The February Post – Anxiety…

Posted by What It Takes To Be Me in Anxiety, Being Alive, Medication, Panic, Psychology, Psychotherapy, Psychotherapy with P, PTSD/Extreme Emotional Stress Disorder and tagged with anxiety, anxiety attack, attachment based psychoanalytic psychotherapy, February, flashback, flashbacks, medication, medicine, panic, panic attack, Post-Traumatic Stress Disorder, psychology, psychotherapy, PTSD, sexual abuse flashbacks Tuesday, February 27, 2018

Anxiety. That’s the word of the month for me. Not just the usual anxiety that I struggle with, about clearly identifiable things like ‘Will there be a horrible brown envelope from the DWP in the post today?’ or ‘What if the new flatmate turns out to be really scary?’, but that awful non-specific thing we like to call generalised anxiety. It been coming over me out of nowhere several times a day, gripping me with its icy cold claws, digging into my skin, even my soul – and there is absolutely nothing I can do about it. My heart pounding so hard and fast it makes me think that there is a genuine chance it might explode in my chest. That sense of doom, of just knowing that no matter what I do, something very very bad is going to happen, and there is no escape. That horrible fizzy feelings behind my knees that makes me feel simultaneously completely paralysed and as if I can’t be still for even a second.

That. I’ve had an awful lot of that this month.

In therapy P. and I try to slow things down, try to work out what it is I am reacting to – but, unlike anxiety about something tangible and definable, this fuzzy whizzing fog of fear won’t be so easily captured and analysed. Of course we know that if there are a lot of things going on for me, I am much more likely to experience these episodes of panic and anxiety – but more often than not, it feels as if it’s been triggered by something so microscopically small that we can’t even distinguish it with our emotional super lens trained directly on it.

I can’t remember a time where I’ve suffered quite so much with anxiety (that wasn’t caused by something specific). And this constant fighting off an unseen enemy is exhausting. Recently I have even been considering whether or not I may need to look into getting prescription meds to help me manage it all.

Now, I know that many people have strong feelings about the use of medication to treat mental health disorders. Some feel they are an evil that should be avoided at all cost, while others say that they are absolute life savers. Personally, I am not for or against using meds. I have not been on any kind of medication for a very very long time – but the reason for that is that I have had some very severe adverse reactions to a number of drugs (both ones to treat physical and emotional ills), and for that reason my GP is very reluctant to start me on anything I’ve not been on before. Also, the one psycho-pharmaceutical I have ever been on without having one of those aforementioned severe adverse reactions happens to be one that is frighteningly high on the toxicity index, so – owing to a proven tendency to not stick to agreed safe dosages – I am rarely allowed to have even that. But, as I said, at the moment the anxiety is so bad that I am seriously considering trying to persuade my GP to let me have some sort of anxiety reducing chemical prescribed. (I’m not terribly hopeful that she will agree to do so; she once told me that she ‘doesn’t prescribe sleeping tablets for sleep’ in an attempt to not have to prescribe me an untested medication).

This kind of anxiety is kind of new to me. Or, at least having such frequent episodes is. I’ve had panic and anxiety attacks before, and I am a pro at getting exceptionally anxious about anything that could possibly go wrong – but I’ve never had multiple episodes every day. I am very used to suffering from PTSD flashbacks – I have those all day, every day – but this is something very different. As horrible as the flashbacks are (and they really are truly disturbing, each and every one of them), at least once I have managed to come out of them, I know what they were about; there is a distinct traumatic event attached to each one of them. But these anxiety attacks.. I really don’t know what to make of them.

Of course P. and I will continue to explore them, and hopefully they will get better. But for now.. it’s really tough.

Anyway, I think I’ll end this post here. It’s not quite the update I would have liked to write, – but I guess it is what it is.

To all of you out there,
be good to your Selfs

I Survived A Therapy Break

Posted by What It Takes To Be Me in Abandonment Issues, Anxiety, Attachment, Being Alive, Communication, Drawing, Expressing Emotion, Expression Through Art, Personal Growth, Psychology, Psychotherapy, Psychotherapy with P, Separation-Anxiety, The Therapeutic Relationship, Writing and tagged with Adult Me, allowing all of yourself in therapy, anxiety, attachment based psychoanalytic psychotherapy, attachment issues, attachment-based therapy, Community, crisis resolution team, crisis team, CRT, drawing, experiencing emotions, expressing emotions, expressing through art, Little S, psychology, psychotherapy, psychotherapy breaks, separation anxiety, separation-anxiety, surviving a therapy break, the therapeutic relationship, therapy breaks, transitional objects in therapy Friday, April 21, 2017

We’ve been on a break, my therapist and I. A Pesach / Easter / training combo break. Leading up to the break I was very aware of Little S. inside having a lot of feelings about P. going away. This, even though, I – or should I write we..? – were also going to be away for almost the entire break. There was an increased and very distinct need for emailing and texting P. to make sure that she was Real.

