topic's to discuss

[nightfalls]

Most of the time when I go to a T appt. I don't talk about all the stuff I think ahead of talking about, I end up talking about the small stuff, the same over and over small stuff that gets me knowwhere. It is frustrating after a appt. when I've waited x# of weeks to get and then it be feeling pointless to have gone. I don't know how to just jump into a conversation, start where I left off, or even just plainly remember the something big I needed to talk about, I get all nervous and feel bad for not getting into the stuff I need to. They think all is fine, I'm coping well, thing are great. but I still FEEL bad. I still think off, is there ever a point that someone gets to that they do feel just good? Like the stuff around them is ok, good, bad, does not matter because they are fine. I feel like it is fileing papperwork, I go through the pile over and over and over but I Never get to the REAL stuff on the bottom because life just keeps putting on the pile more and more. So how do I just disregard the top of the pile and start at the bottom? Sorry I'm rambling..

[finding my way]

Hi Nightfalls! Do you ever write in a journal? Journaling is a very good way to start figuring out how you feel. You could just bring in some excerpts from that, or make a list from what you've written of what you feel is important to bring up. I used to write little papers before I went into therapy. Sometimes (though not often) I even dropped them off before hand so my therapist could read it before a session.

[Guest ASchwartz]

Hi Nightfalls,

How come you have to wait 6 weeks to see your therapist? Is this usual? Do you have a therapist you can see every week?

I agree with "finding" and writing and bringing the journal or list with you to the meeting can be very helpful.

Allan

[FlowFreak]

I know for me to get past the small stuff it takes some time for the relationship to gain the trust I need to be able to get to the underlying.

I also agree with FMW and Alan about journaling/writing. That's been a huge thing for me I've been doing for a long time.

I don't always talk about everything I write, but just writing and getting it out somewhere helps, and also helps to facilitate getting past the small stuff in T.

[Mark]

I can think of two separate situations that might lead to this happening (where you don't talk about what you want to talk about)

1. you can't remember what you want to talk about in session; it all comes back to you afterwards but during you get caught up in minutia and don't recall what is important

2. you know what you want to talk about but it is anxiety provoking and you don't want to touch it with a 10 foot pole and so avoid it and talk about smll stuff instead.

A variation on 2 would be that you want to talk about it but don't know how to get started on that - it never seems to be appropriate to bring up that stuff because it is "heavy" and you want to be polite

Journaling or notetaking is a good way to approach the problem whether it is more like #1 or #2. If it is like #1 then the notes will help you to remember what to talk about. it would be a good idea to go through your notes or journal entries the night before your session and try to summarize them into an agenda or list of things to talk about. You could then hand a copy of that list to your therapist and thus avoid having to bring it up and instead have him or her read the list and do the bringing up for you.

If it is more like #2 then knowing what to talk about isn't the issue; it is finding the will to get through the anxiety associated with bringing it up. So in that case maybe you could bring up something less threatening like the fact that you are holding stuff back that you'd like to be able to talk about but don't know how and you can talk about that (which is in itself troubling but not the same thing as the trouble it self), and doing so might help be the seque you need to get into the actual stuff you want to talk about.

Then there is another possibility which is that you don't feel that it is appropriate for you to burden your therapist with your stuff. You don't feel worthy, or you don't want people to think badly about you or you don't want to burden them. Different variations on the theme. In that case you know how to do what you need to do but just don't feel it is safe to do so. In that case, I'd think about talking about how you don't feel safe. - again - approach the issue from the side without trying to launch into it. Test your therapist with little bits of the issue to see that he/she can handle it with grace.

There is always this urge to be polite in therapy, but therapy is one of the few places where being polite can hurt you more than help you. But before you can feel safe doing that, you need to trust your therapist will be able to handle the weight.

Edited February 19, 2009 by Mark

[nightfalls]

HI,

Thanks FMW, Allan, FF, and Mark.

