Doubt

Tonight I’ve been obsessively looking at therapist websites. How on earth do you pick one? How can you know if they are the magic person that can help? Beyond checking that they list trauma and ptsd as a specialty, and maybe also dissociative disorders.

Ron lists dissociative disorders as a specialty on his site also. At least on the Psychology Today site he does, where I guess he’s prompted by a template. On his personal site, he says he doesn’t specialize, because each client is unique.

Oh me oh my. Do I go by whether I respond to their picture? Is this online dating? Or whether I respond to their words? Someone may have little gift for good writing, yet be a very good trauma therapist, I’m sure. Essentially, they tend to say the same sorts of things anyway.

Do I try and see someone expensive, maybe every two weeks? Does the expense of the therapist equal skill?

Flipping through these sites does seem to fulfill a need, without the risk of actually talking to anyone.

Clearly, my last session did not go that well. I’m full of doubts, not so much about Ron’s competence as a therapist overall, but whether he knows how to help with dissociative parts. He’d never heard the term DDNOS when I told him about it. He says he doesn’t follow all the ins and outs of the DSM. Shouldn’t he at least know about this, even if he doesn’t believe in diagnosis?

At the same time….I do feel angry with him, and also needy I suppose. I’m not sure what the anger is about really. It feels somewhat like anger I tend to have with men – resentful, hurt somehow.

Last session we did talk for a while about what happens to me after sessions – why I feel so terrible. He seems to think it’s because parts have lost their chance to talk to him for a whole week, and are sad. No way is that the reason. Even if they feel like that, it wouldn’t cause the complete shut down that happens.

This time, V. spoke at the end of the session. She was just hugely sad, with a heavy, dark kind of sadness. She didn’t cry though, and nothing seemed traumatic. But today, I spent most of the day in bed. I was so sad, and just couldn’t think normally. I didn’t remember anything in particular – it was more like a state. It didn’t seem like feeling to me though, really. More like depression. Feeling seems more fluid to me, like I’m a person having a feeling, while this was more like an overwhelming state of being.

I still think I’m being taken over by a part’s feelings.

Is this a good thing to keep doing? I have no idea. It’s been a few years now, and I’m not sure this is getting better. I emailed Ron in the middle of the night when I couldn’t sleep, and he didn’t reply. I didn’t ask for a reply, so I guess it’s OK, but it didn’t help either.

It’s as if the therapy is keeping me from making my life better, because I’m always dealing with the fall out of the therapy. Once I add work into the equation, there’s almost nothing left.

I’m feeling negative. I don’t understand what’s happening, I just know it feels bad.

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35 comments
  1. Oh Ellen, I am so sorry. Sometimes when I read your posts I just so see myself and it’s just crappy. My T asked what I felt in the middle of my therapy shutdown moment and I was sitting there curled up in a ball crying but remember coming outside myself and laughing that it felt crappy. It was the oddest moment of being two people at one time or at least of being me and laughing at my younger self that she felt so terrible. I don’t know why your post reminded me of that. I guess I just want to validate that I kinda get how scary it is too feel so crappy and have no more energy left for anything other than work and therapy. Ron should know what DDNOS is, btw even if he doesn’t like to diagnose.

    • Ellen said:

      Thanks AG. That scenario reminds me of what I call switching – sometimes, in order to answer a question, I’ll switch out of a part so I can answer. I can get out of an emotion really fast that way too. And yes, it is scary to have nothing left for daily life – exactly.

      I guess, to be fair, Ron did help me discover parts, which no other therapist had done. He knows what dissociative parts are, but he didn’t know that diagnosis. Which yeah, does not fill me with confidence. Even though I do feel attached to him. It’s confusing.

      • I don’t know if I have DID or not. But it is dissociative something and it feels like I’m falling apart or going crazy and if it is even a bit of what you are going through…I just wish you could feel better.

        • Ellen said:

          Thanks AG. Nothing you’ve written would make me think you have DID. I don’t either, I’ve got DDNOS. But parts are on a continuum, as Ron says and I do believe him there. When you talk about your ‘yonger self’, that is a part of you, in some sense, right? And one part belittling another part – you need parts for that to happen. But. There are gradations with it. I’m further along the dissociation spectrum than most of the bloggers I follow, but not as far along as a DID person. Anyhoo. Thanks for the sympathy. I wish we both could feel better today.

  2. Here’s my take on choosing a therapist, for what it’s worth. I prefer working with women because 1) whether or not they have experienced abuse, they do know what it’s like to be a woman in this world and the complexities of gender politics and 2) there’s a lot of transference that happens in therapy and what I do NOT need is some kind of crush on or fantasy about my therapist. (I know, this wouldn’t work if I were gay or bisexual). Those concerns may or may not matter to you.