I think that what Little S. means by someone being Real is a combination of them not forgetting her when she’s not with them and for them to not abandon her when things get rough. But, at times it is also a way to express genuine fear that maybe the relationship with the other person is too good to be true, it is asking for reassurance; are you Real, or just a figment of my imagination, because it seems so unbelievable to me to have someone who is really there for me when I need them.

A break always brings out a lot of abandonment issues, especially for the Little S. part in me. From Adult Me’s vantage point this makes perfect sense, I understand why this happens; so many people in my life haven’t been there when I’ve needed them the most, so, naturally, when someone as important to me as P. declares that she’s going to be away, it is bound to trigger all manner of emotional echoes inside me. But, as much as Adult Me can see this, it doesn’t actually make it any easier for Little S. to deal with the anxiety and sadness that these separations inevitably bring to surface. To Little S. the worry that P. might be going on a break because she has been too much for her is very real, as is the fear that P. might – during the break – realise that she prefers not to have to deal with her ups and downs, her neediness, her constant need for reassurance.. Before a break the tension inside Little S. will keep building, until she is convinced that a) there is no way she can survive this break and b) that, should she through some form of miracle survive, there is no way that P. will ever choose to return.

A few years ago, back when I was still seeing A., I would never ever talk about any of this directly with her before a break. I would suffer in silence, and maybe – very maybe – mention it after the break was over, although generally in a very brief glossing over kind of fashion. Before a break, I would just feel the anxiety mounting, bring me closer and closer to breaking point, but I would not really acknowledge just how difficult breaks are for me. This, of course, lead to breaks being absolutely catastrophic in my mind, and it was extremely rare that I would not need to be working with the crisis resolution team during them.

In the first year or so of seeing P. I slowly and very gradually became better at talking around the subject of breaks, slightly dipping my toes in it, so to speak. I would talk about it in the way Adult Me sees it, intellectualising it, rather than actually feeling it. In part this was because I didn’t really know how else to approach it; intellectualising difficult feelings, analysing why they are triggered, rather than actually feeling the feelings, is how I have got through an awful lot of difficult times; it is a well beaten path. But, as I have been working more and more closely with P. to try to notice that there are feelings stirring inside, and to identify what those feelings are, I can now fairly often allow myself to stay with them.

The other part of why – back in the early days – I didn’t really talk about the feelings was that many of those feelings [particularly the ones to do with abandonment and separation, and the shame of needing someone else] belonged more to Little S. than to Adult Me, and Little S. hadn’t yet found her voice. Or rather, I hadn’t yet found a way to allow Little S. to express herself directly in our therapy. But, eventually we cracked it; first by letting Little S. email and text P. between sessions and then by Little S. speaking directly to P. in sessions [as opposed to through Adult Me]. It’s been a long journey, but I do feel that Little S. is now reasonably able to take part in therapy when she wants or needs to.

So, this time around, on top of the many emails and texts asking P. if she is Real, she was also able to not only talk about her feelings prior to the break, but she was able to experience them while she was talking about them. And that felt like a very big step forward.

The break in itself actually went quite well this time. Of course we all missed seeing P., and there were a few times when either Little S., bob, or Adult Me needed to email P., but there wasn’t quite as much anxiety to deal with as there might have been, had we not been able to experience and explore some of the feelings before the break, had P. not helped me make space for these feelings to be not only shared, but also heard. P. doesn’t ever make me talk about difficult feelings, but she does actively encourage me to try – and we set the pace together. She makes it very clear to me that it is safe to allow feelings out, that she wants to hear about them, whether it be in session or in an email, a text or in a drawing. And, possibly most importantly – especially to Little S. – she reassures her that she will be able to bear those feelings, that they won’t be too much, and they won’t result in P. no longer wanting to see her. That feeling and talking and talking about feelings is very much welcomed and valued in our relationship. Even when it’s scary. Especially when it’s scary.

Another thing that P. and I do to help Little S. manage during breaks and particularly difficult times, is to let one of P.’s ‘little friends’ – a soap stone hippo called Ringo [*not his real name, gotta protect his privacy!] – stay with me. I will also leave something of mine with P. to further strengthen the sense of connection between us during the break. As Little S. would say: “Something to help you ‘merember’ me, in case you start to forget.” It may sound like a childish thing to do, this exchanging of personal artefacts, but, Little S. inside is just that – she’s little – she may live inside the body of an adult, but she still finds comfort in having something physical to hold on to help her connect with P. So, no matter how silly it may seem to outsiders, taking Ringo with me everywhere I go, it makes all the difference in the world to Little S. And that’s worth a lot!

