It happened, just like I knew it would

Trigger warning for self harm, mention of suicide

A month and a half ago I wrote this on here:

"I've been seeing my T for a few months now and was getting to the point where I was going to be talking about things I've never talked about before. I knew that if I did that and then he referred me out, it would feel like a rejection and I would be devastated.
So I pretty much told him that. I said that if he thinks there's any chance that he could come to realize that I'm "too much" for him to handle, I would rather that he refer me to another therapist now, because if he did so now I'd be able to work with another therapist in the future, but if he did that after I started talking about the most painful and shameful things then I don't think I'd be able to ever open up like that again.

It went well and I felt a lot better having gotten it out in the open and having been reassured.

I should have known better. It happened. He said my self harm was worrying him and that he doesn't have the skills to help me with my emotional regulation. He gave me a referral to someone who does DBT. He said he had an obligation to refer me out to someone who could help me because he doesn't have the skill set. He said just like a GP would refer someone to a cardiologist if they had a heart problem, he needs to refer me to someone who is trained in DBT. He asked the head of a program he works for who to refer me to, and he gave me that name and phone number.

This past weekend I ended up in the ER getting stitches for self harm again, and I told him about how I'd learned to suture and had started suturing my own cuts. Apparently that was too much for him. He isn't a medical doctor and he's seriously overestimating the risk of accidental death from it. I wouldn't advise anyone else to do it, but I'm a biologist with enough background in anatomy and enough training in sterile technique that the risk of accidental death is practically non existent.

He promised he wasn't abandoning me. He promised he cared about me. He said he wanted to continue to work with me after. That he wanted me to go do DBT and then come back to work on other things with him after doing a DBT program. He told me he cared about me and that if he didn't want to continue working with me he wouldn't be saying he wanted me to return after doing DBT.

But what if the DBT doesn't work? What if this is just who I am and I can't be fixed? What if he doesn't want to work with me when it turns out that he can't just ship me off to be fixed and then work with a less screwed up version of me?

This is exactly what I told him would happen. That I'd be too much for him to handle.

He said he wants me to have an initial appointment with someone whose name he gave me who does a private practice DBT program and then call him after to update him because he cares and wants to know that I'm doing the program or help me get into a different one if I don't like the therapist. But I looked her up and her program has mostly terrible reviews by people saying she's condescending and that the billing department is awful and sends bills for things that were already paid and bills things incorrectly and all kinds of stuff. I know every practice will get some bad reviews, but these were all terrible reviews with similar complaints over several years.
So there's no way I'm calling her. Plus she's really far away from where I live and work.
I don't want to be open and vulnerable with someone else only to find out that they can't fix me either and get pawned off on somebody else yet again. I've had so many awful therapy experiences. This was me giving it one more final chance.

I asked him if he'd care if he never heard from me again. He said it would upset him. Then he asked if I was suicidal and I said no, and then he asked about why I would ask about him never hearing from me again and I told him I meant giving up on therapy, not killing myself.

He said he really believed he could help me with other things but that I needed someone who could help me with emotional regulation and not self harming, and he didn't have the training, and that he really did want to continue to work with me after I did DBT.

I told him I'd consider it. I do believe him about everything he said about why he's doing this and that he does care. I believe that he believes he's being honest with me. But it still feels like rejection and abandonment. And it's still him saying that he can't help me. He wants someone else to fix me so he can help some other hypothetical version of me who is a less awful and screwed up person.

Part of me wants to just give up. I was handling things before I started therapy. I can go back to handling things on my own. I gave therapy one last chance, and I really did try. I made myself vulnerable. I may do a lot of stupid things, but even I eventually learn from my mistakes. Therapy has failed enough times for me and it just failed again. Why would I try yet again and expect something different? This time really really hurt. I should have known better.

I'm so very sorry it worked out like this.

It sounds like the SH was too much for him; not you. There's a difference. I know it feels like it's you. It's your T's responsibility to refer you if he doesn't feel he can help. And T's are supposed to address SH first and get that under control before moving on to other topics. SH isn't you. It's an addiction. You can stop. I haven't SH in 3 years. It's hard at first like any addiction, but it gets easier over time. You need to learn coping skills and apply them every day, even good days. DBT can help with that.

