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CBT for C-PTSD


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Karai,

Even good insurance plans typically will "capitate" the amount of psychotherapy a person can get in a calendar year (or in a lifetime). Meaning that they set hard limits regardless of need. And it is common that people will have more need of psychotherapy services than insurance companies will help pay for. You should be prepared for this eventuality, psychologically at least.

Mark

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Hi Mark,

Thanks for the eye-opener! That sounds just like insurance companies--money before people. But, I guess money doesn't grow on trees! I definitely will keep this in mind. But it won't be easy--there's sooo much to worry about already! (I think I have a headache --lol!).

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  • 1 month later...
Karai,

Even good insurance plans typically will "capitate" the amount of psychotherapy a person can get in a calendar year (or in a lifetime). Meaning that they set hard limits regardless of need. And it is common that people will have more need of psychotherapy services than insurance companies will help pay for. You should be prepared for this eventuality, psychologically at least.

Mark

That is the sad truth and also why I think CBT is the best treatment. Because unlike other talk therapies they give you the tools to help yourself once you run out of covered appts. and teach you nto rely on yourself rather than a particular therapist.

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Hi Cynthia,

CBT may be the best treatment, but if it doesn't "work" because of the limited sessions allowed by the insurance cos. well, then, what good is it? Sorry, I guess anything is better than nothing--some coping skills are better than none! Okay, you mention that it gives you the tools necessary to help yourself, but at the rate that I'm going, well, I don't think my toolbox will be very full, and I got approx. 20 hours left covered by insurance, according to my therapist!!! I guess I will have to find a PT job to maybe cover the rest on my own, which means no room in the week for therapy! What a vicious cycle!! Gotta laugh....(or cry!).

Edited by karai
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Guest ASchwartz

Karai,

It is true that insurance companies can be fairly rigid about coverage beyond what is allotted. However, it is possible for the therapist to appeal for more sessions on the basis that the patient is in great need. That is something you might try. Also, you are not the first person who got a part time job of some type to pay for the therapy. What I want to add is that, if it comes to that, ask your therapist for a discount until the insurance takes over next year.

Allan :o

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Hi Allan,

I thought 24 sessions was it! Non-renewable! I will definitely check with my therapist and insurance co. on this. On the other hand, maybe my remaining 20 sessions should be a goal I set for myself in getting better! Thanks for enlightening me.

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Hi Cynthia,

CBT may be the best treatment, but if it doesn't "work" because of the limited sessions allowed by the insurance cos. well, then, what good is it? Sorry, I guess anything is better than nothing--some coping skills are better than none! Okay, you mention that it gives you the tools necessary to help yourself, but at the rate that I'm going, well, I don't think my toolbox will be very full, and I got approx. 20 hours left covered by insurance, according to my therapist!!! I guess I will have to find a PT job to maybe cover the rest on my own, which means no room in the week for therapy! What a vicious cycle!! Gotta laugh....(or cry!).

I completely understand and sympathize Karai. I am also happy to see Allan chimed in with some excellent advice! Almost CBT like advice in that Allan looked at the same situation from another POV and you seem to feel more hopeful now:)

What book or books has your therapist had you read to accellerate your rate of progress? My entire group was over in about 20 sessions but it was pretty intensive and we started with the book by Sam Obitz and Michelle Craske that focuses on the use of the TEA form thought countering exercise and I still use them and feel like I am still making strides long after my group has ended so even if Allan's excellent suggestion does not bear fruit you still have plenty of other alternatives. I'm rooting for you:D

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Hi Cynthia,

If Allan's suggestion does not pan out for me, well, I don't mind finding that PT job to cover all the therapy I need, at least it will get me out of the house.

I have not been assigned any books to read by my therapist as yet, but he gave me a self esteem article and a related 3-part homework assignment to do. This is supposed to take approximately 2 months to complete, and consists of listing all the good things I feel about myself. Well, it sounds simple enough but took me 2 days to just think of---nothing! I couldn't find anything to jot down so I ended up creating a worksheet to list all these positive things instead; I figure at least I will have done something constructive in those 2 days! Well, surprise surprise, this gave me my first 2 items! Anyway, I am still working on this and have only completed the first step of the first part after almost a week. For every positive thing about myself I can think of, I can think of 3 negative ones. Well, I'm not going to give up yet--I have to have something to show at my next appointment!

Regarding those books you read, do you have the titles for them? Maybe I can ask my therapist about them too. Well, thanks for the suggestions and wish me luck in completing my homework!