So, when you’re facing a break in your therapy, here is my advice to you: listen to what all of you need to make that break as bearable as possible. Don’t allow your Adult Self to stop your Little from getting what they need to manage it. To the best of your ability, talk about the fears and worries that all of the different parts of you carry about this break. Write it in a letter if it is too hard to say it out loud, if the fear of rejection gets too much. And if needed: ask if Ringo can come stay with you. And, if asking for a Ringo to stay with you feels too much; start small. I was given this tip by one of my readers many years ago, and at first, having something personal of P.’s felt way too overwhelming for me, so we started by my borrowing a random pen of hers that I could use to write in my journal with. And a little note from P. to help reassure me that she wouldn’t forget me and that she would be back.

But now that I have worked my way up to having Ringo stay with me, I wouldn’t have it any other way.
And neither would my sisters’ kids!

Be good to your Selfs.

A drawing Little S. made last night to show how happy bob, she and Adult Me feels that P. is finally back

Starting Over After A Break

Posted by What It Takes To Be Me in Abandonment Issues, Anger, Attachment, Defence Mechanisms, Expressing Emotion, Inner Conflict, Psychology, Psychotherapy, Psychotherapy Breaks, Psychotherapy with P, The Therapeutic Relationship and tagged with " reasoned Little My, abandonment issues, Adult Me, anger, attachment, expressing anger, expressing emotions about psychotherapist, expressing negative emotions, fear of being abandoned, If you're angry you're angry, inner conflict, Lilla My, Little My, Little S, Moomin Valley, Mumindalen, Om man är arg så är man arg konstaterade Lilla My och skalade sin potatis med tänderna. Man ska vara arg ibland. Varenda knytt har rätt att vara ilsket, Pappan och Havet, peeling her potato with her teeth. "You're supposed to be angry from time to time. Every little creature has that right.", psychology, psychotherapy, psychotherapy breaks, starting over, starting over after a psychotherapy break, the therapeutic relationship, therapy breaks, Tove Jansson, trust, trusting the therapist, trusting your therapist, withdrawing, withdrawing from therapist Wednesday, September 3, 2014

“Lily, oh Lily – I don’t feel safe
I feel that life has blown a great big hole through me.”
And she said,
“Child, you must protect yourself,
You can protect yourself;
I’ll show you how with fire..”

I have had my first two post-summer break therapy sessions now. And it has felt, well.. strange. Both on Monday and today I found myself uncharacteristically tongue-tied at the beginning of session. [I am often silent during the first few minutes of a session, but I don’t often feel that I can’t speak]. There were plenty of thoughts and feelings buzzing around, but I just didn’t seem able to catch hold of any of them to translate into words.

In the very first session I was initially completely overwhelmed by how powerful the relief of seeing P. was. I hadn’t expected to have quite such a strong emotional response. I could almost physically feel Little S. doing backflips in sheer joy at the sight of P. in her chair. Back where she belongs.

And, at the same time, there was a real urge to withdraw and protect myself from anything and anyone who wasn’t me. To go to my island, the one that is so tiny that it only has room for me. The one where I feel safe in the knowledge that no one else can get to me.

See, that’s the funny thing about Little S.; as happy as she was to see P., – and she was very happy – she is also naturally suspicious of others. Just because P. was back and everything seemed alright, it didn’t necessarily mean that Little S. would readily take that at face value. So, she went from being absolutely delighted to have P. back to ‘You disappeared on me, so I’m not quite ready to trust you yet’ in seconds flat. You see, Little S. is – as I explained to P. in today’s session – a lot like Little My of the Moomin Valley; there is only ever enough space for one feeling at a time and she can go from one to another in no time at all. One second ‘overjoyed that P. was back’, and then – boom – ‘suspicious that she might do another disappearing act’.

- Little My - "If you're angry you're angry." Little My reasoned, peeling her potato with her teeth. "You're supposed to be angry from time to time. Every little creature has that right."

“If you’re angry you’re angry,” reasoned Little My, peeling her potato with her teeth.
“You’re supposed to be angry from time to time. Every little creature has that right.”
[From Moominpappa At Sea by Tove Jansson ©1965]

P. suggested that maybe Little S. is quite angry with her – or even really angry with her– for leaving her to fend for herself while she went on a nice long break. As soon as P. said that Little S. – sensing danger at being called on her negative feelings – had to go into hiding, and Adult Me was left to explain that Little S. wasn’t quite ready to deal with those feelings yet, [“Little S. has left the building”] even if P.’s guess was probably spot on and Adult Me would have liked to have been able to talk about it, together with Little S.

At the beginning of today’s session, while still in Unable To Speak-mode, I became aware that there was a song playing in my head. It seemed unlikely to be chance that that particular song had decided to play, so I shared a few somewhat random lines from it with P.: “Child, take what I say with a pinch of salt, and protect yourself with fire”. At the time I felt very aware that I was leaving out two lines about feeling unsafe and being afraid, but as I am writing this now, I am thinking that maybe that’s not the end of the world? I have another session tomorrow, and if I want to, I can mention making that choice – so we can look at the reasons for consciously leaving those oh-so-revealing lines out, or I can leave it as it is, because even though I missed out parts of the lyrics, we kind of managed to touch on the themes of not feeling safe anyway.

