Appointment with H’s P

[Ozzie101]

I was finally able to meet and talk with H’s P, though I don’t know how helpful it really was. The takeaway:
1) P said H’s dissociative episodes are normal for trauma victims.
2) He doesn’t see any signs that there’s a physiological reason for them.
3) He thinks it’s HIGHLY unlikely the meds he’s on are enhancing or contributing to the episodes.
4) The only way to fully address the issue is through trauma-specific therapy.
5) H should not drink alcohol while on his medication.

It was pretty clear that H has been honest in sharing what’s been happening because P was already aware of the episodes and what happens.

So, it sounds like therapy is the real answer, which I suspected. But since H has quit therapy for now, it doesn’t really help.

In related news, H was out of town for nearly a week. While he was away, we had a phone conversation in which he told me I was going to notice real changes in him. That he had thought and processed a lot of stuff (he apparently made a lot of notes) and was in a better headspace about things. He has a new attitude.

This same thing happened two years ago when things with us were really blowing up — he was away and had an epiphany. Things did greatly improve but it was temporary, as several months later new stressful situations arose.

I asked how he plans to do this and he talked about how he just looks at things differently and he’s thought through and is implementing new initial responses to triggers. Like using a stress ball because physical reactions help him.

I know that he does eventually work through things and they no longer trigger him. He does it at his own pace. And I think he genuinely means it that he has a new attitude.

But I also know it won’t last because he doesn’t have the tools to process things and handle stress without going through periods of rage and dissociation.

[formflier]

What did the P say about homicidal threats?

Was your husband part of the conversation?  Did you also have private conversation with the P?

The good news (as I see it) is there is a medically approved plan for your husband to get better...I would not longer participate or in any way "validate" that "there is nothing that can be done" (or whatever he says)...or that "he doesn't know what to do".

1.  No alcohol.  (correct...?  Not limited or only at certain times...but NONE..right?)

2.  Therapy for the trauma.


That brings up another question.  Does the P understand what the trauma was?  Do you understand that?  Can your husband verbalize the trauma?

Big picture:  I think this is an important step for you and the relationship.

What next?

Best,

FF

[Ozzie101]

He thinks everything is normal and fits in with trauma reactions. Kind of like my T.

He was part of the conversation (though he just let me talk so, really, he was present but not involved until I finished).

He said he would “never recommend someone drink alcohol while on these drugs.” H didn’t react to that. He knows how I feel about any drinking at this point and he gets very annoyed and defensive if I mention it.

As for T, H is on a break — partly because he’s frustrated with it. It doesn’t work. He can’t connect. It’s too slow. All Ts come up short and just string you along to milk you for money. I suspect these are excuses. He’s impatient. But I think there’s also fear — fear of having to fo real work and of having to share deep emotions and poke at painful things.

I don’t know if P knows. I don’t even fully know — can just make guesses and assumptions with what I have. My T thinks it’s abandonment plus growing up in a house where he didn’t connect or bond with his adoptive parents. H has never gone deeper than that or given any other clues.

I’m torn because if there’s more to it, I want to know. But I also don’t want to pressure him to share things if he’s not ready to.

[formflier]

He thinks everything is normal and fits in with trauma reactions. Kind of like my T.
 

So do you think your hubby had admitted to homicidal threats prior to this conversation.  Did the P know about them already?

It sounds like P understands the threats and isn't terribly concerned...was that your take?

Best,

FF

[Ozzie101]

Yes, he knew and, no, he wasn’t concerned.

[formflier]

So were his comments about "there is nothing that can be done" addressed?  Or that "things aren't working" (not sure exactly how he would say it).

Best,

FF

[formflier]

Hey..this is worth of a separate "high 5". 

You've worked really hard on this and getting to this point!      I'm proud that you stuck it out.

Honestly..I take his comments about "you'll see..it will get better" as an acknowledgment that he knows the ball is in his corner.

Best,

FF

[Ozzie101]

I see it the same way. He’s aware he has a problem. It’s just that he’s struggling to figure out how to address/fix it. In a way, I’m lucky. My H is aware enough to realize there are issues and he has a responsibility to fix them. Not everyone has that…

As for whether they were addressed, not really. He’s had that conversation with his P before. The P actually suggested H take a t break to sort of cleanse the pallet or reset.

