Psycho-Babble Psychology Thread 910319

Shown: posts 1 to 16 of 16. This is the beginning of the thread.

 

Managing a therapeutic relationship

Posted by emilyp on August 4, 2009, at 23:00:25

Many of the posts on this board relate to frustrations that individuals feel with their therapists. Often people feel overly dependent. (This is especially true this time of the year when therapists go on vacations.) Alternatively, individuals feel as if they are not respected by their therapists. People have written that their therapists are not listening or are simply not there for them. More recently, I have read many posts by individuals who were seeing therapists that have decided to retire and termination has been extremely painful. This is just to name a few; there are many other issues regarding relationships with therapists that have been raised.

Much of this is natural with a therapeutic relationship, especially one that lasts many years. Yet, at the same time, it seems to me the pain and frustration individuals feel is very high for something that is suppose to be supportive and helpful.

As a result, I thought it was worth starting a thread asking people for suggestions regarding (i) ways to make therapy less painful yet still helpful or (ii) alternatives to therapy that can help with depression, anxiety or bi-polar. All and any suggestions are welcome.

 

Re: Managing a therapeutic reelationship

Posted by LadyBug on August 5, 2009, at 1:06:12

In reply to Managing a therapeutic relationship, posted by emilyp on August 4, 2009, at 23:00:25

What a great topic.

After working with my T for almost 12 years, she retired. It's been hard and every once in awhile I miss her like crazy to the point of me crying.

I agree therapy and the therapy/patient relationship can be painful. For me that was a good part of the time. I grew so dependent on my T. I loved her, idealized her and put her on a pedestal. That sure didn't help my self esteem especially in the end as I was going through the darkest times in my life. I felt like nothing and felt like she had it all.

Seriously, I regret therapy and I don't hardly ever admit that. I was too attached to her to leave, until one day I had no choice. In December of last year we said goodbye. I miss her but don't miss the process. Every once in awhile I cry because I miss her so much, today was one of those days. She came to mean more to me than anyone besides my kids. A love I longed for in real life that could never be found.

I don't have any suggestions to make therapy less painful. I suffered my share.

LadyBug

 

Re: Managing a therapeutic relationship emilyp

Posted by Dinah on August 5, 2009, at 9:16:05

In reply to Managing a therapeutic relationship, posted by emilyp on August 4, 2009, at 23:00:25

Do you have any?

FWIW, my therapist says that the same things that cause me distress allow me to be helped by therapy. He thinks it's good for people to feel attached, even if feeling attached causes pain. I don't really understand that. To me the solution to pain is to care less or be less attached. That seems perfectly logical to me. How to be strongly attached and minimize pain is something he tries to explain but I honestly don't understand what the heck he's talking about.

I think short term separations are different from long term ones. For me the key in short term separations is object constancy. I always knew that knowing where he was going helped me, because it gave me a place to put him. Otherwise it seemed like Poof! he was going on vacation and therefore he would disappear. He wasn't here so he was gone. I suppose it would help to be able to hold him in my mind without knowing where he's going, but it seems beyond my abilities at this point. That actually helps more than having a picture of him or a meditation tape he made for me that has his voice on it. Which is kind of weird when you think about it.

Both short term and long term, I'd think distraction would help. Both distraction in terms of the mind, like games or activities, and distractions of the emotions, like dogs or friends or loved ones.

My therapist says that people with a wide support system who care about a lot of people feel better about loss. I'm not quite sure what I'm supposed to do with that.

Seldom Seen wrote a lovely post about how to cope with therapist loss.

Hmmm... sounds like my ideas are all "x said"'s. Other than distraction, I haven't found them particularly achievable for me yet. Maybe my brain is too limited.

Overall, I've worked hard for the relationship I have with my therapist. I think it's helped me in very important ways. And I think I'm a fool for working so hard at something that will inevitably cause me pain, even if it is helpful now.

 

Re: Managing a therapeutic relationship

Posted by Moonshadow on August 5, 2009, at 9:54:04

In reply to Re: Managing a therapeutic relationship emilyp, posted by Dinah on August 5, 2009, at 9:16:05

I'm dealing with this now as I switch therapists. I try to do constant "reality checks":' I'm in therapy to get better, not to be loved or make a friend.' 'My T has skills to help me get better. ' 'I can find the love and support I long for from my T in friends and family who have a reciprocal relationship with me' I sometimes wonder if the closer I get to my T the farther I get to those around me. And I know that's not healthy long-term.

