The 'Therapy Trap'...and how to get out of it
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- เผยแพร่เมื่อ 4 พ.ค. 2024
- In this video from The CTAD Clinic, Dr Mike Lloyd (Clinic Director) discusses a question raised about how to prevent trauma from previous therapies entering into new therapeutic relationships. Mike describes how this problem can form, and what can be done to avoid such a 'therapy trap'. #therapy
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Thank you for answering our question. We started with a new therapist a few weeks ago - the 10th in 8 years. This is the first time that we've had somebody specialized in dissociative disorders, so I'm hopeful this time will be better. I might send her this video too. - Rory
That is good news, and I really hope this works out well for you.
OMG this is my story! Thank you for this video.
A previous therapist that harmed me for a long time got sentenced to jail and thrown out of his profession. Because luckily also another victim went to the police around the same time as me and they were able to make a case against him.
Years and a few therapy attempts later I now finally have a good therapist to work with all themes and parts, including the past abusive therapist.
Good grief, that is awful. I am so glad you are ok!
Amazing explanation.
My current therapist talks about rupture and repair all the time. I told her right at the start how bad previous experiences were. She immediately said, right, so there's no trust. It was incredible to have someone understand so quickly and transparently.
Sounds like you both did great!
Lost my therapist of three years due to my lack of funds and his retirement. Five months with no mental health support whatsoever. At the same time, I became homeless. It has been challenging to hang onto life at times. It has been impossible to find anyone who even KNOWS about DID, let alone someone who will treat it, let alone someone who accepts the state's insurance for outpatient mental health treatment. We are in no-man's land, Dr. Mike (in the US). Thank you for all you do.
Really sad to hear this, and hope things improve very soon for you.
my system is mainly showing avoidant attachment on the outside and there is a background of neglect that leads to a mirror of this pattern, just with avoidance and pulling away instead of pushing. I often feel like Ts are prepared for the pushing but clueless what to do with the pulling away that reenacts a neglect pattern instead of an open conflict pattern. Just wanted to mention it. Seems like it is kind of rare but is does exist.
Hardly rare for people with severe childhood trauma. An inexperienced therapist underestimates severity in clients who are superficially socially appropriate and functional. Rookie mistake.
Thank you for raising this, Theresa, it does happen and some services don’t understand the pulling away effect. Damaging either way if left unresolved.
@@Cathy-xi8cb I don't know. People who specialize in DID are usually expecting disorganized attachment and a pattern of attachment cry and impulsive behavior mixed with interventions from controlling parts. I know a lot of systems and dealing with one that is mostly avoidant without visible attachment cry is truly rare. Generally, having a system that is over-controlled instead of impulsive is rare too. There is nothing in the main textbooks about treating DID that explains how to help a system like that because they are very focused on keeping boundaries with people who push boundaries. There is a gap in training for DID that is outside the norm. I am with a DID specialist with 30 years of experience, certainly no rookie in this, and it is an atypical pattern for DID.
Thanks a lot für this video. I still struggle 3 years after a therapy rupture with it. We spend 5,5 years with her and it ended up suddenly and she never spoke with me again since it..Many therapists after it told me it wasn't my fault, it's a personal think by her, but it is hard to cope with for me. Furthermore she didn't recognised my partial DID and so, some small alters can't understand why everything ended so suddenly and they are still very sad...though, now we recognied, that she also was very rude and unproffessionel to us. I tried to begin a therapy afterwards, but this time, it was me who broke after a year, I really was to afraid, I could'nt do it again. The small alters refused to trust again and boycotted the new therapy. There are a lot of problems to trust anyone again. One year ago, I started again with therapist number 3...this time, it seems to get better, but we both have no idea how to handle the strong emotional reaction reffering to the rupture. It is still there. Would you make a video about how (smalll) alters can cope with new relational trauma? Is there a chance to do emdr with partial DID then? .Best regards from Germany! I like to watch your videos!
