What type of therapy - or any?

[Onlyinthrees]

Hi,

I have Persistent Depressive Disorder.
I had a major episode a few years ago. Now I’m medicated and I’m back to mild/ moderate. That seems to be as good as it gets for me unfortunately, but I’m trying to find ways to improve it a bit more.
I saw a psychiatrist a few years ago and they recommended that I should go on medication (get the GP to prescribe it, which I did) and to do therapy. However I would have to find it myself. I’m in ROI so it’s not NHS. The GP can’t refer me anywhere either.
My local university runs a service where you can get reduced rate therapy but I have no idea what kind I need.
I went to them before a few years ago but I didn’t know what I wanted and I don’t think I was ready. I did person centred therapy because they recommended it but it didn’t work out at all.
Since then I’ve realised that a lot of what I’ve been working through has been the effects of being emotionally abused by my parents.
So I sort of want to focus on looking at how that has affected me and the way I see the world, the way I react to things and most importantly how that affects my relationships, mainly with my partner and my dc.
I made the decision to cut contact with my parents and siblings to a bare minimum and that has been hard but had a positive effect overall. I would like to learn in therapy how to stay strong in keeping firm boundaries with them. It can be very, very hard to do this sometimes.
My problem with therapy is that I always get so stressed out by it. I hate having to sit in front of someone, make eye contact etc and talking about the stuff that has happened to me makes my stress levels go through the roof. I keep thinking about it outside of the therapy no matter how hard I try not to and it makes my mood worse. Maybe it’s just not worth it for me?
I can’t let myself go to pieces in front of a therapist. It has happened a couple of times and it’s been awful. I usually keep things very repressed but when they start to come out, it’s really bad. I’m on meds now and I’m quite numb but I know it would still be awful.
Im just wondering if anyone on here has any advice on what kind of therapy I should look for? Is it worth it if it makes me feel so terrible? Or will it just make things worse?

It sounds like you would benefit from a psychodynamic psychotherapy approach as opposed to something like CBT -
however you would need to be able to tolerate adverse emotions to be able to explore difficult experiences -
often people feel worse before they feel better, but a person needs to have the emotional resilience / ego strength to be able to tolerate the prolonged distress that comes from working on difficult experiences

CAT aka Cognitive Analytic Therapy sounds like it would really help

That’s probably not for me then. Thanks.

My psychiatrist recommended this for me years ago but she wasn’t able to refer me. I have my notes from back then and I actually looked into it recently as it did sound really good but I can’t find anyone who actually does it. Would you happen to know what other therapies would be similar so I can look out for those instead ?

Hi @Onlyinthrees have a look at this website for CAT therapy, it's the official website and has the list of accredited CAT therapists. Lots now offer video work, so location may be less of a problem unless you def want face to face therapy?

Please have a look at my AMA on remedial hypnosis. It doesn't require you to relive a history which is anything but history in your mind, nor do you have to say very much at all, because you know what happened. Be aware that it doesn't work for everyone – as is the case for all therapies.

I am definitely looking for face to face, but thank you. I did video/ phone therapy during COVID and I couldn’t get on with it at all.

Why not psychoanalysis? If you look at training institutes you may be able to get reduced or moderate fees.
Plus you wouldnt have to make eye contact if you are lying in the couch.
Psychoanalysts are also skilled to work in displacement ie, not directly with the trauma. So it may be helpful at first.
it is a budget but it is definitely worth it 🙂

Psychodynamic.

Thanks everyone for the suggestions.

I will look into psychodynamic therapy and psychoanalysis.

Unfortunately I just found out the university aren’t taking on any new clients atm, so I don’t know what I’m going to do. It’s so hard trying to figure this stuff out on my own.

Sorry, realised I didn't include the link 😖
Here it is just in case.

https://www.acat.org.uk/about-the-association-of-cognitive-analytic-therapy-acat/find-a-membercat-professional/find-a-cat-professionalcat-therapist

If you're thinking psychodynamic or psychoanalytic look at the UKCP website or the British Psychoanalytic Council (BPC) website. They're professional/ regulatory bodies and will have 'find a therapist' sections. Have i remembered that youre in Ireland? If these bodies don't cover your area they may be able to tell you the bodies that do? HTH and good luck

and if you're willing to see a trainee (sometimes they're actually the better option!) you can (locality depending, the options I know of are West Midlands, West Yorkshire and London) get 4/5 sessions per week of psychoanalysis with a trainee for a very low fee, but you have to pay for the assessment.

Personally, therapy is less about the modality and more about the relationship I have with my therapist.
Perhaps just try to find a therapist with whom you feel confident enough to sit and chat with. Once comfortable with that, then you could begin to explore your issues slowly. Therapy isn’t always the quick six week fix people want or that is portrayed on the tv. Just building the initial trust can take a year or more, before you go deeper. It can be uncomfortable, but a good therapist will support you through the tougher times.