 

Re: Managing a therapeutic relationship

Posted by pegasus on August 5, 2009, at 10:58:41

In reply to Managing a therapeutic relationship, posted by emilyp on August 4, 2009, at 23:00:25

I wish I had some of those answers you're looking for. I don't really, but I wanted to respond, because my experience seems to be somewhat different than those of others who have posted so far. I was very very attached to my first T, and our therapy ended when he moved away to another state. It was extremely painful to lose him.

It's been over five years since he left. At this point there is no doubt in my mind that I'm better off having started that therapy than I would be if I hadn't. Yes, it was painful. And I grew so much. I agree with Dinah's T that quite a bit of the benefit I got from therapy would probably not have come about if I had not also risked (and experienced) the potential pain of a close, attached relationship.

I want to try to describe what I mean, but I suspect that it won't make much sense if you haven't experienced it yourself. A lot of the benefit that I experience now from that therapy is because I've internalized my ex-T to a decent extent. When times are tough, I still turn to him in my mind, and he's still there being supportive and helpful. I realize in a more distant way that that is really *me* being supportive of myself, in a way that he modeled for me. But it still feels like it's him, and I believe that if I *could* see him now, he would be as warm and supportive as I imagine him to be. It's because I allowed the intimacy and attachment of that relationship that I was able to understand that that kind of support could exist, and what it was like. I'd never experienced it anywhere else in my life. And . . . that's also what was so extremely painful when he left.

When I say it like that, it sounds like it was easy for me to allow myself to be that attached. But it totally wasn't. It was really, really hard, in part because I knew what I was risking. I was very resistant for a long time. Then I eventually started to really trust him. When he told me he was leaving, it was my worst fear coming true. And . . . I'm still glad I worked with him. He was a good T, and our work together still helps me every day.

I think part of why I can retain the sense of overall benefit is that he was pretty skillful in the way he left. We remained in email contact for quite a long time afterward. At first it was every week, then every couple of weeks, then every month, and now I still email maybe twice a year or so. He also invited me to call him on the phone after he left, and I did once just to check in and hear his voice. A couple of years after he left, I had a series of phone sessions with him, to process some of my remaining issues with his leaving. He was generally pretty warm in his email responses, although more and more brief as time went on. And the phone sessions were wonderful. I was able to retain a sense that he cared about me because of that continuing contact, and because of the discussions we had about that before he left. He insisted that we would always have a relationship. At the time it was cold comfort, which I didn't accept very gracefully. But now, I'm really glad he emphasized that point. He's right. We will always have a relationship. I believe that he won't forget me.

- peg

 

Re: Managing a therapeutic relationship pegasus

Posted by Dinah on August 5, 2009, at 11:20:24

In reply to Re: Managing a therapeutic relationship, posted by pegasus on August 5, 2009, at 10:58:41

Yes, that is what my therapist tries to explain. And seldomseen as well, if I understand correctly.

I think I have so very much difficulty with object constancy that it is a very difficult thing for me to grasp.

My therapist thinks that means I need to work on it more, because learning to do that will make me less abandonment sensitive in life as well as in therapy. But it's been fourteen years. I am fully aware that he cares about me. If I can't internalize him now for any real length of time, I doubt that I have the capacity.

 

Re: Managing a therapeutic relationship Dinah

Posted by pegasus on August 5, 2009, at 13:15:57

In reply to Re: Managing a therapeutic relationship pegasus, posted by Dinah on August 5, 2009, at 11:20:24

Dinah, I wouldn't be surprised if you were right. I bet some people don't have as much capacity to become attached and/or internalize a T. I imagine that it's probably on a continuum. I guess I'm lucky that it worked out for me. I wish I knew what the variables are that determine whether it'll work. One thing is that I think I'm fortunate to have a lot of good support resources. Even so, it was about all I could take.

I also have had object constancy problems. And despite the pretty picture I painted in my last post, I have gone back and forth a lot in terms of believing in that relationship, and having my ex-T internalized. But what has improved is that I know that, and I do remind myself of that when I get into the dark side where I think I'm worthless and no one would ever remember or care about me. What I'm able to do now that I couldn't before is say, "Whoa now. That's the black. I want the white. What could be the gray that is probably the truth. That gray is actually pretty good, isn't it?"