Thank you for covering this. I know I experienced this! To have a very good therapist to know what to do and to put up boundaries right away is very important. The idea is to be able to have guidance, help, and be able to eventually parent/love and guide yourself. 😊 You explained that very well. I always tell everyone - Think of it like going to school and you get attached to a teacher, but you still have to go home after school. Because that is what a good therapist is , a good and caring and loving teacher. But as a patient, you must move up to keep learning. All therapists and drs are guides and tools that want to help and teach you to learn skills you never did as a child into adulthood. 😊
Teaching is a great analogy to this, thank you, really helpful thoughts!
Not all Drs and Therapists…
Great video. Would like to point out that when dealing with the NHS, it's likely that it's people outside of the therapeutic relationship (managers, CPNs) who interfere with or define the therapeutic relationship. Eg they might only allow the 'adult' part to speak and punish anything else or they very likely will cut therapy short for operational reasons. Be very aware that NHS therapy may well be inherently damaging, even if the therapist is good at their job when allowed to practice ethically. I would argue much NHS therapy for DID is not ethical.
This is why it is so important for the whole team to have a good understanding of dissociation, not just the therapist.
I am glad this video came up on my feed. I have just had a housing support worker trigger me and it has taken most of the last week to calm the disregulation. This person has no in depth training or understanding of relational trauma. The housing provider wants access to my flat to carry out checks. They don't realise that for me is losing my safe space and refugee from the World, but also not having built enough of a trusting relationship with the support worker that I trust them not to do stuff without my permission.
Totally relate.
I feel extremely lucky to not have had these problems. I've only had 2 therapists and both have been perfect. I understand how things could go wrong and my heart goes out to those who have struggled to have a good relationship with their therapist.
I've had some very emotionality abusive therapists in my past. But whenever I started with someone new, I always hoped they'd be different. Yes, I'd
be very guarded & took time to build trust, but I tried very hard to not use my past experiences against my new therapist. I'd tell them some of what happened to me & what that did to me as a way to explain what doesn't work in a therapeutic relationship for me, but I never used my past against them. If I did slip up, I'd apologize. Both sides have to be responsible for themselves. To work with someone who's DID because of severe organized abuse & other traumas, the therapist has to be well educated & experienced & willing to be in supervision & seek guidance from other expert
therapists to keep. My current therapist is in supervision & has consulted Dr. Janina Fisher, Dr. Colin Ross, & others about our work together. I came to her because my last therapist, who I love very much because he saved my life, retired
My current & past therapists spoke to one another about my situation which is very important for continuity of care.
thanks this is so real, it's hard to find an understanding therapist and some don't work well. so i imagine with dissociation its way harder. for me in therapy my struggle is that therapists dont really understand me that well... because they dont really get my situation. so often i have to calmly thank them and leave at some point or end up having to debate what i mean which can be isolating
One major thing that most therapists did not admit to was me being in my original environment that started a lot of the triggers - it’s so important that the therapist understands the current dynamic and your ability to be vulnerable in that place. It’s common sense now, but so many people didn’t even think it’d be a block to healing.
Thank you for making this. I feel like I avoid vulnerability with therapists because I sense the risk of encountering this problem, and I don't want to retraumatize myself. I'm pretty good at not blowing up at therapists, but I usually just end up walking away, because I don't feel seen or understood, and I don't feel like it's safe to express my anger and frustration, especially when I know its likely a projection from my trauma.
Thanks for the comment, I hope you get to a place where this can be done, safely.
@@thectadclinic Thanks. I am working with a qualified therapist now who has lots of experience with trauma and DID (25 and 6 years respectively), so I think it will probably work out this time. She responded really well when I got triggered early on by something she said, so that's a good sign.
Sometimes I have the feeling my therapist is really angry with me because I am not caring enough for the inner world. But that turns me into a frightened child and I just feel offended and want to flee the room.
