PTSD therapy - is it typical to treat symptoms rather than causes?

[weesa]

I've been living with PTSD since I was about 13, after having a traumatic medical experience (gyn-related). I don't go to doctors as a result (avoidance), as a doctor's appointment for me means months of acute PTSD symptoms, starting from when I schedule an appointment until several months afterward.

I recently sought out therapy for the first time for this, and this afternoon's session will be my 6th.

My goal ultimately, is to get to a place where like most people, I'll be able to tolerate procedures that are disliked without being traumatized by them, and undergo a simple physical without having my life disrupted emotionally for the better part of a year.


Therapy thus far has been helpful, in that I've been able to unburden myself of experiences I've never spoken about, and have gotten excellent advice on how to control my anxiety episodes. The therapist has told me that I exhibit symptoms consistent with those of adult survivors of childhood sexual abuse, and has suggested that my childhood medical experience has led to these symptoms. As well, pretty much all of my gyn-related medical experiences since the initial childhood event have been re-traumatizing, which she also acknowledges.

But my therapist seems to want to concentrate on controlling the effects of PTSD, and not the causes.

We talk about ways to control anxiety attacks, and I've gotten excellent advice on meditation, which has helped my anxiety overall. We've also talked generally about my past medical experiences, and she agrees that many of the providers I saw were unprofessional, and as well, has pointed out that most of my subsequent experiences were also traumatizing, because I've become hypervigilant.

I've tried twice now to discuss the initial traumatizing event and my feelings about it - my shame response - feelings 'watched' and that people 'knew', and the sense of procedure being "non-consensual" - but when I do, I get odd advice - "you're overly self-conscious", and then the discussion leads back toward anxiety-control methods.

This is confusing for me, as I don't understand why conversation about the trauma itself is being avoided.

At this point, despite having better control of my anxiety, I still have no desire to see a doctor, as I know I will likely be re-traumatized. In my last two sessions, she suggested I start looking around for a health care provider, but I refused. She seemed pretty befuddled by this.

I explained that while I felt our therapy sessions have been helpful in that I've been able to gain better control of my anxiety, I also feel as though we're treating symptoms and not underlying causes - much like taking aspirin to treat a brain tumor - the aspirin may reduce the headache, but the tumor remains, continuing to cause headaches and other problems.

I told her I was concerned that by not directly addressing the underlying event, I will be able to better manage my anxiety but will continue to be traumatized - and that going forward I'll have even more experiences under my belt that will produce flashbacks, disassociation, and anxiety. I suggested we address and resolve the underlying trauma (in conjunction with continuing the anxiety management methods) and asked what treatment methods are available. She suggested EMDR has been helpful for some people, but said she didn't offer it as a service, but that she could recommend someone.


So I'm confused about what to do at this point....


Not being super-familiar with therapy - am I being too controlling in my sessions, in suggesting that we address underlying causes and not just symptoms? Am I supposed to do that, or is the therapist supposed to suggest the course of action?

Has anyone else had similar experiences of being treated for symptoms and not causes? Is this how PTSD is typically addressed?

Am I being unrealistic in my treatment goals? Is it realistic to expect to be able to react more "normally" in situations that were previously traumatizing?
 
Has anyone had EMDR? Did it help?


Thanks, in advance!

LJ

[rudra]

I feel so bad for you that this has gone unanswered for so long!

Anyhow, I've got some similar things that come up during a gyn exam. This has been going on for my whole life - it involves my first memory of being alive and an instance of non-typical childhood sexual abuse, which has been repeated in medical settings. The most recent of these being during a surgery for an injury last May. The unnecessary and refused medical procedure given to me anyway (I cannot prove my refusal) caused an ongoing medical problem.

I went to a therapist after that, and was re-diagnosed with PTSD (No big surprise there!). I know what caused it, what the issues are over, and the focus was on how to deal with it so that it doesn't happen again.

