When Your Therapist Goes Away

Posted by What It Takes To Be Me in Abandonment Issues, Anxiety, Attachment, Coping Strategies, Drawing, Expressing Emotion, Expression Through Art, Music, Personal Growth, Psychology, Psychotherapy, Psychotherapy Breaks, Psychotherapy with A, Psychotherapy with P, Sadness, Separation-Anxiety, The Therapeutic Relationship, Video and tagged with abandonment, asking for help, attachment based psychoanalytic psychotherapy, big kids do cry, bridge over troubled water, card from therapist, coping during breaks, crisis resolution team, crisis team, CRT, drawing, email to therapist, expressing emotions, expressing negative emotions, fear of being abandoned, garfunkel, getting help, holidays, letter to therapist, preparing for a break, psychotherapy breaks, simon, the therapeutic relationship, when your therapist abandons you, when your therapist goes away, when your therapist is away Tuesday, December 29, 2015

Here we interrupt the regular scheduled programme for a Holiday Special: “When Your Therapist Abandons You”

“Big Kids DO Cry” – a little illustration I made while sitting at the library pondering what childrens books REALLY teach our children.

Yes, it’s here once again – that darkest time of the year when your therapist has almost certainly gone off and left you. My guess is that you’re just about half way through it by now, and at this point things will either have got a lot easier – because you’ve got used to having the rhythm of your week disrupted – or, got rather a lot worse – because you’ve been trying desperately to hold it together, but now you’re running out of whatever it is that has kept you going until now. Or, you may be – like me – dealing with both of those scenarios, simultaneously; things getting both easier and much much harder at the same time. [Really playing the odds with my guesses here, aren’t I?]

So, let’s talk about it.

I realise that I have written about breaks a lot, and I am likely to be covering similar grounds once again, but there is one slight difference; this post is written from inside a break, not in anticipation of it. It is quite possible that I am remembering this incorrectly, but my feeling is that I generally tend to write quite a lot more prior to the beginning of a break to then go fairly quiet and disappear almost entirely during it.

Either way, this is where I’m at: I last saw P. on December 21st. Prior to previous breaks I had got increasingly better at, sort of – very sort of – broaching the subject of The Break before it actually happened, rather than just ostriching [that’s the technical term, look it up!], which is how I dealt with pre-break anxiety pretty much all the way through the five years I was working with A.

With P. I had begun to at least mention that I was aware – very aware [I’m sure you know the feeling!] – that a break was coming up, and that there were in fact feelings connected to it. I may not have been quite brave enough to really explore those feelings, the desire to go back to ostriching being too strong, but I would at least acknowledge the fact that there were a lot of feelings floating about, messing with my head, heart and soul. This time I took it a few steps further. A few weeks before the actual break – all the way back in early December – Little S. wrote an email to P. that I thought I might share with you:

To P.

I am feeling very extremely sad that soon you are going to go away from me again. That is because I don’t like it when you are away, because then I can’t see you anymore ever again for a very long time. And I will miss you too too too much. And maybe I won’t even remember what your voice sounds like. Also I think that maybe you will forget everything about me, because I know that usually I can be very easy to forget. And also maybe I will forget all the things you have said about feeling bad and being bad. And that makes me very especially worried in my soul. Because then sometimes I do Very Bad Things. And then I will know that I am bad, because of doing those Very Bad Things. When you are away no one can remind me about feeling bad and being bad, and I can’t tell the difference all on my own. I can only remember it when you tell me. So that makes me feel very extremely worried.

From your Little S

PS. Maybe before you go away you can think of a song that I can listen to, like you did one time before, because I really really liked that. Because then I can listen to it and I can think about you and my soul can remember your soul. Or maybe you can write a little letter to me before you go. But you don’t have to do anything if it is too much trouble. I understand.

As you can see this is an email written by Little S. completely on her own, without Adult Me stepping in or editing away the most embarrassing bits. This is not an easy thing to do, allowing your inner child to voice their fears – in their own way – in spite of your adult self’s embarrassment and self-consciousness, but it is such a valuable tool, because when it comes to therapists [read: pseudo-parents] going away, it is often that very young part of you that takes the biggest hit. All those fears of being abandoned, forgotten, and left behind shoot straight through Adult Me’s far tougher shell, and allowing those feelings to be exposed can really make a difference.

So, we took time to look at those feelings, with P. working very hard at getting us [all the different parts] to acknowledge our true feelings, both about the actual break and about P. herself. – Yes, we are talking about acknowledging anger and disappointment and feeling let down here. Can’t honestly say that I quite managed to go all the way this time round, either, but it certainly wasn’t for lack of trying, and especially Little S. did a great job of using a few sessions to speak directly to P. So, yes, I’m really rather proud of us all.

Knowing that things might get more than just a little bit rough during P.’s absence I sorted out a referral appointment with the crisis resolution team for the day of my last session with P. This, too, was new: me reaching out to ensure that a bit of extra support would be on hand prior to actually hitting rock bottom.

This has worked out really well, especially since the person I saw for the assessment told me right away that they would be working with me all the way through until P. is back, rather than doing the usual little dance of “We’ll see you x times, to begin, and review your needs as we go”. That has been incredibly helpful, because as much as I always say that how difficult a break is going to be is completely independent of how long it is, it is far easier to cope with little chunks of a day or two at a time, than trying to deal with an overwhelming fourteen day break in one go.

Knowing that I’d be working with the CRT throughout meant that we were able to schedule regular appointments, and also to ensure that on top of in-between appointments I would definitely be seen on all significant dates during this period: Christmas Eve [that’s when we celebrate Christmas back home, and I reserve the right to call people who insist on celebrating on the 25th Stragglers!], New Years Eve, my mother’s birthday and the anniversary of my first suicide attempt [when the abuse I was being subjected to came out]. So, that has really has been very useful.

In our final session before the break, Little S. gave P. a letter which she read in session, so that we could talk about it, and P. gave us a card on which she had – among other things – written a special bit for Little S., to remind her that feeling bad is not the same as being bad, and that she won’t forget me, because she ‘carries me in her heart, just as I carry her inside when we’re not together’. Also, as she has done over the last few breaks [and some particularly difficult weekends] P. leant me her little soap stone hippo – let’s call him Ringo – who fits perfectly in my hand, to keep me company. Needless to say [but I think I’ll say it anyway], both Ringo and the card have been invaluable to me.

It’s not been a bump free ride, but I do feel very proud of how I was able to prepare for this break, and for accessing help during it, rather than making it harder than it needed to be.

Do be kind to your Selves.
And your elves.
They are not just for Christmas, you know!

All the very best,

What song did P. leave me with? For me to know, and you to guess.

But here’s a good one:

http://youtu.be/UVDg8fVC4EQ

Twenty-fourteen – A Year Of Changes & Challenges

Posted by What It Takes To Be Me in Abandonment Issues, Acceptance, Attachment, Flashbacks, Hearing loss, Memories, Personal Growth, Psychology, Psychotherapy, Psychotherapy Breaks, Psychotherapy with A, Psychotherapy with P, PTSD/Extreme Emotional Stress Disorder, Sef-Awareness, Separation-Anxiety, Suicidal Ideation, Suicide, The Therapeutic Relationship and tagged with abandonment issues, acceptance, acting out, Adult Me, attachment, attachment based psychoanalytic psychotherapy, being accepted, being accepted by your therapist, building trust, change, Chrismukkah, Christmukkah, communication, Drayton Park Crisis Centre, Drayton Park Crisis House, Drayton Park Crisis House And Resource Centre, Drayton Park Women's Crisis Centre, effect of failed suicide attempt, ending therapy, endings, ethylene glycol, Extreme Emotional Stress Disorder, failed suicide attempt, flashback, flashbacks, hearing aids, hearing impaired, hearing impairment, hearing loss, inner child, Little S, Post-Traumatic Stress Disorder, psychotherapy breaks, PTSD, Real Me, sadness, sexual abuse flashback, sexual abuse flashbacks, starting over, starting over with a new therapist, suicidal ideation, suicide, suicide attempt, terminating therapy, testing your therapist, the therapeutic relationship, therapy breaks, trust, twenty-fourteen Sunday, December 21, 2014

I thought I’d make one final push to get an update out before the end of the year. I’m not in a great place, hence radio silence on most channels, but sometimes that’s when the best blog posts come out, so let’s hope for the best. Could be nothing, could be something.