I really appriciate your reply's, I will give your suggestions some thought. I have tryed a journal before just to keep track of stuff but never brought it in. I guess I relate to what Mark is suggested, the topic's are anxiety provoking and I'm too polite.

Mark, Can you explain more on why being too polite can hurt you? Or I suppost I am myself the example in which I don't talk of stuff I may need too?

True that it is I don't feel safe discussing these topic's, I feel it is horrible, I don't want them to think horribly of me, I am also afraid that they would confirm that there is something wrong, I guess it is different, I feel something is wrong but to have another confirm that there is, is more scary.

Or that there is nothing wrong and I really am just a horrible person to have thought so much stuff. wow and this is where I freeze:eek:

[Guest ASchwartz]

Hi Nightfals,

I will try to answer your question, not instead of Mark but in my own way and Mark may have his own answer to your question about why being polite in therapy hurts you.

I have multiple years of experience as a therapist and many times people would tell me that they did not want to "hurt my feelings" or have me think "bad of them" and, so, they tried to hold back on their anger.

I always explained to my clients that the therapeutic relationship and the therapeutic office are an island of safety in which people can experiment with new and healthier behaviors without the fear of being judged. Therefore, when this type of issue came up, I gently encouraged people to tell me about their anger at me, why they were angry and what I had done to make them feel angry. I also told them that they could wait until they felt more secure but that it would be best if they could start now.

I also explained to these clients that it helps me when people tell me not only that they are angry but what mistake I may have made.

Anger is a healthy emotions but too many of us were taught from earliest childhood that it is bad or that we are bad for getting angry. It is not true. Yelling and screaming are not helpful but explaining why one feels angry helps the other person understand. In therapy, anger gives the therapist and client an opportunity to work out where the misunderstanding took place and get clarification.

Here is a true example using no names at all:

I had seen this young male client earlier in the evening. A couple of hours later I closed my office and walked along the street to my car. (by the way, it was dark outside of course). I was lost in thought over the therapy sessions of that day and over my clients. It seems that this young man was walking past me and was upsed that I failed to greet him. At the next session he was very quiet, unusual for him. I waited and started to sense that something was wrong. When I asked he denied anything was wrong. I knew that he was a person who had a lot of trouble expressing anger and I asked him if he might be "upset" with me about something. I was surprised to hear him tell me that he felt hurt and rejected when I passed him in the street. I told him how shocked I felt because I literally didnot see him because I was so lost in my thinking. I apologized to him for that. He felt much better for a couple of reasons: 1. He was able to express his anger at me, 2. I accepted his anger, 3. I apologized to him and explained what happened.

We then went into deeper meanings of holding back anger and the fear of rejection.

I welcome your questions and hope this helps a little.

Allan

[paula]

How would you reply to someone who's got a lot of hanger, that has built up over the years, since childhood?

Anger that is not your fault? Anger that you know eventually, you will have to rid, but are having problems trying to rid!

Anger that has been there for since you can remember, & was made to feel like it was in fact your own fault, & have since found out, that it is not your fault, but only found out this through growing up?

[Guest ASchwartz]

Hi Paula,

If I was their therapist I would say "lets discuss all the things that happen and let's remember that you are going to get angry at me sooner or later and let's discuss it when that happens."

Allan:)

[paula]

Hi Allan

Hi Paula,

If I was their therapist I would say "lets discuss all the things that happen and let's remember that you are going to get angry at me sooner or later and let's discuss it when that happens."

I understand what your saying but, approaching in that way would only defer the problematic situation, do you not think?

I realise, that to get the anger condition under control, you must first get the situation out in the open, to deal with the anger that relates to this situation... Am I right in thinking that?

[Mark]

Mark, Can you explain more on why being too polite can hurt you? Or I suppost I am myself the example in which I don't talk of stuff I may need too?

Most of the time being polite is a good thing - it is what allows society to function for one thing. If we weren't polite to one anohter, we'd be expressing a whole lot of frustration and selfishness and inappropriate sexuality and similar stuff and the world would be a very different place; probably not a better one. In general, I'm all for politeness.