A lot of therapists will offer a feee telephone or f2f 20minute q &a session so you you suss them out and see if you want to take it further. No shame or guilt in saying no and essentially interviewing several therapist before you find the right one for you.

Personally, therapy is less about the modality and more about the relationship I have with my therapist.

I don't want to disagree here, but this is something that just isn't supported by the evidence. People say it a lot, but modality matters! There are a lot of faddy therapies, but generally, for depression, you'll be looking at CBT or a CBT-type therapist, or a psychoanalytic/psychodynamic therapy. The difference will come down to your view of therapy, the genesis of mental health and whether you believe that you are impacted by history, or you can choose to get better.

I’m a MH nurse. Considering that you specifically want to work on managing emotions and their impact plus relationships and boundaries, I would suggest DBT (Dialectical Behavioural Therapy). DBT is a form of cognitive therapy specifically designed for those struggling with managing difficult feelings, often in the aftermath of abuse. It involves weekly individual therapy and also group based “skills sessions” in which you learn about emotion regulation, healthy coping mechanisms and how to manage relationships. I’m not sure exactly how it works in the ROI but this centre might be a useful place to start https://www.dbtcentre.ie/#services

@BuffShax thats one reason why I used the works ‘personally’. Therapy is an individual journey. I would like to add that a good therapist will not stick rigidly to just one modality, but will be able to use their training and expertise to create a therapeutic space in which the client feels safe to explore whatever they need to and create a plan together which suits the client and their needs. This may well consist of one or more modalities combined. We are all individuals, as such a ‘one plan fits all’ does not apply.
We can all make suggestions to the op, but if they aren’t happy with the relationship with the therapist, then no matter what modality is chosen, the client either will not engage/attend and the therapy will fail. There is good evidence to support that the relationship between therapist and client is the therapy!

Thanks so much. I will have a look.

I suppose I am looking for something more structured and with a time frame because I tried the type of therapy where I did most of the talking and I just kind of talked myself around in circles. I want to confront what happened to me but I also want to move past it and in some types of therapy all that seems to happen is I think about it obsessively and it just isn’t productive.

I was just coming on here to suggest CAT (cognitive analytic therapy) and I see it's already been mentioned. Have a Google, OP, and see if it could be a fit for you

Thank you so much.
I will definitely look into dbt.
I actually wondered about this but I thought it was for people with personality disorders.
I have done cbt before (years ago) and it was helpful to an extent but when my mood goes low or I’m under stress, I can’t use it. It just goes out the window.

Thanks. It does sound good. I’m looking into it. It’s just difficult to find where I live unfortunately.

“Personality disorder” is a bit of a loaded term. Most people with a PD diagnosis largely struggle with emotional regulation due to trauma, and DBT helps with this. It’s particularly useful if you’ve had CBT input but struggle to use it in crisis situations as DBT will give you the emotion regulation skills to then be able to successfully use the CBT skills.

My mother and two of my siblings have been diagnosed with personality disorders.
I read in my notes from years ago that one of the other psychiatrists had said that I might have a personality disorder but my own psychiatrist insisted that I didn’t come close to meeting the criteria. I believe she was right but I think it’s very likely that I have some of the traits/ behaviours having grown up with it. I think the difference for me is that deep down I recognise behaviour s that were “normal” for us, aren’t normal or healthy at all and I really want to try to change and to break the chain of mh problems and trauma for my own dc if I can. Whereas my mum and siblings seem to be caught in this cycle that never ends and no matter what they just won’t see it and in my heart of hearts I don’t think they actually want to change or feel they need to. One of the things I find most difficult to cope with with my family is the fact that they all think the way they behave is normal, or someone else’s fault. They are all in denial and try to twist things constantly. My parents would be horrified to hear me accuse them of being emotionally abusive, but they were. I always believed that it wasn’t really their fault- it was the mental illness or the alcohol or drugs or the fact that they were very young parents who had to deal with many traumas themselves. Now I see that they convinced me of that over the years but none of it changes the fact that they deliberately exposed us to violence, arguments, self harm, suicide attempts, they put us in seriously dangerous situations and they neglected us.
My psychiatrist wrote on my notes that she sometimes felt like she was acting as a parent to both me and my mother. She also said that the only way I could communicate my emotions or ask for help was through using clinical language and framing it as a symptom of a psychiatric disorder. I always thought I was good at identifying and expressing my feelings and that I was able to ask for help but now I see the opposite is true. When I look back to when I was a teenager and young adult I now see someone who was desperately trying to communicate normal needs and feelings but I literally didn’t know how and had never been allowed. It was frustrating and very upsetting and I thought the frustration I felt was an illness itself.
Sorry for rambling. I think I’m just trying to work all of this stuff out.
DBT sounds like it could be very useful for me. I will definitely look into it. Thank you so much.