How do you decide what 'issue' to work through and when?

Hi @CheerBear 👋

I can read your dilemma and know first hand how difficult this can be. I found the same, too many professionals can further complicate matters at times as they can have varying opinions and approaches. And the accumulating costs can be astronomical and out of reach for most.

I am not seeing a psychologist presently, mainly due to not finding a suitable one for the reasons you described. But I am on the look out for one. I did once see a good clinical psychologist whom specialised and covered several mental health areas, such as child abuse trauma, anxiety, depression, sexual abuse and other areas of expertise that did cover most of my issues. But you already have a psychologist whom you are happy with so this may not suit you to pursue.

In regards in deciding to tackle what when - for me it would of been tackling first the most debilitating symptoms that was effecting me and my day to day life; so I could function better in the now, no further damage could occur and i could make more progress moving forward in my life.

I did delve into the causes with psychologists and psychiatrists for a short time which was extremely painful and hard. Once I covered this in therapy addressing it briefly I left it there, as for me personally it was best left in the past as it was continually too triggering and not helpful after awhile. Initially it helped release the grief over what happened - that was beneficial but too much delving caused me to relive it over and over....that was adding to my trauma. So it can be a very individual experience.

I found working on the strategies/thoughts patterns/actions that helped me emotionally and psychogically to move forward with my life was the most nessecary to tackle first.

Hope everything works out for the best for you soon @CheerBear

Hi @CheerBear,

Ideally what should happen (and hardly ever does in my experience) is that the psychologist should develop a solid case formulation and from there, then develop a treatment plan. This is why I kept asking (and not getting) a case formulation and treatment plan from (A).

When someone has lots of muddles, the muddles are very rarely unrelated. More commonly, they are all intertwined and tangled up together.

What I was taught at uni (and thus I assume every psychologist was taught) was that the first step is to get a really comprehensive picture of what is going on for the client. Then you can identify the precipitating and perpetuating factors (and also protective factors). From there, you can develop a treatment plan.

So, for example, if disordered eating was identified as being due to extreme stress, then figuring out how to deal with the stress would in turn address the disordered eating. In contrast, if you focus on the disordered eating without dealing with the stress, it is unlikely to be helpful, in the same way that constantly cleaning up an infected wound without treating the source of infection isn't that helpful. Does that make sense?

I totally agree with you regarding the time and cost factor! Right now, I'm really not sure how TTT is going to help me unmuddle my muddle at the rate of 50 minutes per week. I still very much feel like I'm trying to bail out the Titanic with a teaspoon - and since my turtle whisperer dumped me, the Titanic is already 99.5% underwater.

Hi @CheerBear@Phoenix_Rising

It was very interesting what @Phoenix_Rising wrote and got me thinking on my own personal experiences and my daughter's. Yes elimating the stress that causes mental anguish can be helpful. For i.e. if a person is not eating because of worry, anxiety, low self esteem or body image than dealing with the latter causes would better help the eating problem in the long term. But that can take a long time to sort out and sometimes there are no quick fixes for the causes or the stress that is to blame - so it is nessecary then to deal with the symptoms first in order to function better in the now and not endure more harm physically and mentally whilst working the psychological or,physical stress that has caused it.

For example my daughter was raped and abused mentally in a domestic violence situation. She was only very young and acting against our guidance at the time (being 18 we had no control over her choices). She started to self harm, would not eat and was being violent towards others as a result of the stress of the assault/trauma.

When she went to head space they tried to get her to talk about the assaults and traumas in order to fix her anger outbursts, depression, anxiety, violent and self destructive behaviour. In counselling they said anything else was a bandaid solution. They asked her a lot of questions in counselling which made her relive the experience and this distressed her to the point she flew into a rage. She could not handle it and was not ready.

It then became necessary for her symptoms to be controlled first as it became debilitating for her to function in every day life, to hold down a job and to even address the stress that was causing it rationally. The anger issues could of seen her in jail. So she had to deal with it first before any further damage was done. Too much damage had been done and any dealing with the cause/stress that was triggering her symptoms could take a life time to heal if at all. So she had to deal with the symptoms - the low self esteem/worth, anger issues and mood swings that resulted from the stress of trauma to be able to move forward with her life.

Its never black and white and very individual to ones situation.

She is now, 5 years lately, only ready to address the assault and issues that caused it - but will only talk to me as she trusts no one as a result. She has improved greatly and still refuses to see a psychologist to talk about it. She does work in her anger issues. And she has a limit to what she reveals to me about what happened - otherwise if I get her to talk too much about the stress she can become Self destructive and depressed again through reliving it. It is a work in progress. So as you can see it depends on the severity of the mental anguish and the situation to know what issue to deal with and when.

Hi @Former-Member,

Yep, definitely very individual. That is why a MH professional needs to do a case formulation and treatment plan. I certainly wasn't suggesting that it is always most appropriate to deal with intense trauma stuff before addressing other things. I was just giving an example. I'm sorry if it came across as suggesting that addressing icky trauma stuff is always a good idea as a starting point. Indeed, DBT very much focuses on teaching distress tolerance and emotion regulation skills before going near any trauma stuff. I'm glad to hear your daughter is doing better now.

Thank you @Phoenix_Rising for your kind words. I wish my daughter could do DBT as I think it would help her tremendously and it was advised by a psychiatrist she saw when she was scheduled. There is not a private hospital near us near us that offers this, my daughter would of had to have travelled a long way to have received it and this put her off unfortunately.