Too much politeness can be a bad thing, however. Politeness works best when it is given to strangers. the more intimate (I mean emotionally intimate; not sexually intimate) you become with someone, the less useful being polite all the time becomes. This is because politeness necessarily means that you are presenting a somewhat edited version of yourself to the other person, and ultimately, if that other person never gets to see the "real you", then you interfere with the development of ever deeper intimacy. And this 'ever deeper' intimacy is a very important place and space to cultivate because it is only in this environment where you can feel truly safe with another person for a moment or two. And it is only when we feel safe that we can try new ways of being and grow. And it is in this trusted safe space where we can learn how to feel better about ourselves - becuase we by and large develop self-esteem from the outside-in. People smile at us who love us, and we internalize that and it is their smiling face image inside of us which sustains.

Too much politeness interfers with the creation of a trusted safe intimacy between people who are already close. However, there is no such thing as too much politeness when you are dealing with strangers. Knowing when to be polite and when to put politeness down and be "real" and more "raw" is a social skill that can be developed and which gets better with practice.

In therapy, if therapy is working out and if the therapist isn't too stiff, an emotional intimacy will develop between the therapist and the patient, and when this starts to form, too much politeness on the part of the patient will interfere with the development of this intimacy (just as too much formality on the part of the therapist will also interfere with it).

Often the patient wants to protect the therapist from something inside them which they think is no good - anger, or a very negative self-image or something like that. and there is a fear of rejection which gets hyper magnified as well - what if I share this memory with my therapist and I see her flinch. Even if she tells me it's okay I saw that flinch and I "know" that this means she thought I was a "terrible person". All thesse sorts of fearful automatic thoughts can run through your head and stop you from feeling safe enough to share.

The fact is that the therapist might flinch, but it's probably not because he or she is rejecting you - it's more like - its always hard to hear about what hard things people have been through.

So - as Allan has pointed out - it's vital that there can be a discussion about the letting down of the guard - that there be a dance and a

"dialectic" (a back and forth) between actually letting down your guard, and then stepping back and processing/talking about that event. The stepping back and talking about it removes some of the urgency and helps clarify the meaning of the events that took place. Trust cannot form all at once, It must happen in slow layers and for every moment in therapy (or any other intimate relationship) where you take a risk, you must also pull back and have a little distance. So long as the direction or trend of the relationship is towards more disclosure in the context of an ever expanding feeling of true safety, you're on the right path. And it is the right path becuase when you feel safe, you can grow and when you don't feel safe, you are all contracted inside and stiff and you can't grow very easily.

Paula asks a really great follow on question - which is what do you do with built up anger that is substantial - how do you let this anger out in a safe way when you don't know how to do that and you risk letting too much out at once. At least, that is my translation of what Paula is asking about - correct me if I've got it wrong please Paula.

I think Allan's response is correct - in such a situation where you have toxic levels of anger built up and you don't know how to drip it out appropriately it's still good to talk about it, and to express exactly that fear out loud - that you don't know how to control it and sometimes it just comes out too much. The therapist and the patient in this case can talk about how to handle that sort of thing when it happens - what the ground rules are. For instance, it may be necessary to stop therapy for that day if too much anger spills out. I personally had a patient bring a knife to therapy one day and pull it out mid session. My patient wasn't really trying to threaten me, I don't think - it was more like please take this thing away from me or I will harm myself with it - but it still felt extremely unsafe in the room and I had to stop therapy for that day. But we had therapy the following time and we talked about the knife and we got past it. In DBT they are very good at setting these kinds of limits up front. If you spill too much anger you will get cut off from therapy for this amount of time but then you can come back. It's all worked out ahead of time so it is not a surprise to anyone. Those sorts of rules can be necessary for working with people who are constantly suicidal becuase they help that patient have a container/consequence for their aggression/anger. The goal is not to withhold therapy, but to create a context for helping someone stay within therapy - in that case, the therapy is set up to encourage more politeness so to speak. In the case I started out talking about - there is no threat of actual self-harm (that I know of) and the risk there is more that intimacy cannot grow due to too much self-control on the part of the patient (not not enough of it!), so in that case, the recipie is to aim for advising the patient to be less polite. It's a dance. A balancing-act. A titration (which is what they call it in chemistry).

