PTSD Treatment and Why You Might Stay in It for Far Too Long

Keywords: PTSD Treatment.

I think healthy therapy and PTSD treatment aims to work towards independence for the client. I do not doubt that theoretically, most practitioners would agree with this, though the reality is often very different.

Efficient therapy doesn’t just depend on having the right knowledge and understanding, but also requires emotional maturity on the part of the practitioner and a willingness on the part of the clients to open up and persist through the tough parts of healing.

While a premature ending of the therapy process is certainly not helpful, too long a therapy process in which progress has come to a halt is equally a waste of time and resources.

Dissociation and Containment in Treatment of PTSD and CPTSD

The process of dissociation is part and parcel of any trauma. It is the cornerstone of Post-Traumatic Stress, and happens as a survival response because you feel emotionally overwhelmed. What this entails—concerning healing—is that you have to work through the dissociation in order to access the underlying emotions and bring completion to those same emotions.

You can only have completion of emotion when you have sufficient containment, and it is only within adequate containment that emotion can be held, and henceforth be processed.

Efficient therapy doesn’t just depend on having the right knowledge and understanding, but also requires emotional maturity on the part of the practitioner and a willingness on the part of the clients to open up and persist through the tough parts of healing.

If this is not clear, let’s look at it from the other way around.

Release and Resolution in PTSD Treatment

What can make the therapy process go on for too long is when there isn’t a clear understanding of the importance of containment and resilience on both the part of the therapist and the client.

When you experience an emotional release without having the strength to meet the intensity of the emotion fully, it can lead to a cycle of “build up and release” that can continue over and over again. It might feel like you are doing the work, but what happens is that you might become addicted to the release part and actively seek it; without containment, this faulty process will repeat itself indefinitely.

Release is not necessarily resolution!

What might also happen is that when you start to feel the suppressed emotion and the history that goes with it, is that the emotion is plainly too overwhelming to hold and therefore retraumatizes you.

It is of vital importance to go in and out of overwhelming emotions to build up resilience and containment. If you do not do this and do not create sufficient breaks within this process, you will drown in the overwhelming emotions all over again to the point of freeze and dissociation, which obviously is not helpful.

The Limitations of a Cognitive Approach Only in the Treatment of PTSD

Most standard therapy has a top-down approach, meaning that it uses a cognitive understanding only. While this might be helpful when you have just started PTSD treatment, as it is easier to talk about what happened to you rather than talking into what happened to you, this approach doesn’t go deep enough to allow you to work towards full resolution.

This top-down process does help, though, to create a road-map and understanding of what has happened to you, and might help to ease some of the blame, shame, guilt, and self-reproach.

What it most often does NOT do is process the emotional content itself, which makes up the trauma. You can’t do this by talking over what you feel and what happened to you. You will have to go into the emotional residue and somatic holding of it in order to come out of it.

Therefore, there is a limit to a cognitive approach only, and when you stay too long in this type of therapy, you will likely feel you are just rehashing what happened to you without making any further strides in healing your Post-Traumatic Stress and Complex PTSD.

The Web of Codependency: Transference and Projection in PTSD Treatment

The last issue I want to mention here is the trickiest one, and that is the codependency that can creep into the client-therapist relationship

When you go to counseling or therapy as a patient, you have realized that you need help. That mindset and the reaching out for help comes with a certain vulnerability. It comes with a certain need, which makes you decide to enter into a therapeutic relationship.

From a therapeutic client-therapist relationship perspective, being vulnerable with or even having some dependency on your therapist for as long as the therapy lasts, can be acceptable and be naturally present.

This dependency might get compounded, though, if the client has severe neglect or abandonment issues. As a therapist, you have to be extra vigilant in managing the resulting attachment by having healthy, professional client-therapist boundaries.

When Things Get Ugly: A Lack of Boundaries and A Need for Validation from Both the Client and Therapist

In the above scenario, what might cause therapy to go on for too long is what I refer to as the “savior syndrome” of the therapist, which likely comes out of a need to be validated.

A therapist might get too involved in the healing process of the client and overextend him or herself. That being too involved and overextension is often there out of a need to get validation and projects itself as trying to get positive results and getting positive feedback from the client.