[formflier]

The P actually suggested H take a t break to sort of cleanse the pallet or reset.

When does P think he starts again?

What can you tell me about your husband's T?  Has he had more than 1?

Best,

FF

[Ozzie101]

He’s had 3-4 since I’ve known him. The last two he connected with, then got frustrated. The female T (FT) worked with him on anger management exercises and he saw her for over a year. He started getting upset because the clinic (a big clinic that doesn’t make things easy as far as billing and scheduling) was problematic. Also, she didn’t know much about trauma stuff and had never heard of CPTSD.

Then he went to a male (MT). They connected because he also had been adopted and he has experience with helping trauma victims. Then he missed two appointments in a row and H got fed up.

I don’t remember much about the couple before that. One told H he didn’t need therapy. The other was very short-lived.

[formflier]

Did any of them have PhDs?  Where any of them actual psychologists?

I'm thinking that your husbands case is one where you need someone highly educated and with lots of experience...plus they obviously need to connect.

Best,

FF

[stolencrumbs]

Did any of them have PhDs?  Where any of them actual psychologists?

I'm thinking that your husbands case is one where you need someone highly educated and with lots of experience...plus they obviously need to connect.

Best,

FF

If what your husband needs is trauma-based therapy, then I'd look for a T that specializes in that. Not one that lists that as something they do, but one that pretty much says that's all they do. That made a huge difference for me. I'd seen 4-5 different Ts in the past five years or so, with varying degrees and approaches, and the one I have now, who does explicitly focus on trauma, has by far been the most helpful for me.

I tend to think experience and connection are significantly more important than having a PhD. It's a research degree. The difference between a PhD and a Master's level T is that one has spent 2-3 extra years doing research on a highly specialized topic that is unlikely to be related to what they do in T. Find the right fit with the right approach.

Oh, I'll also add that my T does very little going over the past, and there has been absolutely no "reliving" the past or past trauma. It is very much focused on the here and now, and dealing with the effects of past trauma. So if your H is in part worried about reliving the past or having to talk about hard, painful things, that is not necessarily what trauma-informed therapy is about. At least as my T approaches it, it is pretty explicitly about *not* doing that.

[ForeverDad]

Ozzie101, let me ask an overview or review question... You've been married for some 6 years, here for less than 3 years.  He's seen multiple therapists.  He's still having episodes and then admitting them.  Do you see him actually learning to behave better?  Is the marriage improving or is it still churning back and forth between misbehaviors and then learning moments, over and over?  In other words, is there sufficient progress thus far to say there's still hope?

I believe there are no children involved, so long term custody and co-parenting is not at issue.  Do you have a long term requirement to maintain the relationship?

EDIT:  Perhaps I ought to explain myself.  The P recommended a break of some sort.  Was it from therapy... or the relationship?  Could it be you were being given a hint?  That's what triggered me to suggest you ponder the bird's eye view and not get lost in the weeds.

[Ozzie101]

I appreciate the additional input and insight on Ts. His latest one (MT) has experience in helping trauma patients but H got frustrated with him and quit. There is another T my T recommended (actually the one she sees) who deals a lot with adoption, abandonment and trauma issues but she stays booked up and H hasn’t tried her yet.

ForeverDad, the P recommended the therapy break to H at a previous appointment. H mentioned this time that he was on a break and P neither acted concerned/surprised nor mentioned timeframes.

As to your questions: you are correct. We have no kids together.

Do I want to remain? That’s something I still struggle with. We take steps forward and steps back. It’s hard for me sometimes to see the overall picture, like you said. At times I believe he’s genuinely struggling and trying to do better and at others, I think he’s avoiding and just trying to placate.

So, my answer? I really don’t know. He’s been doing a lot better lately. But I’ve been here before. I’m giving him a chance to show effort and improvement while watching for any red flags. Meanwhile, I go back and forth between wondering if I’m being unfair or just naive.

Long term? I need to see overall progress. He can be moody. He can have bad days. Who doesn’t? But, ultimately, those should not spill onto me and he should make real and productive efforts to develop healthy coping skills.

When he’s stable, as he is now, he’s incredibly rational, reasonable, thoughtful and self-aware. That’s part of what makes the shifts so dizzying.