I would think that fourteen years could be considered giving it a decent try. From what you say, though, it sounds to me as though you have internalized your T quite a bit. Maybe not perfectly, but I hear you saying that you are fully aware that he cares about you. I think that awareness is part of it. Maybe not the warmest, fuzziest part. And yet, do you think you could have been so aware of it 14 years ago?

peg

 

Re: Managing a therapeutic relationship emilyp

Posted by obsidian on August 5, 2009, at 22:41:49

In reply to Managing a therapeutic relationship, posted by emilyp on August 4, 2009, at 23:00:25

I think it is helpful if possible to maintain close relationships with people outside of therapy. I suppose this is a given though. I found that over time therapy gave me more of an ability to have those relationships.

I don't know...I didn't have close, trusting relationships with people before therapy, at least not to the extent that I do now. I think I had to grieve a lot of things, and I did so in real time, through my relationship with my therapist. It's tough though, that preoccupation that can come with being in therapy. I think you have to remain open to life outside of therapy and do a lot of self care.

I'll put forth the following random ideas:
1) read- what you can about what issues you struggle with, the therapy process, the relationship, etc. I do recommend "In Session", self help books, books that are meaningful to you

2) keep interests- find those things you can be passionate about

3) find support- maybe a support group relevant to some issue you face

4) find some sort of healthy self expression outside of the therapy hour, i.e. writing, art, music, whatever

5) find a therapist who has the ability to set and maintain healthy boundaries- it's just so important

Pain is inevitable though, and as someone said somewhere - sometimes the only way out is through

.02
-sid

 

Re: Managing a therapeutic relationship obsidian

Posted by Daisym on August 6, 2009, at 0:43:53

In reply to Re: Managing a therapeutic relationship emilyp, posted by obsidian on August 5, 2009, at 22:41:49

I think the real truth is that the relationship built in therapy is often your relationship with your self and to your life. What we long for from our therapists is really what we long for in our life - if there was another to get it from, we most likely would. It is, as someone said, a huge risk, outside those walls.

That said, I think the most important thing you can do to minimize the angst is to populate your days and weeks and weekends with people you can be real with. That is one of the real benefits of therapy - being able to be real. If you can figure out how to have that with others - you don't "need" your therapist to carry it all. And I think it is incredibly important to have fun. Find fun, make fun - do those easy, light things. Therapy is heavy and deep. Try going light and see how much relief there is in that.

And it has been said many times, but the more you can bring yourself to talk about all your feelings for your therapist, with your therapist, the easy those feelings are to manage. When we have to guess how our therapists feel, what they are doing and what their future plans are, we drive ourselves crazy.

 

Re: Managing a therapeutic relationship emilyp

Posted by seldomseen on August 6, 2009, at 9:04:02

In reply to Managing a therapeutic relationship, posted by emilyp on August 4, 2009, at 23:00:25

After giving this thread some thought, I've decided that key to managing the therapeutic relationship - or any other I think - is mastering distress tolerance.

I know I certainly would go to great lengths to avoid any kind of relational distress, but in therapy I found that there was this man, he wasn't going anywhere, and I was going to have to negotiate it or quit - which I did several times at first.

I felt like the process was hurting me, and *he* was hurting me. Everywhere there was just pain. It was a lot to tolerate and integrate.

Yet he repeatedly said "It's okay you feel this way, it's not going to overwhelm you, it's not going to take you under, it just is". I was outraged. How *could it possibly be okay that I felt that way*.

But in the end, he was right. I think it is about accepting the way you feel rather than fighting it, recognizing it for what it is - just a feeling, expressing it and being heard, and carrying on anyway. Dinah calls it radical acceptance. I think some sort of mindfullness training, or DBT should be part and parcel in therapy for some people. I know I would have benefitted greatly from it.

These therapists are not mind readers or miracle workers, though I suspect that they do harbor some magiks. I'm sure they are not out to deliberately cause us pain, but definately are with us in a situation where we do.

We are ultimately the ones that have to tolerate it.

Seldom.