It’s been a rough year. There are no two ways about it. At the beginning of the year I ended with my therapist of five years and started over with a new one. It’s a big transition, moving from A. to P., and a huge emotional undertaking. It’s a bit like being asked to switch out your parents. Sure, your parents might not always get you, might be unfair, might make mistakes, might be downright unsuitable to parent anyone, but at least you know them, right? You know their habits, their triggers, their blind spots and you know how they react to the things you say and do. And you also know how you react to the things they say and do. It’s that comfortable – if often less-than-ideal – Familiar versus the scarily unpredictable Unknown that I’ve written about so many times in the past.

That was pretty much what I was going through with A. at the beginning of the year, as we slowly neared and then reached The Ending. Things had been running along the heading-for-an-irreparable-relationship-breakdown route for some time – probably for far longer than I was ready to admit to you, or myself, at the time – but at least I knew what to expect, knew when odds were that my words would be met with silence, knew when there was potential for disappointment. I also knew what not to say and what not to do to keep the status quo, to keep us from falling off the edge. In addition, I was standing on the bedrock of our previous years together, all the times we had communicated really well, spoken a similar emotional language. I had a good sense of where we had one another, of how big or small the distance between us was at any given time, how close we could get, how much trust there was and where the boundaries of our relationship were; all those things that had made our work together so meaningful and fruitful for such a long time. So, it was with a lot of sadness that I had to accept that the time for us to part ways had come.

I had met P. only once before we actually started our joint therapeutic journey. Fifty shared minutes during an initial consultation to decide whether or not we could be A Match. I left that first meeting in December last year feeling that, yes, she could potentially be someone I could learn to trust, given enough time and space to Thoroughly Test what sort of stuff she was made of. But, apart from that gut feeling I didn’t know much about her [or attachment-based therapy] when I went for my first real session in February. I knew that there was something about the way she actively sought to make eye contact in that first meeting that both scared me beyond reason and made me feel that she genuinely wanted to get to know the real me. Actually, let me rephrase that: the way she actively sought to make eye contact with me scared me beyond reason, because she so clearly wanted to get to know the Real Me. Not just the Me she could glean or guess at from the polite introductory phrases or the bullet pointing of my fragmented, chequered and often painful past during this initial meeting, but the Real Me hiding behind all that – the Me that only comes out after the Thorough Testing has been done. The Me that even A., after nearly five years, was only just beginning to get to know.

I took the plunge, and it turned out that the water was far more calm and warm than I had expected. As K. put it only the other day: ‘When you finished with A. I didn’t think you’d ever be able to build a relationship with another therapist. I thought the trust had been shattered for good. I’m amazed at how quickly your relationship with P. has developed.’ I get exactly what K. meant, because it was what I, myself, was thinking at the time. How would I be able to trust? Why should I?

I suppose the answer to that lies in the way P. is, really. I wasn’t at all ready to trust, and P. was able to accept that completely, without any expectation that this would change. Was able to meet me where I was at. She was able to accept that I simply didn’t know if I really wanted to go on with therapy, or even with life. The exact thing that had ultimately caused the breakdown with A. The very thing A. had made clear she couldn’t accept; that I may not only feel that life wasn’t for me, but that I might actually act on it. P. made me, almost immediately – without the Thorough Testing – feel that this was a part of me she could accept. She in no way gave me license to act, but she simply accepted that this could be one of the paths our journey might take.

Then, of course, only a few months later this was put to the test. A splash of a toxic chemical on my tongue, the swallowing of some tricyclics – which I still to this day don’t remember taking – an ambulance ride from the women’s crisis centre to A&E and eleven hours in a coma.

Some might say this was part of my Thorough Testing. I’m not going to argue for or against. All I know is that we survived it: P. didn’t break, didn’t conclude that the reality of acting out was so different from the theory and phantasy of it that she could no longer work with me.

And our relationship grew a little stronger.

The aftermath of this overdose – along with a previous, more serious, intake of that same ototoxic chemical – was the loss of most of what remained of my already damaged hearing. Another big thing to deal with; the knowledge that my actions would have a lifelong effect – near deafness. But, also, in a backwards kind of way, the realisation that even when I mess up it is still within my power to do something about it; the decision to hop on the not-so-joyful steroid ride, the slight but miraculous recovery of some hearing, the sorting out of hearing aids [even though it at times makes me feel I’m ninety-something rather than thirty-something].

And all year long this journey has of course been fenced in and intercepted by flashbacks, by horrendous memories of a past that is never really in the past and by nightmares that don’t go away just because I wake up. Post but-never-quite-over traumatic stress disorder. The stuff that makes day to day life all but impossible to plan. The never knowing if a day will be a 40, 100 or near continuos flashback day. Making plans, cancelling plans, scheduling and rescheduling – because I simply can’t know in advance if any given day will be one where I can leave my house without putting myself at risk.

At the moment it seems worse than usual, more 100-a-day days than 40s. I went to visit my father for the first time in two and a half years at the end of November. That may have something to do with it. I don’t know. It might be related to the fact that both P. and K. have now gone on their respective Chrismukkah breaks, leaving Little S. feeling sad, scared and abandoned, and Adult Me struggling to cope in their absence. Or it might be chance. But, whatever the reason, it’s not so easy to deal with.

Anyway, I want to take the time to thank all of you who have faithfully stuck with me through the ups and downs of this year, in spite the updates being few and far between. It does make such a difference to me. It touches me deeply every single time one of you takes the time to post a comment or write me an email to share a bit of your Selfs with me. I know that is how most of my replies to your communications begin, but it is for a good reason: it’s the truth. I am very grateful for your support.

So, wherever you are in your lives, whatever is going on for you right now, good or bad, I do wish you all the very best.

Daring To Trust

Posted by What It Takes To Be Me in Creativity, Drawing, Expressing Emotion, Expression Through Art, Flashbacks, Psychology, Psychotherapy, Psychotherapy with A, Psychotherapy with P, Sexual Abuse, The Therapeutic Relationship and tagged with attachment based psychoanalytic psychotherapy, childhood sexual abuse, creativity, dare to trust, daring to trust, drawing, expressing emotions, expressing through art, expression through art, fear, fear of being too much, fear of breaking people, fear of breaking therapist, fear that therapist can't cope, flashback, flashbacks, forming a therapeutic relationship, honesty, leap of faith, new therapist, openness, psychoanalytic psychotherapy, psychotherapy, relational depth, sexual abuse, sexual abuse flashback, sexual abuse flashbacks, sharing, the therapeutic relationship, trust, trust issues, trusting, trusting the therapist, trusting your therapist, working with a new therapist Thursday, March 20, 2014

Today I did something that scared me, something that made me feel, something that needed me to be braver than I have ever been before. I shared something that I had never ever shared with anyone before.

I have now been seeing P. for just over a month. Ten sessions to be precise. And it has been, well, quite a big change for me. It is hard to not constantly compare the work I am doing with her to the work I did with A. It isn’t so much that I keep thinking that one is decidedly better than the other, but I am struck, over and over, by how different it is to be in therapy with P. The relationship we are tentatively building has a whole different feel to it, there is an added dimension to it, a quality that is hard to paint in words, but which is so real I can almost feel it physically.

That said, I miss A. I do. I really miss her. I miss the way I would spend time in session self-analysing and contemplating different angles to things, turning things round and round and having the luxury of going through all the ins and outs of my thoughts, with A. every now and then reflecting back to me what she heard me say.

I find myself, sometimes, making statements that I feel would have fitted well in A.’s therapy room, but which don’t quite work in the space I share with P. I find that doing my ‘getting into therapy mode’ routine, which I have been doing for nearly five years with A., feels awkward and out of place with P. I still do it, because it is simply the way I kick into gear, but I always feel very aware that P. is there, waiting for me to look at her and greet her properly.

So, there’s a lot to get used to. I find it so scary, the way P. meets me at the door, always with a big, warm and welcoming smile, and the way she seeks to make eye contact with me. I find her invitation to form a real relationship with her absolutely terrifying. There are alarm bells going off all over the place, simply because they have been tuned to mistrust that kind of openness and warmth, has been trained to automatically look for the ulterior motive behind any random act of kindness.