[Cat Familiar]

I don’t think you’re either unfair or naive. What I do think is that you’re hopeful.

Hopeful is good as long as you see behavioral change and accountability.

[formflier]

I'm sure some of the PhDs are more research and some are more focused on clinical areas.  The PhD that I see has a bunch of extra letters around her name...I'll have to go look them up.

FFw and I had one prior "family therapist" that was a PhD...and still practicing well into his 60s.  He also does research and promotes BAUD therapy for PTSD.  

Prior to our current "high" that FFw and I are on his therapy resulted in a period of time where I thought "we were fixed".  When she regressed I called him for advice and he said something along the lines of...

"Only look for psychologists with PhDs...and not fresh ones.  Lots of experience needed to handle what you have going on.  That lead me to my current P, that has a PhD and is also in her 60s.  She is fairly open with me about how when BPD "erupts" in my family...that it is very taxing on her..and she limits her exposure to those cases.

My point to Ozzie is lots of experience needed because your hubby "bobs and weaves" a lot to "get out of the way" of healing/accountability...etc etc.

Best,

FF

[stolencrumbs]

I'm sure some of the PhDs are more research and some are more focused on clinical areas.  The PhD that I see has a bunch of extra letters around her name...I'll have to go look them up.

FFw and I had one prior "family therapist" that was a PhD...and still practicing well into his 60s.  He also does research and promotes BAUD therapy for PTSD.  

Prior to our current "high" that FFw and I are on his therapy resulted in a period of time where I thought "we were fixed".  When she regressed I called him for advice and he said something along the lines of...

"Only look for psychologists with PhDs...and not fresh ones.  Lots of experience needed to handle what you have going on.  That lead me to my current P, that has a PhD and is also in her 60s.  She is fairly open with me about how when BPD "erupts" in my family...that it is very taxing on her..and she limits her exposure to those cases.

My point to Ozzie is lots of experience needed because your hubby "bobs and weaves" a lot to "get out of the way" of healing/accountability...etc etc.

Best,

FF

I definitely agree with this: "Lots of experience needed to handle what you have going on."

I'm just a little skeptical of the value of a PhD in terms of helping and treating patients. Obviously, some will be great, but I'm doubtful it's because of those extra letters. It is a research degree. That's what the extra years are for, as compared to a PsyD, which is the "professional doctorate" equivalent, which is more focused on practice.

I'm probably a little biased since I'm surrounded by PhDs of all stripes all of the time, and can confirm firsthand that many of them are complete idiots. I'm just not sure it's a useful marker for how good someone is likely to be in any particular field.

[formflier]

I'm probably a little biased since I'm surrounded by PhDs of all stripes all of the time, and can confirm firsthand that many of them are complete idiots.

All fields have this...I'm still chuckling.

Here is the thing...I personally know pilots that are flying..that I would never get a license to, let alone fly passengers around.

Best,

FF

[Ozzie101]

I get what you mean about being hopeful, Cat. I guess I am a fairly hopeful, optimistic person and tend to look for/see the best in people. That said, I hope I’ve experienced and learned enough that I won’t be complacent or too much of a pushover. I want to see things clearly: progress when it’s real, avoidance and excuse-making when it’s not.

And, yes, I think someone with a good deal of experience is needed here. I know of one person (my T’s T) but want to look for some other possibilities. I have no clue when he’s going to feel “ready” to start up again. Right now he seems confident he can manage change and improvements without help and he’s doing fine, but it’s only been three weeks since his epiphany. I have no illusions that he can keep that up. Especially not when another big stressor hits.

[formflier]

So...perhaps I got the wrong vibe.  His P thought a "break" would be a good thing.  Am I right to assume the P has an idea of how long the break should be?

I'm doubtful that P would say "take a break and when you feel like it...get back in there"

2nd thought.  We all know there will be times when he goes sideways on this...it's important that Ozzie updates her language..stance and boundaries on "there is nothing that works..no plan..etc etc."

Last thought:  There is no break on alcohol..right?  And your hubby is onboard with taking a break from T..but otherwise following the direction of his P (and I on track?)...so the future with alcohol is ?

