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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Dinah on April 16, 2010, at 19:52:13
I'm not very happy with my therapist. It looks like my guess of laziness is closest to the mark on why he's not enthusiastic about tackling emetophobia in therapy.
I was actually ashamed for him today. Not something you like to feel for someone you care about.
He told me very reluctantly that if I looked up a treatment plan and brought all the materials to his office, he'd be willing to help me with it.
I very delicately - and I really do mean that, I was very delicate and neutral about it - said something about being surprised. He flushed with apparent anger and muttered something... I think it was about not knowing anything about that kind of treatment. He did say he didn't want vomit in his office. He didn't want his office to stink. I told him that I had never heard of actual vomit being conveyed to a therapist's office. That it was more images and tapes of sounds. I asked him if he would find that upsetting himself. He said no, he'd probably joke like a schoolboy about it being gross. I told him I didn't think that was likely to be all that helpful.
Darn. I find I can't recall significant parts of the exchange at all well, other than that I was being very very careful, and that he seemed angry. I felt ashamed for him, because he didn't seem to feel ashamed for himself.
Am I missing something about this? Is it a perfectly respectable thing for a therapist to ask a client to come up with a treatment program and find all the materials, etc?
Geesh, that alone would be treatment enough.
I don't want to see him the way I'm seeing him right now. I think I've always been very good at being realistic about who he was, and more importantly who he wasn't. I think I've always been very accepting about his humanity. But lately...
I don't like it. I want to think better of him.
Posted by TherapyGirl on April 16, 2010, at 21:03:36
In reply to I think I need help in reframing, posted by Dinah on April 16, 2010, at 19:52:13
He does sound terribly reluctant. Does he get defensive when he feels out of his treatment comfort zone? Could that be it?
My T was willing to try just about anything that she thought would help, but if it was something outside of her training, I did the leg work. Your T's reaction seems a little different from that, though.
Maybe he's uncomfortable with body fluids?
At any rate, I'm sorry. I know what these breaks in the connection feel like. I hope you two figure it out -- I know you can because you've done it so many times before.
Posted by rnny on April 16, 2010, at 21:50:25
In reply to I think I need help in reframing, posted by Dinah on April 16, 2010, at 19:52:13
If it was me, I would report him to the board who licenses him. Not only about his relying on a lay person to come up with a professional treatment plan, but it is unethical in my opinion for him to use a patient like that. Furthermore his comments are out of line.
>>>He did say he didn't want vomit in his office. He didn't want his office to stink.<<<
Posted by Dinah on April 17, 2010, at 9:10:46
In reply to Re: I think I need help in reframing » Dinah, posted by TherapyGirl on April 16, 2010, at 21:03:36
I'm inclined to think he was on medication or something yesterday. He also talked an awful lot about himself. But that would only explain the fact that he was honest and graceless in explaining his thoughts. And in general I should be glad he did, because he's been confusing me since it came up with his reluctance and with the fact that he never gives the same excuse twice for why he's reluctant.
Yesterday I mentioned this, and asked if this was the real reason. He said he wasn't sure. He didn't remember all the reasons he gave. But he imagined they were all partly true.
While in some ways I enjoy the fact that he is more honest with regards to what's going on in the room in the here and now, in other ways I see the value of the blanker slate approach. It's possible to fill in the blanks with the noblest ideals. The more he opens his mouth, the more I see him... Well, I'm not going to say as a real, flawed, human. I saw that long ago, even before he was anywhere near honest about his reaction. But I find more reason to be disappointed in him when I know the precise nature of the flaws.
I daresay we'll get past it. It'll just take yet another of those pesky readjustments of how I see him. It's just that I'm not sure I want to readjust my view of him to include shame for him.
Posted by Dinah on April 17, 2010, at 9:20:20
In reply to Re: I think I need help in reframing, posted by rnny on April 16, 2010, at 21:50:25
He may not have used the word "stink". He might have said he doesn't like the smell of vomit, and doesn't want his office to smell of it. I'm not entirely sure what on earth he imagined would happen. I'm not afraid of vomiting myself, and would hardly have culminated treatment by vomiting in his office. And the literature I did bring him was clear that the therapist was not supposed to use sound tapes of himself pretending to retch, so it would seem bizarre if he thought the treatment would involve him doing it. What did he think was going to happen? I'd go find a drunk on the street and bring him up to the office? I really need to ask him this. His thought processes might be interesting.
