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Hi Ms. Control,
What a great question. I do think a combination of therapies can work really well, under the right circumstances. I'm not sure I would have said that at the start of my journey. If my T had suggested that I supplement my therapy with, say, group therapy or DBT when I started with him, I'm sure I would have experienced that as rejection. Now, however, as my dependency on my T turned out to be a bit of a negative experience, I think having other resources to turn to can be really empowering. I think the muck I got stuck in was due to the experience of having only one therapist and the dependency issues it brought up for me. That and my therapist's inability to help me through the muck. Having only one therapist is the prevailing model of psychotherapy. The standard thinking is that two therapists often leads to the client splitting. I can see how that would happen and I can see how I would have been prone to do that at the beginning of my therapy though I don't think I would do it as much now. Awareness of the splitting can be a great tool to work with.
Since "threes" are generally a difficult number of people, what about having three therapists (making the group total 4)? It could be set up that way at the outset, that they all know about one another. Clients would be informed about splitting at the outset so that they would at least be aware of the possibility that it might happen. You could see each one once a week so you'd have support 3 days of the week. If you spread it out, you wouldn't have to go more than two days without support. You'd have the experience of different personalities and you'd be able to compare and contrast to see what works better for you and what feels best. It would almost be like having three parents to go to.
I think having only one therapist is wrought with lots of pitfalls just as having more than one therapist is wrought with pitfalls. Different pitfalls but isn't that true with everything, like the therapist note disclosure article highlighted?
What a great question. I do think a combination of therapies can work really well, under the right circumstances. I'm not sure I would have said that at the start of my journey. If my T had suggested that I supplement my therapy with, say, group therapy or DBT when I started with him, I'm sure I would have experienced that as rejection. Now, however, as my dependency on my T turned out to be a bit of a negative experience, I think having other resources to turn to can be really empowering. I think the muck I got stuck in was due to the experience of having only one therapist and the dependency issues it brought up for me. That and my therapist's inability to help me through the muck. Having only one therapist is the prevailing model of psychotherapy. The standard thinking is that two therapists often leads to the client splitting. I can see how that would happen and I can see how I would have been prone to do that at the beginning of my therapy though I don't think I would do it as much now. Awareness of the splitting can be a great tool to work with.
Since "threes" are generally a difficult number of people, what about having three therapists (making the group total 4)? It could be set up that way at the outset, that they all know about one another. Clients would be informed about splitting at the outset so that they would at least be aware of the possibility that it might happen. You could see each one once a week so you'd have support 3 days of the week. If you spread it out, you wouldn't have to go more than two days without support. You'd have the experience of different personalities and you'd be able to compare and contrast to see what works better for you and what feels best. It would almost be like having three parents to go to.
I think having only one therapist is wrought with lots of pitfalls just as having more than one therapist is wrought with pitfalls. Different pitfalls but isn't that true with everything, like the therapist note disclosure article highlighted?
At one point in my therapeutic journey I think having more than one T would have been very difficult for me. Now, however I am finding it to be a very beneficial experience. I have many issues or diagnoses if you will. I have bipolar disorder, a personality disorder, an eating disorder, I am a trauma survivor, and child of an alcoholic. Currently I utilize 3 different Ts for different purposes. I have my primary T who I see weekly who is trained in CBT. The focus of therapy is whatever I want it to be but always with the underlying goal of challenging perceptions and modifying behavioral patterns (whether they be associated with mania, depression, eating, or relationships). Because the therapeutic relationship with T1 is bringing up transference we have been dealing with that as well.
With T2 I process the issues underlying the transference and how to put T1 in her proper place in my head and in my emotional world. We make it a point to keep the focus off of T1 because she really is no the issue, she is just the trigger. This stops the splitting that Liese mentioned which can very easily happen. In which case the therapy would be counterproductive.
With T3 (who I have the longest history with) I address the issues that trigger off my eating disorder.