I'd learned in previous therapy, and some ad-hoc discussions with others who have PTSD on how to deal with the flashbacks. Probably the most useful thing I found was what I learned from a Vietnam Veteran. Certainly the content of our flashbacks is very different, but the method I adopted from him for dealing with them was the same: Focus on something that you KNOW is in the "here and now" - TODAY. Something that did not exist when the triggering event happened. It can be something about the town or city you are in. Something about the building you are in. The presence of a person or pet that you didn't know/have back then. Today's newspaper. Focus on THAT. Realize that it's "real", it's in the here and now with you, and the content of the flashback is "just" a memory and it really cannot, in itself, hurt you now.

The things I learned in past therapy instances involving PTSD was to go over what happened (which really was not that useful), putting the blame on whoever caused the issue, realized that I was a vulnerable person in a vulnerable position and could not stop it.

In the recent therapy instance, the therapist realized that I had that down pretty good. I realized there were things in the distant past, I realized there were medical abuses that happened years ago, and I realized there were medical abuses/accidents/miscommunications that happened recently. Our focus was on preventing them from happening yet again.

To start with, make out an advanced directive, in accordance with your own state or other jurisdiction, which describes the medical procedures that you will or will not accept under particular instances. Some of these you may not have thought about before, but they are quite important for you to describe what you want BEFORE it becomes an issue.

When you go to a doctor or hospital, they have you sign a consent form for treatment. READ the consent form. If the person behind the desk belittles you saying, "It's just a standard consent form.", reply that you do not sign any legal documents without first reading them, and that it is NOT standard for YOU. You may put in other items in that consent form, or withholding consent for particular procedures. If there are things you will not consent to having done, write "I specifically withhold consent for (treatment or procedure)." They may try to talk you out of it, or tell you that you can't do that, but hold your ground. It IS your right! Give them a copy of your advance directive too. Also, keep it on your person in case you are in an accident and taken for medical treatment in another city. Even if you are out of state, it still tells them what you consent to, which they will heed if they are at all ethical. Another thing is to send a copy to your insurance company. They don't want to pay for procedures that you refuse! They will then not approve payment for these, and no doctor or hospital will do anything which they will not be paid for.

Another thing, when you do see a doctor for ANY reason, take someone you trust with you. Have your OWN witness to what was said, done, what happened. In the best of circumstances, they will serve as an adjunct to your own memory on what the doctor said, told you to do, how to take a medication, when to come back, or whatever. If anything does happen outside of your consent, have your ducks in a row to make a case. If you will be anesthetised for surgery, write on your body any refusals you have, and take a picture of that refusal along with your wristband, and that day's newspaper (to certify the date). If you find that an unwanted/refused procedure was performed, take pictures of THAT evidence, along with the written-on-your-body refusal, newspaper, and wristband. Have a trusted friend or relative there with a camera cell phone.

You're far from the only one with problems with GYN care. I had them too after the medical abuse that happened to me years ago. I started researching, trying to talk myself into going for them. You know what? I found that they really can't find much in a "well woman" pelvic examination that there are not already better diagnostic tests for. Cervical cancer is a rare cancer. Pap smears can screen for it, and it has a high false-positive and a high false-negative rate. A CSA blood test is far more accurate. Pap tests lead to biopsies which can lead to other invasive tests, and culminate in a hysterectomy. All of these have risks, which cumulatively are higher than dying of cervical cancer. For me, a gyn exam is not worth the risk or the mental trauma. Heart disease is the #1 killer of women, and tests for heart problems are downplayed or not often done. Lung cancer is a killer of many, but rarely are chest X-rays performed. Skin cancer is well up there too. Please read this article from the Harvard Journal of Law and Gender, written by a woman who argues against women being forced or coerced into pelvic exams.

http://www.law.harvard.edu/students/orgs/jlg/vol27/dixon.php

[morro]

I'm sorry to hear that you came across a therapist not willing to try and resolve the underlying issue with you. I have had a similar experience, and it must be frustrating for you now. I do have some answers and information that might help you find someone with a method or two that you could try to help ease the PTSD you may be experiencing.