Wow. Exactly what i have experienced. Thank you for this. I wish i could share my experience, but it's exhausting. I am still working through it with my current therapist. It's been 2 years and i am finally reaching a point where my previous therapist doesnt come up as much. It has really stalled working on the childhood trauma that caused the development of DID. Thank you so much for these videos.
Thank you for this, it is really important we know what some people have to go through before we even get to start. Hope you are ok.
I can relate to alot in this video, particularly steps 1-9... thanks for bringing it up and highlighting the dual responsibility. Anyone expecting the T to sort everything out won't get so far!
Would like to point out that Ts can also be the initial trigger for ruptures - not just the client.
And lastly, I feel the way a T communicates the boundaries which are required for the relationship is VITAL. So much can arise out of poor communication leading to misunderstandings on both sides... and then further ruptures... That's why an initial therapeutic contract / discussion (with follow up in writing) setting out how to manage things like emails/ responses / lateness etc is so important so that wrong assumptions are ironed out at the beginning. Or it can feel like the T moves the goal posts later on to suit them, which may feel unbalanced and unfair. Checking in periodically with processes is really important too esp if the client doesn't feel able to bring it up themselves.
Glad it was helpful! Yes, I agree, we have so much potential for making mistakes, it is critical we are careful.
Yes, it is the therapists job to know about how to work through this. But as a client it is good to tell whatever emotions that comes up related to the therapist, and to be able to trust them in their proffession. Feelings of trust, repulsion, anger...whatever; One part adores the therapist and another part doesn't. I hate that part of having did; Not trusting "myselves" and our judgements in different situations..
Agreed, being able to be open, safely, about what is being felt is critical.
Explained well. I think the issue that can get in the way of repair, is the unequal power dynamic and the 'expert' status that the therapist can hide behind. Ultimately if a client wants to 'keep' the relationship action defences can kick in to appease which doesn't mean it has been repaired. It just can mean the client doesn't feel able to properly voice. Eventually that voice will rear up in some way if it starts to feel safe and may surprise the therapist if they think everything going well. Also it's not all about the past and it's not all about the present, it's a combination. If a therapist negates the present and how they interact, which will not be perfect and puts it on the client and their past and its all projection I think it sets up a terrible dynamic...client the 100% dysfunctional one and the therapist the 100% functional one. When really that isn't the case. I do think you're right though 'baggage' from previous poor relationships can be brought into a new one and thats in or out of the therapy room. poor experiences makes one more vigilant against future scenarios. I was told by an expert in this area to 'test' future therapists , see how they act in relation to behaviours early on. Like all relationships people can just be on 'best behaviour' early days and only once both client and therapist more comfortable then they show their complete selves warts on all. By that point attachment has kicked in. I did what I was advised, I showed aspects of my poorer relational behaviours early on in first session, for example excessively questioning; being critical, asking for things to be a certain way. They all got very defensive, argumentative, combative, passive aggressive, controlling. I think most clients and therapists can be lovely and act well when the other is, it's a real test of relational capacity if the therapist can still act decent when faced with poor behaviour, set boundaries and discuss the issue at hand really listening. I don't think as a whole many people deal well with their own anger or others. I have had many conversations about this and with friends. A lot of repression, dissociating it, stonewalling, cutting people off ( ending) and then when it does come out to not be heard yes can feel invalidating.
Thank you for making this video 💛. For me, I liked the walking out sessions because I could be proud of standing up for myself, even in the midst of feeling like I’m being belittled and gaslit and feared. Have never had a repair session, sadly; I still keep my distance with people to this day.
Thanks for this video. I definitely struggle with this issue and it's so hard not to feel like it is my own fault. The therapeutic relationship itself is always been very hard and having had a therapist who did cross boundaries by inviting me to his own home, has not been helpful. I was inspired by this video to talk to my current therapist about my struggles regarding the therapeutic relationship itself and to talk about our latest session where i felt misunderstood, and rejected, scared. I brought a drawing that i made after the previous session to show to him (we previously talked about these drawings i made), it was an expressive selfportrait. And so this was helpful because i told my interpretation of the drawing, and he told his, and what helped is that he saw things in the drawing i didnt see myself (anger, dissapointment).
