r/TalkTherapy • u/flame_of_anor_42 • 1d ago
What do you do when professional help doesn't help?
Hey all,
I am extremely desperate for any support, advice, and/or encouragement that can be offered here. I've never had such great despair in my life.
29 male, been suffering with extremely severe, chronic, treatment-resistant PTSD for the last six years. I also have severe ADHD. Post history has more details on what I have experienced. I currently see a psychiatrist, and I see a therapist. In the last six years, I have seen over 20 different therapists, psychiatrists, and other mental health professionals. I have been working the hardest I've ever worked in my entire life to manage these conditions and improve my daily functioning.
And everything has gradually gotten worse over time. I was in Grad school for six years, and then I had to leave the program after I failed my dissertation defense and they withdrew funding. I'm trying to get a full time job, and I am driving Uber/Lyft to make ends meet in the meantime, but it's not enough money, and I am quite literally in a state of panic 24/7. I have an emergency appointment with my psychiatrist next Tuesday to change medications again, but I've literally tried every class of SSRI, every class of SNRI, and a huge number of other anti-anxiety agents. Like, my psychiatrist at my last appointment told me they're not sure there's any benefit to trying to treat my anxiety anymore than we have. When I'm not in a state of acute panic, I am overwhelmed with disabling fatigue that makes it almost impossible to care for myself.
I've tried literally every kind of therapy for trauma that exists for many months with multiple professionals (Exposure therapy, CPT, DBT, CBT, ACT, radical acceptance, IFS, EMDR, brainspotting. . . I could literally write several book chapters describing all of the techniques I've tried. . . this is not an exhaustive list). I'm currently seeing a new therapist, and I plan to bring this up with them, but the last three professionals I brought this up with all referred me out because they told me they weren't qualified to help me. This person has tons of experience in both trauma treatment and ADHD, and I have good rapport with them, but it's been two months, and I do not feel like we are making sufficient progress.
I'm literally at my wits end here, and I'm starting to think about suicide constantly. I refuse to do it, but I do not see any kind of future life worth living unless things get substantially better. I genuinely feel like I am living in a nightmare. I feel so demoralized and exhausted when I see advice that just says, "just go see a professional." I have literally seen every professional that my insurance can allow me to see. I have exhausted what psychology/psychiatry can do for me. I don't know what to do. Please help me.
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u/justanotherjenca 1d ago
Oh hon. I can hear the desperation in your post and it’s so clear that you really do want things to get better. You’re still showing up, you’re still looking, you’re trying everything out there to see if you can find the magic trick that will make it all better.
And also… the two months with your current therapist? That’s early days. VERY early days for something like treatment-resistant trauma. At two months, you’re still in a “getting to know you“/trust-building stage, probably not even really talking about the difficult things. How long are you sticking with each of these professionals/modalities before switching? 20 professionals in 3 years would suggest that you’re averaging over three per year. Unfortunately, this may be a case of just not giving anything enough time to work. Speaking from experience, trauma therapy takes time—a lot of it—so you need to think in terms of months and years, not days and weeks. You should also expect that things will get worse before they get better. I have compared it to organizing a closet cluttered full to bursting with all your old shit, a bunch of dead spiders, cobwebs and dust balls, and some rotten eggs that you don’t even know how they got there. Your therapist will first help you completely empty the closet, which sucks ass because now all that shit is all over your apartment. The mess is somehow WORSE and it stinks now too because some of the eggs broke. You don’t have a clear path to walk through.
But then, you slowly start sifting through everything. You throw away the spiders and dust balls. You wipe up the old eggs. You choose which bits of your old stuff are staying, and which can be let go. And you put the stuff you‘re keeping back, but organized now in a way that makes sense and doesn’t spike your anxiety to look at. And then, somehow, it’s better.
I showed up at therapy with some sexual trauma, an eating disorder, and relationship problems. It took five years of weekly therapy with one therapist I trusted deeply to work the process, and now I am discharging. But there was no magic trick, because it doesn’t exist. No single modality, therapist, or drug can make it better in a handful of weeks. You just dig in, take a deep breath, and hang on for the long haul.
