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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Speaker on January 1, 2004, at 13:23:47
As some of you know I have had to find a new T and things are going as well as can be expected. I guess with starting over I am wondering when its time to quit analyzing and just start living. I have PTSD and I do have flashbacks and nightmares but have learned to cope with these. Have any of you ever had PTSD and had flashbacks and nightmares that stop? If that really can happen I think its worth continuing. I have asked if this is the goal and of course I get the pat answer that everyone is different and we will just have to see. These flashbacks and things do disrupt my life but then paying this huge amount for therapy is difficult too...if I'm always going to have one then maybe I can stop therapy and at least have some extra money. Any advise or experiences are welcome. Thanks.
Posted by Dinah on January 1, 2004, at 13:50:58
In reply to When to End Therapy? Dx. PTSD, posted by Speaker on January 1, 2004, at 13:23:47
I have a few books devoted totally to terminating therapy, and also many books with chapters on it (that are the first things I read). And yet darned if I can tell you.
Do I recall that you do CBT therapy? I considered my CBT therapy complete when I could deal with my residual OCD thoughts and occasional panic attacks. I had klonopin as well. I consider my OCD to have been "cured" by CBT, even though I still have OCD thoughts and the occasional panic attacks because I can recognize the thoughts for what they are, and I deal with the panic attacks with breathing exercises and medication. I don't think they'll ever go away completely. They seem to be a way my body copes with stress.
If you feel like you're comfortable enough with your sypmtoms as they are, that you have them under control, that they don't cause enough distress that they interfere with your life, and that you'd rather have the time and money you currently use for therapy, the books I've read seem to indicate that you have a good case for termination. And nowadays termination is generally not final. If you have an upsurge in symptoms or a new life circumstance that you need help with, you can go back for a long or short booster.
The other alternative is to change your therapeutic focus. If you do CBT you could try EMDR or hypnosis. You could try a more psychodynamic approach. That's what I'm doing right now. I feel stuck a bit, and I'm not willing to lose my secure base by having my therapist change his style too much, so I am going to use EMDR as adjunctive therapy while having my therapist help me deal with the fallout (if any).
The personal experiences I've read where there is a "natural" ending to therapy seem to describe the client spending less time thinking of therapy between sessions and more time thinking about alternative uses of time and money. There might be anxiety at the thought of stopping but not terror.
I'm not sure there is a definitive answer...
Posted by judy1 on January 1, 2004, at 14:53:43
In reply to When to End Therapy? Dx. PTSD, posted by Speaker on January 1, 2004, at 13:23:47
my flashbacks, etc. haven't stopped so I'm no help to you there. what I do however, is take a lot of breaks in therapy- for all kinds of reasons- financial, too difficult, or just feeling better. maybe you can start with taking a break and seeing how you do, if you're able to cope well don't go back, if you have difficulty then resume therapy. I think the longest I have stopped is about 6-7 months. I never really thought about therapy during that time. best of luck with whatever you decide- judy
Posted by DaisyM on January 1, 2004, at 22:23:01
In reply to When to End Therapy? Dx. PTSD, posted by Speaker on January 1, 2004, at 13:23:47
You may be experiencing a pretty common event that happens after short time with a new Therapist. Sometimes referred to as a flight into health. You feel better so think it is time to stop. There isn't a dependency...etc. And it might be. I would recommend exploring your reasons with your new Therapist and I like the idea of taking a break to see how you feel. From what I've read, most PTSD suffers do begin to identify their triggers and are therefore mostly able to keep things under control. Hypnotherapy is highly recommended to control flashbacks.
Posted by dragonfly25 on January 1, 2004, at 23:02:16
In reply to When to End Therapy? Dx. PTSD, posted by Speaker on January 1, 2004, at 13:23:47
hi speaker
this may not be right for you, but the best thing that ever happened to me in dealing with those issues was not dealing with them. i know that this sounds like bad advice but for me in hindsight i was getting worse from therapy...i felt like the therapy kept the nightmares etc alive and burning. once i was away from a setting that didnot focus on that stuff it made it so much easier to get a handle on it. i personally feel that sometimes therapy, esp freudian type, can make the problem much worse. don't get me wrong, it is not easy! but i am quite happy about repressing things. what ever you decide make sure you do it safely. maybe you could try therapy that focusses on other issues while weening off completely, if possible?? but it has ended for me, if that is any help.
dragonfly
Posted by Speaker on January 2, 2004, at 0:29:29
In reply to Re: When to End Therapy? Dx. PTSD, posted by dragonfly25 on January 1, 2004, at 23:02:16
So, if I understand you right you are not in therapy at this time? Did you find that the flashbacks and nightmares lessened when you quit or did they lessen and therefore you felt is was ok to quit? You mentioned you were able to identify the triggers and then able to put into practice coping skills...how long did this take you?
