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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by petunia on February 19, 2009, at 18:51:51
Hi all, I am new to this forum but have been lurking a bit. I have a question for you, any serious response welcome.
I have complex PTSD and just went to see a new therapist to continue EMDR therapy. I would have preferred a woman, but this guy was the only other EMDR therapist available, so I had no real choice. The last therapist, whom I saw for a year and made a lot of progress with, there was a conflict of interest and is no longer an option. I am going specifically to address some specific triggers that are keeping me from working; once I can go back to work I can pick my own therapist.
So today I went in to see the new guy. He's taking a history, asking questions, and when I duly affirmed that I had a history of physical and sexual abuse as a child, he started asking me all these very intense direct questions regarding the sexual abuse: what did he do? was it penetration? was it intercourse? did I tell anyone?
I answered as far as I could stand, but it shocked and startled me so much I started crying and shook my head no... and then he kept on asking me! I asked him why he needed these details, and he just said he needed them. I had to insist several times that he had no need to know the details and I am not willing to give them. I found myself defending this position, and explaining that for me to give him a picture means seeing the picture myself... but shouldn't he know that already?
The things I am remembering in EMDR are not sexual in nature, so as far as I am concerned he really does not need these details. But he jumped on the sex stuff so quickly I never got a chance to tell him.
To be honest, I didn't *feel* anything icky or prurient from him; I thought maybe he was asking because he thought he needed to, and after the third time he backed off. But frankly -- and this is why I am asking you all -- I don't *feel* a lot of things! And I am especially good at missing the initial overtones of abusive situations. Especially when someone stomps on a trigger, and that is one. As soon as he started diving into all that sexual detail, I lost my adult bearing and never got it back for the remainder of the session.
My question here is, how does this questioning strike you? Ignorant mistake, or inappropriate and try to find another therapist?
I'm supposed to see him again on Monday. If I decide it's an ignorant mistake, then I will walk in and set some very clear boundaries. If I decide it's just not a good sign, I will find someone else.
All comments welcome. Thanks for hearing me out --
Petunia (sorry for the dippy name; it was the best I could come up with at short notice :)
Posted by backseatdriver on February 19, 2009, at 19:20:30
In reply to Q about appropriate t questions (possibly trigger), posted by petunia on February 19, 2009, at 18:51:51
Petunia, welcome! I love your name. Petunias are one of my favorites in the garden.
I think you should shop around some more if you have the time. This person missed important signals from you. You set a boundary by asking why he needed to know, and he just barreled on through and responded to you not empathically, as he should have, but obsessionally, which is a technical error and dangerous for you because he could have retraumatized you.
I don't think he *meant* to hurt you, but he certainly *did* hurt you, which suggests to me that he's got a problem dealing carefully and empathically with intense material. He can't control his own responses -- his anxiety and fear -- enough to stay off your triggers. If there's time and energy to look around some more, I would do it. You deserve better.
Yours,
BSD
Posted by petunia on February 19, 2009, at 20:02:30
In reply to Re: Q about appropriate t questions (possibly trig, posted by backseatdriver on February 19, 2009, at 19:20:30
Backseatdriver, thank you so much for your thoughtful and detailed reply.
I will keep looking; unfortunately my choices are *extremely* limited. When I can pay for it myself, that's another story.
In the meantime, I will go back on Monday and lay down the law. We don't need to go there. And if he gets huffy or ignores me, well I guess I'll have a pretty clear answer. I think I need to also ask him how many PTSD and complex PTSD patients he's had -- I meant to but I never got that far today. *sigh* I am so grateful that I am getting better, but it's days like today that make me wonder...
Thanks again!
Petunia
Posted by wittgensteinz on February 19, 2009, at 20:13:06
In reply to Q about appropriate t questions (possibly trigger), posted by petunia on February 19, 2009, at 18:51:51
Welcome to babble!
In my opinion the intensity of his questioning was at best insensitive. It makes me wonder whether he was filling in some kind of PTSD/sexual abuse inventory and reading questions off of a list? Even if this was the case, he should have realised how personal and intrusive these questions would be and how potentially triggering.
I wouldn't say his questioning was inappropriate - but definitely insensitive and it was certainly a shame he didn't leave you opportunity to say what was relevant to your treatment. Maybe, if you feel able to set your boundaries, there is a value in seeing him at least for the next appointment to talk it through and see whether this is his usual approach or rather that he was filling in the paperwork/getting a quick history and was rather tactless. Obviously, if this has really shaken you/upset you then it might be wise, within your means, to try and find a different T.
Good luck.