We also spoke about feeling unsure if this need to protect myself through withdrawing [from P.] is something I – or at least Little S. – genuinely needs to do in order to cope, or if it is something I now do per automatik, unquestioningly and without thinking, because it is what I have ‘always’ done.

I suppose that this is a constant battle for me; striking the right balance between being mindful of Little S.’s needs, and challenging her to take tiny steps forward.. It is also, admittedly, a struggle at times to manage Adult Me’s frustration with the amount of time Little S. needs to take any little steps at all. I often find myself having to repeat the mantra that ‘baby steps are also steps’ to Adult Me, because if she had her way, she could quite easily race ahead at a pace neither Little S. nor Adult Me is ready to cope with..

All the very best,

Lily from the album The Red Shoes. This video features in Bush's short film The Line, The cross and The Curve.
Kate Bush © 1993

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,

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..

Encased In Ice Cold Fear, Trapped In Panic Mode – Upon Seeing A Ghost

Posted by What It Takes To Be Me in Anxiety, Counselling with Z, Expressing Emotion, Flashbacks, Panic, Psychology, Psychotherapy, PTSD/Extreme Emotional Stress Disorder, Sexual Abuse and tagged with anxiety, body memory, childhood sexual abuse, encased in ice cold fear, expressing emotions, Extreme Emotional Stress Disorder, extreme fear, face blindness, fear, flashback, flashbacks, panic, physical reaction, Post-Traumatic Stress Disorder, prosopagnosia, psychology, PTSD, seeing a ghost, sexual abuse, sexual abuse flashback, sexual abuse flashbacks, trapped in panic mode Thursday, October 17, 2013

I am feeling a little worried that this blog is becoming somewhat scattered, that there isn’t much of a red thread running through it anymore, and that it might be difficult to follow what’s actually going on with me, but sometimes, well, I sit down, fully intending to write an update on what I wrote about in the previous post, and it just feels like the moment has passed, and there are other – more pressing – things I feel a need to write about. Tonight is one of those times. There are two main things I feel I want to write about, so I think I will write two separate entries, to give you guys a chance to rest your eyes, hearts and souls a little in between sittings..

This Monday I went to my session with Z. as I usually do; a little lost in thought, trying to get into The Zone. The room I see Z. in is situated in a building which houses an entirely different kind of project, which is nothing to do with the counselling I am doing. In order to get to Z.’s room I have to walk through first a tiny reception area and then what seems to be some sort of dining hall. There are usually a fair few people in there when I arrive for my session and I generally just walk straight through it, not really paying attention to who is there. This time ended up being very different.

Sitting at one of the tables, right next to the door I needed to go through, was a person who was an absolute dead ringer for M., one of the people I was abused by. NOT the way he looked back then, but the way he would look now: older, heavier, but with those same eyes, the same way of looking at me..

I’m not really sure how to explain what happened, but it was as if my body reacted instantly to this person, before my brain had even had time to work out the reason for the reaction. I have prosopagnosia, a condition that is a little bit like being dyslexic, but with faces instead of letters; my brain simply doesn’t store the memory of peoples’ faces, and it is very, very rare for me to recognise people. Even people I know well, like my sisters, I’m unable to picture, when I’m not with them. But, somehow, with this person, my body reacted instantaneously, before I had even clocked what [who] my eyes were seeing.

All heat seemed to drain from my body at once, I felt ice cold, my heart was beating so hard it was painful, my legs went spaghettiose. I felt like I couldn’t breathe, and that I actually didn’t want to breathe. But somehow I managed to keep walking.

I made it to the stairs leading to the waiting room, and bumped into Z. who was coming down them. I could hear her greet me, and I know I said something back, ‘though I have no idea at all what I said. All I remember was that I thought my knees were going to buckle under me, and focusing ALL my energy on this tea cup Z. happened to be holding, because that was the only thing that seemed to not be spinning, that seemed real, safe. [Could write a whole essay on why it was the tea cup, rather than Z. herself, that seemed real and safe, but it seems of secondary importance right now.]

I got to the top of the stairs and into the waiting room and collapsed on one of the chairs, shaking from head to toe. My hands were trembling completely out of control. It is something that happens to me in moments of extreme anxiety or fear, and I tend to hide my hands so that no one will see it.

By the time I got into Z.’s consulting room I was in what I could only describe as a state of shock, unable to speak. I’m not sure how long for, it might not have been very long in real time, but it felt like an eternity. I felt like all my words were stuck in my throat, blocked by this horrible, unmeltable, icy lump of fear.