Posted by Speaker on January 2, 2004, at 0:41:40
In reply to Re: When to End Therapy? Dx. PTSD » Speaker, posted by DaisyM on January 1, 2004, at 22:23:01
DaisyM,
I wish I was having flight of health :). It's more like its just to much trouble to tell all of this stuff again...I'm still a bit frustrated I have to go to a new T. It just feels like the price for help is to high. How are you and your family doing? I thought about you a lot over the holidays...remembering those days dealing with illness, the holidays, and EVERYTHING else. I appreciate your response and will consider approaching it with the new T, however, I know he will say I have things he can help me with but I have to tell him what has and is going on...I guess I'm just tired of all of this.
Posted by Speaker on January 2, 2004, at 0:45:17
In reply to Re: When to End Therapy? Dx. PTSD » Speaker, posted by judy1 on January 1, 2004, at 14:53:43
Judy,
That seems reasonable to take a break. Do you have times when the flashbacks lessen? I'm just wondering if this is going to be a forever thing then I don't want to be in therapy forever too.
Posted by Speaker on January 2, 2004, at 0:54:06
In reply to Re: When to End Therapy? Dx. PTSD » Speaker, posted by Dinah on January 1, 2004, at 13:50:58
Dinah,
Great memory...yes, I am in CBT. However, its not that my symptoms have lessened and they are as distressing as ever. It's that it just seems like the price for help is very high. I know the cure for the pain is in the pain...but I'm not sure there is a cure here. I am still a bit frustrated over having to start over with a new T and it is just so hard to "tell" what has happened to even bring him up to speed enough to be able to help or have any insight. I guess I'm just frustrated with this whole situation and wonder if it's worth it to keep going. I do like the new T and he seems very smart and like he could be helpful but as I said is it worth it? I did do EMDR with the old T but it was a bit overwhelming for me. I understand CBT and have been very comfortable with it. What made you decide to move on to another type of therapy?
Posted by fallsfall on January 2, 2004, at 7:28:52
In reply to Re: When to End Therapy? Dx. PTSD » Dinah, posted by Speaker on January 2, 2004, at 0:54:06
Speaker,
I started with a new therapist 6 months ago. For the first couple of months it was pretty dreary - talking about people he didn't know, explaining patterns of mine he hadn't hear about. Feeling like he couldn't help me because he didn't know what my story was. UGH.
But I really think it is worth it. One day we really connected. He also does seem to understand me often even when he doesn't have all the details. Sometimes he makes assumptions and I have to correct those. I was with my old therapist for 8 1/2 years - she knew everything. But going to someone new brings a new perspective to things, and sometimes going over the old things yet again does let me see things in a new light.
A new therapist is hard. But if s/he is good, it should be worth it.
Posted by Dinah on January 2, 2004, at 8:05:01
In reply to Re: When to End Therapy? Dx. PTSD » Dinah, posted by Speaker on January 2, 2004, at 0:54:06
Ahhhh, I misunderstood. When you said
"I have PTSD and I do have flashbacks and nightmares but have learned to cope with these. "
it sounded a lot what I feel about my OCD. If my OCD were my only remaining problem I'd probably feel able to continue to put my CBT skills into practice on my own and only return to therapy for tuneups. But if you don't feel that you have learned to cope adequately with the flashbacks and nightmares, I think I'd try to continue on despite the discomfort of starting over. That will pass.
Posted by dragonfly25 on January 2, 2004, at 8:52:44
In reply to Re: When to End Therapy? Dx. PTSD » dragonfly25, posted by Speaker on January 2, 2004, at 0:29:29
what happened was i left therapy after years of intensive therapy (i was quite young), when the choice became more mine i reevaluated it, and basically said screw it. the flashbacks had diminished but i attribute that to my refusal to talk about those issues and klonopin at the time (i do not take that now). i feel i became more whole when i took control of that, i was out of therapy for years again and i struggled for quite a while, but not with the flashbacks/nightmares per se. i was struggling more with 'life' i have gone back to therapy, with someone else but not to deal with that issue. i again am questioning how helpful therapy is, teh more i focus on, the worse it is. they some times keep yoiu ruminating. i am by no means 'better', but i feel a hell of lot more stable than i did before. and i am not haunted anymore. i can not watch certain movies, and i will leave or close my eyes and try to think of good things if ever in a trigger situation. and one of my biggest triggers which use to make me nuts, is everywhere, so i actually desensitized myself to it. identifing the triggers sort of happened gradually, certain situations, and movies (really bad for me), it didn't take long to identify but it took years to manage them safely. i hope i answered your questions and that i have been of some help.
ps- i am a bit worried that i am giving out bad advice. pls don't do anything drastic, i just found that not focussing my life around it made the woorld of difference. keep me posted
dragonfly
> So, if I understand you right you are not in therapy at this time? Did you find that the flashbacks and nightmares lessened when you quit or did they lessen and therefore you felt is was ok to quit? You mentioned you were able to identify the triggers and then able to put into practice coping skills...how long did this take you?
