Hi TAS, I understand your pain. It sucks. I have been there (and partly still am), and I can still very much imagine what it must feel like for you. The only thing I can say from my experience is that T has a reason to set those boundaries. For one, T is not part of your real life. You need to be your own person and not depend on someone who will never be there for you in the 'real world'. T is there for you. Every week. Because T cares about you. If T didn't care, he would tell you that he couldn't work with you. He does. T just has to have boundaries. (Which still sucks).

Also, from my experience, through the years T has become a LOT easier with in between sessions contact. I recently went through something really difficult only she and my partner knew about, and she even phoned me twice to check in. Because she cares, and because I have shown (through the years) that I don't rely on her in a life-support kind of way anymore, but that I know which decisions to make, and that I really value her opinion/care. And she does care. She just knows that if she'd shown that in a similar way three years ago, I would only have become more reliant on her instead of stronger on my own...

I'm sorry if it sounds harsh, but I really really think your T is acting in your best interest. You just don't see it yet. But you will. Don't leave T please

And, between the lines I can read in your post that you know that T does care about you...

Poppet, I just want to say to your original post so don't "scrap" what Poppet said Tas.

I have that same disorganised attachment thing going on with me, and I also can't keep a "solid picture of T in my head", but I will say this knowing that I can't depend on T between sessions is easier than thinking I can when they allow contact. Old T allowed contact but the hurt when she never responded was extremely painful because like Poppet and Mayflower said your T is never going to really be a part of your life no matter how much we wish for that. Your T is a part of your "once a week" and so perhaps accepting that as a gift will set you free from the feelings of dependency? Well I'm hoping so anyway, because I also struggle with those issues you described.

Good luck with discussing your feelings with your T!

B2W

(((TAS)))

You know that I couldn't stay away from this thread as I'm a big fan of dependency so I'm not much into once a week sessions and no out of session contact. The only literature I've ever found that called for once a week sessions was written for treating dependent personality disorder. The point of view was, "you don't want this person to become dependent upon you and you will have to bring up the end of treatment." It seems as though perhaps the therapeutic community is denying the dependent person the very experience they need in order to heal? Just my opinion.

It could all depend on the particular situation. I was not functioning with one session a week. If you believe the trauma literature, which I know I continually quote, it talks about the T needing to encourage contact, repeatedly. I can get you the link to a specific article if you want. I'm just not entirely convinced that working through an incredibly huge amount of pain is necessary to get to where you want to go or even if it's the road there. I do think that strict boundaries, regardless of what they are, are necessary in order to heal. By boundaries I mean limits of the relationship as defined by your needs and Ts needs.

Here is my favorite quote:

quote:

The therapist, therefore, must abandon traditional reserve and shift to a stance of "active engagement" (Olio, 1989). This stance offers explicit, repeated invitations for contact between the therapist and client, followed by observation and inquiry regarding the meaning to and impact on the client. Active engagement reflects the balance of sufficient initiation by the therapist, to create a responsive environment without reaching a level or intensity of intervention which becomes intrusive or controlling. If the therapist holds back, out of fear of intrusion, he or she may fail to provide the level of contact and emotional involvement necessary to encourage disclosure and access to the traumatic memories and accompanying affect.

Another one of my favorites:

quote:

This shift can often be difficult for clinicians who have been trained to view neutrality and therapeutic distance as a valuable asset and who may fear creating an overly involved or overly intrusive environment. While a significant level of emotional involvement is an essential ingredient in the therapeutic relationship with victims of childhood abuse, over-involvement on the part of the therapist must be monitored as well. Active engagement requires the therapist's willingness to initiate interaction with, and attune, to each survivor. The therapist must engage in an active process to develop a relationship that fits the particular individual's needs, rather than one which simply reflects the therapist's assumptions of the "correct way to proceed." This stance includes the therapist's responsibility to inquire about the client's internal experience as well as monitoring the quality of his or her everyday life.

And last, but not least, from a Kathy Steele article:

quote:

Session length and frequency must be adjusted to what works for the patient, meaning what best supports therapeutic progress that improves the patientis daily life and decreases crisis. Session length is generally accepted as one hour, though a number of trauma patients maintain better containment and functioning with an hour and half. The session should not be longer than the patientis tolerance for the work, nor shorter. Most importantly, sessions should always begin and end on time, affirming the dependability of the therapist. Session frequency is generally set at once, sometimes twice a week, and seldom at three times a week (e.g., Chu, 1998; ISSD, 1997). The more frequent the sessions the more dependency emerges as a core feature of the relationship. Many patients need more than one session per week to maintain and improve functioning. Thus, frequency should take into account the patientis tolerance for dependency, as well as the therapistis capacity to maintain dependable attachment and flexible but consistent boundaries. Generally, adequate frequency and length has been achieved when the patient is able to move out of crisis and into more productive therapeutic work.
Phone calls are an important intervention to consider. Generally, crisis calls should be minimized or eliminated and check-in calls, if necesssary, should be substituted. Check-in calls should planned, time- limited, brief, and therapy should not be done during them. They should be used in a stepwise movement toward establishing object constancy and internal self-soothing for the patient. Again, an adequate balance is attained when the patient is less crisis-prone and able to better engage in therapy.