    I do pay attention to what people write on their websites. It doesn’t have to be beautifully written (though I am probably influenced by that) but it does need to resonate with my values. For me that means nothing about religion and little to nothing about spirituality. That’s not how I think about the world, even if I do care about some of the same things that religious and spiritual people do. One thing I liked when I first chose E. was that her online intake form asked about things like if you got out in nature and how many hours you spent watching TV. Since those are things I’ve emphasized with my kids, that really resonated for me.

    But ultimately, you just take a leap of faith and try someone. E. always suggests you give it three sessions to see how things feel after you get past the initial get-to-know-you visit. You won’t like everyone, and that’s okay. I mean, it doesn’t feel great but it’s perfectly normal. You can tell them you don’t want to come anymore, or you can just cancel an appointment and not reschedule.

    It’s all a challenge and hard work to slog through when you already don’t feel good. But a good therapist makes a huge difference. I hope you can find someone as caring and competent as E.

    • Ellen said:

      Thanks for sharing your experience Q. I worried about #2 also. And I did develop a crush, which dissipated as soon as I talked about it, lol. It’s true though – for many reasons, having a T of the other sex is different. My problems with men can come up, but then, my problems with women come up also in the other case.

      I agree with needing values that match up, for sure. Did you find cost a deciding factor? I’m wondering if more education/higher fees mean a better T, but can’t really afford the pricey T’s.

      • When I first went to see E., it was not expensive for me, because she accepted my insurance, and my co-pay was only $10. But a few years ago she stopped accepting that insurance because they paid her very little. But I didn’t want to change to another therapist. So now I pay $67/session, about a third of the cost (my insurance still pays the rest).

        I prefer people with a Psy.D. because I know they have had the longest, deepest training. But of course you have to work within your budget. Earlier in my life I would not have been able to pay what I currently do.

        • Ellen said:

          You seem very lucky with your insurance. If I could find any insurance to pay even half, I could afford most therapists. Here, psychiatrists are covered for all. Nothing else. With some work benefits, you can get $1000 bucks per year for a psychologist only. Which would not cover a lot of sessions. So anyway, I pay the full shot.

          Thanks for sharing your experience Q.

          • That is terrible coverage. What about laws that say psychological illnesses and treatments have to receive the same coverage as physical illnesses (a stupid distinction anyway since there is no clear separation)?

            • Ellen said:

              I’m not sure we have those laws in Canada Q. However, if we do, the answer would be that illnesses need to be treated by an MD, and for mental illness, that is a psychiatrist. Which basically means meds rather than therapy. Other types of therapists are for ‘problems in living’, which, the argument goes, do not need to be covered by health insurance. A fair amount of therapists here offer sliding scales, and Ron does also, but I’m not really poor and so don’t qualify for that. I can pay basic rates, just that means I save less, or buy less….

              It is terrible coverage, thank you. I’m amazed that you have such great coverage actually. I’d think the insurance companies would balk at funding ‘just talking’ as they do here.

            • Well that’s surprising, I mean that we have better coverage in the US than in Canada (though I know I have better than average US insurance through my employer). Here talk therapy is covered by insurance, I think because there is scientific research showing it to be effective.

            • Ellen said:

              I dunno Q….insurance companies here are in the business of making money, not paying it out. I don’t think they care what is actually effective. Maybe I’m cynical, but I work for financial institutions, and they’re not impressing me with their caring. 🙂 It is surprising the US is beating out good old ‘socialist’ Canada here, but I’m happy that you have the coverage you need. Wish I did also. Cheers

      • Wow, this is a really great resource – thanks for sharing! I will also share with others.

      • Ellen said:

        Thanks shaking. I especially liked the recommended books section of this site. Cheers.

        • This.shaking said:

          It is good – but needs some updating! Thx! TS

  3. I just read some of your posts from December 2010 (I think) – just randomly picked some from years ago. At that time, too, you were looking for a therapist and listing how it had gone with others. I see now that some of my considerations are different from yours (you wrote that women irritate you more easily).

    Ultimately, it’s about your trust in the person’s competence and capacity to hold calm in the face of your storm. You’ll end up questioning any therapist, no matter how good, at some point, but if in your more stable moments you know the person is on your side and teaching you things that help, then that’s the right person. I hope you find him/her.

    • Ellen said:

      Maybe I should go back and read those posts also! he he. I have seen a lot of women T’s, because I thought, as you do also, that they’d be better able to understand and be less scary overall, but in my actual experience, it didn’t turn out that way. I found the T’s I went to almost too ‘nice’ and quite easily hurt.

      I do trust Ron’s skills in his capacity to hold calm and not be reactive, and just to try and build connection. He’s empathetic, and he doesn’t impose his views. He’s not hurt by anger or disagreement. He definitely cares and is committed. I like him a lot.