Does this help? I've certainly used a lot of words (grin!)

[paula]

Paula asks a really great follow on question - which is what do you do with built up anger that is substantial - how do you let this anger out in a safe way when you don't know how to do that and you risk letting too much out at once. At least, that is my translation of what Paula is asking about - correct me if I've got it wrong please Paula.

Erm... In a way yes Mark! I have a lot of problems trying to explain what it is that I am looking for... This is the biggest problem that I have, & I must say that I really struggle with this issue, not only now but always... I seem to face the problem on trying to express what it is that I really want... I know that this relates a lot to my Dyslexia, but if only I knew how to put in words the feelings & meanings that I am getting, when I want to know the answer to any thing... I am not to bad at answering other people's questions, but trying to ask my own question is... Something I can't explain! I know what I want to say, but I cant say it! I hope I'm making some sense here?

Mark, what I'm trying to say is... Please bear with me. I am trying to say... Right, here goes...

When you have a lot of anger which has taken years of build up, say as far back as you can remember, & that a lot of this anger was made to feel like it was your fault, & finding out in the past, not so long ago, say 4/5yrs ago, that in fact this anger was not your fault, but deep down inside you feel like it has been left to long to discuss these issues... Yet, you can't forget these situations & the blame & consequences that you suffered at the time!

That the anger was there all along, through being blamed of these issues in the first place, and now with separate things coming to light, which clearly puts you in the clear & would of done at the time, if certain people would of cared to look into depth, like they just have done, that having to carry all this anger around anyway, knowing you could of gone into depth your self to prove your innocence, but feel that why should you have to prove something when you should of been-seen to be innocent on your own say so without any doubts...

So now... Apart from carrying all that anger around with you for all these years, now, you also have the anger of events, that have just come to light!

But the problem that your facing is... You couldn't let go of the anger from all those years ago & kept it locked in your head & couldn't talk about it then... & now you also have a load more of anger to add to it, knowing that you haven't dealt with the first lot, let alone adding more to this anger...

Am I making sense! I hope I am so to try and get advice on the situation...

[nightfalls]

Thank you Allan and Mark for your reply's

Mark, I see what you are saying. I don't know why I get stuck into the same pathway. Seems like there is never enough time to let that relationship form. Therapy is always time limited eg. 6 sessions? How can I get to it all in x # session I know of the cut off point when I start. Its a let down. You get to #6 and then what? mabe I still feel off, mabe I've not said it all, then it is over and you have to start over again with someone new or a new place. Its really stupid to be honest. Why can't someone go till they just feel better? Why have to start over again, trying to build a relationship, honestly I think it takes me 6 session to really want to talk to the person to feel ok to talk to them. Its a disappointment. Just makes me mad at myself. I hate this but I'm confused what do I do, am I just caught in all this that it is hard to stop, should I stop, do I need to stop, do I need to go, why can't they tell me what I should be doing they are the dr's they ask me what do I want, I wish I knew, I don't know what to do... If I had it all together in a way that I actually felt it was together I could reply. I give up, and walk out feeling more disappointed in myself.

[paula]

I don't know why I get stuck into the same pathway. Seems like there is never enough time to let that relationship form. Therapy is always time limited eg. 6 sessions? How can I get to it all in x # session I know of the cut off point when I start. Its a let down. You get to #6 and then what? mabe I still feel off, mabe I've not said it all, then it is over and you have to start over again with someone new or a new place. Its really stupid to be honest. Why can't someone go till they just feel better? Why have to start over again, trying to build a relationship, honestly I think it takes me 6 session to really want to talk to the person to feel ok to talk to them.

nightfalls, why do you only get 6 sessions with your Therapist & why do you have to start again with another Therapist?