Z. at first assumed that it was an air freshener that had triggered this reaction in me, as in a previous session I had reacted to it, as it somehow reminded me of another, similar, smell that almost inevitably sets off a chain of flashbacks, so she went to open the window a little wider. I managed to let her know that that wasn’t it. I’m not sure if I actually told her, or if she asked and I just shook my head.

Eventually I was able to explain to Z. what had happened, who I thought I had seen. Who I felt sure I had seen.

It was such a strange sensation, all these extremely intense feelings, very similar to when I am having flashbacks, only I wasn’t in a flashback. I was reacting to something real. To someone real.

I tried to calm myself down, tried to tell myself that no matter how much this person looked like M., the odds that it was really him was very, very small, infinitesimal, really. But, somehow that just didn’t matter. I experienced a complete split between intellect and emotion, an absolute refusal to believe that it was just someone who looked like him: every cell in my body was telling me that it was him, and no amount of rationalisation or probability calculation could change that.

It was as if every single incident of abuse that he had ever subjected me to in the year or so he was living with us were washing over me all at once, like an enormous tidal wave, sweeping all rational thought from my mind, leaving me completely and utterly encased in ice cold fear, trapped in panic mode. I managed to tell Z. this; that I felt terrified, like the abuse could start over at any second, because in my mind M. was sitting downstairs, and he was always able to find a way to play his cruel games. It didn’t matter that there were lots of people in the building, or that Z. was in the room with me. He could do whatever he wanted, absolutely whenever he wanted to back then, and to me this was still true now. Z. tried to reassure me that no one could hurt me, that I was safe, and I could hear 8-year-old Little S ask “Am I?” in a tone drenched in doubt, so certain in the knowledge that there is nowhere in the entire world I am safe from him, as long as he is still alive.

I genuinely cannot remember feeling so scared or so panicked ever in my life, not since the abuse was actually happening. And that feeling hasn’t subsided. I feel like I am stuck in this horrendous place where my usual, reasoned, realistic way of dealing with things is completely helpless to shield me from my own feelings. I am trying my best to tell myself that it can’t have been him. And at the same time, in my head, it was. There was something about the way my body just reacted to seeing this person, that just makes it impossible for me to accept that it wasn’t.

I told Z. that I was scared of when I would have to leave that room and go downstairs again, even though on the way out I don’t have to go through the dining hall. Z. very gently offered to come with me, so I wouldn’t have to go on my own, in fact she offered more than once, but I had already switched into my ‘Let No One In, Trust No One’-mode, telling her “I’ll be OK. I’m always OK”. To which Z. answered that I certainly had come through a hell of a lot, but she also reminded me that there was no need for me to ‘Be OK’ in session or with her.

I did leave on my own. I’m not sure how. All I know is that as soon as I was out of the building and across the street, tears were streaming down my face and I had to stop twice to be sick before I even got to the bus stop.

I feel so frightened now. And I am scared about going to my next session. I want to go to it, but what if he is there again? I don’t know if I can cope with it. In many ways it doesn’t even really matter whether or not it really is him: the fear he instilled in me back then has returned with a vengeance, regardless of which it is.

I wrote Z. an email earlier this evening, asking could she meet me downstairs in the reception area next session, because it might help me feel a little less frightened if I know I won’t have to walk through the dining hall on my own. It is very unusual for me to ask for help. I am so used to always relying on myself to find ways of dealing with everything on my own, no matter how hard. But I was thinking about what Z. said in session, that there was no need for me to ‘Be OK’, and decided that it was better to ask than to push myself through more fear and anxiety than what is actually necessary.

I am sorry that this ended up being such a long post. I suppose there was a lot I needed to get out of my head.

Be kind to your Selves.

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. :)

The Beginning Of A Parallel Journey

Posted by What It Takes To Be Me in Counselling with Z, Expressing Emotion, Flashbacks, Personal Growth, Psychology, Psychotherapy, Psychotherapy with A, PTSD/Extreme Emotional Stress Disorder, Sef-Awareness, Sexual Abuse and tagged with childhood sexual abuse, counselling, expressing emotions, Extreme Emotional Stress Disorder, flashback, flashbacks, living with flashbacks, long term therapy, overcoming trauma, personal growth, Post-Traumatic Stress Disorder, psychoanalytic psychotherapy, psychology, psychotherapy, PTSD, self-awareness, sexual abuse, sexual abuse flashback, sexual abuse flashbacks, short term counselling, sibling sexual abuse, staying with emotions, trauma, trauma focused counselling Sunday, August 18, 2013

My most beloved transitional object

You may remember that a few posts ago I wrote about deciding to go ahead and do some short term specialised trauma-focused counselling, parallel to the psychoanalytic therapy I am already doing with A.