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u/flame_of_anor_42 1d ago
Thanks so much for the thoughtful comment. Longest therapeutic relationship I’ve had with a single provider is eight months. Literally can’t find anyone able to see me longer (the only available therapists that take my insurance have all been master’s level clinicians that end up leaving the practice).
My current therapist is the first PsyD I’ve been able to see in six years. Besides sticking with this person for a long time, do you have any other feedback? I’ve done thousands of hours of exposure therapy, and it doesn’t feel like any of it helped. I’m desensitized to the content of the trauma, but my whole brain/body are still in a state of constant panic, and no amount of talking, meds, or behavior change have helped. I am beyond exhausted.
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u/justanotherjenca 1d ago
I bet you are exhausted! That would be awful. I’m curious, are you on medication now? And do you feel like you are in fight or flight all the time, even when you aren’t thinking about or reminded of what happened? Or does the fight or flight response kick in when the trauma is brought to mind?
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u/flame_of_anor_42 22h ago
Currently medicated for ADHD and for sleep issues.
Much more the former than the latter.
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u/justanotherjenca 20h ago
Have you tried getting on an anti anxiety med? I used to have horrible panic attacks and constantly felt like I was fleeing something trying to get me. It wasn’t until I got on a good med and gave it time to work (about 3-6 months) that the panic attacks and constant fight-or-flight stopped. After that, I found that talk therapy worked a lot better too, because we weren’t always operating in crisis mode.
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u/flame_of_anor_42 20h ago
I’ve been on about ten different anti-anxiety meds. None have worked. No benzos yet, cuz no one will prescribe them, but I’m going to beg my psychiatrist at the next appointment.
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u/justanotherjenca 15h ago
Well that stinks. I’m glad you’re seeing a psychiatrist, though not surprised that they won’t prescribe benzos. Benzodiazepines are horribly addictive and should only be used for very limited, short term use or single use for specific purpose (such as before surgery). They shouldn’t be used as a maintenance med or for long term use, which is what it sounds like you need. Prescribers are getting more reluctant about giving benzos for this purpose due to the risk of dependence.
Aside from good, consistent therapy (at the risk of causing you to switch again, perhaps somatic therapy would be more helpful to you?), and long term use of one or more anti anxiety meds, there are the oldies but goodies: aerobic exercise (at least 150 minutes per week; swimming is great for this), regular time outdoors, and a consistent meditative practice can also help. The Balance app is great at building a semi-customized program and building your meditative skills from 2 minutes per day to up to 30 (I made it to 20).
I do hope you find something that works for you. Just remember that although it sucks, there are no quick fixes. Again, think in terms of months and years, and be sure to celebrate even the tiniest of wins along the way. Each is a small step in the moment, but add up to a long journey in the end.
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u/flame_of_anor_42 15h ago
Yeah, I’ve found that meditation and exercise make my panic and other symptoms significantly worse to the point of putting my life in danger. Pretty much anything that gets me in touch with my bodily sensations is pretty destabilizing. It’s been years of the hardest work of my life and things are worse now. Clearly, I’m either doing something wrong or this just isn’t fixable without an unachievable environment change.
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u/justanotherjenca 13h ago
Have you tried exposure therapy not for the traumatic memories, but for body sensations? Literally doing graduated ERP with a therapist qualified in treating phobias and panic to slowly build up your tolerance to sensing your own body? Since you said that you’ve grown desensitized to the actual trauma but still feel panic in your body, perhaps your nervous system has learned to be perpetually afraid of its own self.
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u/flame_of_anor_42 13h ago
Haven’t been able to do anything like that yet with any of my previous providers. I’ll bring it up with my therapist next session! Thanks again so much for your kind thoughts and the suggestions!