Such a shame as I think she would improve even more if she had tried it. She controls her anger a lot more and can hold down a job etc, but her self esteem is still very low she is very introverted. I saw that you are doing a DBT thread - I will pop over and have a read as it sounds interesting. Thanks again

i dont have anything to add but im interested in reading along

Hi @CheerBear and everyone,

I've been seeing mental health professionals for over 25 years (mainly psychiatrists, some psychologists and others, such as support worker from Phams). Therapeutic fashions have come and gone in that time and I have been involved in a number of different approaches, some structured, some much less so.

These days I approach therapy as a means to improvement, not cure. Hoping for cure was a recipe for frustration and unhappiness in my case, whereas seeking and finding improvement in a more wholistic way allows much greater assistance to me.

This is how my current psychologist sessions go:

. My psychologist and I enter room and she asks how I am and have been since last seeing her

. I respond spontaneously and the session proceeds in a natural conversational flow from there.

This seems an unstructured kind of therapy and it is my preference. Because we are focussed on 'being in the moment' with each other in the session itself, it's hard to predict what exactly will get discussed on any given day. All my sessions with this psychologist so far have involved discussion of both obvious behavioural issues as well as deeper psychological issues. Sometimes our discussion goes into the area of social work. In most sessions, we laugh a fair bit, which I think is great. I feel I am getting a lot from these sessions, without it being highly intellectual, theoretical or structured. I feel a trust in the deeper mind's ability to 'throw up' things that need talking out in my sessions. And I think this may have a longer term benefit to my overall quality of life.

I wonder if this makes any sense or is just an odd personal tangent. Either way, thanks for reading and trying to make sense of me.

Hi @CheerBear

You explain what you are experiencing so well.....honestly in parts you could of been talking about me, in other parts my daughter. I do know that sense of fear about being in a situation that feels certain past traumas and hurts could happen again and the fear, worry, and "helplessness" (being the big one) and distress that comes with it. It is a vicious cycle and it can have some basis in reality (it's possible) - I do understand. I have survived certain traumas only to be faced with them again and I can relate.

I feel these fears and worries of what may happen in the future that you feel you have no control over would be highly beneficial to address now with your psychologist. Sometimes we can hold in things for too long until the reality strikes when the feared situation draws closer. Talking to her may alleviate some of the anxiety and distress that incorporates your situation of not feeling in control of your life right now.

It is very true what you say - none of us can control what is thrown at us in life. I have discovered this to my dismay time and time again. But we do have control about how we deal with it (although our helpless feelings will debate that). It's talking back to it that will see us deal with it better. I think the latter is the hard part when past trauma becomes involved as we are dealing with the scars from that when triggered thinking it could happen again or actually is happening again in our minds. And the emotional pain and feelings of helplessness is huge. It overwhelms. So we fight those negative self destructive feelings that propel us to harm ourselves so as to distract from that pain that is unbearable to us. For some that is self harm physically - others it is drugs and alcohol, reckless activities and sometimes reckless sex and relationships. All are classified as actions of self harm. All these harmful actions seek an escape and distraction from the pain and situation that we feel no control over. Here lyes the danger.

So there is a lot of muddles going on there as @Phoenix_Rising so perfectly described and is spot on.

So summing that all up:-

Dealing with the symptoms of self destructive feelings and/or tendencies is the first line of defence for you to address with your psychologist I feel, to keep you safe and from becoming overwhelmed and distressed. I have self harmed in the past, I know the immediate danger such overwhelming feelings of distress, un bearable emotional pain, fear, worry and helplessness can lead to - despair at times if it goes on to long. It may be helpful to discuss a plan of how to deal with this extreme overwhelming emotional pain to alleviate the immediate emergency is the priority; addressing coping strategies to deal with the latter and self destructive urges "in healthier ways" was the first step for me (otherwise I may not be here now).

Then I was in a better, safer place to deal with the issue at hand. What the issue was that was causing the symptoms of distress andself destructive urges and actions. To discuss those feelings of not being able to cope or control the probable traumas and/or the present ones. Addressing the feelings of helplessness, grief, fear and despair which so often accompanies the mental scars of trauma. I did want to fix it too and there were ways I discovered that I could find peace of mind to achieve a better quality of life and move forward. So in that sense I did fix the symptoms most of the time, I can still relapse but never as bad as before or for as long. Those scars are still there - I don't think I will ever fix them, but there are ways of not letting them control my life so I can move forward and be happy. It's possible @CheerBear. Hold onto hope.

I do think DBT could be very helpful in dealing with the above for emotional regulation and could be one healthier way of coping with the symptoms, to distract from the pain or talk back to it. @Phoenix_Rising could advise better there as I have never personally tried it or know much about it but the way she described it sounded very interesting and I found that helpful. I will be reading more about to see what I can learn from it.

Also the relationship and therapy @Mazarita described having with her psychologist I believe would enrich ones life for the better. I would love to find such a psychologist - I will keep looking.

Never feel your posts are too long - I found this thread very helpful and I thank you for that. Your brain is not scrambled - you are dealing with significant mental scars left from past abuse and it's understandable to me. I think so many of us on here can relate. You are also finding yourself feeling not safe as that piece of paper is about to expire and that is triggering your symptoms. Something urgent to discuss also along with the above with your psychologist or legal advisors.

With all you are going through and are still able to attend to the welfare of your children and their needs displays resilience and determination to see the best possible life for your family. And you will, never doubt it. You have the strength to handle any future situation that may be thrown at you - never doubt this and you will gain back control. Believe in you. And thank you for being you and helping others whilst you have real struggles of your own. You deserve the best and in time life will thank you.