I set out on this journey four weeks ago and it’s been quite a ride thus far, but before I begin writing about said journey, let me introduce you to a new character: Z., my counsellor. I have to admit that when I met her the first time I wasn’t entirely sure about her. My impression was mostly positive, and I absolutely felt that she was someone I could work with, but there was also a little bit of fear that she might not be quite strong enough to resist my habit of luring therapists and counsellors alike down side paths and blind alleys. What I mean by that is that, in the past, back when therapy was something I was doing because someone else wanted me to do it [parents, doctors, psychiatrists], I was very very good at finding ways of showing up for session each week, skilfully avoiding doing any actual therapy.

What I did was to go in and talk about something entirely unrelated [I spent an entire year talking about ice-hockey and the LA Lakers with my first therapist], then dazzling them by intellectually linking whatever I had decided to talk about with psychotherapeutic theory. I realise, of course, that this was something I did because I simply wasn’t ready to engage in therapy, so in one way this behaviour is hardly surprising. But, at the same time, there was always a part of me that was deeply disappointed that none of my first three therapists ever pulled me up on my fairly obvious attempts at outsmarting them, and that they were instead, session after session, drawn into complex discussions about attachment theory, projective identification etc etc. I think what I was really craving was a therapist who would step into that pseudo-parental role, different to my own parents, steering a clear path in showing me that they were more interested in me than in my ability to spin intricate and dazzling webs.

It wasn’t until many many years later in my very first session with D. that a counsellor finally told me that ‘Although your knowledge is very impressive, it’s not why we’re here.’ Felt like hitting a brick wall at a hundred miles an hour and then being told that it’s pretty silly to go running at a wall, when there was a perfectly good opportunity here to learn to use the ladder that was leaning against said wall. I’m not saying that D. was necessarily the first counsellor or therapist to see through this game I was playing, or to understand the reasons for why I was playing it, but she was the first person to properly make me feel that she understood that I was absolutely terrified and that rather than allowing me to carry on defending against this fear by using intellectualisation she cared enough about me to want to help me step onto the ladder and do something different. There was no pressure to make it to the top of the wall in the time we had, but instead there was a lot of focus on acknowledging the achievement of making it onto the first step. Any subsequent steps would be a bonus.

So, knowing that I was about to begin a completely new type of counselling with Z., one which focused solely on the sexual abuse I suffered, one where talking about my parents, or being adopted, or the million other things that are part of my life and who I am, would play very little part, I was completely and utterly petrified. Thus, meeting Z. for the first time was a big deal. Naturally, meeting a counsellor or therapist always is, but I was very aware of the need to find a counsellor who wouldn’t gobble up deliciously smoked red herrings thrown their way, and so there was a lot on the line in that first meeting.

Coming out of that meeting, my general impression of Z. was – as I said earlier – mainly positive, there was still a part of me that felt concerned that her statement that she ‘wouldn’t push me to go somewhere I didn’t want to go’, might potentially indicate that she was someone who, if I wanted to, I could easily string along in an attempt to not only avoid having to go to painful places, but to avoid challenging myself to move forward at all. Like I said to my sisters after the first session: ‘Z. is someone I would have had for lunch 10 years ago’.

But the four and a half years of doing therapy with A., along with the counselling I did with D. prior to that, has made me realise how much there is to gain from doing my utmost to stop myself from going down that route. To, in a sense, stay on that ladder and keep climbing it. So, I knew that even if I was somewhat unsure of Z., I knew that I was different, as were my reasons for going into this counselling. Of course, as much as I try to consciously stop myself from hopping off the ladder, there may still be a fair amount of unconscious [or subconscious, if you’re so inclined] motivation for leading myself astray, hence, needing to feel sure that Z. would be able to spot this when I can’t.

In my second meeting with Z., many of my initial fears were laid to rest. She came to the second session with a very clear view of what she would like us to work on and helped guide me through it. This is very new to me; I’m used to doing psychoanalytic therapy, where I’m pretty much always in the driver’s seat, and it’s a real challenge to now, suddenly, let someone else co-pilot. There were some things Z. had wanted to do in the second session, which she soon realised weren’t quite right for me, as they were things I had already worked out and implemented for myself, and she swiftly adapted to this, changing course to suit my trajectory. This lead to something I would never in a million years have thought possible: already in session three I took a plunge and showed her a drawing of one of the abuse situations and talked about it. It was scary as anything, but was much helped by discussing – prior to me handing the drawing over to Z. – what I wanted her to do with it so as to not have a repeat of that session with A. where I interpreted her immediate return of a drawing as a sign that she couldn’t quite bear looking at the reality of the abuse. Instead, this time, we made the agreement that Z. would hold on to my drawing until I indicated that I would like to have it back. Z. also showed some initiative when she felt I was getting into my normal way of racing ahead through a story, as though I’m talking about someone else, with complete emotional disconnect, by stopping me for a while and asking me to reconnect and to tell her what talking about this made me feel. This is very new to me. Naturally, A. is also very interested in what I’m feeling, and often tags a ‘Can you say more?’ [one of my absolute favourite questions] or ‘Can you unpack that?’ onto something I have said, in order to coax more out of me. But, I’m not used to being actually stopped in order to reconnect several times during a session.

