Too "complex" for a psychiatrist???

Hi @Sahara,

Thanks for sharing your thoughts on this thread. Below is an edited version of part of what I wrote up while therapist shopping last year. After 2-3 attempts, my brain was starting to fry from telling the story over and over, so I wrote a lengthy document outlining my history. As part of that, I have a section titled "things I need in a therapist."

I recognise that a BIG part of my muddle is due to the very complicated relationship I was in with my psychologist for 16 years. The relationship was abusive (mostly verbal, occassionally physical) and very intense. It was definitely a-typical and has created a lot of muddle. I know that trying to connect with a new psychologist on the backdrop of that muddle is super challenging. I desperately wish I could have just kept working with my uni counsellor. Two years on, I am still grieving very deeply for her because she genuinely helped me make sense of the world.

Anyway, this is what I have identified as what I'm looking for in a therapist...

Things I need in a therapist

I really don’t cope well with "fluff." I’m never sure how to articulate this clearly, but I definitely know it when I see it. The university counsellor and I worked exceptionally well together and I think that was in part because she was quite pragmatic, while at the same time being super empathic and recognising when I was emotionally overloaded. K (counsellor) was really good at helping me find a way to do things, which worked for me. That is, she didn’t just have the attitude that if I believed in myself enough I could do anything. We seemed to work really well together to problem solve things. It was like…we didn’t approach things with the attitude of "just believe in yourself" and we definitely didn’t approach them with the attitude of "I can’t do this," but rather it was like "what needs to happen and what can we do to achieve this in a way that will work."

I need someone who can hold in tension the different parts of me. I need someone who can respect that I have a very strong academic ability and good insight into my issues, yet at the same time I often become overwhelmed and consequently I get emotionally dysregulated. I find it highly offensive when people try to reason me out of a chaotic state with comments such as "you are so intelligent, why are you behaving like this."

I need someone who understands that I am doing the very best that I can. If you believe that as someone with BPD, I am overly-dramatic, attention-seeking or manipulative, then we will not be a good fit.

I need someone who won’t freak out if (ok, when) I get dysregulated. If I get dysregulated and the other person reacts by becoming loud and/or authoritarian, or attempts to threaten or shame me out of my chaos, the situation escalates.

I need someone who has a strong awareness of the power differential inherent in the therapeutic relationship. I need someone who strives to minimise this power differential as much as possible whilst also recognising that it is impossible to ameliorate it altogether. I also need someone who understands the experience of disempowerment inherent in being a consumer within the mental health system and within other systems (e.g. the welfare system, and the system of disability employment services). I need someone who recognises the relative power (compared to me) that they have within such systems by virtue of the fact that they are perceived by society as an "expert." I need someone who has a strong awareness of how frightening and disempowering this is for the client.

Ideally I would like to work with a DBT therapist. However, thus far, I have found that many therapists who claim to do DBT actually only do the skills component. I already know the DBT skills inside-out and back-to-front. Thus I find it intensely invalidating when people tell me I need to do a DBT skills group. Given that DBT is a manualised treatment and I have read the manual multiple times, I cannot see any logical reason why I would want to sit in a group and be "taught" the skills that I have already learnt from reading the skills training manual. I would like a DBT therapist who practices the whole model or at least has a solid understanding of the whole model and will work with me to problem solve how we can "fill in the gaps" if, for example, the therapist is not able to provide the telephone support component of DBT. It seems to me that for a lot of therapists, the very comprehensive and intensive DBT model of therapy has been "dumbed down" to just the skills component. The goal of DBT is to help the client create a life worth living. The skills alone will not do that. The skills help the client to stay alive long enough to do the intensive therapeutic work, which can then help the client to create a life worth living. That is what I am looking for. I can keep myself alive – but at this point I don’t have a life that is worth staying alive for. I need a therapist who is committed to helping me create a life worth living.

I am open to working with a therapist who practices within a different model of therapy because I know that the therapeutic relationship is the primary ingredient in any successful treatment of BPD/complex trauma. However, it is essential that the therapist values evidence-based practice and can give me a clear rationale for any proposed treatment plan.

I accept that I am unlikely to find a therapist with extensive experience in working with clients with both BPD and ASD. I accept that most mental health professionals have limited knowledge and/or experience of ASD. I do, however, expect my therapist to be open to learning more about ASD and how this impacts on both the presenting issues and the treatment plan.

@Phoenix_Rising

it is good you know what you are seeking in a therapist and what works for you. It sounds like your relationship with your last therapist ended badly and I'm sorry to hear that. Therapists need to be professional and have high standards as they are working with very vulnerable people whose emotions may be a bit unbalanced. I wish my therapist had more insight and had behaved better towards me.

I am upset that my therapist 'dumped' me (Said she couldn't help me) but the relationship was quite tense at times so it wasn't a huge surprise at the end but I still feel she acted unprofessionally. In the lead up to it, she started cancelling quite a few of my appointments, would walk around the room and find distractions when I was with her and while i was talking, and i just felt towards the end that she wasn't really present and didn't really care. Phoenix, you are so right about the power disbalance. She had all the power in the relationshp and I think she quite enjoyed that she could dump me as a client and it would mean nothing to her. I think she knows I am very upset and that she enjoys having that feeling of power over someone. It is the worst feeling to trust someone for years and tell them intimate things about yourself and rely upon them and then they end the relationship. To be honest, I don't feel she did help me very much but I was desperate and needed help and it was still someone to talk to and she listened. She SAID she did CBT, schema therapy etc. but I don't think she did. To dump your client after years because you can no longer help them is a pretty big cop out, isn't it? What happens to the client now? Other than I feel like a burden and have no one to talk to and will have to START ALL OVER again with someone new.

What am I looking for in a therapist now? Trust is a huge thing for me now. I need to know my therapist will be in it with me for the long haul.

Hello Phoneix Rising....I havent read your story yet....I am currently wallowing in a quagmire of depression and suspect your story would not brighten me up. How absolutely wretched for you however. My experiences with the Queensland Public psychiatric services was ghastly, although I would expect some improvement since the 1980s and 1990s.

I assume (am I correct?) that the psychiatrist you were hoping to see was in the private sector, as you dont get a choice in the public. Even in the private sector, I was under the care of doctor X, who was unable/unwilling to suggest finding a new therapist as I was not responding to the therapy he was offering. Always remember, these therapists are people with the usual strengths and failings as other mortals...although overall there is a very large ego involved. Try not to be down about being letdown, in the future you will be able to put a positive spin on things. Please keep us up to date and remember ALWAYS you are a survivor not a victim.