Tag Archives: psychotherapist coping with suicidal clients

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 , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

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,

 

xx

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 , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

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.

xx

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. :)

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 , , , , , , , , , , , , , , , , ,

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.

xx

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!

Putting Feelings Into Words

Posted by What It Takes To Be Me in Anger, Anxiety, Attachment, Boundaries, Countertransference, Expressing Emotion, Psychology, Psychotherapy, Psychotherapy with A, Rejection, Suicidal Ideation, Suicide, The Therapeutic Relationship, Transference and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

I am not someone who commonly contacts my therapist between sessions; the resentment I always felt towards those of my father’s clients who did so has heavily enhanced my desire to not be That Client. In fact, I have only done so twice before. Once after a friend of mine killed herself right before a final session before a break, and once, earlier this year, after a session where I was simply overcome with anxiety about having broken A. and feeling sure that I had finally become too much for her, because something in session had made it seem she wasn’t really coping. But, following the session I described in my previous post, in which A. had told me that she couldn’t work with me under the threat of suicide I made a very conscious decision to write her. Below is that email.

 

*

Dear A.,

It’s late Saturday evening and I find myself feeling like my head is still spinning from trying to make sense of what happened in our last session. I decided already yesterday that I would sit down and try to write down my thoughts over the next few days and send them to you on Sunday; I felt it wouldn’t be a very wise thing to do, sending off a rash email before I have had time to sit with all of this for a little bit. Also, I figure sending it on Sunday gives you two days to think about what I’m saying, should you want me to come for session on Wednesday, so it’s fair on you too.

This is what you said on Friday: ‘I can’t work with you under the threat of suicide’. This is what I heard you saying: ‘I won’t work with you if your level of distress passes a certain point. It’s now got to that stage, and I can’t handle it.’ If I allow my mind to wander a step further it would go something like this: ‘This is too much, too scary, and I don’t want the responsibility. She has become too much for me. I’m out of my depth and I don’t know what to do. I want out, but I don’t want to be the one to end therapy, so I’ll give her a ‘choice’ which is almost impossible to go along with. ‘

I know you said in session that you didn’t know how I might react to what you had to say, but you’re an intelligent person, and it seems reasonable to assume that you must have realised both that this would have a really big impact on me, and have thought of at least one or two scenarios of how I might interpret it. Considering how fear of being ‘too much’ for people and the constant worry about breaking people have been major themes running through the last four years of therapy, it doesn’t take a particularly big leap of the imagination to see that this statement of yours would be experienced as direct proof that I have once again managed to become too much for someone..

Like I said to you in session, this does feel incredibly unfair. In the last four years I have been trying to open up, to stop holding back and to overcome this fear of breaking people – to trust that you can cope, even – and now that I have taken this step, you tell me you can’t work with me. When I have asked you ‘Are you OK? Can you cope [with what I bring to session]?’ you’ve consistently opted to not answer, and then suddenly you give me what you present as a choice, but which to me feels increasingly more and more like a black or white ultimatum. ‘Either you stop being suicidal, or therapy stops’.

I do understand that you are in a very difficult situation and I can easily imagine how very stressful it must be to work with me, especially when I’m dipping like this, I really can. However, I’m not sure exactly what prompted you to make the decision to give me this ultimatum now, because I honestly can’t recall having said anything in the previous session that I haven’t said before. I remember saying that ‘it feels like everyone knows how this is going to end’, but that is something I have said many times in the past.

Were I to venture a guess I would say that it may have been my arriving late for the first session after the break that was the trigger. The fact that you commented on it, makes me think that this was possibly (and, if so, understandably) quite frightening for you, seeing as I had previously made it clear that if I ever don’t show up for a session you’d have good reason to think I’ve taken drastic action. I’m not sure if you believed me when I said that the reason for my lateness was that I used a different route (since I was staying at Drayton Park), and I simply miscalculated how long it would take to get to your place, but that really is the truth. I wouldn’t be so cruel as to be late on purpose solely to test how you’d react, and I would never play games like that with you; I have too much respect both for you as a person and for the work that we do, to do that.