Posted by Speaker on January 2, 2004, at 9:32:45
In reply to Re: When to End Therapy? Dx. PTSD » Speaker, posted by fallsfall on January 2, 2004, at 7:28:52
Thanks, thats exactly how I feel...I guess I just needed to hear from someone that is a step ahead of me. If you don't mind answering, what prompted changing to a new T for you?
Posted by Speaker on January 2, 2004, at 9:41:09
In reply to Re: When to End Therapy? Dx. PTSD » Speaker, posted by dragonfly25 on January 2, 2004, at 8:52:44
The only thing I would do that I consider drastic is to stop therapy. I have taken breaks like three months and thought the "haunting" would stop or lessen but to no avail. I really haven't been able to tell the new T anything that has happened except that I was hurt and that my dx. is PTSD. Just going and trying so hard to put to words what happened is so stressful...just thinking so hard makes it hard if you know what I mean :). Your viewpoint has been very insightful and I appreciate your sharing. Thanks It helps to know someone else knows what I'm talking about.
Posted by dragonfly25 on January 2, 2004, at 10:03:14
In reply to Re: When to End Therapy? Dx. PTSD » dragonfly25, posted by Speaker on January 2, 2004, at 9:41:09
hi
i wish i could give you more help, i struggled for a long time with it. thinking/talking about it is physically painful. have you ever been free of flashbacks for even a short time? was your otehr T doing CBT? if not i might stick it out for a while. it is suposed to be the best for ptsd. but i think it is really important that you tell your T these concerns, about wanting to live your life etc. good luckdragonfly
ps- i actually meant don't stop therapy if you are not sure you are ready, when i said don't do anything drastic- sorry, that might have come accross diffeerently
Posted by judy1 on January 2, 2004, at 11:24:22
In reply to Re: When to End Therapy? Dx. PTSD » judy1, posted by Speaker on January 2, 2004, at 0:45:17
"Do you have times when the flashbacks lessen?"
Yes, and that usually is why I take a break from therapy. I have no idea why this happens, except I have another cyclical condition (bipolar disorder) and maybe that's related somehow. I also take breaks if things get difficult in therapy, because my symptoms worsen (including flashbacks), and despite my therapist easing off, once my symptoms return they come back with a vengeance. I have learned coping skills (like you) and if I just have occasional flashbacks, then I am able to deal with them myself.
"I'm just wondering if this is going to be a forever thing then I don't want to be in therapy forever too."I don't either, in fact I probably fight that concept more than anything. I don't think we can predict where our illnesses will go, stresses in life worsen them, and who can predict stress? I do know that I'm emotionally healthier in my 30's then I was in my 20's- and I'm hopeful that will continue.
take care, judy
Posted by judy1 on January 2, 2004, at 11:34:14
In reply to Re: When to End Therapy? Dx. PTSD » Speaker, posted by dragonfly25 on January 2, 2004, at 10:03:14
don't feel bad about recommending repression, I have used that 'coping skill' many times. and quite honestly it really does work for me for significant amounts of time. I totally agree that dredging up the past can make symptoms significantly worse. what helped me the most with therapy was coping skills. it's interesting that my pdoc (who does therapy also) believes in bringing up the past and dealing with it and my therapist does not (she's more into coping skills). I don't know what the current thinking is with PTSD, but there sure seems like there are a lot of different treatments.
take care, judy
Posted by DaisyM on January 2, 2004, at 14:37:57
In reply to Re: When to End Therapy? Dx. PTSD » DaisyM, posted by Speaker on January 2, 2004, at 0:41:40
The Holidays were Ok -- I took your advice and went without him to my moms with the kids. They had fun, I didn't. Oh well. I'm glad they are over. Thanks for thinking of me.
My husband is in a "good" period for now. In fact, he has "decided" that he is sick of being sick and is planning on *making* himself feel better and do more. I have my doubts but I understand how frustrated he is. He is going back to work which should help. Might make me crazier worrying about him but we'll see.
I'm glad I'm not changing Therapists. I can't imagine working with someone else, but of course mine keeps proving how good he is and that he is a good fit for me. :) You are brave to try again. Let me know how it goes.