Just know, however, that to treat the causes for PTSD, you need to have the symptoms under control to a certain degree and so what you've been doing so far is useful, and in no way a waste. Keep it up!

In your post you mentioned your therapist talking about EMDR. I frankly am not too sure if that is such a good choice. Though it is gaining popularity, it is still somewhat a controversial method, because there still is some scientific dispute on whether eye movements really help with overcoming trauma. The therapy pretty much walks you through your traumatic source while moving your eyes back and forth, but there is still an argument whether this is really helpful or not. Wikipedia sums this up in a nice sentence: "Although one meta-analysis concluded that EMDR is not as effective, or as long lasting, as traditional exposure therapy, several other researchers using meta-analysis have found EMDR to be at least equivalent in effect size to specific exposure therapies."

Personally, I wouldn't want to leave the fate of my mental health to a method that's still being argued over.

Now, in the quote above, "traditional exposure therapy" was mentioned, and this is what I personally suggest you seek in terms of a therapist that can provide such therapy. Exposure therapy works. It's scientifically tried and has gotten results. The states is the best country in the world to do this in because it's where is was developed and is in most use. However, it is not an easy method since it involves you to delve in to your fear neck deep repeatedly.

You usually practice relaxation exercises (which you may have obtained already) to prepare yourself for the exposure. With a therapist, you either read or have read a narrative, or verbally walk through the underlying trauma until you are overwhelmed with it. By doing this for extended periods of time (an hour to an hour and a half) repeatedly, the therapy aims to get your brain to get used to the overwhelming content of your trauma.

Now this sounds pretty forceful, but it does make some sense if you think about how avoidance plays a large role in PTSD. Because people with PTSD avoid encounters with anything that might remind them of the event, the PTSD patient never gets a chance to even try to overcome the trauma.

There are a few things that I suggest if you should try exposure therapy.
1) Be 100% sure and determined you want to do it and you want to get better.
     - it's not easy and so you need to choose for yourself and know why you're doing it
2) Take medication and have your symptoms in control before and while you're doing this.
     - to make the best of the treatment you want to be in the best condition when you start this therapy. you also want some medication to help ease you and relax you while/after sessions such as minor tranquilizers.
3) Find a therapist that you like as a person.
     - this therapy requires you to be in a environment you feel is safe, and the most important part of that is the therapist. feel free to skip from one therapist to another if you don't think you can let your guard down with the ones you meet. exposure therapy is intimate stuff since you're going to be working through your fears and trauma with a stranger.
4) It'll take time.
     - the change won't happen overnight, and in fact it may worsen a little before it gets better. but just always know, it does work, and your hard work won't be put to waste. and after you have sorted everything through, it'll feel better to have less flashbacks, nightmares, and anxiety. it'll feel better to get a little closer to functioning normally.

Try searching for people who specialize or have experience in PTSD or exposure therapy, not just CBT (cognitive-behavioral therapy). There are plenty of therapists out there that match your needs, and also many that don't. Your therapist sounds very skilled in treating anxiety disorders such as panic attacks, but PTSD can be very different in terms of treatment needs. I think it's fantastic that you're willing to attack the causes rather than just the symptoms. Please keep that feeling close to your heart and good luck on getting better.

Sorry for the long post, but I hope this helps.

[Rosalie]

Not being super-familiar with therapy - am I being too controlling in my sessions, in suggesting that we address underlying causes and not just symptoms? Am I supposed to do that, or is the therapist supposed to suggest the course of action?

Has anyone else had similar experiences of being treated for symptoms and not causes? Is this how PTSD is typically addressed?

Am I being unrealistic in my treatment goals? Is it realistic to expect to be able to react more "normally" in situations that were previously traumatizing?
 
Has anyone had EMDR? Did it help?


