Its all in the approach: you, your therapist and #PTSD

This latest blog post is about a different kind of continuing struggle: finding the right therapist.  I am keyed in with a new guy now and I am confident and comfortable in his office. But, it was not always that way…

Just happy (or not) to be here…

I think a lot of times when a new Veteran enters the VA system, or a therapists office, they are initially just so happy to be getting help.  A weight is lifted when you can finally feel like the person you are going to dump your problems on is a willing participant.  But with one major obstacle overcome, more are waiting to smack you right in the face:  Trusting your therapist, establishing boundaries, learning that your therapist is not a wizard but more a sounding board for you to work it out yourself.

It is not until a little ways down the road that a Veteran has enough experience to question “is this therapist right for me?” or “am I putting in the time and effort required?”  Here is my disclaimer up front: I am not endorsing kicking your Doc to the curb at the first bump in the road, nor am I saying that I was correct in the way I dealt with my former therapists.  But, I am saying that the right fit and learning the approach will save a lot of time and heartache.

Trust Issues Everywhere

Part of therapy for PTSD is relearning how to trust.  I would argue one of the most immediate and significant trust hurdles begins the moment you walk through your therapists door.  Some of my most serious setbacks, avoidance of therapy, and general deflection of the real issues came at the expense of my therapist at the time.

When I relocated to New York I was ushered into the VA system where there is an abundance of new interns cutting their teeth on us juicy veterans.  My first encounter with an intern went poorly to say the least. The lack of therapy I received was my fault.  I was eventually overwhelmed by the stress of trying to go through cognitive processing therapy, trying to work, and being away from my family. But I can point to that first failed attempt and isolate the cause directly to my approach with my therapist.

The “You must be joking” moment…

I remember walking through the door and thinking “is this bring your daughter to work day?” Then, when she introduced herself as my new therapist I immediately thought “there is no way this woman can help me. There is no way she will ever understand what I went through.  I am a combat veteran. I led men her age into hell. SHE IS NOT A VETERAN. What can she help me with?”

I cannot emphasize this enough THAT IS THE WRONG APPROACH.




First, going in with an open mind is an imperative. Second, and just as important, the life experience of your therapist is not proportional to the amount of help that you will get. The therapist is there as an instrument. All of the hard work, and the positive gains, come from within.

I wasted the next two sessions grilling her and questioning how she could help me.  I eventually stopped going halfway through the writing exercises in cognitive processing.  I wasted time and energy.

Here we go again…

One of the reasons I gave the VA for stopping therapy was the time commitment in the middle of the day. I said that with everything I am juggling, I could only go in the evenings. Shortly thereafter I was contacted by another therapist within the VA who had evening hours.  I wanted to be committed, or at least give the impression I was committed, so I showed up on that first day.  I still had not learned from my first encounter.

I walked into a slightly older clone of the previous intern.

“Oh good, her aunt works here too…”

I started this new first session with the same barrage of questions I had for the previous therapist. It’s funny looking back, and I say this with a smile, but she took me apart like a shotgun that day.  She cut through all my bullsh!t insecurities, established professional boundaries, and dug out all the issues I had with the last therapist.

My tiny therapist who could double as the president of sorority in a B movie saved my life.

Over the next 2 1/2 years under her guidance I finished cognitive processing therapy and prolonged exposure therapy. She adjusted my approach to getting help for myself.  It took time, and on occasion some steps back, but the results without question are positive.  But, once again, as the title states: it’s all in the approach.

3 thoughts on “Its all in the approach: you, your therapist and #PTSD

  1. Your Classmate

    FIRST, thanks for sharing this Mikey. I am a veteran myself and also studying to be a psychologist (maybe) someday. I get what you are saying about the trust issues. I have them too.. I am not sure if I had them growing up as well, but they definitely became worse as a result of my deployment (non-combat yet stressful experiences). As a student trying to learn how to help other veterans (and myself), I have to agree with your post. The therapist (counselor, psychologist) is simply a guide for recovery. The relationship we have with the therapist (and vice versa with the client) is THE MOST important part of therapy. So, if trust is lacking in this relationship, the therapy is just as good if not worse than a self-help book. There is no valuable interaction taking place. Maybe a good place to start, is to tell the therapist how we feel. If we don’t trust – tell them. They need to know. On the flip side of that, therapist need to learn the military culture and most therapist understand the importance of a good trusting relationship. Even more so, the therapist might already feel the disconnect and be struggling about how to “repair the alliance rupture” (or simply stated – connect). It is hard on both sides. However, honesty goes a long way. There are a lot of young interns that REALLY want to help. They might not have been veterans themselves, however, their motivation might be a parent, uncle, grandparent veteran that they loved and watched struggle. I have learned that the hard way – often judging my classmates and thinking to myself (there is no way this kid is going to help). You are brave for trying and trying again to find that “good fit.” Perhaps that is part of the recovery process, getting to a place where we can trust and connect with our guide.

  2. mikeypiro

    Well, a first right back at you. Thank you for reading. And a second big thank you for pursuing a psychology degree. With more Veteran psychologists a new returning Vet, or an old one just looking for a hand will have that immediate connection and hopefully be encouraged to stay and continue. It is a delicate dance between you and I, and more often than not, I have big clumsy feet to start.

    I know the interns really want to help, and as I had stated, I had to mature in my approach to really be able to get the help. My sole piece of advice for them is to keep up the fight and don’t give up on us. I know you will not, but my wife knows how stubborn I am, and how stubborn we can be…

    In the end, we need you and maybe we do not know how much to start… Thank you again!

  3. Your Classmate

    Mikey – I really appreciate your metaphor of the dance. I often envy the doctors that are portrayed in Grey’s Anatomy – which are always able to save a few lives within one hour of the week. Thanks for your advice to motivated therapists that want to help.

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