But, I am determined to not allow myself to use that fear as an excuse not to dig deeper. I am determined to find a way to ‘dare to trust’, to challenge my own hardwired concept of the world, of others being out to cause me harm. So, I’ve been pushing on with P. I’ve used my sessions to talk and talk and talk and talk about this fear of attaching, this extreme inability to trust – I’ve talked very openly about it all and she, in turn, has responded to it. And I think that that is where some of the healing may lay; in having those fears heard, having that reluctance be understood and accepted. Because – paradoxically – that is what may ultimately allow me to let my guard down, to allow P. in for real.

And today I took a leap of faith. I brought my journal with me, and I shared a drawing I made this morning of something that happened to me, something I had relived in the form of a flashback earlier today, and which I have never ever shared with anyone before.

It was incredibly scary to do, and before I did it, before I even opened up my journal, we spent time talking about what I was feeling, what the fear really was. I explained that there was something about P.’s presence that made me feel more scared than I would be, if I were on my own with the drawing. That something about her being there made me feel more exposed, more vulnerable, because I didn’t know how I would react to looking at the drawing in front of her, and I also didn’t know how she would react. The metaphor I used to explain it to P. was that it’s like standing in front of the mirror, naked, and then doing the same thing, but with someone next to you. The first is hard enough to do, the second all the more frightening.

At first I just sat with the journal in my lap, looking at the drawing I had made, without sharing it with P. Just to see what that would feel like, to test the waters. I found it difficult, had to actually use my hand to cover up the parts of my drawing that felt too difficult to look at. And then, in the middle of doing this – in the middle of shielding myself from my own drawing – it occurred to me that I didn’t need to be the one who was stuck with the drawing. I didn’t need to shield myself from it. I could give it to P., and she could protect me from the full force of the raw horror that the drawing contained. So, I handed it over to her, barely daring to look at her.

But I did. Look at her. And, yes, there was a reaction to what I had drawn, an obvious emotional response to what she was seeing splashed across her face, and it made me feel very afraid, anxious that maybe I had pushed her too hard, too soon. But then P. spoke, first about how what I had shared in the drawing was something no child should have to experience, and later, about how she felt about me having shared it with her. And it made me feel better.

In the session before this one, I also shared something, in words rather than through a drawing that time, and towards the end of the session P. asked me how I felt about what I had shared. So I talked about it. And then – the thing that made me really feel that there might be a possibility that I could trust her to take good care of me – she asked if maybe I needed to also know how she was feeling, having listened to me. So, I nodded and said that I thought that would be good, feeling so immensely grateful that she had understood how enormous my fear of breaking others with my story is.

And that – her honesty in sharing exactly how listening to me affected her – is what made it possible for me to take this huge step in today’s session. Because, something about that – about P. not holding back on her own response, is what makes me feel safe, makes me feel that she knows her own limitations, and that – because of this – she wouldn’t allow either one of us to go further than we could cope with.

“It’s time we made a place
Where people’s souls may be seen and made safe
Be careful with each other
These fragile flames..
For innocence can’t be lost
It just needs to be maintained..”

Innocence Maintained  © 1998 Jewel Kilcher

Surviving An Ending: Starting Over

Posted by What It Takes To Be Me in Attachment, Coping Strategies, Family, Loss & Mourning, Personal Growth, Psychology, Psychotherapy, Psychotherapy Breaks, Psychotherapy with A, Sadness, The Therapeutic Relationship and tagged with attachment, attachment based psychoanalytic psychotherapy, being OK with not being OK, coping, coping strategies, ending, ending therapy, endings, family, grief, loss, missing psychotherapist, mourning, new psychotherapist, new therapist, psychoanalytic psychotherapy, psychotherapy, psychotherapy breaks, psychotherapy ending, sadness, stages of grief, starting anew, starting over, the therapeutic relationship Sunday, February 23, 2014

Finishing with A. was always going to be immensely painful and would inevitably leave me with a whole host of scary feelings, and nowhere to put them. So, in a bid to keep myself from harm’s way I decided to give myself a time-out immediately after The Ending.

Chickening out of allowing any kind of time or space for those Scary Feelings to rear their ugly heads, I made sure to book a seat on the first morning flight available after The Ending – and – looking back, I think that was a wise choice, indeed; getting through even just an afternoon and evening after my final session with A. was a momentous task, and didn’t feel like something I could have coped with safely for any length of time at all, to be perfectly honest. Far safer to spend time with sisters and nephews and brothers-in-law, all of whom provide sufficient distraction, and help me find some balance between being hit at full force by the painful loss of my relationship with A. and shutting down altogether. In short, I made a conscious choice to be around people who I knew I would feel OK to not be OK around, if that makes sense.

But, now I’m back. And – fearing that reality is about to strike – I have purposely thrown myself into all things Olympic in order to buy myself some more time and shelter myself from the whirlwind of emotion which is sure to soon come sweeping across my soul.

I had my first two sessions with The New Therapist this week, and that was both absolutely emotionally draining and a huge relief. The New Therapist – who I have decided to call P. [as that was the letter that immediately came to me the very first time I met her, at the initial consultation], is very different to A. Although she is a psychoanalytic psychotherapist, just as A. is, she is also attachment-based. And that is a whole new ballgame for me. It’s all very relational, very direct and very open. Even at our first meeting I noticed that she actively wants to make eye-contact with me, and seeks to engage in a completely different way. And that will take some getting used to. As much as I have often found myself frustrated with what I have experienced as a certain lack of closeness or intimacy with A., now that it is being served to me in this way, it is quite a scary thing, because in that slight distance between A. and I, there was also safety: for better or for worse I could opt to hide in that space if I needed to, and I have a feeling that is something that will be a whole lot harder to do with P. There is something about this open invitation to attach that leaves me feeling vulnerable and somewhat exposed. And allowing myself to enter into a relationship in that way feels strange and more than just a little scary.

I will say that, instinctively, I rather like P., and I think that – once I get more used to this new way of relating to The Therapist, this could be quite fruitful. But, at the same time, I do have a lot of ambivalence: I find myself going back and forth between ‘Go on, dare to trust. Everything you have seen of P. so far points towards you being in safe hands. Try to not hold back so much’ and ‘Don’t do it. Don’t let her in. You’ve been wrong about people in the past, and ultimately you’ll be let down, and you’ll end up being hurt’.

As I am writing this post, I suddenly feel very aware that with every difference I note between A. and P., the realisation that I won’t be seeing A. anymore knocks on the door – makes my eyes tear up – and I am also struck by the feeling that I am somehow being disloyal to A. in writing about anything even remotely hopeful about P. Almost as if I am cheating on her with another therapist. I remember feeling something very similar when I started seeing A., having learnt so much from my work with D., and worrying that in one way or another moving on to a new therapist meant that I didn’t value what D. had offered or the hard work she had done with me. I know that these feelings will eventually subside, and I also know that in some ways I had outgrown A. – or perhaps we had both outgrown our relationship – and the time to part ways had come. But for now, each reminder that things have come to an end in my relationship with A. hurts. Because I really miss her.

I suppose that in a way, ending with A. – and the fact that I really won’t be seeing her again – is a bit like dealing with a death, and I suspect that over the next several months I will be going through all the different stages of grief.

But, hopefully, I won’t be doing it on my own.

Ps. To those of you who know about my trip to Sweden: I know that I am missing out two absolutely massive things about my time there, both of which deserve some proper analysing; I will return to those things in a later post, but for now, I am choosing to leave it out. *hangs the STILL PROCESSING sign on the door*

The End Of A Relationship

Posted by What It Takes To Be Me in Abandonment Issues, Anxiety, Attachment, Coping Strategies, Creativity, Expressing Emotion, Expression Through Art, Loss & Mourning, Panic, Psychology, Psychotherapy, Psychotherapy with A, Rejection, Sadness, Separation-Anxiety, The Therapeutic Relationship and tagged with abandonment issues, creativity, ending, ending therapy, endings, expression through art, final psychotherapy session, final therapy session, goodbyes, last psychotherapy session, last therapy session, loss, mourning, nail varnish flower, panic, psychotherapy ending, rejection, rubber duck, sadness, saying goodbye, saying goodbye to your therapist, separation anxiety, separation-anxiety, sometimes a rubber duck is just a rubber duck, sometimes a rubber duck really is just a rubber duck, the therapeutic relationship, therapy ending Wednesday, January 29, 2014

Sometimes A Rubber Duck Really IS Just A Rubber Duck
..these ones, of course, aren’t..