 

Re: Managing a therapeutic relationship

Posted by pegasus on August 6, 2009, at 9:07:01

In reply to Re: Managing a therapeutic relationship obsidian, posted by Daisym on August 6, 2009, at 0:43:53

I agree with everyone who is advocating taking care of yourself, and having good support/relationships with others to the extent possible (which seems to increase as therapy progresses). And . . . as I think about this more, I realize that the most helpful thing for me in dealing with such an intense relationship was learning to be as direct and open as possible with my T, like Daisy said. Talking about all of it with my T brought the most relief. Having it all on the table when he left was very helpful, both then, and now. I have less to guess and ruminate about, and more evidence about the strength of the relationship.

I also truly believe that there isn't a way to manage a therapeutic relationship so that there isn't significant risk, or significant pain, along with the benefit. So, maybe that's also got to be part of the work: learning to tolerate risk and pain. Which is tied up with developing object constancy, and trust -- with respect to the T, and also with respect to oneself.

I'm thinking as I'm typing, and I'm finding this topic really helpful for organizing some previously disorganized thoughts. Thanks for starting it emilyp!

peg

 

Re: Managing a therapeutic relationship Daisym

Posted by peddidle on August 6, 2009, at 9:56:59

In reply to Re: Managing a therapeutic relationship obsidian, posted by Daisym on August 6, 2009, at 0:43:53

> I think the real truth is that the relationship built in therapy is often your relationship with your self and to your life. What we long for from our therapists is really what we long for in our life - if there was another to get it from, we most likely would. It is, as someone said, a huge risk, outside those walls.

**My T started talking about that towards the end. She also gave me a book, and part of the message she wrote inside said "Remember, the power you put on me and my presence in your life really belongs to you. It is your's." I think I understand what she's saying, in theory, but it's very hard to accept, especially since we didn't get to really explore that issue. Which, again, leads to the other point that's been stated and repeated many, many, many, times-- it's so important to talk about your feelings regarding your T and the therapeutic relationship itself, no matter how scary or awkward it feels.

 

Re: Managing a therapeutic relationship pegasus

Posted by Dinah on August 6, 2009, at 11:58:03

In reply to Re: Managing a therapeutic relationship Dinah, posted by pegasus on August 5, 2009, at 13:15:57

> Dinah, I wouldn't be surprised if you were right. I bet some people don't have as much capacity to become attached and/or internalize a T. I imagine that it's probably on a continuum. I guess I'm lucky that it worked out for me. I wish I knew what the variables are that determine whether it'll work. One thing is that I think I'm fortunate to have a lot of good support resources. Even so, it was about all I could take.
>
> I also have had object constancy problems. And despite the pretty picture I painted in my last post, I have gone back and forth a lot in terms of believing in that relationship, and having my ex-T internalized. But what has improved is that I know that, and I do remind myself of that when I get into the dark side where I think I'm worthless and no one would ever remember or care about me. What I'm able to do now that I couldn't before is say, "Whoa now. That's the black. I want the white. What could be the gray that is probably the truth. That gray is actually pretty good, isn't it?"
>
> I would think that fourteen years could be considered giving it a decent try. From what you say, though, it sounds to me as though you have internalized your T quite a bit. Maybe not perfectly, but I hear you saying that you are fully aware that he cares about you. I think that awareness is part of it. Maybe not the warmest, fuzziest part. And yet, do you think you could have been so aware of it 14 years ago?
>
> peg

Fourteen years ago he didn't care about me. Well, not in any more than the most abstract sort of way.

My solution to those feelings was to fight to relationship. He cares about me now not so much because of any wonderful intrinsic qualities I have, but because we've put in time and effort and commitment into building something.

I think I was very lucky in that I didn't really have to battle feelings of worthlessness. Not only was I loved by both my parents, however flawed they may have been otherwise, but I was raised in a religious tradition that emphasized on every level that every child of God was special and worthy of love. I may feel inferior socially, or bad about my looks, or embarrassed about my behavior at times. But my worth was never in question. If it took a while for me to feel that he cared for me, it's mostly because it I was used to the fact that he didn't really.

I think that, for me, the object constancy problems have more to do with the same qualities of my mind that make me so talented at dissociation.

I don't have a *wide* support network. My husband, babble... I don't think I'm close enough with the circle of friends I met at church to consider them a leg on my support stool yet. But the legs I have are relatively sturdy. My marriage is better now than it's ever been. I think my husband is mellowing out, at least a lot of the time. I find myself able to talk to him way more than I used to.