But the hard part is that he said it was not something he recognized and experienced himself. And the more i tried to explain, it did not seem to help. He suggested that i should say when i feel this way again so that he can make changes in his behaviour. Which made me feel like the responsibility is solely on me again, and also like an impossible task. And this also took me back to the long term relationship had wherein i've felt this way so often. So in the end i'm feeling misunderstood again!!
I feel like i should quit seeing this therapist. But it is hard, am i quitting again?? Is there no other way? Can i expect from a therapist to know their way with these things?
Therapists absolutely should be able to help with this.
Excellent! I had the same problem with my therapist until 2020, when I decided to go to a clinic that is specialised in trauma. I got to know DBT, took a course in 2021 and attended a day clinic for people with c-ptsd. I still don't think that the therapist I see on a weekly basis is particularly good at handling anything trauma-based so I don't talk about that. Instead, I wait for this therapy to end and then go and find a trauma specialist.
Thank you, and hopefully you find that right one for you!
My girlfriend has been seeing a therapist since she was little (She just turned 34 last month). She's had a ton of bad interactions with therapists over the years. One of her alters plays this game of "out think" the therapist and tells them what she thinks they want to hear, which screws over the others who are trying. I fear she'll never get anything substantial out of therapy and I don't know how to help her.
Thanks for spreading awareness. Recently i was about to stop therapy because of being scared of creating a toxic cycle like this and i still haven't talked about everything my therapist unknowingly triggered. Unfortunately he's not specialized in treating childhood-ptsd in conjunction with additional damage caused by previous mental health workers.
The way therapy has always fallen apart for me is because of bigotry from the therapist - either racism and/or homophobia. Therapists never like to be told they’re wrong or that they’ve made a racist assumption. Once that occurs it’s game over, I’m labelled as confrontational and I have to find a new therapist.
Grief, really sorry to hear you have been through this.
Sorry that this has repeatedly happened to you. Unfortunately there are some Therapists who haven't or aren't addressing their own issues and prejudices.
I‘m done with doctors and therapy!! I asked for help in order to get well and rise like a star. But doctors and therapists do nothing but holding me in this weak and sick position. It is as if they need me in a weak position in order to feed themselves. It‘s literally killing me. THEY are killing me and not helping me. I don‘t want this stigma of a weak and sick victim. It‘s a trap. I want to stabilize and rise. Not possible with our health system in Germany!
The opposite of what you should have been shown, really sorry to hear this.
@@tinypixiekitten7806 I‘m sorry to hear that you‘ve had to make the same experience. 🥺 A hug from me 🤗 Trust yourself 🏆👍
Mike, this video is completely on target. I had major therapy trauma coming into my new therapeutic relationship after a life crisis. She has done EXACTLY what you have described and has admitted how difficult it is to do but that she will continue doing it until my system is convinced that she won’t break, or leave, or traumatize…
Thank you for this, I really hope all keeps going well for you!
Would be good if you could have an initial free session so you could discuss this issue. You could then decide if the therapist is able to deal satisfactorily with your issues. Rather than having things go wrong and both ending up traumatised. I think its imperative that the therapist has their own regular therapy/ supervision sessions so that they also have support.
Could be part of the initial Q&A of working out which therapist is suitable?
@@thectadclinic Yes if that is an option. On NHS you could wait for a long time and you don't get a choice of therapist.
Thank you Dr Lloyd, and I appreciate you acknowledging that therapists are human as well. I think that fact can be a shock to clients who have fallen into "the idealization trap". Your video is enlightening from many perspectives.
When you’re working with a PERSON- client as a therapist - facilitator - coach - whatever - there are TWO KINDS OF COMMUNICATION THE PERSON IS GIVING YOU ;
The FIRST - called the ‘CONTENT’ - That’s the feelings - experiences - stories - the issues that are on their minds - asking you to hold, and help them learn about.