I have over 7 months sober from alcohol.
Alcohol was ruining my life, so I quit.
Self harm isn't like that. Sure, it's addictive, but it's not that I'm too addicted to quit, it's that I don't see the need to quit. When I self harm I do better academically and professionally. It's not going to ruin my life the way alcohol was because it's not psychoactive and doesn't impair my judgement.

I want to be mad at him but I can't be. He pointed out that if I was in his position I would feel ethically obligated to do the same and I was like "yeah, obviously, I know that"
(The fact that he knew that about me and that I'd acknowledge that means he really was getting to know me...)

Why couldn't we have just ignored the self harm? Worked on everything else and treated the issue of self harm the same way we treat the fact that I smoke cigarettes? The cigarettes are actually more likely to result in my premature death than self harm is.

I don't feel like going into a debate about why SH is bad. It's like trying to convince an alcoholic that alcohol is bad. Or a drug addict that drugs are ruining their lives. Not my place. But it is dangerous. It is bad. And the fact you can't see that shows how addicted you are. I'm guessing your T made the right decision to refer you. Sorry.

Hi LabRat,

I'm sorry this happened. It sounds very painful & upsetting.

Maybe you could see your current T and the DBT person at the same time (instead of going to the DBT & then back to your current T). When I remember correctly, you wanted to go twice weekly anyway.

I understand the want to just ignore the SH and work on other stuff. I understand that the SH "helps". The point my T always makes is that even if it might not cause me to die prematurly, it's still a lot of damage that's done to my body. He also says that yes, smoking is also damaging, the damage is more longterm and not as "present" as SH.
Maybe your T is thinking along the same lines.

Take care

Hugs (if wanted). So sorry, that sounds so painful.

Do you think he would be willing to see you while you do DBT? If he wants to use the GP analogy, then you could point out that a GP doesn't stop seeing a patient after sending her to a cardiologist. He works with the cardiologist to treat the patient.

I have found it very useful to have two therapists at the same time. They each have different strengths that I find helpful.

Thanks you guys. I really appreciate the responses and support.

I don't know if I'd be able to bring myself to ask. I'd feel too pathetic. Like my first instinct is to want to just disappear and never contact him again. I know it's not rational, but my response to feeling rejected is to feel ashamed of my neediness and to want to at least have enough dignity not to grovel. I don't want to stick around where I'm not wanted and make other people put up with me. :/
And if I asked I'd be making myself vulnerable all over again and he said no it would feel a million times worse.

I might ask anyway after I've had a few days to get over my emotional reaction and can actually start handling the situation like an adult.
The irony is that this kind of emotional reaction is exactly reason I should be doing DBT. Sigh.

So sorry it is all so painful atm.

Also from all that you have told, I think DBT would be a great idea. If you had bad vibes from the one your T recommended, maybe you could ask him for some other suggestions for DBT T's? It sounded like he could know some other suitable T's as well. Also he didn't close the door, he just wants you safe and in treatment that might help you and he feels he can not help you on your SH issue as it has gotten worse lately? He certainly is worried and I must say it sounds quite worrying to anyone - er visits and sutures and all.

Since he is pretending to be a doctor... if we extend the analogy, this outcome is like botched surgery or treatment failure. But he's off the hook with a referral? I don't see how any of this is ethical.

I got the same "i'm abandoning you because i care" routine. I was told I should get with a new therapist asap and this would help me. And then we'd be able to work together again. And she recommended DBT. All of these things turned out to be lies or just plain nonsense. I dug myself out of the hole. It is possible.

I don't agree. The OP is self-injuring to the point of needed stitches (and exploring the option of self-suturing). I believe the OP's therapist has admitted treatment failure and is doing the only ethical thing he can do at this point.

Her therapist has said he would stay available - but she needs more help than he is capable of providing. I don't typically land on the side of therapists, but in this case, I think his recommendation is correct.

There are a lot of issues with your argument that you do better with self harm. I realize that most of these issues probably stem from the fact that self harm isn't socially acceptable. However, that's the reality. Most people would argue that your judgement is already impaired as evidenced by the fact that you self harm, if in a different way to alcohol. Let me ask you this - do you see yourself as antisocial? If not, then you must place some value on what other people think and feel. The overwhelming consensus is that self harm is not an acceptable means of coping. How then can you not see a need to quit? From your posts here, I think you are being dishonest with yourself about your motivations to continue to self harm. I do not mean this in a harsh way at all. I just wonder if you're masking a more painful truth with pretend pragmatism.