Witti
Posted by petunia on February 19, 2009, at 21:19:52
In reply to Re: Q about appropriate t questions (possibly trig » petunia, posted by wittgensteinz on February 19, 2009, at 20:13:06
Hi Witti! Thank you for your kind and thoughtful reply. No, he wasn't reading questions off a list. I wish he had been, as that would have explained it. He was writing, but his questions were entirely his own. It may have been a form, but the kind with lots of lines and few check boxes. It was pretty much rote until we got to the sexual abuse, then he stopped writing and started quizzing me. I had to say stop, not once but several times, and in retrospect I was on the verge of a panic attack.
I think the reason I did not feel that it was badly intended is because my strong response seemed to shock him... but then he went on questioning and insisting on answers. That's when it became way too much. It didn't harm me (beyond a few hours angst) but it's NOT a good start.
In person, for whatever reason, I generally have to say "no" multiple times before I am believed, even when I am blunt, even when I am obviously upset, and I've never been able to figure out why. Maybe I'll ask this guy straight out why he couldn't believe my "no" the first time, and get something useful out of the experience. :)
He may not understand complex PTSD at all, thinking that single-trauma PTSD is where it all starts and stops and he's got it figured out. If that's the case, it all comes down to whether he is willing to accept me as I am -- if he's not, then this is the first step along ten miles of bad road, and I need to stop it before I waste a lot of time not meeting his expectations of what PTSD should respond to or look like.
I can't tell you how much I appreciate the feedback. This will definitely help me set the boundaries. I think I will go back on Monday, and between now and then I have some time to think over my approach. Thanks again!
Petunia
Posted by no_rose_garden on February 20, 2009, at 1:01:04
In reply to Re: Q about appropriate t questions (possibly trig, posted by petunia on February 19, 2009, at 21:19:52
(((Petunia))) sorry it was so hard
I would directly ask him what you want to know. Like how what he's doing will be helpful. ANd ask him if he can be more compassionate...if not, then maybe it's time to look elsewhere.
just my $0.02
Posted by antigua3 on February 20, 2009, at 7:48:19
In reply to Q about appropriate t questions (possibly trigger), posted by petunia on February 19, 2009, at 18:51:51
Well, I'm familar with this type of behavior. I have complex PTSD as well.
Even before I saw my pdoc for the first time, I had to fill out this 15-page questionnaire that I thought was entirely too personal and intrusive to have to answer before I even saw him. A couple of years later, I'm still not convinced that he actually read it, or he wouldn't be so dense at times. :) It was terribly triggering to have to complete that questionnaire, and I know it was a compilation of forms that he uses to evaluate patients.
In any case, my pdoc used to be a lot like you described. He didn't know what issues (CSA) would be triggering and would often stomp all over me w/o realizing the effect it had on me. We've worked our way to a mutual way of dealing with these issues now. He will ask if we've gone too far, and respects my answer when it is yes. But it has taken a lot of time and effort to get there.
I also have seen an EMDR therapist, but I knew her before I even started EMDR.
In my experience, an EMDR therapist is extremely interested in abuse histories because EMDR has been "proven" (and define that as you like) to be effective in relieving memories associated with the abuse. Also, EMDR can trigger abuse memories that had been unavailable to us, or in my case even unknown, so some therapists want to be sure to get a full history before proceeding so as to be able to help better if these feelings emerge unexpectedly.
That doesn't mean this guy wasn't insensitive and didn't respect your wishes.
I'd go back and evaluate him one more time and if you think he's too overpowering for you, try to find someone else. I'd make it clear what you expect from the therapy, and to outline what are safe/unsafe territories for you.
I hope it goes well for you,
antigua
Posted by sassyfrancesca on February 20, 2009, at 10:17:08
In reply to Q about appropriate t questions (possibly trigger), posted by petunia on February 19, 2009, at 18:51:51
Hi, Petunia and welcome! I would imagine his questions are routine......but you have hired HIM, and you are in charge.
Simply tell him that you don't wish to discuss...whatever it is you don't wish to discuss....good boundaries!
hugs, and welcome once again!
Sassy
Posted by lucie lu on February 20, 2009, at 13:35:20
In reply to Q about appropriate t questions (possibly trigger), posted by petunia on February 19, 2009, at 18:51:51
Welcome, Petunia. I'm glad you decided to post.