Hello I came on this forum, or rather joined it because I am concerned for a close friend of mine but I didn't realise that the website covered PTSD as well.  I am in therapy for PTSD currently with a lovely female psychologist.  It took around 20 years for me to get a diagnosis of PTSD and then about another 6 years before I arrived at this treatment.

It is going well with her.  She quite freely shows that she cares about me as a person, not just as a client or service user and it does help that she has such an empathic approach to me.  I just wanted to say that I have, in the past, believed some of the counsellors I have had, to be terrified themselves of talking through trauma with me.  I guess no matter how qualifications they have they are still just one human being like us.  One chap who came to my house approximately 20 years ago hypnotically regressed me to being 10 years old again and I was doing fine until he asked me some random question - at which point I burst out of the mild hypnotic trance, flew at him, didn't harm him physically but came off the sofa like an eagle in flight and yelled and ranted at him.  Then I went quiet and lit a cigarette and wouldnt speak.  He was traumatised himself.  He didnt actually do anything whatsoever to help me though. Just sat there shocked, upset and scared and pretty much left after.  Actually that sounds worse than it is.  I was a timid, shy, unassertive 23 year old and our sessions were normally conducted with me staring at the ground and talking quietly and politely.

It was his idea to regress me back to 10 years old.  I dont think I had raised my voice to any adult in my life and I myself had literally no idea, from that day to this, what the hell it was all about.  I shouted at him.  I just didnt actually swear or hurt him or lay a finger on him.  Clearly the whole, being 10 under hypnosis was not a good idea.  I was like a mouse at that time.  I didnt get any further help - he saw me once more and avoided talking about his choice of therapy and hypnosis including my reaction.

Now I am older, I look back and think, the man was part scared, not of me, but of what he had done and part defeated by how to deal with it.

About 10 years ago a counsellor advised me againt talking about it.  I did say I thought that was a bit rubbish an approach.  He was worried about digging around in my subconscious which is probably psychologically sound practice in some ways but still indicated to me again that he himself was nervous and unqualified to deal with whatever may come up.

Could you ask your therapist if she is qualified to deal with actual deep seated trauma - does she just have qualifications in your bog standard cognitive behavioural therapy or is she qualified to go deeper with you?  There are nice, polite ways of asking.  It definately isnt you doing anything wrong.  No way.  I really dont think it is.  It is probably more likely that she herself, has not had the requisite training in this area.  PTSD requires a lot of courage and fearlessness on the part of the therapist to treat because of the potential for the client to get really messed up or very upset.  I myself have been known to go a bit catatonic to be honest.  She has to call me "back into the room" by making me touch walls and describe the colour, sensation, etc.  I do trust that she will know what to do if I throw another wobbler, although I havent in the last 20 years.

I feel sad for you that she steers you away from what you need to talk about. Therapists are just people.  I respect their years of training but likewise believe they should be brave and honest and tell you if they are frightened of dealing with your fears in that much depth or just not trained to do so.

Best of Luck if that is the right word, hope you will be alright. 


Thanks, in advance!

LJ
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[aj-boston]

I'm not an expert on therapy either.  However, advice I've received from friends who have gone through therapy and/or stuff I've read - and the approach I am taking - is that you have to find the RIGHT therapist FOR YOU.

I would suggest following your "gut." 

Your thoughts are valid, and if you feel your therapist is invalidating them, that's bad.

Make sure, of course, you are understanding what she/he is saying, etc.

But my own opinion is that it is their job to help you, so if you feel there are important things that become sticking points and can't be resolved with your therapist, I would move on.  At least try a few/lot of people.

One therapist I saw said she couldn't keep seeing me if I kept being late, and I was like, since that's a problem, shouldn't you help me work through that?  Obviously I'll try harder, etc., but since this is obviously a problem, it's obviously something I can't just flip a switch on.  But she wouldn't allow it.
I felt that she invalidated my thoughts on several other things, too.  So I chose to move on.

I think it can sometimes take a while to find the right therapist.  But it is important to.

Good luck!