I had brought my beloved Doth with me to session. Doth, for those of you who haven’t had the pleasure of meeting her, is a porcelain doll I’ve had since I was a child. She was made by my best friend’s mother and she was the only person who knew about the abuse while it was going on; I used to sit with Doth, whisper in her ear the things my brother and M. made me do. So, needless to say, she is very very precious to me, and as childish as it may seem, I thought having Doth with me in session might make it easier for me to talk about the abuse, because, in a way, she has already heard it all. I felt regressing to that childhood ritual of talking to Doth about the awful things that were happening might help me overcome my fear of talking about the abuse for fear of breaking the listener.

I think this parallel work with A. and Z. has the potential to be a very good thing. I had worried that I might be spreading myself too thin, or that it would become too confusing working with two people at the same time, but for now it seems to work quite well. Also, the work I am doing with Z. is very short term, only sixteen sessions in all, and is by its very nature a lot more intense than the therapy I’m doing with A., and I am hoping to use my sessions with A. to ensure that I remain safe while I’m doing this very painful work. I have already noticed that I am again having more flashbacks than the norm, but this is something I had expected. As I told a friend of mine: ‘Doing this was always going to be a totally rubbish time’, but I am hopeful that it will ultimately help reduce the amount of flashbacks I have, and also, that it will help me go further with A.

Sixteen sessions, even if structured, is not a lot of time, especially given that I suffered abuse from more than one person, and that the abuse went on for as long as it did, so I am hoping that doing this with Z. will open the door to carrying on talking about the abuse with A. once counselling comes to an end, much in the same way that the counselling with D. set me up for actively trying to avoid throwing red herrings at A., and subsequently, Z.

In other words: onwards and upwards, one rung at the time.

Be kind to your Selves,

Where Do We Go From Here?

Posted by What It Takes To Be Me in Anger, Anxiety, Expressing Emotion, Psychology, Psychotherapy, Psychotherapy with A, Suicidal Ideation, Suicide, The Therapeutic Relationship and tagged with anger, anxiety, expressing anger, expressing negative emotions, fear of being too much, fear of breaking people, fear of breaking therapist, fear of rejection, fear that therapist can't cope, psychoanalytic psychotherapy, psychology, psychotherapist coping with suicidal clients, psychotherapy, suicidal ideation, suicide attempt, talking about suicide, the therapeutic relationship, therapist coping with suicidal client Wednesday, August 7, 2013

I have been meaning to upload this post for a few days now, have kept telling people that I was going to post an update in the next few days, but, for whatever reason, I just needed a little more time to think before writing it. As I wrote in a previous post, it hasn’t been my intention to turn this little therapy drama into any sort of cliff-hanger, I just simply wasn’t quite ready to write the update until just now, hence the delay. Nothing more to it.

A. replied very briefly to my email, acknowledging that she had received it and confirming that she was expecting me to come for session the following Wednesday. This was good; I wouldn’t have wanted her to respond to my email at length, I just wanted her to have read it and to have had some time to think about the things I was saying, so that we could talk about it in the next session.

I began that next session with a simple ‘So where do we go from here?’ thinking that that was open enough to invite some sort of mutual discussion. Instead my question was met with silence, and I felt instantly annoyed, because I had really hoped that A. would recognise the need to respond to me openly and directly, to engage in a dialogue with me, rather than to hang back and wait for me to say something for her to analyse. So, naturally, the next thing that came out of my mouth was dripping with frustration: ‘You know, it would be quite helpful if we could have an actual two-way conversation about this.’

We did have something of a conversation, eventually. Thankfully. Because, I think I would have walked out once and for all, had that not happened. My anxiety was sky high coming into that session, not knowing whether or not this would be the session where A. would tell me that she definitely couldn’t carry on working with me, regardless of whether or not I promised to not get suicidal again, because I was simply too much for her. And, also, there was tremendous fear that what I had written in the email would have a negative effect, or would be misunderstood, would have tipped things in the opposite direction of what I had hoped for. So, I really needed to be able to have a conversation with her about where we stood, what was going to happen, what the deal was going to be. I couldn’t have handled the not-knowing, the guessing, the excruciating uncertainty regarding the future of our therapeutic relationship.

A. brought something up which I had mentioned in the previous session, namely the idea that if I did go along with her request that would almost certainly mean that talking about suicidal feelings would become taboo. She told me that there were no taboos, that I was free to explore absolutely anything I wanted to in session – but – that I was not free to act.