Best,

FF

[I Am Redeemed]

If what your husband needs is trauma-based therapy, then I'd look for a T that specializes in that. Not one that lists that as something they do, but one that pretty much says that's all they do. That made a huge difference for me. I'd seen 4-5 different Ts in the past five years or so, with varying degrees and approaches, and the one I have now, who does explicitly focus on trauma, has by far been the most helpful for me.

I tend to think experience and connection are significantly more important than having a PhD. It's a research degree. The difference between a PhD and a Master's level T is that one has spent 2-3 extra years doing research on a highly specialized topic that is unlikely to be related to what they do in T. Find the right fit with the right approach.

Oh, I'll also add that my T does very little going over the past, and there has been absolutely no "reliving" the past or past trauma. It is very much focused on the here and now, and dealing with the effects of past trauma. So if your H is in part worried about reliving the past or having to talk about hard, painful things, that is not necessarily what trauma-informed therapy is about. At least as my T approaches it, it is pretty explicitly about *not* doing that.

Very solid points, SC.

My therapist is a licensed clinical social worker whom I actually started seeing while she was still a graduate school intern. She has a master's degree and is a trauma specialist trained in CBT, EMDR, LENS neurofeedback, and other therapy techniques. She is by far the most informed therapist I have ever seen and has a working knowledge of personality disorders.

My therapy consists of CBT and EMDR and most recently the LENS. The overarching counseling theory used in her practice is family systems theory, with an integrated approach that pulls from other theories such as learned helplessness, adaptations theory, and ecological systems theory.

Incidentally, she has related to me that therapies such as trauma focused CBT and EMDR are not effective for treating BPD. CBT requires a lot of outside effort on the client's part to implement tools for developing healthier coping skills, managing triggers, and stopping intrusive thoughts. EMDR is effective for complex trauma because it helps "flip" neural pathways from being stuck in faulty, negative self beliefs into positive messages that align emotions with rational thoughts about what is true.

EMDR is not effective for BPD because they truly believe the negative core messages about themselves, whereas complex trauma victims without BPD generally have a sense of self that has just been conditioned to believe negative core messages.

[Ozzie101]

That actually is what the P said, FF. He was clear he didn’t think it should be permanent, but didn’t give any kind of timeline.

He’s not taking a break from alcohol. He doesn’t keep it in the house anymore — that I know of. Last year he was hiding it. I’ve suspected in the last couple of months there’s been some of that going on with him when I’m not around but I haven’t had proof.

This bothers me because if he does it while stressed or upset, it can make a big difference. But he knows how I feel about it. I’ve made that clear. If I’m around, he limits himself to a beer or a glass of wine and has it with food and he’s perfectly fine (this only happens when we’re eating with friends and they’ve brought a bottle or something). But sometimes, if he’s upset and doing it secretly, he’s not.

He gets very defensive about the drinking because he doesn’t like being told he can’t do something. I really don’t know what to say or do at this point. Pushing any further drives him the other way and becomes nagging and counterproductive. From reading I’ve done with alcoholism, nagging us discouraged. The only thing I can think of is to set boundaries and consequences.

[formflier]

He’s not taking a break from alcohol.

What does his P say..when your husband says this.  I'm really curious to understand how that conversation goes.  

P:  Drinking alcohol with these meds is a really bad idea.

Ozzie Hubby:  "I'm not going to listen to you, yet I am going to tell my wife and others that there are no solutions for me to get better and I have no idea how to improve...did I mention I'm NOT going to follow my doctors advice?"


Next:  I'm sure you have verbally made it clear that you are NOT onboard with alcohol use.  I'm curious what your actions "say" to him about this.  Do they match your words?

Last big picture thing:  I would put what has been said and done into two different categories.  Before the meeting with P and his statements about "I'll be better..you'll see" (or however he phrased it) and what he says and does after the meeting.

When would be the next time you and hubby could go out for a brunch and have a relaxed...unhurried...conversation about life, your relationship..the future..etc etc.

I think this is a time for encouragement and curiosity (going after details) on your part.

Best,

FF


 

[GaGrl]

You've seen patterns with the alcohol. You pick up that he might be hiding it, his stresses triggers more drinking (that you may or may not see), he comes home highly agitated and has a blow-up that frightens you.

I agree. Right now, I see your path forward as boundaries and consequences. The trick is going to be watching for the signs that let you absent yourself before there is a blow-up. That level of vigilence just gets to be exhausting, though.