Edited by karai
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It's important to remember that when you have a problem and want to work on it - helping professionals may be absolutely essential to the process of healing/change, but they only facilitate the change - they do not do the change themselves. What I'm getting at is that it is important to own the change that you experience as something you've created - not the doctor. This is, of course, far more true of a statement/suggestion when you are working with a psychotherapist than with a surgeon :) A therapist can point you in a direction and help hold you on a path (like a good coach might) but after a point in time, you may find that you've learned the skills you needed to help yourself - say to help yourself change your mood - and have them within yourself to use independently of the therapist. Such skills are like any other skills - if you use them a lot you will maintain them and grow them and if you stop using them they will atrophy. There's a reason why they talk about the "practice" of therapy. If you stop practicing the skills you've learned you will run the risk of losing them.

I don't meant to suggest that its ever easy to reach a point where you can function completely independently. People are social and it is most always helpful to have someone else to bounce ideas and perceptions off of. But I do mean to suggest that people can become more independent and capable as a result of practicing therapy-oriented coping skills.

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Hi Mark,

I think you are telling me that I shouldn't see therapy as something on going, never-ending--that eventually I will have to stand on my own 2 feet. I get it. But right now I feel that goal is something that is so very far away. I know I am becoming dependent on my therapist because right now he is the only one I can talk to, besides people on this site. I am surrounded by family and "friends", but family have their own lives and are very judgmental and my "friends" I can't trust. The only person I feel safe opening up to is my therapist. It would be good to see that bright light at the end of the tunnel, but right now it seems just a flicker from a match--very weak and quickly extinguishable. I do understand that I have to change my way of thinking, but once I'm out in the big, bad world (out of the therapist's office), years of negativity is pretty hard to get rid of. I guess I react first, then think later. I haven't learned those coping skills yet to handle these emotions, let alone understand why I react the way I do. Sometimes I feel just hopeless--okay there we go again with that negative thinking! Well, at least I caught that one. I guess I'm a work in slow progress. Thanks for your input. Now I understand that therapy shouldn't be a "forever" thing, and that I have to own and practice what I learn. Maybe there is hope for an old dog like me afterall.

Edited by karai
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Hi finding my way,

Thanks for the reassurances. That should make me feel better, but tonight I'm in kind of a funk brought on by my therapist not returning my call yesterday. Of course this could be a totally innocent situation, like not getting the message, but regardless, I'm still in this funk. I refuse to bother him during the weekend, so I'll wait til Monday to call him again. Like I said, I wish I could learn new behavior faster so I don't ever have to feel like this again. Can't deal with this kind of feeling any longer. I want to sleep so I can just not think about it, but all I do when I go to bed is think! Nothing new. I'll just deal with it like I usually do--surfing the internet all night long. But thank you anyway, and sorry for burdening you with my negativity.

Edited by karai
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Well, yes, you need help at this phase of your journey, not just assurances. And yes, you will reach a point of greater independence down the road, but there just are phases when we can't figure things out alone. That neediness may feel like a burden. I think we are all taught to think that. But how does that help? For me, learning to find patience for my neediest parts calmed down a lot of the struggle. It also opened my eyes to the neediness in those around me. No I can't fix all the neediness everywhere, and maybe there isn't even one thing I can do about it, but I don't have to go all reactive and run away either, see what I mean? Hope you got some sleep!:)

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Hi finding my way,

Gee, I never realized I was so needy. Yuk!! I recognize that in one of my friends and was adamant about never being like that. But you're right! I guess this dependence on my therapist is being needy. Actually, that phone call wasn't a "needy" phone call; I just wanted to pick up the tapes he was going to give me to help me with my sleep problem, a week earlier than my next appointment. (I had really bad insomnia last weekend and didn't want to go through that again this weekend). Actually I didn't really need it anyway. I had 3 - 4 hours of uninterrupted sleep last night which is really good for me. I feel rested today. Regarding my therapy, I feel I'm not progressing much because during my appointments, I can't think of much to say, but outside of his office I have these great discussions with him and tell him everything I want to say, all in my head! I figure I'll write this all down in my journal and read it to him in my next appt. but it all seems so awkward. Maybe I'm still hesitant about revealing anything about myself. I can't talk freely like I do here on this website---because I'm not anonymous to him!! We're face to face with nowhere for me to hide! Go figure, I'm a therapy coward. Do you think I should print out some of my posts for him to read? I think he'll get to know the yukky me faster, then I'll get to where I want to be sooner. Well, thanks for your help. Take care.

Edited by karai
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In classical psychodynamic psychotherapy, the client is supposed to get dependent on the therapist. And then over time this dependency is worked through and greater independence results. I'm not sure that it always works out that way, but it does sometimes.

At any rate, I would not worry too much about being too needy or whatever right now. If you're working hard to confront things that are uncomfortable in your therapist you're probably on track. And if you're learning to catch yourself in negative thoughts that before you might have just uncritically accepted, that is good too. It takes a while.

Please don't be hard on yourself.

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Hi,

finding my way, you're too kind, and no, you definitely are not yukky!