I have to admit that I feel upset about your decision to tell me this on a Friday, knowing that it’s the longest possible time before the next session. I also cannot for the life of me understand why you would wait until after I had been discharged from Drayton Park to have this discussion with me, rather than doing it while I was still there, taking advantage of the fact that I wouldn’t be going home to try to deal with this on my own, but would have people around me who could offer support. This seems especially strange, seeing as I told you that my stay at Drayton Park had been extended until Monday because I knew that the first session back might leave me feeling vulnerable and unstable, since things between you and I had seemed rocky before you went on leave.

As I said before, I can absolutely understand that it must be really hard to deal with me, and it may well have left you feeling you couldn’t cope working under those circumstances, but surely there must have been other ways of doing this? Rather than, for example, making it clear that ‘If you tell me that you are intending to kill yourself, I will have to contact your GP/crisis team/have you sectioned etc..’ (thereby taking some steam off of you), you went straight to ‘If you’re suicidal, I can’t work with you’.

I have no problem with you looking after yourself; if you feel you can’t work with me when things are like this, then – absolutely – you should raise that point. Of course a therapist both needs to and should look after herself, I take no issue with that at all. But, what I do feel has been done quite poorly is the fact that you drop this bomb in my lap without doing anything at all to ensure that I am as safe as possible with it. You could have said ‘If you don’t feel you can make a promise to not kill yourself, I’m really sorry, but I won’t be able to work with you. It would be impossible to do this work. I know this will probably feel like a rejection and I am sorry about that. It’s not my intention to leave you feeling that you have become too much for me, but I do realise that it may have this effect. I may be able to refer you to a colleague, if that is something you would want.’ Or even something so simple as to pick up the phone, call the crisis team, who you knew I was still under, to let them know that you have just had a really difficult conversation with me and you want them to be aware of this as I may need extra support over the weekend.

I really don’t want our work together to end like this, and I certainly don’t want the take away message after four years to be that I’m too much even for the professionals, and that is what it would be, should we terminate therapy at this point. I know you would soon find someone else to take my slot, you’d move on and I would eventually fade and end up being a learning experience for you. I, on the other hand, would be left with the incredibly painful knowledge that I am too much even for professionals, and, really, if even my therapist can’t cope with me, what hope is there..?

I know that some of the things I am writing in this email will inevitably come across as wholly unfair, and I recognise that my assumptions of what is going on for you may well be entirely wrong, but at the end of the day, this is how I have experienced all of this.

You mentioned that I may need some time to think about what you have said and what choice I want to make, and I feel unsure of what the timescale for this is, and whether or not you are expecting me to come to session while I work it out for myself.. I don’t even know if I’m meant to show up on Wednesday or not.

I really do hope that we can talk about this soon and find a way forward, whichever direction that path takes.

xx

I Solemnly Swear Never To Be Suicidal Again? – An Entry About Fears, Promises & Honesty

Posted by What It Takes To Be Me in Anxiety, Attachment, Boundaries, Counselling with D, Countertransference, Depression, Expressing Emotion, Psychology, Psychotherapy, Psychotherapy with A, Rejection, Suicidal Ideation, Suicide, The Therapeutic Relationship, Transference and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

When I uploaded the previous post twenty days ago, I was fully intent on posting the next one the following day. As you can see, this didn’t happen. Instead I have been telling myself every day since then that ‘You really must get around to writing That Post today’, each day finding conscious and unconscious reasons not to do so.

I’m not always good with feelings, with dealing with them, I mean. Especially pain. I have a tendency to shut down, to frantically try and get away from anything that may make me experience emotional pain. And I do this even more so if I perceive that the pain is being inflicted by someone I respect and care about. In some ways I suppose this behaviour makes perfect sense. Who wants to feel pain? Who wants to feel hurt by someone they hold important in their lives? And, yet, looking at it from another angle, it is sort of strange, particularly from someone who has spent so much time doing therapy, where much of the work centres around exploring and examining pain, past and present, often inflicted by those we find hardest to blame.

So.. this will be a hard one to write. But, I felt that I owed it to myself to be brave, to not hold back, to be honest and let it all out. After all, that is why I have this blog..