I feel so desperately sad.

Had my final session with A. earlier today. And I just want to cry. In fact I have been crying. A lot. It just feels awful. I hate the way things have ended, it doesn’t feel good at all; there are so many loose ends that we were just never able to tie up and we will now never get the opportunity to do so. I feel we came to an impasse at some point last year, and no matter how hard I’ve tried, it’s just not been possible to break it. And that is what is making me feel so terribly sad, what I mourn. I knew that I would have to end therapy with A., that there really was no other path left to take, but, I would have liked to have been able to rebuild at least some of the things I felt got broken in the midst of this therapeutic breakdown of sorts.

I knowingly opted not to write about the last four sessions as they happened, because I wanted to use these few weeks to deal with therapy coming to an end on my own and in my sessions with A., without discussing and analysing it to bits elsewhere beforehand. I just felt that if I spend a lot of time between sessions writing about them, especially about all the things I didn’t say in session, it would somehow dilute something, would make it easier to remain emotionally remote in session, because I would have already felt the initial force of impact when dissecting it in black-on-white writing. And with this very important final phase of my work with A. I wanted to try to avoid that. Especially knowing how good I can be at switching off emotions, even when I’m actively trying not to.

But, now that it is over, I would like to share some of the things that have been going on. I’m not sure that I will be able to write about it all tonight, it all feels so terribly raw still, so there may have to be a few posts on the subject over the next few weeks, but I’ll make a start today, to the best of my ability.

There is this broken record that’s been playing in my head on repeat this whole time: How am I supposed to say goodbye at the end of the final session, walk through the door and never come back..? It’s a thought I have been wanting to share with A. throughout, but I wasn’t able to give voice to it until today, in the very last session.

The idea of never feels so terribly painful and inescapable that I’ve not quite known what to do with it. In the last few weeks, I’ve often found myself suddenly struck with sheer panic about the fact that I would soon not be seeing A. anymore. That she will no longer be my therapist. And – even more painfully – the realisation that, not only will A. not be my therapist anymore, but I won’t be her client. The link will be completely severed. Forever.

And it hurts like hell.

So, I had to come up with a solution to help me deal with that. Something. Anything. And in the end it happened in the shape of two rubber ducks.. I spent some time thinking about whether or not I wanted to make a card for A. for the final session, or even give her a little something. It’s something I’ve never done in all of our years together. You see, my father – The World’s Greatest Psychotherapist – used to get Christmas cards and Easter cards and Happy Midsummer cards and other bits and pieces from his clients, and I always deeply resented this intrusion of his work in our family home. Feeling that he was already so much more involved with his clients than he was with his family, I really didn’t want reminders of his clients dotted around the house.. As a consequence of this, I’ve always felt I can’t quite cope with being That Client, and as a consequence A. has never been sent a card or left a gift or anything like that.

In the end I decided that actually, doing a little project of some sort, while dealing with the ever nearing ending, might be useful. In essence, to put my own needs before any thoughts about what impact this may have on anything or anyone. So, I came up with the rubber duck idea. It seemed fitting, because I have told A. many times that “sometimes a rubber duck really IS just a rubber duck”, meaning that not everything said in session is an echo of the world outside, and even if there is a bigger duck in the outside world, sometimes dealing with the smaller duck inside the therapy room, will be just as effective at resolving something..

Anyway, I bought two ducks to decorate with my trademark nail varnish flowers. [Having never used nail varnish on this material before, I wanted to have a back-up duck should I need to have another go, using different paints.] As it turns out, nail varnish works really well on rubber ducks, and I didn’t need the back-up, spending an hour and a half painting the duck and thinking about my journey with A., allowing the emotions it brought out to just exist. The idea with giving A. the duck – apart from serving as a reminder of what I used to tell her – was that it might make it a little easier to walk out and never come back, if I knew that there would be something of me left behind. No, I don’t really feel that nothing of me would have been left behind, without the duck, but leaving something physically behind, made it less abstract. Then, last night, I decided to paint the second duck as well, because I thought that if I have the twin to A.’s duck still with me, there wouldn’t be such a definite severing of the link between A. and I. A very comforting thought. So, that’s what I did. When I was done, I named A.’s duck Graduation Day Duck [End of Therapy Duck, was a little too negative] and mine Separation Anxiety Duck. [I think we’ll save analysing that for another time..]

I’ve previously written about the things I’ve felt I’ve needed from A., in order to make this parting of ways more manageable. I can’t say that I’ve really had any of those things, at least not packaged the way I had imagined. But, at the same time, some things have been said – tiny little things here and there that have seeped through when A. has been talking about other things, which have made me think you’re really talking about us here, aren’t you? I think therapists sometimes underestimate the amount of time their clients spend analysing them, and the fact that interpreting what is being said is not a magic skill bestowed on their profession alone. Just as they hear echoes of other things in what we say, so do we see shadows and other dimensions in the pictures they paint for us.

In one session A. said something along the lines of how it is really important for me to hear her say that I am special. I can’t remember if I replied directly to that, at the time, but I remember thinking that, actually, it isn’t so much about being special to her, as it is about feeling validated in the fact that I am unique, that even if she sees a million other clients, every single one with a similar background, our work is unique, because our relationship is unique – that our relationship can’t be replicated or duplicated, because of who we each are as individuals, and the unique combination that creates.

At times, the refusal to allow me to have this validation has felt very harsh and has been experienced as exceptionally rejecting, regardless of the intellectual understanding that this was not the intention. In the midst of therapy, I can to some degree see the value in not always providing automatic gratification, to instead look at what this need is really about. But, at the end of nearer to five years, when there soon would be no next session in which to analyse things, I don’t really understand this withholding of validation. In fact, even if it really was just about needing to be told that you’re special, what is the cost in doing that? When there is no further analysis to be done within that particular relationship? I have talked to A. about how the fact that both D. and Z. in their final sessions with me made sure I could really feel that the work we had been doing had meant something to them, too, has been really helpful. To be told that I – simply through being the unique person that I am – have had an impact on them, has had a definite positive effect on me. That is not to say that I am unable to feel good about myself without someone else reassuring me of my value, BUT – a little positive reinforcement from someone you respect can go a long way and create rings on the water that reach very far, indeed. Just look at children who grow up with parents who validate them, and then at children whose parents actively invalidate them, and the benefit of the former becomes obvious. It is human nature to continue to grow in a healthier way as a person, if we feel valued for simply being ourselves.

Today the dreaded final session finally came. At the beginning of it I used the duck to talk about the ending, and the process the duck had been part of [and – yes – I did a little analysing of the names I’d given them], and that part of it felt good. But then I sort of side-tracked myself and talked about something entirely different – something which, had this been a normal mid-therapy session, would have been very useful – but, which in the context of this being the final session felt very much like something that wouldn’t really be nearly as helpful as talking about the fact that after 429 sessions and 21,450 minutes spent together, A.’s and my relationship was about to end. At one point I tried to get back to talking about the ending by stopping myself mid-sentence and stating that ‘No, I don’t actually want to talk about that’, but as A. encouraged me to carry on, and not feeling particularly brave, I ended up using all of the precious remaining time on this side-track.

And all of a sudden, without any warning at all, A. announced that “Our time has come to an end”. Not ten minutes before actual end of session, in order to leave time and space for a proper goodbye, but at the actual end of session, with no time to spare. It’s a bad habit of A.’s, this lack of signalling that time is nearly up, and it was particularly deeply felt today.

So, I left feeling somewhat robbed of the chance to say a proper goodbye, because, really, this session was ended much like any other session, with me putting my shoes on and quickly gathering my things, ready to vacate the room for The Next Client.

Yes, I was able to look A. in the eye and say “Thank you”, and A., in turn, said that she wished me all the best, but, even though she more than likely genuinely does wish me all the best, it sounded awkwardly formal. She tacked a “Thank you for my duck” on after that, with a little more feeling, and that helped some, but I could without a shadow of a doubt have done with another five minutes spent truly acknowledging that what has been an incredibly important relationship for me was coming to an end.

Instead, I said goodbye and walked through the door.
Knowing that I would never be coming back.

And that’s when the tears began falling.

