Author Topic: From once to twice a week?  (Read 3477 times)

BehindClosedDoors1980

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From once to twice a week?
« on: April 03, 2007, 07:26:27 AM »
Good afternoon,
I have been reading these discussions with interest for some time and find them interesting and helpful.  I have been in psychodynamic therapy for a couple months now, having sought it initially to help me deal with the anxiety and pressure of my very stressful profession.

While I am fascinated with the course of my therapy thus far, I am also struggling with the effects of having been a very solitary creature for most of my 27 years. I tend to be very guarded and not prone to opening up to anyone. I find that much of my time between sessions is spent not only rebuilding my walls but also telling myself not to be so open next time (counterproductive, I know).

For these and several other reasons, I have been considering asking my therapist if he thinks it would be helpful to see me twice a week. Can anyone provide some insight into the circumstances in which a therapist would consider this to be helpful? Are there insurance considerations? I admit to being ignorant of a therapist's dealings with (often difficult) insurance companies.

Aside from the legitimate reasons as to why this might be helpful, I also wonder if it's normal for a person to desire more time in therapy as they begin to see and feel it's benefits. I also admit to some anxiety in admitting to my therapist that I am beginning to form an attachment to the therapeutic environment. The vulnerability I am experiencing mentally in thinking about this, having not even broached the subject, is something to which I am unaccustomed. Of course there is a risk involved.


Any insight would be appreciated.
Thanks.

BehindClosedDoors1980

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Re: From once to twice a week?
« Reply #1 on: April 05, 2007, 04:02:56 AM »
Not that anyone asked but I summoned some courage and asked him if thought it would be helpful to see me twice a week. To my surprise, he agreed, saying that he thought I was motivated and that it would help bring my guard down to talk more often.

He wasn't sure it would be possible logistically, but he said that if anything opened up he would offer me the time, even if it didn't work out every week.

Dini

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Re: From once to twice a week?
« Reply #2 on: April 05, 2007, 09:28:42 PM »
Hi Behind Closed Doors,

I'm a male who is a bit older than you and it would somehow seems a little disrespectful (though humorous) to shorten your name in the salutation since we've just met.  Glad to meet you.

First, a disclaimer; I'm a "consumer" not a mental health professional.  But in a nutshell (a good word for it as applied to myself) I've been sober for a bit over 10 years and doing therapy for a bit over 6 1/2 years, both individual and group.  Also in a stressful, demanding profession though currently unemployed and looking for more of the same (stupid me).

Thought I'd respond just so you know you've been "heard."  I've done individual therapy more than once a week for several periods of time (as well as group therapy) and found it beneficial when there were difficult things to work through in the therapy relationship or difficult or traumatic life experiences occurring or the therapy just became really intense (at one point when the "walls" finally collapsed so did I; I experienced a severe depression, delayed onset PTSD, etc.- don't let that scare you, it doesn't mean it's going to happen to you.  It probably wouldn't have happened to me if I had had the good sense when I was your age to seek help and therapy rather than continue to build walls and surround them with a moat of alcohol.  We all have our own paths).

When you say you're afraid of becoming dependent upon the "therapeutic environment" that sounds positive to me because you wouldn't have a fear of being dependent upon it unless it felt safe to you. And above all, the therapist's office must feel safe to you for any positive changes and awarenesses to occur and for you to feel free to express yourself.

After a kajillion therapy sessions I am smiling a little bit at your reference to the dependence being upon the "therapeutic environment."  There's a touch of "distancing" in that statement.  Is it the environment or the therapist you fear becoming dependent upon?  I'm not saying there's anything wrong with either; quite the contrary, if you read through these forums you'll see lots of discussion about how attached we can become to our therapists.  They can become the most important people in our lives, that's why having a good one with whom you feel safe is important.  All the literature says the most reliable indicator of a positive therapeutic experience is a "mutual positive regard" between the therapist and client, and it sounds like you are headed down that path.  

As for attachment, if all goes well and you start experiencing "transferences" of various sorts, hang on to your chair; that's where it gets both scary, exhilarating and where the most profound stuff happens. If/when you "fall in love" with your therapist, it's OK, and it's a good sign that things are working - just be sure to talk about it with him and not try to hide your feelings.  A good therapist knows how to hear, acknowledge, validate and accept all sorts of feelings without transgressing any boundaries.

I admire you; you have the emotional courage at a young age to "look at your stuff" and you had the courage to ask your therapist about that second weekly appointment.  Good going!!

By the way, I'm fairly new here and find this "place" a font of information populated by some very compassionate, kind and insightful people who are honest enough to sometimes "call you" (compassionately) on your own stuff.  In my experience, if you stick around they will bestow those gifts upon you and only ask that in return you be as honest as you can be on any given day.

Take care.