If I understood you correctly, this is just a more or less temporary, consultant relationship? I really don't know much about EMDR and have no personal experience with it. Is it supposed to work well with complex PTSD? As you probably know, there is a lot of difference in treatment protocols for complex vs simple PTSD. Whereas standard treatment for simple PTSD emphasizes abreaction, or revisiting the trauma event in detail and with its original emotional intensity, this approach would overwhelm and retraumatize the person with complex PTSD. So I don't know where EMDR fits into this. But your response to this interview sounds to me as if it felt retraumatizing to you. If you shut down your feelings as a means of coping with internal distress connected with a traumatic history, then it is not at all surprising that you would do the same during the interview as well.
I really hesitate to say anything against this man's technique because I know so little about EMDR. But I have to tell you that personally, I would have been unable to tolerate that interview and would have found it necessary to leave. I would have felt retraumatized and violated by the intrusiveness and insensitivity of his questioning. At the very least, his lack of responsiveness to my feelings would have felt like a violation of my boundaries. Hardly helpful for anyone with a trauma history.
I do hear you that sometimes the options are limited, and you may have to make compromises. And I agree with the others that if you do decide to go back, you talk to him firmly and up front and tell him how violated you felt during the the interview. He may not have realized that, especially if you had shut down. Perhaps the way to do this is to question him on the technical aspects of treatment for complex PTSD, including initial interviews, and how EMDR is used to treat it. Don't forget to ask about potential risks, side effects, etc just as you would any medical treatment. It is one thing to give him the benefit of the doubt, i.e. forgiving some technical clumsiness and insensitivity, if you feel he is on the right track therapeutically, you both have an open line of communication, and are both on the same page. But it is quite another to risk being retraumatized by someone without the appropriate experience to treat your condition. Frankly, if it were me, I would only go back if there were zero other options, but that's just me. I would not have dealt with this as well as you seem to have.
Good luck, and take care, Petunia. I hope all goes well. Keep us posted.
Lucie
Posted by petunia on February 20, 2009, at 16:44:36
In reply to Re: Q about appropriate t questions (possibly trigger) » petunia, posted by sassyfrancesca on February 20, 2009, at 10:17:08
Wow... I am so amazed. Thank you so much for all your responses and goodwill. And hugs!!! I'm so used to going it alone that I forget how kind people can be. Thank you all so much.
*possible triggers below*
To answer a couple things directly, I've been in EMDR for about a year, and it has been incredibly good.
The things that were driving my reactions and triggers were not anything I remembered, and the tiny bit I did remember was more like a knowing that something had happened, and maybe a tiny bit of a picture (someone's sleeve, or the color of the carpet for example) never enough to grab hold of consciously and work with. So EMDR has been wonderful in reconstructing those and bringing them to the surface.
You're right about the desensitization being way too much for some people -- I cannot imagine having had what little I did remember shoved in my face at full emotional intensity. My disorder did that anyway, with all the intrusive thoughts and pictures, and by the time I got help I could not have stood it anymore.
For me, EMDR is perfect, because I get to choose how much I share of what I see, and it comes out when it's safe to come out. The memories themselves can be overwhelming, but it's not a third party making me do it. Having a third party rub my face in something horrific is just waaaaaay too close to some other things, you know?
A little background: I remembered a little bit of CSA when I was in my early twenties, thought I was nuts, but was fortunate enough to encounter a counselor who not only knew I wasn't nuts but helped me to confirm it to my own satisfaction and deal with it. I am now in my forties. So a lot of it I had already been dealing with *in the abstract* for some twenty years -- not having memories, but knowing that these things did occur and dealing with them as they came up whether I could actively remember anything specific or not.
But what this guy never got around to letting me tell him is that I haven't remembered anything of a sexual nature in years. What I have remembered more recently has been of a physical/psychological terror nature. In his questioning, he whizzed right through the physical abuse but stopped the train altogether at the sexual aspect. I was completely shocked -- not only because of his incredible intrusiveness but because it simply had not been relevant to me for many years, at least not in a in-your-face PTSD trigger kind of way. If he had done the same sort of questioning regarding the physical abuse it would have been every bit as bad. What I didn't realize until late last night was that the way he was questioning me made me feel as though I was having to answer to him for my father's sins, and how inadequate my response to them was. It was like I was suddenly sitting in a courtroom, on trial. Now, how much of that is transference and how much is counter-transference, I'll probably never know. :)
I really don't think he gets it. But what matters more is whether or not he is willing to.
I talked with another person today, and she said everything you guys said. :) Basically, do what you have to do but don't ignore it, stand your ground, erect definite boundaries, and if he can't or won't acknowledge his actions and their effect on me... leave.