Endings: Standing On The Brink Of The Unknown

Posted by What It Takes To Be Me in Anxiety, Attachment, Being Alive, Counselling with Z, Psychology, Psychotherapy, Psychotherapy Breaks, Psychotherapy with A, Relationships, Sexual Abuse, Suicidal Ideation, The Therapeutic Relationship and tagged with abandonment, anxiety, attachment, childhood sexual abuse, ending therapy, endings, fear, fear of rejection, loss, psychology, psychotherapy, psychotherapy breaks, separation, separation anxiety, sexual abuse, suicidal ideation, terminating therapy, termination, the therapeutic relationship Tuesday, January 7, 2014

Being in therapy is being in a relationship. Therefore it follows that ending therapy is an as complex and complicated – and sometimes painful – process as ending any other relationship. There are loose ends and jagged edges to deal with, memories – good and bad – to look back at, and a struggle to not panic and in desperation seek to go back to something that just isn’t there anymore.

I have always said that things that are familiar are often also comforting to us, even when The Familiar isn’t necessarily a good thing in itself. The Familiar is comforting because it keeps The Unknown at bay. And nothing is more frightening than The Unknown.

I have four more sessions left with A.
Four more sessions, after more than four and a half years of working together. In short: it is nothing. I am standing only millimetres away from The Unknown, and I have to find the courage to not turn and run, but rather to allow myself step in to and somehow tolerate existing within it.

I have been spending a lot of time over the Chrismukkah therapy break thinking about what exactly it is that makes this ending feel so difficult, because, intellectually I can see that ending work with A. has more or less become a necessity, both because I am unable to give her the reassurance that she needs that I won’t end my life, and – perhaps more importantly – because we have simply come as far as we can, working together. The conclusions I have reached, as to why the ending is difficult is summed up in the first paragraph of this post; this is the end of a very special relationship, so how could it not be difficult? But, on top of that ‘normal’ difficulty, apart from the anxiety and sadness and sense of loss that any ending brings with it, I think that there is something I need to take from this relationship, which I fear A. might deny me, and this is what makes it so much more painful.

In November, when I finished counselling with Z. – that, too, was a difficult ending. But, I do feel that in the last few sessions – and especially in the very last one – Z. managed to provide me with that one thing I needed: the reassurance that it mattered to her too, that we would not be working together anymore. That I had made an impact on her. That she would actually miss seeing me. What I am talking about here is not a need to be told that I am her favourite person ever to work with, but something far more simple; an open acknowledgement of the fact that working with me is special, because I am special: there is only one of me. So even though my slot would soon be filled by someone else, someone just as engaging, it is still different, because the relationship between Z. and I could only happen because of who we are as individuals, and what we accomplished in those sessions was specific to our relationship, to what we jointly brought to the table.

I talked with A. about this ending at the time, explaining that those things Z. said to me meant a lot, and significantly helped make that ending, if not less difficult, at least not painful, and left me with something positive to carry forward. The fact that Z. actually told me these things, actually said them out loud, rather than simply assume that the way we had been working together and the way we relate would automatically lead me to know it, I think is important. People who have been abused tend not to take things like that for granted, because actions and the meanings of those actions have been so terribly mixed up and confused in the past.

So, I suppose, what I would like from A. is something similar. I’m not talking about any earth shatteringly emotional revelations or dramatic proclamations, but just something said, in clear plain direct speech, about the work we have been doing and about what this ending means.

I asked A. earlier in the year if I matter to her, and she decided to not answer my question, and I am sure she has her reasons for that, but, I think what I need – especially now – is for her to step away from those reasons, whatever they are, and just meet me openly and honestly. The lack of this direct communication in the last few months, is part of why therapy is now coming to an end, and seeing as there will be no Next Session in which to analyse why I asked the question, an answer would be good, would provide me with that Something that I need.

But, as I wrote earlier, my fear is that A. will not opt to go down this route of openness and honesty, and this is where I feel the pain is created. To need to hear that working with me has mattered to her, that getting to know me, hearing my thoughts, means something, is important, and to leave, having been denied it, would be excruciatingly painful.

Of course, I don’t know that this will be how things end, and I really hope that A. will have taken onboard the things I said about ending with Z., and what made that a more positive ending. But, the fear is still there, looming like a dark cloud over my head.. I am seeing A. for the first time after the break tomorrow, and I will carry on talking about all of these things with her, as I had been before the break. I just hope that her response will be different.

Before concluding this post, I just wanted to say thank you to all who have emailed me following my last post. I am sorry that I haven’t been able to reply to all of you, but, hopefully, in time, I will. I know that this post hasn’t really been a direct follow-up on the previous one, and it isn’t because I am trying to shy away from the seriousness of the situation, which remains sadly unchanged, but because I feel that – for now – I need to try to deal with things in slightly smaller chunks, and if that means navigating by auto-pilot for a little while, well, so be it. As my sister said We much prefer Auto-Pilot to No Pilot..

But, once again, thank you all for your very kind emails and comments. They have been read, heard and appreciated.

Much love,

Scaffolding

Posted by What It Takes To Be Me in Abandonment Issues, Acceptance, Attachment, Being Alive, Counselling with Z, Creativity, Diagnosis, Expressing Emotion, Loss & Mourning, Personality Disorders, Poetry, Psychology, Psychotherapy, Psychotherapy Breaks, Psychotherapy with A, PTSD/Extreme Emotional Stress Disorder, Sadness, Sef-Awareness, Suicidal Ideation, The Therapeutic Relationship, Writing and tagged with attachment, attachment based psychoanalytic psychotherapy, attachment to places, being alive, creativity, crisis resolution team, DBT, Dialectical Behaviour Therapy, Drayton Park, Drayton Park Crisis Centre, Drayton Park Crisis House, Drayton Park Open Day, Drayton Park Women's Crisis Centre, Drayton Park Women's Crisis House, Drayton Park Women's Crisis Service, ending, ending one's life, expressing emotions, Leah Thorn, MBT, Mentalisation Based Therapy, Mentalization Based Therapy, personality disorders, poetry, psychology, psychotherapist coping with suicidal clients, scaffolding, suicidal ideation, suicide, talking openly about suicide, termination, trauma focused counselling, Writing Monday, December 16, 2013

I was supposed to be dead by now.

It feels kind of strange to write it, but it is true, nonetheless. A little over four weeks ago was when it was supposed to happen. I had booked the hotel room where I was going to go to, to end my life. I had everything I needed to do it. I was completely at peace with the idea of going through with it, felt satisfied that I had tried my very hardest to get onto a different path. There was only One Last Thing I needed to do before setting my plan in motion. Except chance intervened and stopped me from being able to do that One Last Thing, and there was no way I could go ahead with ending my life without that.

So, instead I ended up going another round at Drayton Park Women’s Crisis Centre. I was offered a place, having initially been turned down for it, as I was deemed too high risk to be safely contained there. Nothing had really changed between the time I was initially assessed and when I eventually took up a place, but, I banked on my good personal credit that if I made an absolute promise that I would not act to end my life as long as I was staying in the house, staff would trust me enough to let me have a place. As long-term followers of this blog will be aware, I made a very serious attempt at ending my life the very first time I stayed at Drayton many years ago, and ever since then I have developed a rather special relationship both with the staff and with the place itself. It has been a go-to place for me in times of real crisis, a place to sort out my feelings, to create space for myself without having to worry about anyone else, somewhere I feel safe enough to really stay with myself, if that makes sense.

This time was very different. Not because the above things were no longer true – they still were – but because in complete contrast to all other times I have gone there, this time I went into Drayton Park with absolutely no belief whatsoever that anything was going to change while I was staying there. The reasons for wanting to end my life were – and still are – things that could not change through short term crisis intervention. But, I decided to take up a place at Drayton Park, in spite of this. I went there in part because I wanted my loved ones to know that I hadn’t just given up without one last fight, and partly to buy myself time, because as much as I didn’t believe that anything would really change, I also accepted that I haven’t got a telescope to the future, and consequently couldn’t know for sure that I wouldn’t be proven wrong. And I desperately wanted to be proven wrong. I desperately wanted something to change.

A number of big things happened during my time at Drayton Park.
Firstly, counselling with Z. came to an end on the day I took up residence. Secondly, I made a decision that long term therapy with A. will have to come to an end after more than four and a half years of working together. A. made it very clear to me earlier in the year that she is not able to work with me under the threat of suicide, and as I am someone who simply will not make a promise I don’t know I can keep, the only fair thing to do was to set an end date to therapy. Finally, in the last few weeks I have been under assessment of the personality disorder services to see whether or not I should be offered a place with them. I have had very mixed feelings about this from day one, have very little hope that there really is anything in it for me, but again, I try to keep an open mind rather than closing doors.