My therapist has asked me to go to a DBT program also. I felt really hurt and felt all kinds of things like rejection, abandonment, shame, that I'm too much for him, etc. I've been seeing him 3 times a week for a while now and lately we've begun talking about this great gaping hole of neediness I have that is directed towards him. He has been totally accepting of the neediness and my attachment to him. He want to keep seeing me while I'm doing the program so we can maintain our connection. I know you've only recently discussed your attachment with this T, but didn't you get a positive response from him? See if he'd be willing to keep seeing you while you do the DBT. I'm really sorry you're going through this. I feel your pain.

I am so sorry LabRat. I know how hard it is not to feel rejected emotionally, even if intellectually you can understand that your T feels forced to do this due to professional ethics. It is really painful. It is frustrating that therapists' codes of ethics pay little or no consideration to the attachment of clients or the harm of sudden breaks or terminations. I'm really sorry.

I hope you will be able to see your T and a new DBT T (but one of your choice rather than the one in the referral).

That's my specialty.
I can make any terrible idea sound rational. I compare the part of my brain that wants me to do stupid stuff to an idiotic pseudo intellectual on the internet. I don't bother arguing with avid anti-vaxxers on the internet, because no amount of reason will convince them that they're wrong and have lost the argument.
When my brain suggests that I do [a stupid thing, e.g. drink alcohol] there's no winning that argument. I'm not going to convince it that it's wrong. The only solution is to not engage.
I just have yet to apply this to self harm the way I do with alcohol or drugs.

I agree that your T is pushing you away or thinking you are "too much." I know those fears, I have them too. I think he finds your self-harm very dangerous and isn't equipped to handle that. That isn't finding YOU too much, it is being concerned for your health and wanting to help "fix" that. He even told you that he wants to see you after trying a DBT program. If the one he gave you seems awful, can you check out another one?

Thank you all. Your responses really helped.
I'm going to put on my big girl pants and handle this like an adult instead of throwing the temper tantrum that I really want to throw or running away and avoiding it all.

Monday I will call my university counseling services (from whom I need a referral to see any mental health provider because of insurance reasons) and ask who I should speak to and try to get a consult/recommendation for a DBT program.
Then I'll call the DBT program and get the logistics. I may try to schedule and get on a waiting list or whatever.

Then I'll call my therapist's office and ask for an email address for my therapist, or, if that's not possible, I'll drop off a letter (I don't think I could bring myself to say this over a phone call).

I'll tell him what came up when I googled the person he gave me and give the info on the DBT program that I'm planning on doing.

I'll ask why he's not willing to see me while I'm doing the DBT (I can't bring myself to actually ask him to see me because I don't want him to say no, so asking why he won't see me, because he didn't offer, still gets the message across that I would want him to continue seeing me, and then he can offer if he's willing).
I'll explain my fears that he will change his mind or stop caring about me when I'm in the DBT program and that I can't bring myself to trust that he'll still want to see me after [however long the DBT program takes] because I'm too afraid of how much it would hurt if I held on to that hope and then he changed his mind or stopped caring.
And I'll explain that it feels like being sent away as punishment and that he doesn't want to see me until I've changed.

I'll handle this like an adult and actually explain my irrational feelings rather than letting myself impulsively act on them and base my behavior on my cognitive distortions at face value.

I really think this therapist is/was "the one" and I don't want to lose him because I can't swallow my pride enough to admit to my vulnerability and feelings and ask for reassurance.

(Half of the reason I'm writing out and posting this plan is so that I'll have committed to it and won't back out of it. I want to hold myself to this. I'm trying to convince myself that this is what I should and will do.)

I think your t is putting too much faith in dbt. I don’t think it cures anyone of self harm behaviors, especially intelligent people who may fully understand why they self harm. It isn’t worthless to try but your t needs to temper his own expectations . You ask a great question. What if dbt does not stop your self harm. Will t still see you if after a round of dbt you still sh? Better to know now.

I don’t think one necessarily needs dbt to curb self harm just a skilled therapist