Dini

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Re: From once to twice a week?
« Reply #3 on: April 05, 2007, 09:37:46 PM »
I almost forgot; my experience with the insurance thing is that it depends on the DSM IV diagnosis, if any, that the therapist or psychiatrist gives you.  

For a while I just paid for my own therapy. (Geez, I already had the stigma of being a sober alky and now I gotta be a nutcase too?  Now I could care less about either stigma).  Then I used the insurance.  We used the diagnosis of dysthymia - low-level depression.  Not a big deal and the insurer would pay for once a week.  When I went into the severe depression, suicidal ideation, delayed onset PTSD, etc. and a psychiatrist got involved, I suddenly had multiple actual mental illness or mood disorder.  With my insurer, that allowed unlimited visits.  

Your insurer may or may not be similar.

BehindClosedDoors1980

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Re: From once to twice a week?
« Reply #4 on: April 06, 2007, 03:07:52 PM »
Hi Dini,

Thanks for your reply! You are very astute to notice some "distancing" in my clinical message. I have experience mild transference in my therapy, not necessarily in romantic feelings toward my therapist, but moreso a desire to be perceived in a certain way - as bright, intelligent, competent, motivated, controlled - which is part of why it's been difficult to let down my guard and ask about being seen twice a week. Of course I was afraid he would perceive it as needy. God forbid I'm needy! :)

I actually think it will be interesting if or when my attachment to therapy and my therapist intensifies. Although we are exploring some trauma from my childhood, of course, I have not experienced any mental health symptoms that have interfered with my life except for some mild anxiety which I think is normal given my stressful and high-profile career. So I have not necessarily been in a position to "need" my therapist in between sessions, except for those rare moments when I feel like disclosing which, of course, are not the times when I am actually in his office :) I suppose what I'm saying is that I feel like I will be able to identify the transference as it occurs and will be interested to see how that plays out. Am I afraid of it? Yes. But I'm sure it's inevitable and that it hasn't happened so far is probably a result of my resisting it's inevitibility.

I love these forums - you who post seem genuine and candid to me. Psychotherapy is such a strange thing, such a strange relationship, and analyzing therapy is just fascinating...

Dini

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Re: From once to twice a week?
« Reply #5 on: April 06, 2007, 07:23:21 PM »
Hi B,

(Hey, I think I figured out a socially acceptable shorthand salutation, OK by you)?

That "desire to be seen in a certain way" is another way of saying you want your therapist's approval.  We all do.  Who wants to tell their innermost stuff to someone they don't think likes them.  And in a general sense, having the therapist's approval and acceptance of us is at the heart of what makes the therapy a safe place and makes it work (humble opinion here).  Nothing wrong with wanting it; the one thing I've found I have to be careful of sometimes is doing something/agreeing to something/going along with something I might not otherwise have done but that I wanted her approval. Lost in the transference of wanting a "lover's" or "mom's" or a real person who happens to be a therapist named XX's approval (or whatever I'm projecting onto the therapist when I'm doing it).  But then that becomes "grist for the mill" and another learning experience.  

Therapy can be an amazingly powerful relationship between two people.  And an amazingly freeing and awareness raising experience.  And it's all a journey; there is no end-game. I think it's just fabulous that you are willing to take that journey at an age when most people aren't thinking or feeling with such depth. (Well, at least I wasn't, though I thought I was pretty hot stuff).

Going back to that "distancing" idea B, if you don't mind my doing so, a couple of things struck me in your post.  "I feel like I will be able to identify the transference as it occurs and will be interested to see how it plays out" and "analyzing" therapy is fascinating.  (I totally agree with the latter sentiment).  What I sense is that you are very bright and are "intellectualizing" the process a bit; I've done that (and do that) too.  My experience is that the more I keep my IQ out of the way and allow myself to feel and experience emotions, the more I get out of the therapy.  I've said this before here; I've got an IQ that supposedly indicates I've got a couple of brain cells - when it comes to emotions or interactive dynamics with other people that often doesn't mean squat. I am still capable of reacting or acting with the emotions of a seven year old.  Sometimes I "understand" something perfectly well intellectually and simultaneously experience it emotionally as incomprehensible, scary, as anger, as hurt as pain as neediness and any and all other emotions that are way "behind" my intellectual understanding.  That's OK.  That's what therapy is for - for me anyway - to get in touch with those feelings whatever they may be (and mine aren't all pretty - that's where feeling safe is important).

And I'm no mental health professional but I don't know that you are "resisting" anything; you sound pretty open to me.  Things take time and allowing oneself to be vulnerable takes time.  You sound pretty bright, self-aware and emotionally courageous.  It's a pleasure to "hear" you speak of your journey.  It's a pleasure to hear your "voice."