      My problem is I feel kind of different, and maybe that’s all about me. I feel like my particular problem might need a specialist in that area. I’m not confident Ron knows where’s he’s going with me. He doesn’t agree – he thinks we are doing what we need to do, and if anything, I’m holding back. I go back and forth, trusting and distrusting, and right now, I’m on the distrusting side I guess.

      Thanks Q for your thoughts.

  4. Rachel said:

    My current therapist charges 20% less than the last therapist I had (Delaney), and is 120% more skilled. I don’t think price correlates with skill. Part of that is also that my current therapist doesn’t take insurance, so her rate is more reflective of what an insurance company would pay, whereas the last one did take insurance so charged a “higher rate” but then took me at a slightly reduced rate. Nonetheless, I don’t believe cost or even education level equate to skill. I’ve seen people with PhDs who did not have the skill and knowledge my current therapist has (at a Master’s level).
    When I was looking for a new therapist, I looked for someone knowledgeable in types of therapy that address the symptoms of trauma (for me, that was schema therapy, DBT, EMDR). And really, it came down to how I felt talking to her on the phone. And then how I felt in our first session. I’ve had so many therapists that I had a pretty good idea of what I wanted and needed, and she fit my needs. She was easy for me to talk to and seemed to really like her job, which is another indicator to me someone will participate in continuing education and overall be motivated and interested in the treatment. I’d say I lucked out, but I also listened to my intuition and learned from the last ten years.
    Also, if Ron is working with trauma, then knowing what DDNOS is seems like a no-brainer. He seems out of the loop a bit. I don’t think you’d have these recurring fears of his lack of ability to really help, if he was helping. Even when I am upset with my therapist and wanting to quit, it isn’t because I don’t think she has the skill or tools to help. I never doubt that with her, but I did with my last therapist. Just my thoughts! Take ’em or leave ’em 🙂

    • Ellen said:

      Great to hear your thoughts on therapist price Rachel. Intuitively, I agree with you. So much of therapy is about personal qualities and engagement a T can bring, rather than advanced academic studies.

      When I was looking for a T the last time, I didn’t know that I had DDNOS, so I wasn’t on the lookout for a T that worked with dissociation. I’d worked with some that said they specialized in ‘trauma’ but that I didn’t click with and didn’t really trust. So with Ron, I just went with whom I seemed to connect with best. And in some ways, he’s been great. Ron also is devoted to his job, and does read a lot it seems, judging from the books he has in his office. He just has this very particular philosophy about not wanting to diagnose, and not being interested in approaches other than psychodynamic, that I’m not as happy with. On the other hand, I know I would fight against the structured type of therapy you do.

      I was back to not wanting to quit, now reading your comment, I’m waffling once again. It tears me up inside when I think of leaving (when I’m not angry). Younger parts of me are so attached to Ron.

      I do respect your opinion, thanks for offering it.

      • Rachel said:

        It is definitely clear that Ron cares, and is invested in the therapeutic relationship and has helped you tremendously with your interpersonal skills/wounds. It sounds like that isn’t the issue, the issue is now you are noticing different needs that he doesn’t seem to be able to help with (parts), which you weren’t aware of 5 years ago when you sought him out. This is the very tough part of relationships – we go into them one person, and we grow and evolve and become more aware and relationships change as our needs change.
        Of course it tears you up, 5 years is a long time and you are attached because he is so kind and loyal. That makes so much sense. It hurts. He has been a great source of support.

  5. This.shaking said:

    Dear Ellen: My T (I’ve been through a number of them!) for the last 5 years is a known specialist in trauma and dissociation and parts. She’s the first one who “got me” and I am now fighting her tooth and nail (never got angry with anyone before! Hah!)
    This site might help: http://www.isst-d.org/ .
    Have you read the current NYTimes Science bestseller? The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma – Bessel van der Kolk also
    Intensive Psychotherapy for Persistent Dissociative Processes: The Fear of Feeling Real by Richard A. Chefetz
    I read both within the last year. Easy to read (except for the pain!) Finally convinced me that I had to go along with my Parts. Seemed to me like Bessel and Chefetz knew all about me. (oh Woe) Who knew there were other folks like me. And now I am coming out a bit to you guys. Wow.
    HTH! Hugs-TS

    • Ellen said:

      Thanks for the recommends. I’ve read the Body Keeps the Score, and it was real interesting. (Recommended it to my T also but he doesn’t seem to have taken me up on that.) I hadn’t heard of the Chefetz book and will definitely look that one up – it seems so relevant. I’ve been to the ISS site and also worked with a therapist they list. I really did not click with her at all though. That’s why I’m a little skeptical sometimes about people’s specialties – I think there’s a lot more involved in being a good T than knowledge.