When I posted, I expected to get maybe one or two brief answers. Y'all have made my day, you don't know how much, just by listening and caring. You are so incredible. Blessings to every one of you --
Petunia
Posted by Emily Elizabeth on February 20, 2009, at 16:58:49
In reply to Q about appropriate t questions (possibly trigger), posted by petunia on February 19, 2009, at 18:51:51
I am a T (early in my career). Your post reminded me of some advice a supervisor gave me once: with PTSD patients, it can be very therapeutic to have them describe the trauma in great detail, as a way to unburden them. That way they won't feel like that they are holding some terrible information all by themselves. BUT, that is done very purposefully, with the client consenting to the experience. AND it wouldn't be done in the intital session. So, my two cents is that, at the very least, it was poor judgement. I mean why would you want to share something so painful with someone who is still a stranger? It's not like you had an established relationship! I don't think he's a pervert or anything, but may not be very sensitive. If you are limited on your choices of T's, I agree with the others that said to talk to him about it.
Good luck. I hope that everything works out.
Best,
EE
Posted by petunia on February 20, 2009, at 17:23:09
In reply to Re: Q about appropriate t questions (possibly trigger), posted by Emily Elizabeth on February 20, 2009, at 16:58:49
Emily Elizabeth, thank you for your input. Yeah, I was kind of wondering whether he's a perv. If he was, he hid it very well in his eyes and bearing. But his interest in that specific subject *far* outweighed his interest in any other.
I've heard the same as what your supervisor told you. The last place I read it was in an excellent book by Babette Rothschild called The Body Remembers. (I had to return it to the library the day before this happened, unfortunately. I sure could have used a fresh look at it.) What I personally am wondering is how and why HE didn't know it. She, and you, and other authors like Judith Herman make it sound like that's what you learn your first day in trauma therapy class.
I guess this guy was playing hooky that day... :)
Thanks again for your post, EE. If you think of anything else (like tips on how to approach this) it would be most welcome. Thanks again!
Petunia
Posted by Poet on February 22, 2009, at 14:26:13
In reply to Q about appropriate t questions (possibly trigger), posted by petunia on February 19, 2009, at 18:51:51
Hi Petunia,
If my T had pushed me as hard as yours did I would have walked out and never gone back. I denied sexual abuse for years and the only way I finally disclosed it was to write it down and let her read it.
As you said your T probably was asking because he felt he needed to, but I think he should have realized how uncomfortable you were and backed off right away, not after asking for the third time.
Personally I would not be comfortable with your T's style, but I can understand if you want to give it another try with some firm boundaries. Just make sure you state those boundaries up front and tell him to back off on pressing you for details on sexual abuse.
Let us know what you decide and welcome to babble.
Poet
Posted by petunia on February 23, 2009, at 11:17:24
In reply to Re: Q about appropriate t questions (possibly trigger) » petunia, posted by Poet on February 22, 2009, at 14:26:13
I decided to go back this morning and confront the guy. He needed to know and I need the practice. :)
But I swear it was one of the hardest things I have ever done. Even though I knew in my head that he has no power over me, even though I knew that there was no further harm he could inflict, even though I knew I never had to see him again, none of that really seemed to matter. I guess that's why I knew I needed to go, because I need to be able to deal with threatening situations and this was as good an opportunity as any.
If I hadn't felt up to it, I wouldn't have, but I felt like I could. I had already decided that whatever came of such a meeting, it was worth the price of admission (getting the opportunity to tell an abusive person "no") and that freed me up a lot. If I had been attached to the outcome at all I don't think I could have done this. By the time the weekend was over the power this situation had in my heart and in my head was *immense*, and I knew it was the disorder and I had to confront it, though that didn't make it feel any less real. Cognitive dissonance in full bloom.
So I got myself all dosed up (legally :) and girded up my loins and marched in there feeling like I was gonna pass out, but determined to go through with it. He started talking, and I said, "Before we start, we need to have a little chat." And I laid it out for him.
(This is where y'all deserve mad props, because I borrowed a LOT of your phrasing from these posts -- thanks!)
I started out by asking, "Are you aware that you triggered my disorder on Thursday with all of that direct questioning about the sexual abuse?" He said, "I knew I was triggering a very strong emotional response...?" And replied, "Yes, that and my disorder as well." I went on to explain just what he had done. I told him why it was unnecessary and why I thought it was wrong, I pointed out that there is no therapeutic use for such questioning, I told him I felt like I was being grilled on the stand in a courtroom as though it was my place to answer for the sins of my abuser, etc. I added that if no doesn't mean no and stop doesn't mean stop, we could not hope to accomplish anything and I did not desire to move forward with treatment.