I would never report even a stranger to the licensing agency over something like this. I'd reserve that for sexual approaches, or some such. I consider other mental health professionals I've seen to be far more deserving of professional censure than my therapist and I didn't report them either.
I'm not angry with him. I feel sad because I feel disappointed in him. The same way people would feel sad when they were disappointed in any person they care about. At least, sadness is my response. Only rarely anger, and certainly not over this.
Posted by Tabitha on April 17, 2010, at 10:47:20
In reply to I think I need help in reframing, posted by Dinah on April 16, 2010, at 19:52:13
Hi Dinah,
Phobia treatment seems like a pretty distinct specialty. I would imagine it takes specific training and practice before a therapist feels comfortable using it. So I can understand his reluctance to agree to this.Saying he'll do it if you pick a specific protocol is probably his compromise. So you could view it as him going an extra distance for you, to meet you half-way. Would that help?
Posted by Dinah on April 17, 2010, at 12:44:48
In reply to Re: I think I need help in reframing » Dinah, posted by Tabitha on April 17, 2010, at 10:47:20
When I first started going to him, for anxiety and panic attacks, I understood that he was accustomed to using CBT for phobias and other anxiety disorders. It seemed like desensitization was in his skill set. I haven't spoken to him about it lately, and maybe he's fallen out of practice.
But, for whatever reason, he does seem to see this as something he's uncomfortable doing. Given that, perhaps this *is* a compromise. I wish he'd just say so though.
Thanks, Tabitha. It does help to think of it that way.
Posted by rnny on April 17, 2010, at 15:35:06
In reply to Re: I think I need help in reframing » rnny, posted by Dinah on April 17, 2010, at 9:20:20
You say you aren't very happy with him in your first post (at least not happy with him based on your session) and that you were ashamed for him during the session. You admit the feeling ashamed for him is something you don't like feeling because you care for him. He said he might joke about some of what might bring in or something like that, like a 'school boy' and you tell him you don't think that would be helpful. You say he seemed angry even though you were talking about something very important to you. You also say you don't want to see him the way you are seeing him at present. And say lately you don't like it. That you want to think better of him. You say you feel sad and disappointed in him. Then you say in my first reply about this that you aren't angry at him. Why no anger? To be licensed he is held to a professional ethical standard that is outlined in the licensing board of whatever state he is licensed in. All a person has to do it look at those standards online and they can compare them to the behavior of a T and see if there is anything the T is doing or has done that violates the code of ethics to report a T.Refraining from sexual abuse is not the only standard a T is held to.
Posted by Dinah on April 17, 2010, at 18:32:28
In reply to Re: I think I need help in reframing, posted by rnny on April 17, 2010, at 15:35:06
I remembered, when I was reading your posts about being selective in choosing friends, that it seems that I had remembered your advocating turning therapists in to their licensing boards. Or rejecting therapists because they didn't live up to the standards you thought they should live up to. I thought about it again when I read your post about feelings and about blaming yourself for your feelings.
I wondered if it all related to a common theme in your experience of life.
People, even good people, even people you care about, will let one down. At least in my experience. Usually in the same ways, because they are who they are and because we are who we are. Our expectations and their abilities will fail to mesh over in the same places. What we do about that is up to us.
I *try* to acknowledge that fact, to realize that people will let me down, and to realize that it's not only inevitable, it's also not the end of a relationship.
I'm disappointed in him about this, yes. I sometimes wish I knew less about his thoughts and feelings on a moment by moment basis so that I could fill in the blanks with a somewhat more noble and heroic image, yes. But what he's given me over the years is priceless. I can recognize the one without forgetting the other. I can realize that while he fall short in some areas, he excels in others.
He has been the best therapist available, for me. Why would I wish to see the best therapist I've known to be in trouble with his licensing board? Why would I want to see him unable to help others?
I always say that commitment is what keeps those life partners together at the times they really don't like each other much. In any relationship of any length, there will be those moments. Not only is love like a wave, all relationships are like waves. There are peaks and troughs. This is a trough in my therapeutic relationship.
