sessions can focus on therapy that can change the course of those activities.

TC

[skeksi]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
You're in therapy for help, they don't send people who need help away.

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

Well said!

</font><blockquote><div id="quote"><font class="small">Quote:</font>
Sometimes, I think, patients need to discuss such activity with their doctors so that they, themselves are sure that the doctor really understands how much they, the patient, are hurting.

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

You know, I found this to be true in my therapy. My T and I discussed my self-injury in depth a couple of times, and then my frequency reduced quite a bit--because I could tell myself, "The pain will fade soon and I can talk about it with T." Being heard and seen, and having my pain be believed and valued, helped dissipate the urgency that led to self-injury.

[darkrunner]

this is all really helping me think about this.

I think this is a good learning experience for me - in therapy and real life. I often do not have enough confidence to express my needs.

It sounds as if many of you have had in depth conversations about this kind of thing with your T's and then it kind of tapered off so that you didn't talk about it so much. My T and I have never really talked about it, and I think I just need to get it out there more and have it be acknowledged, as skeksi said:

</font><blockquote><div id="quote"><font class="small">Quote:</font>
Being heard and seen, and having my pain be believed and valued, helped dissipate the urgency that led to self-injury

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

I just don't know if I have the courage or ability to express it as well to my T.

[lauren_helene]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
sunrise said:
ktgirl, I have heard of therapists trying to extinguish a behavior by refusing to talk about it. Could it be your T is doing that? I personally don't approve of such tactics unless they notify you of what they will doing up front.

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

This must be why my T never says anything when I talk about SI or other self destructive things I've done. Interesting... ignore it and it goes away? That is a very simplistic and I think dangerous tactic for both clients and therapists.

[ECHOES]

Each T is different. Each SI'er is different too.
I think what a T is likely to do, as mine does, is not focus on the SI itself but the message of the SI that says, imo, "This is how much I hurt". (This is also the message of suicidal ideation, etc.)

My T and I talk about what was happening at the time of the SI, what was I feeling. I think that this is the support being offered, her being there and we can talk about it. She is wise to remain seemingly unmoved because anything else could encourage more; she can't let that be a way we communicate, but something we communicate about.

</font><blockquote><div id="quote"><font class="small">Quote:</font>
I feel like I need help in dealing with these self destructive impulses.

</div></font></blockquote><font class="post"> I hope you will share this need with him and all of your thoughts about this. I don't see any reason he would be mad about this or any other topic in therapy. "Anything and everything; whatever comes to mind" is what my T tells me.

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
lauren_helene said:
This must be why my T never says anything when I talk about SI or other self destructive things I've done. Interesting... ignore it and it goes away? That is a very simplistic and I think dangerous tactic for both clients and therapists.

</div></font></blockquote><font class="post">Lauren, I wouldn't assume necessarily that your therapist is taking this approach. If you think he might be, the best thing is to ask him about it, rather than making assumptions that are hurtful to you and perhaps erroneous.

</font><blockquote><div id="quote"><font class="small">Quote:</font>
ktgirl said:
I think this is a good learning experience for me - in therapy and real life. I often do not have enough confidence to express my needs.

</div></font></blockquote><font class="post">ktgirl, therapy is indeed a big learning experience! Learning to express my needs has been part of therapy for me too. I'm still not that good at it, but getting better. You are really early in therapy, and you seem to have learned some really important things! I think you're gonna do great in therapy. Try to be brave and tell your therapist what's going on with you.

[Sannah]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
lauren_helene said:
</font><blockquote><div id="quote"><font class="small">Quote:</font>
sunrise said:
ktgirl, I have heard of therapists trying to extinguish a behavior by refusing to talk about it. Could it be your T is doing that? I personally don't approve of such tactics unless they notify you of what they will doing up front.

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

This must be why my T never says anything when I talk about SI or other self destructive things I've done. Interesting... ignore it and it goes away? That is a very simplistic and I think dangerous tactic for both clients and therapists.

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

I agree

[darkrunner]

well....I did it......I talked to my T about it. I brought it up after a lull in the conversation. During the silence, I debated whether or not to bring it up. I don't know where I got the courage or how I found the words....I was terribly nervous. We had been talking about his general approach to therapy which I asked him about. He has 3 ways to approach therapy, and one is to focus on strengths. He said it is the strong parts of people that help the weak parts get better. So I used this concept to segue into the question by saying something like I felt like he didn't want to talk about my SI behavior, and maybe that was because he wanted to focus on more positive things.

His first response was to apologize - he said he didn't know I wanted to talk about it more. I was so relieved!!!! He said he was concerned about me and my suicidal/SI thoughts/actions. He asked me why I thought it would help to talk about it more. I told him that I feel like I am constantly fighting these suicidal thoughts and urges to hurt myself and that I am getting tired of it and I can't do it anymore and I need help coping. He agreed and asked me to tell him how I am coping right now. So that started a whole conversation about the SI and ED topics, which led into a deeper conversation about some of my issues and past experiences.

He also said some really nice things, about how much he enjoyed meeting with me, that he admired me and thinks I have a lot of courage. I'm not really good at accepting compliments but I tried not to reject what he said....I think I might have been shaking my head though. It was really nice that he said those things.

The best part is that I finally felt like he heard me and that he cares about me. I think I knew that before, but today I felt it, and it felt really really good. *big sigh of relief*


Thanks to everyone who responded with your thoughts and encouragement! I think it really helped me to be able to open up about this to T and it turned out really really well.

kt