All of my Ts are aware of each other and respect my need for privacy in each relationship. With primary and secondary T I will let them know where I am in treatment with the other to keep them informed.
This really works for me. I do not see a psychiatrist for my PRN meds. I have opted to use my primary care because of his knowledge of psyche meds and for my history. I visit them once a month for medical and psyche check ins.
I pretty much feel like I have a huge safety net. Which leaves me feeling safe and supported. Splitting for me has not been a problem because it is just not something I have a tendency to at this time. Earlier in my recovery I probably would have been the queen of splitters.
I really can't expect one person to meet all of the clinical needs associated with my various diagnosis because each diagnosis comes with it's own issues. So for me it works. And all of my Ts have commended me on being such a great advocate for myself and seeking help from different professionals. T2 stated that this kind of treatment (having more than one T) is somewhat unconventional, but if it works and gives me relief and I am not further confused by it, to continue on.
I hope I made sense. I feel like I didn't.
With T2 I process the issues underlying the transference and how to put T1 in her proper place in my head and in my emotional world. We make it a point to keep the focus off of T1 because she really is no the issue, she is just the trigger. This stops the splitting that Liese mentioned which can very easily happen. In which case the therapy would be counterproductive.
With T3 (who I have the longest history with) I address the issues that trigger off my eating disorder.
All of my Ts are aware of each other and respect my need for privacy in each relationship. With primary and secondary T I will let them know where I am in treatment with the other to keep them informed.
This really works for me. I do not see a psychiatrist for my PRN meds. I have opted to use my primary care because of his knowledge of psyche meds and for my history. I visit them once a month for medical and psyche check ins.
I pretty much feel like I have a huge safety net. Which leaves me feeling safe and supported. Splitting for me has not been a problem because it is just not something I have a tendency to at this time. Earlier in my recovery I probably would have been the queen of splitters.
I really can't expect one person to meet all of the clinical needs associated with my various diagnosis because each diagnosis comes with it's own issues. So for me it works. And all of my Ts have commended me on being such a great advocate for myself and seeking help from different professionals. T2 stated that this kind of treatment (having more than one T) is somewhat unconventional, but if it works and gives me relief and I am not further confused by it, to continue on.
I hope I made sense. I feel like I didn't.
Hi MC,
I think it can be good to have a treatment team for some. I have 2 Ts and a P. My P is for med management, so that's why I see her. My primary T is who I saw first and she's my "everything" T but, I have an ED that was severe when we started so I work with T2 because she specializes in that (I was in an eating disorder half day program and she was assigned to me as my case liaison with my T). That is still what T2 does with me - she "reports" my sessions to T1 (sends notes) but it does not go the other way around. T2 has a different modality which is rare in my area and that is primarily why I still see her. T has said it is rare and difficult. In discussing some concerns with her when I saw a CBT T for some skills while I was adjusting to my new job she had some reservations but let me know that of there was any conflicting information I was receiving to bring it up with her. I also discussed my concern I was just "hunting for care" rather than doing the work or looking for someone with different boundaries to avoid dealing with any/hers. She didn't think this was the case - but we had discussed this in the past when talking about multiple Ts in general.
I think all Ts should know about eachother of you elect that approach and that each should be fulfilling a specific individual role. It's counter productive for me at times to process the same thing. Depending on where the client is at, and where they can go in their healing I think the team will discuss. For me I liken it to if I had cancer... I see a team of different parts rather than go to three different hospitals for the same thing. It's a lot to manage so a good "team lead" will help a lot! Is discuss with your primary T.
I will let Liese explain splitting but to give a short opinion on my part... I think it's comparing them and then it's transference on a group level... You hate one and therefore hate all, you are positive with one and then positive with all, you are negative with one and then super positive with the others (and the other way around as well). A lacking example would be a child asks mom if they can stay up late and she says no, so they go ask Dad and Dad says yes... Then the kid thinks mom is all bad and dad is all good and the decision with one changes the relationship with another.