But it's a matter of deciding if the therapeutic relationship is still a helpful one. It's an assessment of where I am and what the relationship is. It's a question of what I need at this point, and what he can offer. It's got nothing to do with the licensing board. I'm not committed to him in the same way life partners are. If I were, there wouldn't be an exchange of money at the end of each session. But it would be foolish of me to reject all of the relationship on the grounds of being disappointed in him about one thing. It wouldn't be in my best interests. It would be a way of life that would lead to the loss in my life of many good things.
No. I'm not angry. Why should I be angry? I'm sad, and I'm hoping I can fit this into my picture of who he is and continue to respect him, care about him, and benefit from the good things he brings to my life.
Posted by BabyToes on April 17, 2010, at 21:21:12
In reply to I think I need help in reframing, posted by Dinah on April 16, 2010, at 19:52:13
Your T knows you and last time he tried to come up with an exercise you very adamantly rejected it. (something to do with an egg or something) Maybe that is why he wants you to find something that is agreeable to you and so he won't waste a lot of his time on treatments that you wouldn't be open to.
If I were a T and wanted to treat this phobia, I would use EMDR. That would be my first choice to desensitize your symptoms. There are other ways, but they take much longer.
Posted by Dinah on April 17, 2010, at 21:43:19
In reply to Re: I think I need help in reframing, posted by BabyToes on April 17, 2010, at 21:21:12
My therapist has been suggesting that too.
However, the one time I tried EMDR, it did nothing for me and the therapist suggested we quit trying.
For some it works, for others it doesn't.
Posted by emmanuel98 on April 18, 2010, at 2:11:58
In reply to Re: I think I need help in reframing, posted by Dinah on April 17, 2010, at 21:43:19
You just wrote about this a couple of weeks ago as something new and revelatory, not as a problem you've struggled with for years. Maybe your T doesn't take this seriously, sees it as a minor neurotic issue that has just cropped up because you recently had a case of the flu.
Posted by Dinah on April 18, 2010, at 9:50:55
In reply to Re: I think I need help in reframing, posted by emmanuel98 on April 18, 2010, at 2:11:58
Oh no! I realized something I'd never realized before about it. That the huge taboo about mentioning it caused a good deal of my troubles.
But the obsessive phobia itself dates back to my preteens. It was so bad in my early teens that I was tending towards agoraphobic. It has shaped my entire life. Where I went to college, what I did for a living, what choices I make in entertainment. My husband had serious doubts about marrying me because of it. This is always, always, in my consciousness. I'm aware of it when I walk down the street, when I drive, when I park. It's always with me.
I probably mentioned it to my therapist at the very beginning, when he took my history, because it was a big part of why I went to a psychiatrist in my teens. But my parents never really believed that. The psychiatrist never really believed that. Nobody did. Everyone just got mad at me if I tried to explain the truth. So I learned to lie about why I did the things I did. It's not like I never mentioned it. My husband knew about it. And I would freely mention it in settings related to psychology. But not in the moment. Oddly enough, my husband never did either. If we were in a situation that was triggering my fear, he'd mention it to others no more than I would about why I had to leave or whatever.
Posted by Dinah on April 18, 2010, at 10:03:14
In reply to Re: I think I need help in reframing, posted by emmanuel98 on April 18, 2010, at 2:11:58
I'm trying to think over whether he really understands how much it still affects my life, and I'd have to say he does.
He just last week talked to me as I sat on the floor in a remote area of my house, while my husband took care of my son who'd thrown up from a migraine. And a year or so ago when I had to leave the house when my husband was sick with a stomach bug. And how much self loathing I felt from another instance a few years ago. I'm still sure I'm going to hell over that one.
He does understand what it is to me, he just doesn't want to be the one to do desensitization with me.
Posted by jane d on April 18, 2010, at 18:25:01
In reply to Re: I think I need help in reframing » emmanuel98, posted by Dinah on April 18, 2010, at 10:03:14
Is it possible that he is very squeamish about this himself and doesn't want to admit it? And that, as a result, he's finding excuses not to do it. His part in your discussion does sound odd.
Posted by Dinah on April 18, 2010, at 21:43:14
In reply to Re: I think I need help in reframing » Dinah, posted by jane d on April 18, 2010, at 18:25:01
I was wondering that too. That's why I asked the questions that led to his response that he'd be like a schoolboy. :)
There may still be some truth to it. Perhaps he thinks it wouldn't be therapeutic to let me know it freaks him out too.