BehindClosedDoors1980

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Re: From once to twice a week?
« Reply #6 on: April 07, 2007, 04:35:44 PM »
Dini,

Of course you may call me any diminutive variation of my username you choose. I'm hardly picky about that sort of thing!

Thank you so much for your conversation. I'm glad to see that there's a bit of traffic on these forums. Despite how common, I still think that there's a perceived taboo for a person to be in therapy, and although many people in my life know (and support) my being in therapy, still it's something I realize would make people uncomfortable if I brought it up in mixed company. So a place like this where people can share their experience is invaluable, and you make it even more so!

Dini

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Re: From once to twice a week?
« Reply #7 on: April 08, 2007, 08:20:44 AM »
Dear "B,"

I agree that despite how common it is, there is a stigma to simply participating in therapy, which is ridiculous because it is actually (to me) an indication that someone is aware and thinking and feeling and exhibiting the emotional courage to explore their inner "stuff." The stigma is that if you are participating in therapy there is something "wrong" with you; when in fact you are doing something very positive whether it's seeking help for something which is a difficulty for you or simply taking that inner journey with the courage to take that journey without knowing where it will lead.

I originally started therapy because I knew I had "stuffed" certain feelings; I grew up in orphanages, foster homes, etc.  Ironically, given some pretty Dickensonian origins, I was able to obtain a good education and become a "professional."  But I knew I had "stuffed" a lot of stuff to do so and my basic coping mechanism when I was younger was essentially, I'm special, I'm Superman, this stuff doesn't effect me, just watch me go.  That, of course, is BS.  I'm as human as the next person and what I had stuffed was the pain, hurt, anger and sadness of it.  All those things needed "out" in order for me to be whole and myself.  In some foggy way I knew that, hence I started therapy as I knew I would need a "guide" for this.  I was in therapy long before I developed a "non-recurring severe depression, etc." (which was the result of long delay grieving, etc. which needed to be released) and the stigma attached to a mental illness/mood disorder is even greater than simply being in therapy.  My particular profession could be described as a shark pool and that is viewed more as a sign of weakness, spilling blood into the shark tank, than with compassion.  I've found that there's a much greater stigma associated with mental illness/mood disorder, even if it's of the temporary type, than there is to being a sober alcoholic.  (Actually, many people don't have a clue what a "sober" alcoholic is or what that means).  The irony is that both participating in therapy and remaining a sober alcoholic one day at a time require a certain amount of emotional courage, humility, honesty, ability to "make amends" when necessary (hey, we all screw up sometimes, that's why the words "I'm sorry" and "apology" are in the language) and willingness to face one's own "stuff" honestly and all of that is pretty healthy in my humble opinion.  I'm convinced everybody could benefit from a little therapy at least at some point in their lives, and not necessarily at a crisis point.  I can think of a few people I know who attach a negative stigma to it and they are precisely the people who (in my humble opinion) really NEED therapy and to look at their own stuff.  

My friends are aware of all of the above with me; if they are my friends it is because I trust them and am honest with them.  No problem.  But I don't shout any of it from the rooftops.  People bring their own perspectives and biases, positive or negative, to the information.  Someone who grew up with an alcoholic father who routinely knocked them into the middle of last week is likely to have one perception and someone who knows somebody who they saw transformed from an active to a sober alcoholic is likely to have quite another.  They're each entitled to their own opinions and feelings about it.  Their opinions and feelings are their business and none of mine.

When meeting new people, I find that if I reveal any of this information, there is a natural course in the development of the relationship when this disclosure flows naturally, as with any disclosure about anything.  I don't force it, nor hold it back when a relationship reaches that point.  Acquaintances, etc. don't need to know.  Also, as time has gone on I've become much less caring of what other people think of any of it; that's their business not mine.  That's not to say it doesn't have ramifications in the "outside" world, it does; I've found that out in my recent job search.  But that's not something I can do anything about.    

I pretty new here myself "B" and I find this "place" and some of the insight and compassion (and chuckles) which some pretty amazing people bring to it very helpful.  It feels like I've found new friends.  Stick around.  I'm glad you're here.  I might suggest just "poking around" to various threads and it's amazing what you can learn - I did that and it helped me see that this "place" is genuine and also helped me identify the people who participate who are really worth "listening to" and engaging with; I'm not naming names because those are your choices anyway.  It's just a suggestion but I know I found it helpful.

I'm also interested in hearing how you FEEL about your therapy as it goes along and as you get further into it (if you don't find that presumptuous or nosy of me).  Sometimes what we can't see in ourselves we can see in others and it works as a "mirror" for ourselves and sometimes other people see things in ourselves which we do not or cannot.  You would be helping me by doing so.  That's the value of honest sharing.