I caution against the idea of more than one without fully investigating your needs. No harm in trying especially if your T is open to it.
There is a good definition of splitting here (midway through the page). http://www.bandbacktogether.co...-disorder-resources/ . It is seen a lot in BPD (which is close to CPTSD and can involve significant areas of attachment stuff) and NPD - so in looking for info be aware you will see these diagnosis but it doesn't mean that is your issue - it's just where splitting information is. For those who have experienced abuse people in their lives as splitting it could be you were the "all bad" kid and your sibling was "all good" and maybe if something happened the definitions would switch (or not). Or one minute your past T was the greatest ever and now or occasionally they are the worst ever. So it's not integrating good and bad in some sense in one person, in the self, or multiple people. It happens with Ts, parents, at work, friends... Everywhere or anywhere. I know I split my parents - I can only think of all the good things or all the bad things - they are split in to almost two sets of parents. I've yet to integrate that they could be good and bad at the same time... So the processing there has been difficult. I also do this with myself (extreme self hate or apathy and occasionally acceptance and have a more difficult time with "the whole").
I think it can be good to have a treatment team for some. I have 2 Ts and a P. My P is for med management, so that's why I see her. My primary T is who I saw first and she's my "everything" T but, I have an ED that was severe when we started so I work with T2 because she specializes in that (I was in an eating disorder half day program and she was assigned to me as my case liaison with my T). That is still what T2 does with me - she "reports" my sessions to T1 (sends notes) but it does not go the other way around. T2 has a different modality which is rare in my area and that is primarily why I still see her. T has said it is rare and difficult. In discussing some concerns with her when I saw a CBT T for some skills while I was adjusting to my new job she had some reservations but let me know that of there was any conflicting information I was receiving to bring it up with her. I also discussed my concern I was just "hunting for care" rather than doing the work or looking for someone with different boundaries to avoid dealing with any/hers. She didn't think this was the case - but we had discussed this in the past when talking about multiple Ts in general.
I think all Ts should know about eachother of you elect that approach and that each should be fulfilling a specific individual role. It's counter productive for me at times to process the same thing. Depending on where the client is at, and where they can go in their healing I think the team will discuss. For me I liken it to if I had cancer... I see a team of different parts rather than go to three different hospitals for the same thing. It's a lot to manage so a good "team lead" will help a lot! Is discuss with your primary T.
I will let Liese explain splitting but to give a short opinion on my part... I think it's comparing them and then it's transference on a group level... You hate one and therefore hate all, you are positive with one and then positive with all, you are negative with one and then super positive with the others (and the other way around as well). A lacking example would be a child asks mom if they can stay up late and she says no, so they go ask Dad and Dad says yes... Then the kid thinks mom is all bad and dad is all good and the decision with one changes the relationship with another.
I caution against the idea of more than one without fully investigating your needs. No harm in trying especially if your T is open to it.
There is a good definition of splitting here (midway through the page). http://www.bandbacktogether.co...-disorder-resources/ . It is seen a lot in BPD (which is close to CPTSD and can involve significant areas of attachment stuff) and NPD - so in looking for info be aware you will see these diagnosis but it doesn't mean that is your issue - it's just where splitting information is. For those who have experienced abuse people in their lives as splitting it could be you were the "all bad" kid and your sibling was "all good" and maybe if something happened the definitions would switch (or not). Or one minute your past T was the greatest ever and now or occasionally they are the worst ever. So it's not integrating good and bad in some sense in one person, in the self, or multiple people. It happens with Ts, parents, at work, friends... Everywhere or anywhere. I know I split my parents - I can only think of all the good things or all the bad things - they are split in to almost two sets of parents. I've yet to integrate that they could be good and bad at the same time... So the processing there has been difficult. I also do this with myself (extreme self hate or apathy and occasionally acceptance and have a more difficult time with "the whole").
Somatic work is what I do in addition to my regular T. It has been an amazing supplement and helps me regulate intense sessions.