With all of these things going on, and feeling completely stripped of any hope that there truly is anything out there that could change how I feel about ending my life, I decided to use my time at Drayton Park to go against what my heart was telling me – a very foreign concept to me. To hold on, rather than to let go.

I spent my three weeks at Drayton Park actively putting up scaffolding around my life, in spite of the very real and painful belief that it was utterly futile to do so.

I put scaffolding up by carrying on with the assessment process with the personality disorder services, even though I was reasonably certain that neither DBT nor MBT were really for me, that I don’t quite fit the bill. More scaffolding went up by re-arranging the end date with A.; it has now been planned so that rather than going from twice weekly therapy to nothing from one day to the next – which was the original idea, and which on reflection felt unnecessarily harsh – we will instead carry on with twice weekly sessions until A. goes on her Chrismukkah break later this week, and then go on to do one month of weekly sessions at the beginning of next year to allow for a tapered, more emotionally gentle, ending. Further scaffolding was created by contacting Z. and asking her and her supervisor to have a think about who they might be able to refer me to, for longer term trauma focused work. Someone who might be willing to work with me, knowing what the full situation is, in terms of suicidal ideation.

I also threw myself into expressing myself through writing, taking part in two creative writing workshops facilitated by the most fabulous Leah Thorn, and was able to share some of my feelings about life and death at a poetry reading during the annual Open Day, which happened to be held during my stay at Drayton Park. [Click here to read one of the poems I read that day].

I was discharged from Drayton Park a week ago today.
I don’t feel any different in terms of wanting to allow my very tired soul to rest. I wish I did, but I just don’t.

However, I am carrying on with the building work I started while at Drayton Park: I am working with the crisis resolution team to have some extra support for the first few weeks of being back home. The extended assessment with the personality disorder people has come to an end. In the only way the NHS knows how an Expert was brought in [in the shape of a clinical psychiatrist I had never met before in my life] to try figure out what the heck to do with me. It was ultimately decided that I was probably right: I don’t quite fit the bill and neither DBT nor MBT is going to be particularly suitable for me. However, although I won’t be enrolled on the personality disorder programme with all that that would have entailed, I have been given a care co-ordinator [henceforth called E.], who I will be meeting with somewhat regularly, to have someone within the blessed NHS who knows me and who I can turn to in a crisis.

Z.’s supervisor also got back to me with a name for a specific psychotherapist who she felt might be a very good match for me for long term work, and I will be having an initial consultation with her tomorrow to see if her gut feeling proves right. Although I don’t necessarily feel that even this type of work will really have the power to change anything, I am trying my best once again to at least be open to the possibility that it could have something to offer – and – for a naturally analytically minded person such as myself, at least this type of therapy [trauma work with an experienced attachment based psychoanalytic psychotherapist] makes far better sense than either DBT or MBT.

In my therapy with A. I have tried to be brave and really explore what this big change, this ending of our work together, means to me, and how it makes me feel, the deep sadness it brings out in me. It’s not easy, but I am hoping that through being as open and honest about my feelings as I can, it will make for a more manageable ending.

So, that – dear readers – is where I am at:
In the process of building something that may or may not stand the test of time.

I do hope that it will, but right now, it is simply too soon to tell.

Much love,

A Fork In The Road – Choosing A Path

Posted by What It Takes To Be Me in Attachment, Counselling with Z, Creativity, Drawing, Expression Through Art, Flashbacks, Inner Conflict, Painting, Personal Growth, Psychology, Psychotherapy, Psychotherapy Breaks, Psychotherapy with A, PTSD/Extreme Emotional Stress Disorder, Self-Harm, Suicidal Ideation, The Therapeutic Relationship and tagged with attachment, communication, counselling, distraction techniques, drawing, expressing through art, Extreme Emotional Stress Disorder, flashbacks, inner conflict, moving on, Painting, personal growth, Post-Traumatic Stress Disorder, psychotherapy, psychotherapy breaks, PTSD, self-harm, self-injury, suicidal ideation, the therapeutic relationship, therapy, therapy breaks, urge to self-harm Tuesday, October 29, 2013

A. has been away since the Friday before last, and it feels like it has been our longest break ever. There is just something about this particular break that has felt sort of endless. Of course, this hasn’t really been the longest one, seeing as she was off on maternity leave last year, but it has felt incredibly long.

I think one part of it is the fact that I have been living in a heightened state of fear ever since I ran into M., and not having A. there to talk it through with has been hard. Yes, I’ve still had Z., but since that’s the place where I’ve seen M., I haven’t been able to relax at all, and that – naturally – has had a direct impact on my ability to open up and talk about things; it is very hard to allow yourself to be vulnerable in a place where you don’t feel safe. That isn’t to say that I haven’t tried to do just that. But, still, it’s in my sessions with A. I usually feel most safe, more sheltered from both external and internal storms. In fact, this is where I am least likely to experience flashbacks. Sure, I do still have the occasional flashback when I’m with A., but it happens a whole heap less there than anywhere else.

A. is back tomorrow, and that’s a good thing, for sure. I feel that there is a lot that has happened in the eleven days since I last saw her, and there is a lot of catching up to do. Prior to A. going on leave I had a session where I tried to be brave and share my concerns regarding not feeling sure about where our therapeutic relationship and work is headed, or even where I would like it to go.

There is one part of me who is listening closely – perhaps even a little too closely – to other people, who all seem to be suggesting that perhaps I am overly attached to A., and that I have really come as far as I can, working with A. That I may have outgrown her, in a sense, and the time has come to start over with someone else. And at the same time there is the intense pull in the opposite direction: that while there are many things that are less than ideal in our relationship and the way we have been working together, there is a golden opportunity here to work things through, to have a different experience to what I have had in many previous therapies.

I think what troubles me most is the fact that I feel so completely in the dark about my own motives for wishing to go in either of these directions. Is thinking about terminating my work with A. really a result of outgrowing something, or is it a case of the exact polar opposite? That, actually, having spent years only dipping my toes I am now dangerously close to allowing myself to dive in head first? Perhaps terminating is a way for me to avoid having to do that? It certainly wouldn’t be the first time that happened. In at least three previous therapies I’ve managed to find an ‘out’, when things have got a little too hot. Maybe I am really just repeating a pattern here? To cut and run, rather than stay and face my fears?

And, at the same time, is my wish to stay with A. purely about this opportunity to go deeper than I have done before, or is it rooted in fear of letting go of the emotional safety blanket A. has been providing for me in the last four and a half years? Change can be a pretty scary thing, and sometimes we all need a little push in the right direction to dare take that final step off the beaten path.

I definitely feel that working with Z., alongside A., in the last few months has been a very positive experience, has made me reflect on the work I have been doing with A. It has helped clarify in my mind what I feel has sometimes been lacking. But, equally, it has highlighted the things I really appreciate in my relationship with A., the things I find a little overbearing in my work with Z.

In many ways, therapy with A. is a very independent endeavour; I am most definitely in the driver’s seat, choosing which roads to go down, which ones to avoid, and what speed we should be travelling at. Counselling with Z. is a lot more directed, something which became very clear when she expressed concern that we may be dipping too deep into things. And, at the same time, Z. is a lot more head on than A. She often asks very direct questions about what’s going on for me, what I am feeling, and, particularly – what I feel about our relationship, pushing me to go to a place where it is a little scary to be. And, this is an area where A. and I don’t really manage to communicate all that well. I am not sure if this is down to me and my fears, or if it is a situation A. and I have created jointly, but I do know that it is absolutely one of the things I would like to change.

A. made a comment when I talked about this, among many other things, in one of the last sessions before this break, which I feel is both valid and makes me worry. She said that all these questions I have about our work together, the uncertainty of where we are going, the not knowing where I would like to go, echoes very loudly in the rest of my life: there is a lack of clear direction and a strong feeling of being pulled in two opposite directions [the wish to live and work through things, and a darker pull towards giving up and ending my life].