But right now I'm going with medications. I found out purely by chance today that he'd told me and written down that my next appointment would be at his office that's an hour + drive each way. But in reality he was going to be at the office I usually saw him at. I told him it was a darn good thing I called to check the time, because I'd have been pretty annoyed to drive that far only to find he wasn't there.
I think that makes it obvious that he wasn't himself at all Friday. So I'll assume temporary insanity, or a recent wisdom tooth extraction that required some pain meds. :)
Posted by rnny on April 18, 2010, at 23:27:43
In reply to Re: I think I need help in reframing » rnny, posted by Dinah on April 17, 2010, at 18:32:28
"People" will let you down, but a paid professional has standards they have to adhere to. That has nothing to do with any theme in my life. You and I simply differ on what is acceptable and what isn't from a T. I am a professional in a field that requires ethics to the max. And so I am keenly aware of the ethical obligations of other professionals and hold them accountable.
Posted by BabyToes on April 19, 2010, at 2:46:31
In reply to Re: I think I need help in reframing, posted by Dinah on April 17, 2010, at 21:43:19
> My therapist has been suggesting that too.
>
> However, the one time I tried EMDR, it did nothing for me and the therapist suggested we quit trying.
>
> For some it works, for others it doesn't.
Dinah,
I know you probably know this, but trying a type of therapy one time doesn't mean the type of therapy didn't work, it could have been the "therapist" that didn't work for you. It works like that for all therapies.EMDR works better for some issues than others. Was this the same issue as before?
I have never heard of an therapist that would have given up like that, but some are trained to deal with the protectiveness a client may exhibit to not "go there" and how to deal with resistance. Some have more experience with EMDR, some have more experience with being a T, there are so many variables that go into place.
I have had EMDR done by 3 different T's and all three experiences are different and a lot depends on the therapy relationship and trust. I am not sure if I would be comfortable in doing EMDR with a T that I didn't build a relationship with. I would want my current T with me while I do it, if it was with somebody else. (at least at first)
But I do know this, if I had a T who has known me for years, and suggests this even knowing that I tried it before and it didn't work, I would at least consider trying it again. I would trust that they knew me and I would trust their expertise in knowing what could really help. This is what we pay them for.
If you feel your T isn't comfortable in doing desensitization with you, maybe it would be a good idea not to force him into it. Desensitization in the traditional sense is a long drawn out process that is very intense and if he isn't trained in doing it, it could cause more harm than good.
It is a form of trauma therapy that is rather specialized, kinda like seeing a cardiologist for heart problems instead of a general family doctor. Even with this, this standard of therapy isn't being taught as much to T's now since we have EMDR which tend to work better. So much has happened within the last 5 years of EMDR and the training involved.
I know since Katrina there are some very qualified EMDR therapist who have stayed in the area because their work is needed badly by so many there. You probably have some of the best ones in your own backyard. I know EMDR doesn't work for everyone, but trying it once with only one T, on one issue is hardly enough of a try to say it doesn't work.
Your T has given you his best advice on what to do about this phobia, why not trust it?
Posted by Dinah on April 19, 2010, at 8:20:44
In reply to Re: I think I need help in reframing » Dinah, posted by BabyToes on April 19, 2010, at 2:46:31
I wouldn't dream of forcing it onto him, or even encouraging him to do it. Given the nature of the therapy, reluctance in the therapist could be counterproductive. I was merely disappointed in the nature of his response.
I do think I can conclude he wasn't himself, since he also made the mistake with the scheduling, and since he also seemed unlike himself in other ways that day.
The EMDR therapist I went to was one of the best in the area. They have different levels of certification. Hers was the highest locally available, and she did supervision. And while she wasn't my therapist, I actually didn't dislike her. I think that's as much as I have been able to say about any therapist I've ever seen aside from mine. I think I felt as comfortable with her as I'd be able to feel with anyone.
It wasn't an unpleasant experience. It provoked no anxiety. It was just... blah. I didn't feel anything that I wouldn't have felt without the eye movements.
After trying hypnotic induction with me, the hypnosis therapist ended our session by telling me that I could get lots of benefits from hypnosis even if I wasn't hypnotized. I took that to mean that she didn't think this was going to happen. I really wanted to be hypnotized too.
