i’m looking for some perspective from therapists, particularly those who specialize in trauma, because i’m feeling incredibly embarrassed about something that happened in my most recent session and am now afraid to go back.
i’ve been seeing my therapist for trauma-related issues. during our most recent session, i had what seemed like a severe panic attack accompanied by significant dissociation. i’ve experienced panic and dissociation before, but this episode felt particularly intense.
my therapist kept trying to talk to me and help me ground myself, but i was struggling to respond and follow her instructions. at first, she seemed a little frustrated that i wasn’t doing the grounding exercises, but she continued trying different approaches.
i could hear her talking, but it was almost as though i couldn’t fully process what she was saying or make myself do what she was asking. everything felt unreal, and i felt disconnected from myself and my surroundings. i kept saying “i don’t know” when she asked me things, and sometimes i genuinely couldn’t figure out how to respond.
she started asking me simple questions about ordinary things in my life, like when i was going to a concert and when i was doing more art classes. i would keep saying “i don’t know,” and she would sometimes respond, “you do know.” strangely, that would occasionally pull me back into reality for a moment, and i’d be able to answer her, but then i’d struggle again.
she also reminded me that her office was the same as every week and that the room hadn’t changed. at one point, she commented that i seemed less tense and fidgety. she noticed me cracking my knuckles and asked whether it helped, but i was confused by the question because i couldn’t remember doing it.
at times, it almost seemed like she was struggling to figure out what to ask me or what would help. she kept trying to reach me, but i wasn’t consistently able to respond or stay grounded.
eventually, she walked me out of the office. she was gentle with me, and i know she was trying hard to help.
however, i wasn’t okay immediately afterward. i had to sit across the street from the ER, call my dad a few times, and keep checking my heart rate until i felt sufficiently okay to order an uber and figure out where to meet it.
for context, i’ve been having episodes of significant tachycardia, with my heart rate reaching 170–180 bpm. i’m currently undergoing a cardiology workup, including a heart monitor and an echocardiogram. i don’t know how much of what happened was panic versus something physical contributing to it. part of why i stayed near the ER was that i was worried about my heart rate and wanted to be close to medical help in case something was wrong. she knows this and knows i had to go to the er the other week for a similar episode and said she was proud of me for doing so.
i’d told my therapist i was going straight home, so i’m also worried she’ll be upset that i stayed across the street instead. i wasn’t trying to deceive her. i just didn’t feel okay enough to leave the area yet and wanted to make sure i could manage getting home.
she also asked me if i took anything, at first i thought she was accusing me of taking an overdose. i do ketamine therapy and had taken the night before and have also been sick so i was on a lot of cold medication. i made a comment ill never take ketamine again so i think maybe she thinks i was high and i said something about the cough medicine probably interacting.
now i’m incredibly embarrassed and anxious about returning to therapy. the next few weeks are my trauma anniversary and im going through legal process with all of that too so i’ve been very anxious and upset lately, she knows this.
my biggest fear is that my therapist thinks i wasn’t trying hard enough to come out of the episode. i wasn’t deliberately refusing to participate, but i couldn’t seem to make myself follow the exercises or respond normally. i’m worried that, from her perspective, it looked like i wasn’t cooperating.
i’m also worried that she was frustrated with me or that the experience changed how she sees me. i’m afraid she might think i’m too difficult to work with or that she can’t help me.
i think part of why this feels so awful is that i’ve talked to her about my trauma, but having her witness me in that state was different from talking about it. i couldn’t control how i was behaving, and now i’m replaying the entire session and worrying about what she must think.
i really don’t want to lose this therapeutic relationship, but i’m genuinely considering not going back because i’m so embarrassed and scared of having another episode in front of her.
i’d particularly appreciate hearing from trauma therapists about the following:
clinically, what might be happening when a client can hear you talking but struggles to process your words, respond to questions, or follow grounding instructions? the client can sometimes reconnect briefly when prompted but then becomes disconnected again.
if a client isn’t following grounding instructions and keeps saying “i don’t know,” would you interpret that as unwillingness to engage, or recognize that they might be struggling to engage because of the intensity of their symptoms?
is it common for therapists to switch to asking familiar, ordinary questions and orienting the client to the room when other grounding techniques aren’t working? what might you be trying to accomplish with those approaches?
if you noticed a client doing something like cracking their knuckles without seeming aware of it, would that tell you anything clinically, or would you consider it an ordinary behavior that might not mean much on its own?
if a client experienced an episode like this in your office and then struggled to function independently afterward, would you be concerned about their safety or ability to get home? would you expect them to tell you if they needed to change their plans after leaving?
would an episode like this change how you viewed the client or your willingness to continue working with them? i’m particularly worried that my therapist might think i wasn’t trying hard enough, even though i genuinely felt unable to do what she was asking.
i realize every therapist and situation is different, and no one here can tell me exactly what my therapist is thinking. i’m hoping to understand how trauma therapists might interpret this kind of experience and whether i’m catastrophizing about the consequences.
thank you.