As I wrote earlier, this comment does have some validity: I can see the echo, and I get what A. was trying to tell me. And at the same time, there is some frustration on my part about the way A. tends to see most everything I say about our relationship as a direct echo of something bigger in the world outside of her consulting room, the way she sometimes seems reluctant to allow me [us] to fully explore what’s there inside those four walls. My general view is that, yes – there are often echoes of the outside world being reenacted in A.’s and my relationship, but, that this doesn’t mean that what is going on between the two of us isn’t equally real and in need of being worked through. One doesn’t negate the other, and sometimes a rubber duck is just a rubber duck.

As you can see there are a whole lot of questions bouncing around inside of me at the moment, and very few solid answers to counter them, but I hope that in the next few weeks I will be able to use my sessions with both A. and Z. to look at them closer.

Self-Harm Distraction Techniques: “Draw, Don’t Cut”
[..the slightly more creative version..]

Being Safe vs. Feeling Safe – The Power Of The Past

Posted by What It Takes To Be Me in Anxiety, Counselling with Z, Defence Mechanisms, Family, Family Dynamics, Intellectualisation, Panic, Psychology, Psychotherapy, Psychotherapy with A, PTSD/Extreme Emotional Stress Disorder, Regression, Sexual Abuse, The Therapeutic Relationship and tagged with Adult Me, anxiety, being safe, childhood sexual abuse, counselling, defence mechanisms, denial, Extreme Emotional Stress Disorder, extreme fear, family, family dynamics, fear, feeling cared for, feeling safe, foster child, foster family, hyper vigilance, intellectualisation, Little S, panic, parents, Post-Traumatic Stress Disorder, psychology, psychotherapy, PTSD, regression, sexual abuse, the power of the past, the therapeutic relationship, trapped in panic mode, trauma focused counselling Tuesday, October 22, 2013

Ever since my run-in with M. last week, I have been on extremely high alert. Like many people suffering from post-traumatic stress disorder I am hyper vigilant at the best of times, but in the last week I have been a million times more nervous than usual, any sound I’m not expecting making me jump. From Monday when it happened until Wednesday night I didn’t sleep. Not as in I’ve barely slept a wink, but I literally didn’t sleep, at all. In fact, getting to A.’s place on the Wednesday afternoon was a real challenge as I was battling the symptoms of sleep deprivation, being confused, nauseas and very unsteady on my feet.

I used both my Wednesday and Friday session with A. to talk about what happened when I saw M. and how it’s really affected me quite badly. In the Wednesday session I was close to tears, just thinking about it, because I felt like any sense of security I had been able to create for myself had been totally and utterly shattered. My jitteriness was so bad that even the sound of A.’s voice made me jump more than once in session. [My relief upon realising it was A. and not someone else each time, on the other hand, was immense].

I have been trying really hard to calm myself, to tell myself that although I don’t feel safe, I am safe. Only it seems to make no difference whatsoever. My feelings out-power my intellect with frightening ease, in complete contrast to how I normally deal with any extreme emotions by rationalising them away. Also, one could argue that the reality of being safe holds very little, if any, value if you don’t feel safe.

Needless to say, my anxiety level has been on a steep upward curve every day since last Monday, doubling again and again the closer I got to my next session with Z.

Z. telephoned me on the morning of my session, just to reassure me that she would definitely be there to meet me at the reception, to let me know that I didn’t have to worry about having to walk through the building on my own. So, I picked up whatever fragments of courage I could find and set out. I had to stop several times on the way, because I was so anxious my legs didn’t seem to want to carry me. I kept looking nervously around, to see if he might be there.

And then it happened. Only fifty metres from the relative safety of the reception I spotted him. He was on the other side of the street, slightly behind me, accompanied by a woman, talking and laughing as if the world was a beautiful place to be. I stopped being the grown woman that I am in that instant and turned into 8-year-old me, hiding behind a tree as he walked past on the other side of the street. I went from Adult Me to Little S in seconds flat.

I hung back, watching him enter the building, not really knowing what to do. It was time to meet Z., but I just couldn’t go into the reception, in case he stopped to talk to someone there. So, I waited a while – I’m not sure how long – and then, on unsteady feet, made my way across the parking lot. As I cautiously approached the door, hoping to take a peek through the glass panes to make sure that M. had left the reception, a man came out through it, holding the door politely open for me. Ready or not, I had no choice but to enter.

I collapsed on one of the chairs immediately inside the door, bending forward, hiding my head in my hands, forcing myself to keep breathing. Z. came up to me right away; I guess she may have been sitting behind the receptionist desk, looking out for me – I wouldn’t know, because I never looked around when I entered.

I somehow managed to get it out that I knew M. was there, because I had seen him go in, and there was no way I could walk through the dining hall, even with Z. by my side. Z. thought for a moment and then told me to wait while she went back into the reception to ask another member of staff to open the fire exit for us, so we could enter the building that way; the only way you can get to the stairs leading to Z.’s room, without having to go through the dining hall.

I made it up to Z.’s room on shaky legs, and as soon as I was in there, I sat down on the chair. I didn’t do any of the things I usually do: put my backpack down, set my Rubik’s cube aside, take my shoes off. I just resumed the position I had had in the reception, head buried in my arms, bending over, sobbing violently without tears. It took me a good while before I was able to get back to myself enough to do those things, to bring myself back to where I was, and even then I left my shoes in such a position that I would be able to just step into them, should I need to flee.

I explained all of this to Z. That, even though she was there and I had made it to the room safely, I was ready to run, to jump through the window if need be. I just wasn’t at all able to catch hold of the fear or rein myself in. Throughout the session that feeling never left. At one point I could hear male voices in the hallway outside the room, and in panic realised that I might not be able to recognise his voice, as he would be speaking in English, and that might not at all sound like the very distinct way he spoke Swedish, with a strong Arabic accent.

That is something that has been playing in my mind almost on repeat during the last few days: the way he spoke. In particular, the way he used to say my name. He never used the short form of my name like everyone else, but would always call me by my full name, only his accent caused him to mispronounce it slightly.

It turned out to be a good session, all things considered. We spent time trying to explore the fear, and also talking about the circumstances surrounding M. coming to live with us. How we had a family meeting, talking about taking this badly psychologically damaged teenager in, and how, at first it had all been very exciting. He had three different foster families to choose from, but – much to our delight – decided on our family. He later said that the reason he chose our family over the other two was ‘because there were children’, and I couldn’t even begin to express the chills that sends down my spine thinking of it now, knowing what he went on to do.

We talked about changes that was made in my home prior to M. moving in: all toy guns, including water pistols, were banned – as M. was a refugee from the Lebanon and had seen war up close. The lock in the family bathroom was fixed, having never been in working order for as long as I could remember. I have a particularly vividly memory of my mother telling me that I was not to walk around in a towel after a bath or shower, as that wouldn’t be something he was used to, since it was something women from his culture didn’t do. It has stuck with me, that conversation with my mother, because even though I had never been someone who did that [always being very careful to cover up, never leaving my room without either being fully dressed or wearing pyjamas buttoned to the very top], I felt that there was some sort of indirect implication that were I to walk around in a state of semi-undress M. could not be held responsible for his actions. That it was somehow down to me to make sure nothing untoward happened.

We also talked a little about something else that I even now find difficult to deal with: the fact that while my parents have never outright said that I am lying about what happened with M., they have both categorically and repeatedly said that “it couldn’t have happened”. The reason they have given for this is that they were acutely aware, taking him in, that he was volatile and somewhat mentally unstable, and couldn’t necessarily be trusted as there was a violent and unpredictable side to him, and – according to them – they consequently made an agreement to ‘make sure that us children were never alone with him’. This – the idea that we were never left on our own with him – is of course highly implausible and falls to pieces at first look: my father was working full time and my mother, while being a stay-at-home mother at the time, certainly wasn’t ever someone who would be keeping her children in her sight at all times. We had always been allowed to roam free, and her own bipolar ups and downs would have had her sufficiently preoccupied to often not know where we were, or who we were with. And I know for a fact that I was regularly sent over to the guest house [where M. was staying] to fetch him. I know this because M. would often pretend that the intercom system wasn’t working when I rang to let him know dinner was ready, and my mother would tell me to not be so lazy and to just go over there and tell him myself..

Z. made a comment about this, about my parents deciding to take someone in who they apparently knew not to be safe, in spite of having three fairly young children at home. She wanted me to talk about how I felt about this, but, while I do have a lot of feelings about it, I simply didn’t feel quite able to, or – perhaps more accurately – didn’t feel quite ready – to express them.