In the UK, we go until we either get discharged or you are better! I know people who have been going for months to the same Therapist. I can understand what you are saying; Why start to build a new relationship when your just getting to know your previous one? I can't see the logic in that!

[nightfalls]

Hi Paula,

I think it is because of insurance, they only cover I think 6 sessions then you have to re-book at a office, but you are not for sure going to get the same person, you can try but it does not always work plus it is for short term stuff not like this, I think I just have alot of topics. I think if I could pay someone it would be different but I can't.

take care.

Edited March 2, 2009 by nightfalls

[paula]

Hi nightfalls

I think it is because of insurance, they only cover I think 6 sessions then you have to re-book at a office, but you are not for sure going to get the same person, you can try but it does not always work plus it is for short term stuff not like this, I think I just have alot of topics. I think if I could pay someone it would be different but I can't.

This is so unfair! You should be the judge of whether you are through or not! Surely, 6x sessions can't be enough for anyone?

So basically, what there saying is; Once you've talked about your problems, which obviously, if you have many of them which most people do & cannot talk about them in that space of time, you are done, even though you haven't talked about the root of the problem? Where's the logic in that? They are supposed to help you deal with the root of the problem. How to face that problem & deal with it!

I agree with yourself in thinking that YES Money does talk! You have rights! I would go further with this!

Are you under a Psychiatrist? If so, then I would explain to him how you feel about this situation with your Therapist! If you are not under a Psychiatrist, then I would pay a visit to your Doctor & tell him you want to be referred to a Psychiatrist, as you have a lot of Psychiatric problems that need sorting which your doctor hasn't the time to see to for you?

Explain to him how this is affecting your life! You are becoming more & more distressed with these problems, & you are afraid that the way you feel, you don't know how much longer you can cope?

I wish you all the luck, but no matter what, you know we are here for you!

[Guest ASchwartz]

Paula and everyone else,

You are absolutely correct. However, these insurance issues have nothing to with the needs of patients. Rather, they have to do with the health insurance policies employers (companies) signed up with and they usually choose the cheapest in order to cut costs. That means that some people cannot get more than 6, or 20 or 30 sessions in one calendar year no matter what. It is contractual and the insurance will not pay a penny more. The only thing a patient can do is pay out of their pocket and that can be expensive.

This is a real dilemma here in the USA.

Allan

[paula]

Paula and everyone else,

You are absolutely correct. However, these insurance issues have nothing to with the needs of patients. Rather, they have to do with the health insurance policies employers (companies) signed up with and they usually choose the cheapest in order to cut costs. That means that some people cannot get more than 6, or 20 or 30 sessions in one calendar year no matter what. It is contractual and the insurance will not pay a penny more. The only thing a patient can do is pay out of their pocket and that can be expensive.

This is a real dilemma here in the USA.

Allan

This is a Bum-ma isn't it! So what you are saying Allan is; No matter what your Health Insurance Policy cost, you still all only get the same? So... everyone's Health Insurance is the same price?

I'm glad we have Insurance Contributions taken out of our pay each month, to pay for Hospital Treatment, Psychiatrist, Psychologist, Doctors, anybody that you have to see medically.

[nightfalls]

I payed once out of pocket and it created more stress then was helpful, it just felt weird handing a wad of cash over to the Dr. after balling my eyes out. I understand they need to be payed but it really on a personal level felt way to off for me. I stopped going, becasue of lack of cash and the weirdness around it. I'd rather be billed. I don't know, the whole thing is frustrating, I wish it was more specific like if you NEED it then that is that but they leave it so open I really can't ever tell. Mabe it is more that I can't tell what I need, when things and moods change so does my perspective on what I can do.