Hey TAS,

Couldn't resist jumping in. I don't necessarily agree with the idea that therapist availability inevitably leads to unhealthy dependency, because that has not been born out in my experience nor in that of many others around here. I suppose I technically have "24/7 access" in that I have my T's cell phone number and email address and she has never set limits on when or how often I contact her. . . however, that has certainly not, in my case, led to me contacting her 24/7! In the earlier stages of our relationship I would call once or maybe during particularly difficult times twice a week, but now that my sense of her as a secure base is more internalized, it is not at all unusual for a month or more to pass without me calling at all. I do email a few times a week, but my messages are brief and she usually doesn't respond. I don't think that could be called an unhealthy dependency. She's always encouraged me to contact her as needed.

Well, anyway. . . that's not to say your T may not have good reasons for what he is doing. I've been reading a book on treating attachment disorders, and one thing the author said was that offering a client with an attachment disorder too much contact before some security in the relationship had built up could actually create anxiety and overwhelm or destabilize the client. This was written by a T who specializes in attachment and seemed to have fairly flexible boundaries and generous out of contact policies in many of the case studies included in the book. So I know it wasn't about him hating his clients or wanting to be aloof and withholding, yet in a few of the illustrations he did go that route of limiting contact quite a bit, because he thought it was best for the specific client, at least for the time being. It actually made me think of you and your T when I read that. I wondered if he might be doing something similar. Perhaps changing things up on you the way he has is an attempt to get the balance right for you. Everyone is unique.

In any case, if you want to continue working with him (and I know you've said elsewhere you have no desire to start over with another T) I guess the pragmatic issue you are facing is how to live with all this.

quote:

I feel as if I can't keep a solid picture of the Therapist in between our visits. I have told him this and he insists on no contact outside of the therapy hour.

I wondered when I read that if an actual picture might help? My T has a picture of herself on her website and sometimes I've been able to ground myself just by looking at it, when I haven't wanted to call. Maybe your T would let you take a picture of him?

I do empathize because I'm having to learn how to live with something I haven't been able to change about my T as well, since I don't want to switch. It's the whole cancellation thing. I explained how it unsettles me and she just said people with evening appointments are liable to getting rescheduled because of stuff that comes up with her kids and their schools. Not the most reassuring response. But I've decided I want to keep her, so I am taking responsibility for this need for consistency myself by finding a way to make morning appointments possible. I am trading babysitting with a friend once a week. I don't know why I didn't think of this earlier.

Phew, I can't believe this got so long. Excuse all my rambling, I guess your dilemma kicked up a lot of related thoughts. I do seriously wish you well with all this, TAS. I believe things will get easier for you, that you will work it out one way or another. I think you are being very brave to stick with things like you have in spite of the pain and confusion.

(((TAS)))

Even though I'm a big fan too, it's still not clear if you and he have talked about it and if you understand the reason why he is sticking to the once a week. Has he explained his reasoning to you?

The trauma literature does talk about the therapist not moving towards attachment too fast because many of us have a fear of attachment as well of a fear of attachment loss but, Tas, you should talk to him if you haven't yet so you understand completely where he is coming from.

On another thread you mentioned that you wrote a letter to him and in the letter you mentioned that he never greets you with a smile. Is it hard for you to talk to him about the issues that bother you?

I am heading out the door and will be fully booked until this evening. I will reply to each of you this evening.

Real quickly, Liese, it is very difficult for me to tell him what is bothering me. He has said he believes the in between contact, he believes, is increasing the negative transference. I feel as if I am to blame for having the negative tramsference. I am not trying to have it, it is here, though.

Thank you and will write more later.
T.

((((TAS)))

I had a really hard time too for a long time talking to T about the issues that were bothering me so I completely understand. It seemed so threatening. It WAS threatening, actually, because if he didn't get what I was saying and said the wrong thing, it could totally crush me. I wasn't able to process anything in the moment and so would go hope and wig out.

The negative transference is not your fault, Tas. We have the memories we have because that's been the story of our lives. It's his job to help you manage it - which he is trying to do by not offering you out of session contact.

I do remember that when you did text him, you would get upset if he didn't reply. Am I remembering correctly?