I recognize they aren't the same thing, but I do think I just don't do well at those specialized types of therapy. If it's defenses, they are ones I'm not aware of. I really really wanted to be hypnotized, and was as cooperative as I could be. I really wanted EMDR to work. It's a seductive notion.
I'm willing to try again, but I rather suspect that if I don't think it will work, it will have even less chance of working than when I had thought or at least hoped it would.
I'm glad it works for you and for others. I'm all for any therapy that brings results.
As for my therapist suggesting it, he admits he's a skeptic. But a lot of therapists he trains with think it's the bees knees. I guess he figures it's worth a shot. Or perhaps he just wants to unload it on someone else. :)
Posted by Dinah on April 19, 2010, at 8:27:01
In reply to Re: I think I need help in reframing, posted by rnny on April 18, 2010, at 23:27:43
I know you feel that way.
I respectfully disagree. I think it does have more to do with more than just therapy. From the admittedly small window into your life from your posts, I think you and I have vastly different ways of dealing with imperfection and disappointment.
I hope your way brings you peace and joy and love in your life. What peace and joy and love I have in my life owes a surprising amount to my way of viewing this.
Posted by Dinah on April 19, 2010, at 8:36:53
In reply to Re: I think I need help in reframing » rnny, posted by Dinah on April 19, 2010, at 8:27:01
Of course I could well be wrong. It was just an impression I had from your posts. It's definitely possible to get the wrong idea from posts.
Posted by BabyToes on April 19, 2010, at 9:39:10
In reply to Re: I think I need help in reframing » rnny, posted by Dinah on April 19, 2010, at 8:27:01
> I know you feel that way.
>
> I respectfully disagree. I think it does have more to do with more than just therapy. From the admittedly small window into your life from your posts, I think you and I have vastly different ways of dealing with imperfection and disappointment.
>
>
Dinah,I know you adore your T and have been with him a long time and have put up with a lot from him at times. But from someone who is new to the site, I can see why they see what they do when you talk about your therapist.
I know you probably don't want to hear this especially from me, but I have been a member and have heard about your relationship for years and
while I don't think he is unethical or feel as strongly as rnny seems to, I do think she does see some things about your T that do cause one to be concerned for you. He has done and said things sometimes that are questionable for a T to behave. Your words are our only window into your therapy, and sometimes you have said the same things (basically) as some of what rnny has mentioned.
Her friends qualifications are one thing, but the standards for a T's behavior are spot on. You do deserve more from therapy than what you are getting in my opinion. But I know you won't ever leave him so I guess you are doing the best you can with what you have with him. But his latest behavior (whether or not he was off that day or not) was unprofessional.
Posted by Dinah on April 19, 2010, at 13:10:49
In reply to Re: I think I need help in reframing, posted by BabyToes on April 19, 2010, at 9:39:10
My therapist is far from perfect. Over the years I've shared both the extraordinarily wonderful things he's done and the less than wonderful things he's done.
I'm able to balance the two.
I realize that not everyone is willing or able to do that.
For me, I think my life is richer and fuller for it. But that's me.
Posted by rnny on April 20, 2010, at 0:43:54
In reply to Re: I think I need help in reframing » rnny, posted by Dinah on April 19, 2010, at 8:27:01
The big conclusion you have arrived at about me from a view through such a small window scares me. I feel it doesn't take much to make an impression on you and one that sticks. It is also hard to reply to you when you refer to my opinion as something you know I "feel that way about" and then challenge it. I know my feelings better than you. I am not going to continue talking anymore on this thread.
> I know you feel that way.
>
> I respectfully disagree. I think it does have more to do with more than just therapy. From the admittedly small window into your life from your posts, I think you and I have vastly different ways of dealing with imperfection and disappointment.
>
> I hope your way brings you peace and joy and love in your life. What peace and joy and love I have in my life owes a surprising amount to my way of viewing this.
Posted by Dinah on April 20, 2010, at 5:57:27
In reply to Re: I think I need help in reframing, posted by rnny on April 20, 2010, at 0:43:54
You're right. I'm sorry. I didn't mean to jump to conclusions about your views on life.
(Referring to the other statement, I merely meant I knew you feel that way about professionals, and about my therapist in particular, because you had said so.)
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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