What happens then is a subtle play of projection and transference between client and patient that draws out the therapy process.

Within that projection and transference, a lot of confusion comes into play. If you aren’t moving along as desired or expected by your therapist, the therapist becomes either disappointed or might get angry and upset with you.

In turn, you, as a client, will pick up on that, and-- if your default is pleasing and codependency-- you will try to please and maybe even want to convince yourself that you are getting better in order to curry favor with your therapist, often followed by the reality that you aren’t making much progress.

This confusing back and forth of playing on each other's needs can become a cycle which both of you can get stuck in; it isn’t very pleasant, to say the least, and often ends with bitter feelings on both sides.

 +  Learn more about CPTSD reenactment and projection right here.

Have you had times where you felt you stayed into PTSD treatment too long? Based on the points mentioned in this article, what were the reasons? Share your thoughts below.

  • Lorraine says:

    This really resonated with me. I was very aware that my therapist held all of the knowledge and power, he would not answer any questions i asked and really created a co dependancy that i felt extremely uncomfortable with. Somehow he made me feel as tho i was responsible for his inadequacies – saying things like he could not challenge me intellectually because i would win, and that because of my intelligence i made him feel ‘castrated’. He would also disagree with me on everything that i said and even said on one occasion that he didnt need to hear what i was saying. In the end i couldnt tell him how i felt, and he would insist that he knew what i was feeling. I kept trying to ask for help with my home situation that deteriorated significantly – he just ignored me! I backed off and said i felt very uncomfortable in a process where he had all the knowledge and power and would not allow me to ask questions or acknowledge how i felt. I said it felt abusive! My therapist got incredibly angry with me, i believe he had been trying to encourage me to express my anger out towards him in an almost ‘brain washing’ way that felt very uncomfortable. What i ended up with was counter transference where he ended up expressing his anger out towards me! Sadly after 5 months i have ended up worse off than i was to start with, but i certainly felt incredibly uncomfortable where i was being brainwashed with the expectation of submitting to a therapist. Hoping i can find a more compassionate therapist but feeling incredibly vulnerable. This article certainly helped me to recognise my perspective, thank you x

    • Roland says:

      Hi Lorraine. Sorry to hear about this experience, but good you were able to move out of it. It is a tough learning experience. Would you be willing to work online with someone?

  • Ali says:

    Thanks for the article Roland – really resonated with me – my therapist wasnt trained to work bottom up ie to work with the somatic part and so there was alot pf cycling until eventually after many years I left in a very distressed state. She did not hold that she was unable to work with the somatic piece and without owning her lack of skill she left me feeling like there was something wrong with me as I felt so unwell. Eventually I realised she a) was didnt have the necessary skills to work with me and b) was never going to recognize and admit that so it was better for me to leave and find someone who could. So much confusion could have been avoided if she had simply said I dont have the necessary skills…so many psychotherapists ate not trained in somatic work and cause so much distress in clients with PTSD who absolutely need to be able to work with the symptoms in the body/nervous system…

  • Susan says:

    I know this. It feels as I have been in therapy for my whole life and I still feel the same. I have given up on therapy.

  • Linda Craig says:

    Absolutely true! I can see this happening because of the involvement because of time spent with a client. We surely must be aware of our own reasons for being in this business. To help and see healing, but not to “save.”

    • Roland says:

      Hi Linda. Agree. We need to be constantly checking in with ourselves and do the necessary supervision when needed. I think the “too involved” and “too attached” to the outcome of therapy is a phase that eventually, as helpers, we grow out of and can become solid practitioners.

  • Gail says:

    I related to the part of discussing the trauma from a cognitive place. I am having a very hard time getting to the emotions related to my trauma and find that I feel like I continue to just “talk” about it. My therapist is pushing me to get to the emotions but I have so many defenses that I’m unable to do so. I am getting frustrated with this. What can I do or she do to help move into the emotions so that my trauma can be resolved?

    • Roland says:

      Hi Gail. You will have to start with feeling and holding the dissociation first. Become intimate with it and ask yourself; “What is the dissociation protecting yourself from?” It is only through allowing yourself to feel the dissociated state that you can get an entrance into the opposite, which is the overwhelming and underlying emotion.

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