I cannot text or email my T but I can call him. I think if I could text or email him, I would be prone to doing that more often than I call. It takes a lot of courage for me to pick up the phone. And, even then, waiting for T to call back can be excruciating. One time I was on the road with the kids and I was pretty upset about something. I put in a call but I either minimized how I was feeling or didn't ask for a call back and so he didn't call me back. I went into an awful spin, then, for the rest of the trip with the kids was convinced that he hated me and I was too much. I imagined he was at home rolling his eyes, thinking, oh, that girl, she's such a pain in the neck and not giving my pain a second thought after that.

After I told him how awful the weekend was, he changed his tack with me and kept encouraging me to call when I needed to. I needed to know that he was okay with me getting close to him.

So, I can see how your T might be trying to help you manage all that awful transference but that's where I think a scheduled check-in call or two might help. He'd know when you were going to call and it would help him manage his schedule. You would know you were going to contact him on this day and that and it would reduce any anxiety around that stuff and might help with the object constancy stuff.

Tas, you really need to communicate to him how much pain all this is causing you and offer suggestions. You are not going to get past this until you talk to him over and over again about it. Maybe you can write it down. Maybe you can bring him some of the threads and the issues we have all talked about. Maybe you can bring him some articles.

It sounds like you do really like him and you're not ready or willing to look around for another T. For me, other than these contact/one session a week issues, he has sounded like a terrific, caring therapist. Sometimes they need to be hit over the head at least 5 times before they understand how much we are in pain about something. Please try to talk to him about all this. It will only help you. There's no reason for you to suffer by yourself.

Tas,

On negative transference being caused by contact between sessions: I want to say that I sort of just went through this with my new T. She got upset with me about contacting her but particularly because I was angry. She said that wasn't the place to work that sort of thing out and that it needs to be in session. So I came up with an idea that she and I both seem to be comfortable with. okay long story short I have that same problem of not being able to feel connected to my T during the long week btwn sessions. So what I proposed and she agreed upon was that once after the session and once on the weekend (because weekends are hard for me) I can send her a light hearted email message that she will respond to. I send her such things as a picture of my puppy etc. It doesn't get heavy and it lets me know she is there. She is available by phone for support/crisis but I don't call her often because it feels awkward.

I do get how bad it feels to have no connection what so ever between sessions. It's like you are to open up and be vulnerable for an hour or so and then that's it. It makes you wonder if it's even real. I hope you can talk to him about this. I really do. And I agree that if he is not open to letting you express your feelings about this then that would be a sign to move on. Ask him why he is being so strict with contact. But ask early in the session so you can process it. This does sound so painful and I know I would be tempted to leave too but perhaps you guys can work it out.

Hi Tas,
I do exactly te same as Turtle, on the evening or day after my session I send an e-mail. I just tell something small and usually add a photo. If i have mentioned something important she acknowledges it and says will talk about it next week. Otherwise she just thanks me for the picture and wishes me a good week. It really hekps me. I also save her replies and if I am missing her go back and read them again, to get the warm feeling of her caring.
I cannot phone inbetween because she only works part time and is always busy.

Try to talk to T and see if he can explain his reasoning.

Tas I don't have much more to add to the great advice that's already been shared.
Except to say that I can empathise with the great difficulty and pain that comes with being brutally honest and putting yourself in a vulnerable position. However that is when and where the healing happens.
If your T is right that out of session contact enhances the negative transference, then he is being caring and responsible to limit the contact. It can feel incredibly rejecting and shame provoking but if the transference becomes unsolvable, there's another vital relationship where you've been let down. Strange as it sounds, he's doing this because you matter to him and he wants to help you get better.
Big hugs xx

TAS,
I am a fan, too. I have had issues with negative transference myself. I think you are doing great in continuing to work with your therapist the way you are. I always cheer for you as someone who keeps trying.

Quell

Thank you EVERYONE for your replies...things are still plugging along...I still think he doesn't like me and now when he calls about appt. changes...I think he is angry with me because he is so short and to the point.

I just feel that he doesn't want me and is trying to have as little contact as possible because he doesn't want to deal with me. I haven't said this to him because I don't want to come across as accusatory.

I don't know. I do know THERAPY SUCKS! Just when you think you are over something, it pops back up again. UGH!

Thank you for all of your encouraging words...and I apologize it has taken me so long to reply...it seems that I have been running nonstop...as I am sure you all can relate to

I am trying to keep on with this, believing it will help. It is so difficult. I never thought therapy would be so hard. I thought I would go in and say, "This is the problem. Tell me what to do and I will do it." That definitely has not been the case.

I feel like someone is taking a backhoe and scraping it along the bottom of my soul...so painful...it's like metal meeting concrete...the concrete is slowly getting broken up...but so painful.

I wish each of you the best on your individual journey!

T.