The Second is a Flow of ‘communication Underneath that content - the flow is constantly non- verbal saying to you as a facilitator, ‘you’re on a good direction w me, - ‘your guidance is just right’ - or ‘it’s not just right,’ or ‘don’t go there,’ or ‘that question is not useful,’ or ‘wait a second there’s something I want to tell you first’ -
But the client person Doesn’t Say that Directly - ESPECIALLY when there’s abuse and trauma in the background -
That’s why Following that flow of communication is SO IMPORTANT
I felt a sense of pride, or empowerment as I was considering your words on the topic. Just hearing about responsibility on my side as a whole so to speak, felt like some personal growth was a thing.I've been lucky with therapy so far, it's like I needed to hear that for my situation itself. I'm not sure that makes sense. Im aware of conflict within myself and I think that helped loosen a knot.
It's great to keep this risk in mind, thank you. I don't remember my years therapy before re-entering but I have a gut feeling that this must've happened for us before. At least this will help me stay aware that it might happen (again?).
Hopefully it doesn’t!
@@thectadclinic Yes, fingers crossed, thank you. 🤞 Our new T has been very safe to us so far. Very engaged and respectful. This channel has helped assure us that this one deserves an honest chance (and so do we).
Oooof. Really good video. In this right now. Had a ‘therapist’ who worked with us for 10 years. The last 3 of them going round in circles.
And are still trying to find someone.
We have gone into every new person and said straight away what’s been happening - but we didn’t use the same words as this video.
So maybe it didn’t make sense to the other people we tried.
Coz they never got it and always moved on to something else, then it ended up a mess, and we would leave after a few weeks. Or less.
Wow.
Thank you for another good video - and maybe using the words from this video (along with the tips from the other therapy videos) will help the next “therapist” we try to get it.
Thank you Dr Mike and the CTAD Clinic.
Really needed to hear this. Thank you.
You are so welcome!
Another great video! Thank you for making this content! I higly appreciate the effort you put into informing and educating people. Your video’s are helping me to be more accepting towards my diagnosis. So thank you!!
You are very welcome!
I feel this is an extremely individualistic response to fundamental systemic psychiatric problems. From my personal experience, my distrust of therapists doesn't come from bad therapy, it has come from years of systemic abuse. That is what must be addressed first before we start talking about what individual responsbility we have in dealing with the aftermath of this systemic abuse. I know I will have a very difficult time trusting any person who cannot understand why I believe this is right. Fundamentally, it's not on a therapist to bare the responsibility of fundamental systemic issues and it's certainly not upon the victim to react 'correctly' to the abuse.
Hi Jesse,
Of course, though what you saying is beyond the scope of this video, and is an entirely different topic. We are talking about individual aspects of working within therapeutic relationships, not systemic abuse. We absolutely want for better systems, and are working to try and achieve this.
@@mikelloyd3055 That makes sense, thanks Mike. Apologies if my comment came across more aggressive/unfairly critical. I'm extremely skeptical in general when people start talking individuals before systems. It's easily used by power to push blame onto people whose responsibility it should never be. I hope in the future we will expand our understanding of acceptable neurological configurations and experiences of consciousness (or DID if you want), so we can start to have these conversations more openly. It will be difficult and painful to address the limitations of psychiatry and to involve more survivor knowledge, I think it's the only way forward to pave a more harmonious future.
Interesting video - Having been fortunate in this regard, this is something we hadn't thought about. Not an insignificant addition to a journey that can be wrought with obstacles and prejudices. Good advice here as usual Dr Lloyd - thank you, g (seans)
Glad it can be helpful!
Well I guess this is reassuring to know it’s a process albeit a very hard one and the reason I’ve been banned from in person sessions. I’m grateful my therapist has stuck with me but I can sense she holds a grudge for the things that have happened.
I truly hope she doesn’t, or at least can work through it well.
We are working on it. It’s been tough.