I am not sure why my parents – who have no problem believing that their own son sexually abused me for more than twelve years – are so adamant that the abuse M. subjected me to could not have happened. Maybe the thought of having twice missed something like that is simply too much? Maybe the knowledge that he wasn’t safe, and the subsequent sense of guilt at not having protected me, stops them from being able to acknowledge – even to themselves – that it did happen? People often defend the hardest against the things that cause them the most pain, and I don’t think my parents are all that different in that respect. I have a few additional theories about their reasons for flatly denying what happened, all of them excruciatingly painful for all involved.. but, for now, I think I will keep the more probable ones to myself, as I don’t feel ready to deal with them just yet. I have on occasion talked to A. about it, but I feel that this blog is perhaps not the most appropriate place for me to explore it further. At least not for the time being.

After session, Z. walked me all the way through the building and across the parking lot outside, only saying goodbye when we got to the street, having first asked me how I was going to get home. It gave me the sense that it really mattered to her, all the things that have happened to me, all the fear I am carrying with me.

And that felt very special to me; very different to anything I have experienced before.

Sharp eyed readers will have noticed that I have made no commented in this post as to whether or not the person I met really is M., or just someone who looks like him. The reason for this is that in so many ways it doesn’t matter whether it is really him or not. In my head it is him, and that’s what I am reacting to, so that’s what I have chosen to write about: my experience of what is going on. Whether the threat is real or not, the fear certainly is..

Trauma Focused Counselling, Psychoanalytic Therapy & Bridging The Gap

Posted by What It Takes To Be Me in Abandonment Issues, Attachment, Counselling with Z, Expressing Emotion, Personal Growth, Psychology, Psychotherapy, Psychotherapy with A, Sef-Awareness, Sexual Abuse, Suicide, The Therapeutic Relationship and tagged with breakdown in therapy, bridging gaps, building bridges, childhood sexual abuse, corrective emotional experience, corrective experience, counselling, expressing emotions, expressing negative emotions, fear, fear of being too much, fear of breaking people, fear of breaking therapist, fear that therapist can't cope, impasse in therapy, personal growth, positive corrective emotional experience, positive corrective experience, psychoanalytic psychotherapy, psychology, psychotherapist coping with suicidal clients, psychotherapy, self-awareness, sexual abuse, short term counselling, suicide attempt, the therapeutic relationship, therapist coping with client suicide attempt, therapy, trauma focused counselling Monday, September 30, 2013

By now I have had nine sessions with Z. Only, it’s turned out very different to what I had thought it would be. Two sessions ago Z. said that she felt concerned about us doing deep trauma-focused work, said that she wasn’t sure it would ultimately be to my benefit if we started unpacking memories that would undoubtedly cause a lot of pain, when we have so very few sessions together and might not have enough time to get any closure. She also said that she was unsure if we should do all sixteen sessions as planned, or if we should perhaps instead spend a few sessions thinking about how the work we have been doing so far could be brought back into A.’s consulting room. Or, Z. added, maybe what we need to do is look at sorting out a referral to someone else, someone who specialises in trauma-treatment, but who – unlike herself – could offer long-term therapy?

All this came as a bit of a shock to me, because, after all, Z. had been handed my referral and would have known the extent of trauma I have suffered, and she also knew the premises we were working on from the outset: sixteen sessions, no more, no less, unless I decided to cut counselling short. Of course, intellectually I can appreciate the concerns voiced by Z., but it was still a tough one to take in. Also – perhaps more importantly – I know myself fairly well, and I could see right away that no matter how much intellectual sense this proposal made, it would only be a matter of time before those deep seated, fear infused questions started popping up in my head and heart: Was that really the reason why Z. wanted to cut counselling short? Maybe this was just what she was saying, because she didn’t want to tell me that I had once again become ‘too much’? What if the real reason was that the stuff I had shared already was more than she could cope with? Needless to say my internal Here-We-Go-Again alarm bells were going off like crazy.

Of course, the rational part of me knows that it is unlikely that Z. would lie to me, or that – given that working with trauma is What She Does – the bits and pieces of trauma I had let her in on would be too much to cope with, but as we have seen time and time again, intellectual understanding and emotional response rarely go neatly hand in hand in perfect harmony. As I said to Z.; in many ways it doesn’t even matter what the real reasons for not doing the full sixteen sessions actually are: ultimately it will almost certainly become cemented in my mind as further proof that I’m ‘too much’. Or, even, that I’m not really worth the hard work that is involved, because, after all – everyone else gets their sixteen sessions, and they’re all trauma clients, too. So, this must be something specific to me.

I told Z. that, although I’m nowhere near as invested in my relationship with her as I am in my relationship with A. [yet], an experienced rejection of this kind would still bring all these fears to the surface in a way that I don’t think would be particularly helpful for me, as it would only serve to reinforce the idea that no one can truly cope with me. That no one wants to hear my story.

I feel quite pleased with myself that I managed to share these thoughts with Z., that I didn’t do what I would have done a few years ago: bury all feelings as deeply as I possibly could, right at the very edge of my conscious mind, and just accept Z.’s suggestion to end counselling early – with a bright smile plastered across my face to hide the invisible tears, to boot. I’m glad that I instead decided to ‘fight back’. [Especially as Z. told me in today’s session that we have another seven to go, which means we will be doing the full course.]

The two sessions since Z. suggested stopping short we have spent, in part, at least, exploring what this proposition of Z.’s has done to me and how it has made me feel about Z. I’ve also explained that I am not looking to find a new therapist; I think it is crucial that I somehow find a way to bring the work I have started with Z. back to my sessions with A., both to allow me an opportunity to discover that I can overcome my fear of breaking people [and perhaps even of breaking myself], and for A. to rise to the challenge and earn my trust back, so that I dare once more take a chance and share some of the truly awful things that happened to me. To, in a sense, come full circle.

A.’s and my story began a little over four and a half years ago. It took me a good year of testing A. in a million different ways to make sure that she was for real before I even considered talking about anything much at all. After that another two years were spent slowly slowly building a genuine relationship. I began trusting her, tried to open up even when I was terrified to do so. And then in year five of therapy – boom – something went quite badly wrong. Both A. and I hit a wall, full speed, from opposite sides, and whatever trust there was got seriously dented as a result. And that’s where we are at now: we are both still in recovery mode.

What I would like to add to our story is a final phase where I get to experience that mutual trust can be rebuilt. Both that I can start trusting A. to ‘hold’ me again, to feel safe with her, to know that she can cope hearing about the things that happened to me, but also that she can regain her trust in me. It would be unrealistic and unfair to suggest that the breakdown and subsequent dent in trust was experienced only at my end; I can absolutely see that the act of nearly killing myself earlier this year, put a dent in A.’s trust in me, too.

This is the main reason why I don’t want to look for another long-term therapist, even if she happened to be specialised in trauma-focused work. I feel that the positive corrective emotional experience needs to happen in my relationship with A. The circle needs to be completed in a single relationship.

I do feel that the work I have been doing with Z. – both the trauma work and the work we have been doing in the last two sessions – has been helpful to me. It has made me try to, ever so gently, bring some of the feelings around the abuse into my sessions with A., to lower my guard that little bit more, and it has also helped me be a lot more direct in the way I communicate with A. about our relationship. I do a lot less tiptoeing around. I still feel that I want to complete all sixteen sessions with Z., because I think the time left could be well spent building bridges. I also think it’s been quite healthy for A. to see how I have responded to a very different type of therapist/counsellor, and I think it has made her reflect on the way she works with me, and what may or may not be useful in our work. I don’t mean that this has been a forced response to a threat of If you don’t do things MY way, I’ll find another therapist, because I don’t feel I have issued such a threat – the decision to do trauma-focused work outside of therapy was made before A. and I hit that wall, had been discussed in my sessions with A. – but that it’s happened naturally, on a genuine feeling level.

There is still a long way to go, for both of us, but I think we will get there in the end.

PS. Following my last two posts I have (a bit surprisingly) had more than one email asking if Z.’s real name is Zoe Xxxxxxx, so I thought I’d state once and for all that NO, it isn’t. Z.’s name doesn’t even begin with Z, I just randomly picked it because her letter was already in use. As I’ve said before, I do always take as much care as I possibly can to mask other people’s real identity, and this includes the identities of my counsellors and psychotherapists. :)

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