Speaking of honest sharing, don't ever hesitate to call me on my own BS, being human I've got some.  And being human there's always something someone else can teach me or show me or simply call me on when I'm being full of BS or I'm deluding myself or puffing my ego or whatever.  I would only ask that you do it with compassion.  But don't hesitate to do it, please.

Keep on sharing "B" (please).  I enjoy your presence here and you add to the "positiveness" of this "room" by being yourself and being "present" and "in the moment" and honest here.  I have a feeling you're one of those folks I'll find is really worth "listening to" (I already do).  Besides, it's kinda nice to have a "fellow newbie" around.

Take care.

Joanne

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Re: From once to twice a week?
« Reply #8 on: April 23, 2007, 06:13:51 AM »
I'm glad to see you asked for what you wanted and received a somewhat positive answer.

Some time has gone by since you originally posted and I'm wondering how its working out? have you met twice a week yet? is your insurance agreeing to pay for it? They sometimes will, if they agree that there is a need. At other times, your therapist might be free to ask you to pay for the second session per week. it all depends on his contract with your insurance company, if he is working as a provider for them.

But bottom line, I admire your spunk in asking for that extra time, and I am hoping it is working better for you. Let me know!

BehindClosedDoors1980

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Re: From once to twice a week?
« Reply #9 on: April 23, 2007, 01:07:17 PM »
Joanne,

We haven't actually worked out a second session per week yet, but the interesting thing is that I haven't really felt the need for it since I asked!! So maybe it was in the asking that whatever was going on inside me (reassurance that my therapist was truly dedicated to me? etc) was expressed.

I know that he's very busy, which is good because I want him to be helping others as much as he's helped me, and I honestly don't know if my schedule will allow for a regular twice-weekly set-up. But asking took a lot of courage, if I do say so myself, and it's out there if I feel like re-addressing it.

Thanks for checking in about this!

You seem to have accumulated a great deal of knowledge about the workings of insurance companies as relates to therapy. How did this come about? Some of what you say makes me sad... but I believe you... that insurance companies pay for as little as possible... have you had repeated bad experiences getting your company to pay for treatment?

Of course you don't have to answer that.

-B

Joanne

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Re: From once to twice a week?
« Reply #10 on: April 26, 2007, 10:27:11 PM »
I'm glad to read my postings are helpful to you. As for the details of what I know and how I know it, that must remain off limits, lest I loose all ability to post as I do here...but isn't it true that the only way anyone knows much about anything important is by being there, paying attention, noticing what goes on and dealing with it for decades and more decades.

Such is my story. Decades and more decades and then, perhaps another one thrown in there for good measure ;-)

And I agree with you, sometimes just knowing that someone is willing to do something is all we need. It's an easy fix, and you seem to have an emotional understanding of what happened inside of you with his simply agreeing. That's the best.

I love those kinds of easy fixes, especially the ones that require real  courage to ask for. Getting them met is sooo sweet.

I only wish those easy fixes would come around a bit more frequently for me this year. But hey, enjoy it while you've got it. It sounds like you earned this one.

Dini

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Re: From once to twice a week?
« Reply #11 on: April 27, 2007, 10:02:42 AM »
Yeah, "B," I echo Joanne's comments.  Asking for "help" in whatever form that may take requires courage; took me a long time to begin to learn that lesson and I am still learning it.  It's not weakness or a matter of being "helpless" but an honest look at oneself and what one needs (which requires a bit of honesty and insight and maybe a friend or two's perspective on it) and then, (oh, and here's the REALLY hard part) asking for it!  Courage.

Way to go "B!"

Joanne

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Re: From once to twice a week?
« Reply #12 on: May 29, 2007, 01:36:25 PM »
What's happening, B? Are you doing ok?

BehindClosedDoors1980

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Re: From once to twice a week?
« Reply #13 on: May 30, 2007, 06:09:36 AM »
Hi, yep, I'm here. I'm about to take a two-week vacation to Greece (can't wait!) and preparations have precluded me from spending too much time on the boards.

I saw my therapist twice a week for two weeks in a row and it was amazing. We got through a few barriers and made some tangible progress. We are back to once a week now and that's just fine with me. Knowing that I could have a second appointment if I wanted/needed it is great comfort.

My anxiety has been manageable and I'm actually enjoying therapy. So I don't have too much to add to the boards these days...

Everyone be well while I'm away.

--B

Dini

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Re: From once to twice a week?
« Reply #14 on: May 30, 2007, 05:09:35 PM »
Hey "B"

Have a WONDERFUL TIME!!

Three of the best weeks of my life were spent sailing around the Aegean with a couple of friends.  See the Acropolis, the National Museum, the Naval Museum in Pireaus (the harbor of Athens) if you're into ships and boats and things, and then get away from Athens and everywhere else is beautiful with warm, embracing people.

Enjoy!