[ForeverDad]

"Only look for psychologists with PhDs...and not fresh ones.  Lots of experience needed to handle what you have going on.  That lead me to my current P, that has a PhD and is also in her 60s.  She is fairly open with me about how when BPD "erupts" in my family...that it is very taxing on her..and she limits her exposure to those cases."

I read that many psychologists limit themselves to one pwBPD at a time and some even have to have their own therapist to handle the fallout.

A few months before my separation and divorce, I sought out a counselor.  I made sure she had a degree.  She was relatively young and definitely not up to the task.  My concerns were with the marriage and she spent three sessions asking about my FOO (family of origin) and not once in those three hours did she address the elephant in the room, my spouse.  Not that I didn't have my own issues, but the urgency was the help I needed to handle an imploding marriage.

[Ozzie101]

Oh, he didn’t say that to his P. He didn’t react at all. And he didn’t say that to me either. But last night he went to a baseball game with a friend and had a beer (being sure to tell me he had had food with it so it wouldn’t affect him). He seems to believe that he can do it without causing a problem it shouldn’t be an issue.

He knows how I feel. I’m at a point where I’m not sure what else to do or say. I’ve told him. I’ve left when he’s “off.” But if I react strongly to him when there’s not a problem (as in, it’s not affecting him) then I look like the unreasonable nagging wife. I can’t always be sure he’s done it since usually he doesn’t do it when I’m around. It’s all suspicion on my part. The only thing I know to do is remove myself.

I do plan on talking to him about some things — for instance, asking him to tell me more about his change in attitude, what it is and what led to it.

[formflier]

But if I react strongly to him when there’s not a problem (as in, it’s not affecting him) then I look like the unreasonable nagging wife. 

I think this is invalid and NOT true.

If the doctor has told him not to add blueberries to his cereal in the morning because it would interact badly with the medicine...and he continued to add blueberries, you are not a nag to point that out...express alarm, especially in the context of his explicit statements that "there is nothing he can do, he wants to do better, watch me I will do better, doctors can't help me...etc etc etc"

Please don't get tripped up that this is alcohol.  It is a substance his doctor doesn't want mixed in..end of story.

The "fact" that he mixes it in without APPARENT consequences only emboldens him.

Now...I do think that you should bring this up during a brunch or other non hurried time where the focus can be on the conversation at hand.

We can coach you..but it's up to him to tie this all together.

1.  He will be better.
2.  He won't follow what doctor orders.
3.  He claims he doesn't know what to do.
4.  He had a beer with food.

Again..you are not a nag for doing this.  You are setting boundaries for the next (fill in the blank) of the relationship you will engage in. 

Is it possible that this just drives it further underground..yep..it is.

Is it possible that he actually follows docs orders for a while..yep..it is.

I'm sure there are other possibilities as well.

How does this sit with you?

Best,

FF

[Ozzie101]

Yes, it’s invalid. But that is his perception. I guess my thing is figuring out how to do the right thing in a productive way.

While he’s open and perceptive, I can have a talk with him where instead of “lecturing” I ask questions — like how he sees certain things working and playing out. Including how drinking (despite what his doctor says) plays a part in his mind.

[formflier]

First of all...I want to start out by commending you for all the hard work and changes you have made.  Sticking with it and having a long conversation like that with P and hubby is a big deal. 

Big!

But remember are we hear to teach others "how to walk on eggshells" or "how to stop walking on eggshells"?

Just as important:  Look in your history.  Has "walking on eggshells" helped our relationship?  Has "stop walking on eggshells" helped out relationship?

I'm not in the least suggesting that when there is a valid, hard day that empathy and compassion on having hard conversations is not in order. 

I am suggesting that we all examine our lives for places where we "continue to walk on eggshells...for no good reason".

Thoughts?

Best,

FF

[Ozzie101]

Very good, fair point and a real answer will take some thought on my part. Where is the line between walking on eggshells and approaching things in the best way? That’s something I need to really consider.

The direct approach on the drinking has not worked well in the past. But, my asking questions to try to get him to think about/acknowledge things (he is often capable of it, though some aren’t) may be more avoidance on my part.

So, yes, good big picture questions here.