And, thanks to both you and Mark, I feel a whole lot better now to know that I'm right on track in my therapy. I guess I'm just so confused right now and, I guess, impatient! I've always been hard on myself for as far back as I can remember; it'll take some undoing but I guess I got the time--I got nowhere else to go but forward. Thanks a bunch!

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  • 2 weeks later...
Thanks for adding this new forum. I have lots of questions about Therapy at the moment.

I would like to know if CBT can be successful when a person has not verbalized all their trauma's with their therapist. Actually, not verbalized them with anyone, it's still memories in their head, triggering?

I think so but you have to get these thoughts down on paper and counter them. I just completed cbt and it is wonderful. I have turned my thinking around and am pretty good at countering 99% of my thoughts in my tea forms now. Cbt is definitely worth trying!

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Hi,

finding my way, you're too kind, and no, you definitely are not yukky!

And, thanks to both you and Mark, I feel a whole lot better now to know that I'm right on track in my therapy. I guess I'm just so confused right now and, I guess, impatient! I've always been hard on myself for as far back as I can remember; it'll take some undoing but I guess I got the time--I got nowhere else to go but forward. Thanks a bunch!

I think you are on the right track and moving at a decent speed. I know I was impatient early on too, I think that is normal because who likes anxiety and all of its side effects? I learned not to be so hard on myself and am becoming more patient with myself and others everyday and it makes life more enjoyable. Hang in there and keep countering your thoughts and you will be feeling a lot better soon:)

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Thanks tmays,

I just can't wait 'til life becomes enjoyable! Haven't experienced that in a very long time, or ever!? I guess I'm still confused and still get those stupid feelings that I can't explain, mostly late at night and early mornings. When it's quiet and there are no distractions to counter the thoughts, just want to scream! I get totally afraid that the thoughts will turn into something worse; guess that's why I'm so impatient. But, it's good to hear that there is hope somewhere down the line...

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Thanks tmays,

So far, victories-0, bad thoughts-a zillion? Sorry, I'm starting to get into one of my funky moods again and am trying to suppress it. I think I have to get back to the Lounge and read all those jokes and one-liners then listen to my sleep tape which usually helps if I concentrate really hard. Thanks again for your positivity (is that a word?). Take care...

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  • 2 weeks later...
Hi Cynthia,

If Allan's suggestion does not pan out for me, well, I don't mind finding that PT job to cover all the therapy I need, at least it will get me out of the house.

I have not been assigned any books to read by my therapist as yet, but he gave me a self esteem article and a related 3-part homework assignment to do. This is supposed to take approximately 2 months to complete, and consists of listing all the good things I feel about myself. Well, it sounds simple enough but took me 2 days to just think of---nothing! I couldn't find anything to jot down so I ended up creating a worksheet to list all these positive things instead; I figure at least I will have done something constructive in those 2 days! Well, surprise surprise, this gave me my first 2 items! Anyway, I am still working on this and have only completed the first step of the first part after almost a week. For every positive thing about myself I can think of, I can think of 3 negative ones. Well, I'm not going to give up yet--I have to have something to show at my next appointment!

Regarding those books you read, do you have the titles for them? Maybe I can ask my therapist about them too. Well, thanks for the suggestions and wish me luck in completing my homework!

Hi Karai,

Wow a lot of replies since I last checked in here. I have not read all of them but remember this is a process and takes time. Just getting started on these assignments and finding even just two things is a good step. It may help to ask someone else what they find positive about you. When you are stuck in misery it's hard to see clearly and that's part of the problem.

As for the Books I read, my favorite is the CBT book by Sam Obitz and Michelle Craske called Been There, Done That? DO THis! it is short and simple and is the book that got me started using the TEA form exercise.

Good luck and keep at it:D

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Hi Cynthia,

Thanks. I actually did finish the first part of my assignment and started the second part. Unfortunately, when I re-read what I wrote, they were not all positive things, but negative things I made sound positive! I pointed this out to my T. and he told me to just keep on trying. I think I'm just a hopelessly negative person! Now I have to do a listing of my accomplishments I am proud of. Well, now it's even worse! I've been around a long time (perhaps too long!) and I have nothing to show for it--positively at least. This "simple" assignment is really stressing me out! I work on my list everyday but stare at it w/ a blank mind. I guess I will disappoint my T. again w/ virtually no progress made! I think I will throw in the towel, or my list at my T! just kidding (NOT!!!).

I think I better take a look at the Obitz book you mentioned; I think I need it desperately! Thanks again. Take care.

Edited by karai
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I think I'm just a hopelessly negative person!

You could start with this one! ;-)

I think the point of the exercise is that you're not expected to do very well at it the first time, otherwise you wouldn't need it. It's good to go back and look at your earlier answers again, and the fact that you noticed the negativity is a sign of progress. The whole point is to bring it to the front of your mind so you can question it.

I think I will throw in the towel, or my list at my T!

This is why most therapists prefer that clients not bring towels (or anything harder) to the sessions. :-P

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