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how do you know when your ready?


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How do you know when your ready to start discussing the trauma add the past?

My psychologist has decided that it's time.

We have had one session and for the rest of the week I have been freeking out and spent a night in hospital (self harm).

I want so badly to be ready for this, I want to get better but I just don't know if it's the right time.

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I don't know if that's a decision that your psychologist should get to make all by themselves.  No matter how well they know you or how much experience they have - you ARE you, and you're the one who has to deal with the consequences of the decision.  If you don't feel ready, trust that.  People who have been abused/hurt/traumatized spend so much time learning to ignore or discount their own confidence/power/autonomy, and part of therapy is taking it back.

For me, some items that suggest to me that I am ready to do some direct work with traumatic memories are 1) I am safe - not actively self-harming, not actively suicidal 2) I have supportive relationships outside of therapy and a clear crisis plan for what to do if things don't go well and I feel confident that I have the skills to manage the distress that comes up 3) I trust my therapist and trust that she knows me well enough to help me judge if something is "too much" because sometimes I push myself too far and I need help stopping.

The theory on staged trauma-treatment is that the first stage of therapy should always be on safety - safety and stability in your external world, your internal world, and in the therapeutic alliance.  Only when that is established do you go on to do trauma work.

Also, you can move back and forth.  It's not like you decide to work on the trauma directly and then you're locked into that for session after session.  My therapy has been flexible - we might decide to work on the trauma directly in one session, then the next session if I have been destabilized or things are hard in the real world, go back to other topics.  Even within a session, we might allocate some time in the middle to directly addressing the trauma, but have time on the other sides as a kind of buffer zone to make sure I don't go out into the world and totally decompensate.

If I started to focus on trauma memories in therapy and I ended up self-harming and in the hospital, for me that would be a sign that something went badly wrong.  Working on trauma is hard and you can expect to feel like crap sometimes afterwards - but I wouldn't expect to end up self-harming and in the hospital.  Perhaps that means that as you say, this isn't the time.  Or perhaps the trauma needs to be worked on in a more gradual fashion with scaffolding around it in the session to help you put things back together again (I tend to need at least 5-15 minutes at the beginning and again at the end of the session to "talk about talking about it" and re-stabilize.  Or maybe you need to take smaller chunks (I needed to help my therapist understand that I can ONLY do intense work on one small memory or aspect of trauma at a time - if she lets me start associating or chaining memories, I will spin out).  Or maybe you need to work on it in a different way or with a different focus.

I get that it's frustrating to not be able to just push through, rip off the bandaid, and be better.  There's a saying in trauma - "the slower you go, the faster you get there."  It's shitty but true.  You need to protect your safety and stability first, or you can end up re-traumatized or more ill than you were in the first place.  I wasn't really able to do focused trauma work with any degree of success until I'd had...probably like 6 years of therapy.  I'd definitely talk about the trauma at times but I wasn't really able to do the intense working through stuff.  I'm now in a stage where I've had to stop doing it for a while due to external stressors.  Pacing is super important.  It sounds like you need to talk to your therapist about your concerns and the outcome of your last session.

Edited by tryp
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Thankyou Tryp that's exactly what I needed to hear.

On points 1 2 and 3 I would have to say no as I'm currently self harming, I have no supportive relationships and I don't know if I trust my psychologist enough to help me judge.

Every moment since that session has been harder and tonight I got freaked out by a guy I know and trust just because he had started to grow a beard and I don't want to be reacting to my friends and colleagues that way.

As much as I don't want to admit it I'm not ready for this.

I wish I was but I'm not.

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I've never been ready - but I do it. I got led into it by a series of bad co-incidences that made it the less horrible of all the terrible options.

I sort of quarrel with my tdoc about this. She keeps putting in place structures that force me to face it, and I keep telling her that I'm scared. But she's right in that if she didn't gently set up structures that encourage me to face it then I just never would and I'd spin my wheels forever, digging a deeper hole. But it took years to get to that point. And as much as I don't trust her, I also sort of do a little bit. Which is more than I can say for anyone else, so.

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I definitely think you should discuss the fact that you're feeling fearful with your tdoc and, perhaps, ask what makes her think you're ready.  But like Rosie said, its hard to ever feel really ready to face past trauma.  I like tryp's three items she uses to determine if she's ready to discuss trauma.  Trusting your tdoc is really important.  You might also ask your tdoc to provide some coping skills to use after the appointment if you start to feel unsafe or feel that you want to self-harm.

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