I'm not sure he was really hearing me until I said, "Are you aware that if you had pulled that six months ago, I would have simply gone home and killed myself? You have NO idea what you unleash when you stomp on a trigger like you did on Thursday." I don't think he realized it really was that serious.
Dude apologized. Sincerely and fully, not just a lame, "I'm sorry you took it that way." We kept on chatting, and it was as if the lights went on for him. He wasn't just kissing my *ss, either -- I didn't feel that he was, plus he had no reason to because I wasn't coming back.
So we kept chatting, and I started to reconsider. I didn't snatch him baldheaded, but I did flat out tell him the unvarnished truth about everything, and he was very humble about it. He apologized multiple times, actually.
Since he didn't seem to have done it knowingly, and he owned up to it and kept on listening even when I was holding his feet to the fire, I asked him if he would be willing to continue on, and he said yes, and we laid out some ground rules. I told him, "I so did not expect this to turn out this way; I came here for the practice. I figured I'd say my little bit and you'd tell me 'have a nice day,'" (I was flipping a bird when I said this, as though that would have been his 'have a nice day' to me). And he said, "I'm almost sorry you didn't get to tell me off like you wanted to!"
So we're good. It's not perfect, but if he's sincere and he can hear a no when I say no, it'll work. It was one of the hardest things I have ever done, but I am so glad I did.
I could not have done it without your help. Every single response gave me more courage (and ammo :) with which to address it. You all validated both options (sticking around for therapy or walking away) which helped me own my freedom to do either. You all helped me craft a VERY strong approach and helped give me the strength to do it by being so honest and sharing your own experiences. So this victory is every bit as much yours as it is mine -- enjoy it! And thank you again!!!
Petunia
Posted by Dinah on February 23, 2009, at 11:27:33
In reply to Here's how it all turned out..., posted by petunia on February 23, 2009, at 11:17:24
Good for you, Petunia! You've probably just saved another client that distress by educating him.
I'm glad he responded well. It does bode well for the future that he's willing to listen and learn. :)
Posted by antigua3 on February 23, 2009, at 12:14:02
In reply to Here's how it all turned out..., posted by petunia on February 23, 2009, at 11:17:24
Posted by backseatdriver on February 24, 2009, at 12:39:43
In reply to That's just great! (nm) » petunia, posted by antigua3 on February 23, 2009, at 12:14:02
Posted by petunia on April 3, 2009, at 0:32:01
In reply to Q about appropriate t questions (possibly trigger), posted by petunia on February 19, 2009, at 18:51:51
As I mentioned before, I went back, told him what I thought, he seemed cool with it, I thought I'd give it a try.
OH WHAT A WASTE OF TIME. This guy was a complete jackass. Didn't even start EMDR until the fourth session -- a month later -- and then stopped it every five minutes, like he didn't want it to move without his permission. He definitely seemed to have the impression that it was all about HIM, and unfortunately I think he may have been impaired as well -- he didn't act drunk or anything like that, but simply detached at strange moments and completely did not remember anything I told him between sessions. I haven't been back since... though I did express my thoughts before I left. :)
Anyway, I wanted to let you know what happened, because I now have a new rule: I am going to pay very close attention during any first session going forward, and if I don't walk out feeling at least as good as I did when I went in, I'll not be back.
I can't thank you enough for all the advice you gave me -- you all made me feel that no matter what I did or decided to do, it would be okay. And it WAS! Not pleasant, but I was able to take care of myself in positive ways, and that's what it's supposed to be about. Y'all rock. :)
Thank you again!!!
Petunia
Posted by Dinah on April 3, 2009, at 8:14:49
In reply to Final update (and I do mean final), posted by petunia on April 3, 2009, at 0:32:01
I am glad you felt ok terminating with him. He doesn't sound like a good choice for you (to put it as kindly as possible).
Are you going to try again with another therapist? There are some good ones out there. And even some good ones who would be a good fit for you. I always figure it's like dating. There are some not so nice people out there, some nice people, and even some nice people who are a good fit for a particular individual.
Posted by petunia on April 3, 2009, at 14:55:19
In reply to Re: Final update (and I do mean final) » petunia, posted by Dinah on April 3, 2009, at 8:14:49
Hi Dinah! Yes, I will try again... I just have to find another EMDR practitioner (uh, a REAL one) in the area who will accept the coverage I have.
As you say, there are some really wonderful ones out there... this one just wasn't among their ranks. :)
I'm not sorry I went through it, I learned a lot, but... never again.
This is the end of the thread.
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