Posted by fallsfall on January 2, 2004, at 18:06:48
In reply to Re: When to End Therapy? Dx. PTSD » fallsfall, posted by Speaker on January 2, 2004, at 9:32:45
The reason I left my old therapist is a long story. If you really want to know, I'll find the posts and you can have all the gory details.
The short version is that I was in a transference with her where I thought she was mad at me. This caused me to panic and do everything I could think of to be the perfect patient. She was a CBT therapist, and not particularly interested in transference. Things got worse and I was in a lot of pain. I was very dependent. She took my case to her supervision group and they said that if I wasn't less dependent in a couple of months that she should make me find a new therapist. Of course, this panicked me even more. But once I actually thought about getting a different therapist and finally I had some hope. It was so hard to leave her (it is still hard - we are working on this in therapy now). But I am now moving (hopefully forward) in therapy.
My new therapist is Psychodynamic (Psychology of the Self). He knows all about transference. It is quite different.
Posted by dragonfly25 on January 2, 2004, at 20:24:51
In reply to Re: When to End Therapy? Dx. PTSD » dragonfly25, posted by judy1 on January 2, 2004, at 11:34:14
don't feel bad about recommending repression,
hi judy,thx, i sometimes worry about giving wrong or bad suggestions.
i believe the current thinking is that CBT/coping skills type therapy is best for PTSD.dragonfly
Posted by dragonfly25 on January 2, 2004, at 21:15:56
In reply to When to End Therapy? Dx. PTSD, posted by Speaker on January 1, 2004, at 13:23:47
hi
i just responded to your post about jung, and i thought i would come back here and finish off. i saw a post you might be interested in in psycho-babble about ptsd.
also if your therapist is jungian etc, you may not be with a true cognitive therapist. that will make a huge difference. it is important that they incorporate all the techniques but if he is trained in some form psychoanalysis, i would hesitate. (i apologize to anyone who favors analysis) from your previuos posts i don't think this is the type of therapy you want.
dragonfly
Posted by Speaker on January 2, 2004, at 21:46:40
In reply to jung post » Speaker, posted by dragonfly25 on January 2, 2004, at 21:15:56
Thanks, at this pt. in time he is using CBT and maybe thats because he knows that's what my old T used. Also, he does work with PTSD a lot and was recomended by the State Psychology Board. I just saw he had done several types of study so I was curious...so far I am pleased as I know he is doing CBT. Thanks
Posted by naiad on January 3, 2004, at 4:53:09
In reply to Re: When to End Therapy? Dx. PTSD » Speaker, posted by fallsfall on January 2, 2004, at 18:06:48
Fallsfall,
Do you mind if I ask, what do you mean you were dependent? It seems to me that a certain amount is understandable. I'm trying to figure out where on the dependence scale I fall. Thanks.
Posted by fallsfall on January 3, 2004, at 8:27:56
In reply to Re: When to End Therapy? Dx. PTSD » fallsfall, posted by naiad on January 3, 2004, at 4:53:09
How do I describe dependent?
My life revolved around therapy. It was the most important activity in my week. I would cancel ANYTHING for therapy (including things like going to a kid's school play...). I thought about my therapist all the time. Every decision I made, I would think whether she would approve. Major decisions would be run by her before they were finalized.
Her vacations were hell. For a majority of the 8 1/2 years I was with her I scheduled backup appointments (either with her backup person, or with a therapist that I had had for group therapy) during her vacations (and she never took more than 1 week at a time), just to make it through her vacation.
I knew what her car looked like, and her license plate, so when I drove down the street I looked for her. She was dropping a kid off to play in my neighborhood one day, she went to my bank, I saw her out for lunch just before my appointment one day.
I was sure that if she ever kicked me out that I would collapse into a puddle. I would NEVER leave her (although, in the end I did). She was the only person who could ever understand me. Everything she did was right - her wisdom was complete.
My life revolved around doing things that she would approve of.
I am still dependent on my new therapist, but not as much as the old one. My new one tries really hard to be a little distant. His armor cracks occasionally so I know that he is a real person and that he does care about me, but most of the time he is a bit "blank slate". He gets much less involved with my day to day life than she did, so I have to deal with more of that on my own.
I think that a certain amount of dependence is good. I think that I'm excessive.
Posted by naiad on January 3, 2004, at 8:46:50
In reply to Re: When to End Therapy? Dx. PTSD » naiad, posted by fallsfall on January 3, 2004, at 8:27:56
Wow, Falls. I have only been with my T for 9 months but I have experienced those obsessive thoughts about him. Not yet to the extent you describe but I could see myself getting there. Right now I am working to expand my care base, by going to a doctor for anti-depressants and considering Imago couples therapy. Maybe those actions will lessen the dependency. Thanks for sharing your story. It helped me.
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