I sat with this for a moment, because to me, this seemed quite different to what I felt she had said in the previous session. There is no way for me to know if this was what she had meant to convey in the previous session but had just expressed it in a somewhat clumsy way, resulting in me hearing something quite different, or if she had taken in what I had written in my email, and realised that what she had demanded initially was an impossible ask. All I know is that this felt different to the ultimatum-like choice she had presented me with the last time we met. So, that’s what I told her. A., of course, wanted to know in what way it felt different, and I said that this felt more doable, that while there is no way I – or anyone for that matter – can promise never to become suicidal, I can choose not to act.

I can’t say that I feel that we managed to talk it all out in that session, or even that we have in subsequent sessions. I couldn’t honestly say that this issue has been resolved. It still feels like it’s sitting there, an invisible but definite stumbling block between us. Whilst I acknowledged that I can make a choice not to act, I never made any sort of promise to A. that I won’t, nor has she pressed me for one. In some ways you could say that we have both just let it drop, allowed it to fall into that silent space between us, lost in the red pile of the Persian rug at our feet. I can’t help but feel that we are both working very hard at pretending that everything is back to normal, even though we both know that that isn’t the case at all.

As far as taboos go, do I believe what A. says, that there are no taboos? I suppose you could say that I do, or – perhaps more accurately – I believe that A. genuinely wants me to feel free to talk about absolutely anything, no matter how hard, no matter how sensitive. Have I talked about how I really feel since this happened? Have I been able to talk about suicidal feelings? About urges to act out? No. I am far too scared that I will say one thing too many and that consequently therapy will stop. In some ways I feel that all of a sudden I am doing therapy under the threat of termination.

Sharp-eared readers will have noticed that none of the discussions between A. and I have addressed the issue which felt most pressing as this whole drama unravelled; my deep-seated fear that I always end up being too much for people, and that I had pushed A. to the point where she couldn’t cope anymore. There is good reason for why I’ve not written about this; we haven’t addressed this at all. Neither my fear, nor any possible validity in my feeling that A. can’t quite cope has been talked about.

I have had a lot of comments and particularly emails about the last two posts, all of which I am grateful for, as they have offered many different angles from which to view what has been going on between A. and I. A number of readers have expressed a fair amount of anger at A.’s way of handling the situation, and as anger sadly isn’t a talent I have mastered, it has in many ways felt good to see others reacting in this way. And, at the same time, because I am a Worrier, it’s made me scrutinise what I have written, to try to ascertain if I may have unfairly painted A. in a darker shade of gray than was necessary. I would like to think that I have been reasonably fair in what I have written, yet at the same time I think it is important to remember that this blog is a stage which I share with no one, and as such only my voice gets heard, only my version of events gets told. A. has had no opportunity to put her understanding of what has been going on between us forward. Also, as I highlighted in my email to A., it is entirely possible that my assumptions about what has been going on for her are altogether incorrect.

One reader very helpfully pointed out that it may well have been that what A. was saying about not being able to work under the threat of suicide was less to do with not being able to cope with me, and more to do with the fact that a client’s suicidality can make therapeutic progress very difficult. This is something I agree with; a client’s suicidality, especially if acute, can doubtlessly make the therapeutic process suffer, may even make it impossible. I also agree that it is fair for a therapist to be clear about not finding a client’s acting out acceptable. However, I also feel that the way A. initially presented the issue to me, ie “I can’t work under the threat of suicide” suggested that it wasn’t so much that she felt that my suicidal impulses or acting out was a hindrance to the therapeutic process, as much as it was a case of her not being able to work under these circumstances, and this is what lead me to interpret her statement as indicative of her not being able to cope. She wasn’t saying that ‘The constant threat of you acting out makes it impossible for this therapy to happen, because it means your energy is focused more on the idea of being dead, than on being here with me and genuinely engaging with this process’, she was saying that she couldn’t work when things were this way.

But, of course it is very possible that I was taking her words a little too literally, maybe expecting too much of her in terms of expressing exactly what she meant in a “perfect” way, and – as I wrote in the email – there is a difference between her actual words and what I heard, and of course the things I read into those words come largely from my imagination, rather than from actual, factual knowledge or confirmation from A.

There is so much more to say about this, and I think this whole thing will take a long time to be fully resolved. But for now, this is where I will leave it.

For the time being I am still seeing A. Although, as I said earlier, there is still much left for A. and I to talk about, we have had some very good sessions lately. No, it hasn’t been addressing the stuff that is going on between the two of us, but they have still been very useful sessions.

I want to once again say thank you to everyone who has taken the time to email or comment on the last two posts. I am sorry that I haven’t been able to respond to all of you, but rest assured that I have read what you’ve written, and I very much appreciate getting your points of view. Whatever they may be.

Be kind to your Selves.

In the next episode of What It Takes To Be Me: I embark on a new journey as I dive head first into the world of intensive, short term trauma-focused counselling. Stay tuned!

By the way, we’ve just passed the 55,000 hits milestone since this blog was relaunched!
So THANKS to all!

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