      Thanks This Shaking. Really great to meet you!

        • Ellen said:

          Thanks for the link This – I really enjoyed a lot of the articles on here. This therapist lives in my city, and has the exact training Ron has (same school). This is the kind of stuff Ron deeply believes in also – and I’m not against it at all.

  6. e.Nice said:

    For me I went with recommendations from other professionals, either who they see themselves or someone they would refer a friend to. That really helper me feel more confident that I wouldnt get some one inept. So if you know someone who is in a related field or works with lots of therapist I would ask them for recommendations (I didn’t lie but made it sound like I was asking for a friend). Then from that list went with someone my insurance covered. Cost doesn’t seem to be correlated with expertise in my experience. In the end it’s who you feel comfortable with. If I was to do it all again, I would know better what questions to ask. I would probably also pick 3 options and do an interview with each. It is pretty much a crap shoot. Sounds like Ron is good for you in some areas but you have some goals that are different (ie functioning afterwards) in other areas.

    • Ellen said:

      Thanks Nice. Yeah, we do learn what is important in a T through doing therapy.

      • e.Nice said:

        I also wanted someone who was good with EMDR… I’ve seen it be really helpful at easing ptsd stmptoms for others. It can be tricky with dissociative disorders though.

        • Ellen said:

          For me, EMDR made me worse. But I do wonder if you could get some relief from it – it would be something to try I’d think. Take care.

          • e.Nice said:

            EMDR didn’t work for me because I was unable to do the resourcing/ safe place but I think at some point (way down the road) it would be worth another shot.

  7. I read this post when you first wrote it, and have been ruminating on how I chose Bea….and to be honest, I’m still not sure.

    I needed a T for my daughter, so I went on psychology today’s website and I made a list of T’s that work with kids. I chose T’s that looked kind in their picture, and who didn’t seem “married” to one type of therapy (like I didn’t want a hardcore CBT shrink, I wanted someone who went with what the client needs). I called them all. A few were crossed off the list based on the phone call alone. When Bea called, she spoke with me at length, and was very engaged, curious, kind, empathetic, and not judgmental. I set an appt for hubby and I to meet her, and she had this very open, unassuming feeling about her. I liked her right away, and felt comfortable.

    I didn’t choose her as my T, until well after I had gotten to know her as Kat’s T. I can say though, in the months that Kat was seeing her, I did call different T’s, and the criteria I used was the same as for Kat– except of course I didn’t need a child therapist. If they listed trauma or eating disorder, or any other of my 100 diagnosis, it was a plus, but it wasn’t a focus of mine.

    Ultimately, I look for a therapist who is open, caring, empathetic, and nonjudgmental from the first contact. I want someone who is not married to one psychological school of thought but is instead willing to work with what the client needs and be creative if necessary (this is where the fact Bea works with kids is helpful, I think). I want someone who is accepting of me, and who sort of just projects that from the get-go. I want someone who is willing to learn/continue education when needed. I want someone who will work with me as an equal (as much as possible) but who can be protective over the little girl and teen.

    I don’t know if that helps at all. I don’t think cost or specialities matter so much in the long run. It’s more about the T, and the relationship. I think that you can click with a non-specialist and heal and grow more from that than if you saw a specialist you didn’t click with.

    I think Ron cares, and of course you feel attachment to him. You’ve been seeing him a long time. I do think there should be a plan try to help you not feel so bad for so long after therapy days. Bea says that we are in therapy to be able to live, that I missed enough of my life already because of trauma– therapy and trying to heal from the trauma shouldn’t take more time away from my life.

    I hope that whatever you decide, it works out. I don’t think there is one right answer, or any easy solution. Xx

    • Ellen said:

      I think you have a great process Alice. To be able to call various T’s and have a sensible conversation is a great skill, especially when you’re looking for the first time. I agree about the specialties – they are of no use at all if you can’t connect with the T. Cost is a factor for me, unfortunately, as there is no real insurance here for non-psychiatric mental health, and I’m not wealthy, and not poor.

      Thanks for encouraging my idea about not being so disabled by my therapy. I’m going to keep trying for that. I’ve got lots of opinions now to mull over. Thx for sharing this.

      • I’m glad this helped…and thanks for saying I have a good process. It works for me.

        And I really do think that therapy shouldn’t take away from your life. You are in therapy to heal, and not hurt more. You deserve to be able to love you life. I hope that you and Ron are able to come up with a workable solution.

  8. This.shaking said:

    Oh, I *really* like your system, Alice! TS

  9. It does sound like you are stuck, and Ron isn’t helping matters. I’d be angry too at him and at the way therapy is going in general. It’s unfair to keep asking you to deal with the fall out like your doing. That’s not doing you any good as a client. I hope you figure something out and soon. XX

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