[paula]

Hi nightfalls

I payed once out of pocket and it created more stress then was helpful, it just felt weird handing a wad of cash over to the Dr. after balling my eyes out. I understand they need to be payed but it really on a personal level felt way to off for me. I stopped going, becasue of lack of cash and the weirdness around it. I'd rather be billed. I don't know, the whole thing is frustrating, I wish it was more specific like if you NEED it then that is that but they leave it so open I really can't ever tell. Mabe it is more that I can't tell what I need, when things and moods change so does my perspective on what I can do.

I agree with what your saying! This Doctor shouldn't charge the way he does, it should go through the books! For all we know, he may not even be declaring this payment?

[nightfalls]

After a embarassing moment I've totally froze with wanting to go to my therapy I guess I'm doing my run and hide thing and feel not worth there time or energy because it is pointless all stays the same. It is hard to be positive when I have the same issues going on in my life as a year before. I guess there are parts of me that are better and mabe all the therapy did help so why now do I freeze up. I feel like a terrible person, I honestly think I just don't like who I am, how I react, how scard I get and then I hide, alone. Hating being alone but not feeling like I deserve anything else. Now I feel like I need to call and say ok now that I ran away and I'm getting over it can I come back-sort of like here too, I freak out and stay away feeling like I don't have a place anywhere to go.

[Guest ASchwartz]

Hi Nightfalls,

The reasons you give for freezing and wanting to hide and not go back are all automatic thoughts. In other words, they are not accurate. First of all, I would guess that things are not just the same as before. I would bet that you have made real improvements but you have dismissed them. You may also fear that you are disappointing your therapist and even us by not making progress (at least you think you are not). Really, it has to do with self acceptance. Watch out for words like, never, always, hopeless, etc, all encompassing words because they are not accurate.

Allan

[malign]

And no one here says you have to progress in order to stay, otherwise I might have to hide, too! :-)

In fact, wouldn't that be more of a reason to come back, if you still have needs?

[karai]

Hi nightfall,

Gee, I thought I was the only one who was going to be a therapy flunky! I too go blank when I'm in session and it gets awfully uncomfortably quiet sometimes. All these thoughts are running through my head and a lot of it I feel awkward or hesitant about saying out loud. I can have great conversations with my therapist, all in my head (one-sided, of course), but once I get into his office--BLANK!! That suggestion by Mark about giving the therapist a list of the things you want to bring up is a good idea. This puts the burden on your therapist and not on yourself. That way all the uncomfortable stuff you would chicken out of talking about will get addressed. This would prevent all those awkward quiet moments from happening in my sessions. Regarding the anger issue that Allan discussed, well, mine concerns confusion. After my appointments, most of the time I'm confused 'cuz I don't know what just happened! Is it because I didn't say much, or is it because I didn't get enough feedback? Or, is it because I didn't say much that is why I didn't get enough feedback? Yet, at my next session, I don't know whether to bring this up 'cuz I don't want to make him feel he wasn't doing his job, or hurt his feelings. Yes, I guess I am being polite. I hope I don't end up running away too, and I don't want to be a therapy flunky (not that you are one) and I hate that feeling of nowhere to go (that's why I hide out in my room most of the time--it's a safe place to be). Allan was reading my mind when he said that we don't want to disappoint the therapist. Yeah, I don't want him to think I don't want to get better. If I was in his position, I think I would give up on me already!

Edited May 23, 2009 by karai

[Guest ASchwartz]

Hi Karai, and all,

Karai, much as I wish, sometimes, that I could "read minds," I really cannot. I made the comment about not wanting to disappoint your therapist because of all the many years of experience I have being a therapist.

My suggestion is to tell your therapist just what you are thinking and feeling at the moment. For example, if your mind goes blank as you report, tell him just that. If you felt angry last time because he said too little, let him know that. If you feel nervous, tell him that. Just say it all, that is why he or she is getting paid and he or she is not a mind reader.

What do you think (lists are a good idea).

Allan