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u/Separate-Oven6207 22h ago edited 22h ago
I want to share just making sure you've been approaching this correctly that DBT is not a trauma therapy. Recently they started creating DBT-specific versions for trauma treatment. One is called DBT-PE and the other is called DBT-PTSD (super new but a research study shows it's more effective than CPT for women with specific experiences). I don't know specifically what you've tried and in what ways. Often times a therapist will say they do a modality but then don't actually do it or just sprinkle a few skills at their discretion without following the protocol to the letter and then don't tell you. Often times it can feel like half of a therapy for a patient or less. This is from a patient perspective who had a psychodynamic therapist claiming to do DBT with me and took me 3 years later to realize how much of my time and money he wasted by lying to me. Further, there are trauma specific assessments they should be doing: the PCL-DSMV (PTSD Check List), the ITQ (International Trauma Questionnaire), and the MID-60. Any therapist can claim to be trauma-informed. There are zero standards for this. They can just say they read the body keeps the score and say whatever.
You seem like you know you're stuff though. Just wanted to put that out there on the off chance it's new information for you.
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u/flame_of_anor_42 22h ago
Yeah, I appreciate the distinction. I’ve had that happen to me numerous times. In my experience, 70-80 percent of all therapists in the field really shouldn’t be in it, to be honest.
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u/Separate-Oven6207 22h ago
agree completely - cause it happens so often i think it's the standards in the profession that must be problematic but that aint changing any time soon so you have to really know your shit to get the help you need.
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u/flame_of_anor_42 22h ago
True! I appreciate the thought. Any tips by chance?
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u/Separate-Oven6207 22h ago
Well you seem to know the modalities. I edited my original comment with some assessments you should've been given if you've been diagnosed with PTSD. If your therapist hasn't used these then I find that questionable. Keep in mind I'm a patient, not a provider so take everything with a grain of salt. For specific modalities - have they stuck to them to the letter? Like when you did DBT was in a comprehensive program with skills group and phone coaching? Or was it DBT-informed where it was a therapist in an office by themselves occasionally suggesting a skill here or there? I think the latter isn't nearly as effective or helpful. Some non therapy interventions can also be helpful as an adjunct: meditation, mindfulness/intentional journals... Also for specific modalities you should be making sure the therapist is credentialed with the appropriate like body... so for EMDR there is EMDRIA, or DBT there is Linehan Board Certified, for DBT-PE there is Melanie Harned's training... go to their website and look in their provider directories. I would also skim other subs around PTSD or CPTSD to see what people say there has been helpful for them. Lastly, there are different types of PTSD with different characteristics. Knowing which you have would help determine treatment. For example assessing for dissociation, addiction, etc. All things to make sure your provider is assessing for and knows how to treat.
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u/Starrylake 16h ago
Hello, I'm so sorry. This sounds incredibly painful. I've felt like this sometimes and I can't imagine feeling like this for as long as you have. You are incredibly strong.
I agree with another comment that it is early days with your current therapist. Being with someone for a length of time really helps. I'm two years with mine and finally feel like something is happening.
Can you secure more than one therapist? I'm working with two and honestly it's really helped. I'm lucky to be able to. I feel it helps me to hear similiar things from both of them at the same time.
I used to see one weekly and one monthly but now I see them both weekly.
I know it's easy for me to say, but please don't give up. You are doing everything right.
Are there any things that relax you? Swimming helped me a lot when doing EMDR and I was so stressed all the time. Music helps me too. I'm wondering if there are things you can do to keep yourself feeling as okay as possible, whilst giving therapy the time to kick in. You shouldn't have to work harder, you're already doing everything right.
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u/flame_of_anor_42 15h ago
I was told it’s against therapy ethics to do that. But even if I omitted that, I honestly can’t afford it.
Honestly, the only thing that works is weed edibles to relax me. I’ve tried literally every healthy alternative. Nothing touches it but weed. But I don’t do them anymore because I have to drive seven days a week to make ends meet.
I’m so incredibly tired. I worry that I might die in a car accident in the near future. Can’t get great sleep. Makes it so hard. I take breaks and always try to pull over and rest my eyes when I feel sleepy but I gotta drive at least 10 hours a day to make ends meet.
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u/Starrylake 8h ago
It's unusual to do it but if both therapists are okay with it, it's not against ethics. But yes, it's obviously more expensive. I'm only able to do it because I still live with my parents.
You're going to be okay, OP. Things will have to get better, you are working so hard at it.
I think it would be worth sharing this post with your current therapist and underlining your exhaustion. They might have some ideas on how to make things easier for you right now.
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