I always try to view each therapist as a different person. I've had 5 therapists in total since 2006. Two of them ended unpleasantly. One said I wasn't listening to him and basically fired me. He seemed to get more and more hostile seeming as sessions went on and I never knew why. All he ever said was that I nodded and and said "uh hu" too much. I was sad he ended the therapy because he was teaching me what boundaries were and I was practicing that. Another therapist I was with for years was just very invalidating, she would snap at me a lot when I would talk about my trauma. She kept telling me I had "no identity"...which really made me sad. One day she just told me "you've graduated therapy" since I guess I was not coming back I brought up something that ended up making her mad. It was something I had mentioned before and she was fine with before....but this time she got really angry and backpeddled saying she was not fine with what I said and never said what she had said about it. She pretty much lied to me as our last encounter. Later after I had stopped seeing her she called my house...but I never returned her call. Maybe I'll talk to my current therapist about these situations. I always wondered if these therapists noticed my possible DID? And didn't know how to handle it?
love the video series you've been doing on therapy. it's really helpful. small thing, the way the numbered text on the screen wiggles in this video makes my dyslexia scream. the static text is fine, but maybe refrain from so many animated effects?
I just had this issues. I’ve walked away from two therapist in two months. I’m taking a break now.
Excellently explained.
Do you think having a "safe word" and time out for both parties to process and reflect could be helpful?
Set this boundary from the start of each session
I think sometimes a break in what could be a conflict situation is useful. Naming and owning the difficulty and trying to work together.
@thectadclinic Thank you for your much needed advice and support.
Wishing you a pleasant Bank Holiday Monday and week ahead.
The part of this topic I always see missed is any discussion or even acknowledgement of the broader structure. It's always spoken about as if it's a property of the patient and that multiple therapists "just so happen" to be unable to handle the projection of trauma. But this misses the aspect of either transference from the therapist (yes they do this as well, not just countertransference) due to the structure of therapy itself, or the projection of normality (informed by the dominant culture) from the therapist onto the patient. If, for example, someone has repeated therapeutic breakdowns because they are trans and many therapists falsely advertise or believe that they are trans friendly then this is not something that can be healed within the patient but is a problem of a culture-bound cognitive dissonance within the profession itself. Within the field of trauma and dissociation this can be a particularly troubling issue with the sheer number of psychs who seem to think that gender expansiveness itself is dissociative.
Thank you for the good work! Can you make a video on "which part" of the DID person is coming to the session? Some say it is the "host" or the normal part. But is it really true? Can it be the "willing" or obedient part, and that meanwhile the other parts are kind of suppressed (and do not agree with: 1/ what's going on during the session, 2/or what is being asked to do by the therapist). So that the DID person is unable to express himself fully during the session.
I can’t tell if this just happened with my treatment team and I don’t know how to stop making it happen if I caused it
Blimey. Exactly that. Compounded by the variability of finding the right therapist at the right time and the client being in defensive mode.
Yes, that variability!
I think the term "therapy trap" is a poor descriptor of this situation, but great for click bait. Attachment issues and difficulty managing conflict are so common for those of us with severe childhood trauma. A therapist that is not required to get therapy themselves in training is more risky. So is someone who isn't licensed; their training is often less intense. A less experienced therapist is also a risk. If you know that you have attachment issues, struggle to manage conflict, and have been burned by other therapists, you need to find out how your new therapist plans to manage your sessions around this. You can....ASK!
Sorry you didn’t like the way the video was presented.
Cathy, the problem is that asking feels impossible... Good for you, being so far along in your development in conflict management.
@@capngrace84 You can be stealthy if you can't find a way to be direct. You can ask how to manage another similar situation with a medical or dental provider. You will get a lot of information about your psychotherapist's strategies and perspective. Confrontational, defensive, assertive, avoidant...they will show themselves w/o knowing that you are actually assessing them. You have to be prepared for what they show you, however. A lot of us were trained to stay in relationships that harmed us. The familiar-but-inadequate or even abusive can seem safer than the new.