I do agree with you. The grey is wonderful. There are so many shadings and so much richness and depth that are lacking in black or white. It's more greyscale than a flat grey. :)

 

Re: Managing a therapeutic relationship

Posted by TherapyGirl on August 6, 2009, at 17:55:45

In reply to Managing a therapeutic relationship, posted by emilyp on August 4, 2009, at 23:00:25

Obviously, this thread is timely and of great interest to me. I don't have my thoughts together enough to respond fully right now, but I am grateful for all of you who have posted on Emily's thread. I'm reading all of your thoughts about this important topic and trying to take them all in.

Thanks to all of you. Babblers totally rock.

 

Re: Managing a therapeutic relationship

Posted by emilyp on August 6, 2009, at 23:27:46

In reply to Managing a therapeutic relationship, posted by emilyp on August 4, 2009, at 23:00:25

I realize that I posted this thread and never gave my own thoughts. I suspect that was partly because I dont have a great response. But nonetheless, I thought I would give some thoughts.

1. I agree that having other support is critical. It is critical whether one is in therapy or not. Yet even with a strong network (I have many close friends, always have even before I started therapy. It was how I managed because my family was not as supportive as I needed) I found it difficult to manage my relationship with my therapist. I think the reason my friends were not as helpful is that at the same time I was struggling most with the therapeutic relationship, I was also suffering from severe depression. When the depression is really bad, I try not to overburden my friends. So at those times I probably became even more reliant on my therapist.

2. Unlike many others who posted, I did not find it helpful to talk to my therapist regarding my frustrations. In fact, I found it even more frustrating. While my doctor (my psychiatrist is also my therapist) clearly understood my concerns, he could not say anything that made me feel better. Having said that it seems like a few of things that I said (or perhaps more importantly wrote) about my difficulties, stuck with him as from time to time he mentions it.

3. I think the way I best dealt with my frustration (until something else happened, see below) was by putting some space between the two of us. I needed to force myself not to feel overly dependent and control my emotions and actions. And the more I could do that the more I felt as if in some way the relationship was a bit more balanced. It was hard and in the beginning it could really hurt. But over time, knowing that I did not feel so dependent gave me some confidence; it also lead me to devote time in my appointments to issues truly dealing with the depression.

4. Despite my posting, I am probably not the best person to comment on this topic because now, after all these years, my doctor and I have a very special relationship that in many ways probably crosses boundaries. I know a lot about his life and his family. We frequently talk about his family problems (he has a very sick family member). I have helped him with his computer and from time to time, there are some things related to the business part of his practice that we discuss. It is not that all of the boundaries are gone he is very professional (he is a fairly well known doctor and must keep his reputation above reproach). For example, he is now vacation and he is clearly not available even though I am having a very difficult time with the depression). But the change in our relationship only transpired due to some events that we both experienced specifically my father died, then three years later my mother died. In between the death of my parents, my doctors father died. It created a very unique (albeit sad) connection between the two of us. Then we experienced another similar life event. I suspect I would still be struggling as much as I was in the past had we not been through such a tumultuous period.

5. Another reason I think the relationship changed is that despite my frustrations, I never, ever tried to cross the boundaries. For many years, I called him Dr. Smith (that is not his real name, but you get the point). This is despite the fact that every one of his other patients called him by his first name. I was simply brought up to call doctors, Dr.; it never occurred to me to call him anything else. I never asked for hugs (not that there is anything wrong with that) or asked him things that I knew were usually out-of-bounds. I think that he respected that and realized that I was not trying to push him. I also think he learned to respect me as a professional I was a senior executive at a large company. Ultimately he started to disclose small things and one thing led to another in terms of us developing a relationship.

So, thats my experience. As I said, I am not sure it provides much input into the discussion. But nonetheless I thought since I started it, I should at least contribute.

 

Re: Managing a therapeutic relationship

Posted by friesandcoke on August 7, 2009, at 0:28:32

In reply to Managing a therapeutic relationship, posted by emilyp on August 4, 2009, at 23:00:25

this is an excellent thread and i have noticed myself in reading some of the posts along the way, the suffering that seems to come out of therapeutic relationships. i myself have suffered from them. as for other ways to treat mental illness, the only one i know of that some have said helps is one i don't do and that is exercise on a regular basis.


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Psychology | Extras | FAQ


[dr. bob] Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org

Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.