The week I had been discharged from Drayton Park I arrived for my usual Friday session with A. I had a very specific question on my mind, one which had been eating at me for a while, and I felt I really needed to pluck up the courage to ask A. about it, in light of what had been going on both with me separately and in our mutual relationship lately. I never got a chance to ask the question, because once I had sat down, A. turned to me and said ‘There is something I need to say to you.’ Alarm bells went off all around my body. Last time she started a session that way was when she told me she was pregnant, and I could tell that this time it would be something possibly even harder to deal with.

‘I can’t work with you under the threat of suicide.’

Ten words. Like bullets to my heart.

I must have sat quiet for ten minutes, my world stopping in its tracks. I felt cold, nauseous, struggling to breathe. Thoughts were spinning in my head so fast it was impossible for me to grasp any of them for what seemed like forever. For a second I contemplated just getting up and leaving, something I have never done in my life, to anyone. But, the pain was excruciating, and I felt that I couldn’t take it.

When I finally spoke, the words that came out, as I was trying to blink away tears that weren’t even there, were a mere whisper; ‘I guess that makes one more person who can’t cope with me, one more person who I’ve become too much for, who I have pushed too far’. I couldn’t look at A. as I said it, because I was too scared of the force of my own emotions.

This fear of becoming too much for people, it’s been central to my therapy from day one. It’s been a ridiculously regularly recurring theme, something many hours have been spent turning inside out. I know where it stems from: that pivotal moment when I was seven and told my mother about what my brother was making me do, when I broke her, when I discovered that there was no one who could help, no one I could tell without running the risk of breaking. And ever since then, that fear has remained, has evolved into this enormous ball of anxiety that now encompasses a million different things that I believe I do, which ultimately drive people away.

Having said that first thing, suddenly there were lots of other things I wanted to say, thoughts I wanted to share, because apart from fear and pain a plethora of other emotions were descending on me at breakneck speed. I took a minute or two to try to pick them out, to separate them. The most urgent one was the feeling that this was incredibly unfair, because in the past several months I had more than once felt unsure of whether or not A. could truly cope with what I was bringing to session, and more than once had I openly asked her if she could. And each time she had opted not to answer. So I said exactly that, adding that it felt like she was going from zero to a hundred with no steps in between. Silence, silence, silence and then ‘I can’t work with you’.

After a few more moments of silence, from both of us, I asked her how she had imagined I might respond to what she had just told me. A. said that she didn’t know how I would respond. In frustration I said that that wasn’t what I asked, I asked how she had imagined I might respond, because in my mind, she is an intelligent person, and it didn’t seem that far-fetched that she might have pictured me hearing what she said as a form of rejection and as further proof that there is no-one who can cope with me, and that it would take me down the path of ‘If even my therapist can’t cope with me, then what hope is there..?’

Later she said, in her very gentlest voice ‘I’m giving you a choice’ and because I wanted to be fair to her and to the reality of the situation, I said that I could see that, and that I can absolutely understand that it must be incredibly difficult – frightening, even – to work with me when I am suicidal. Especially in light of what had happened only a few short weeks ago. And, yet, at the same time I couldn’t help thinking ‘How is this a choice?’ She was saying that she couldn’t work with me under the threat of suicide, but how could I possibly promise to not be suicidal? It’s not something which can be switched on and off with the push of a button. It felt more like an ultimatum; ‘Either you stop being suicidal, or therapy stops’. I was going through the options in my head, thinking that I would be willing to say almost anything – even if it was a lie – if only she would carry on working with me. But, I also knew that I really didn’t want to have to go down that road, because it’s perilous in nature; one which would inevitable and seriously impact whatever work we might do in the future.

I said to A. that if I did make a promise like that, wouldn’t that by default make the whole subject of suicide and suicidal feelings taboo? Because, how could I ever trust that I wouldn’t accidentally step over the line of what A. felt was too much, now that she had shown me that such a line did exist, not only in the realm of my fears, but tangibly right there in that room? Wasn’t it exceedingly likely to have the effect that if things got to the stage where suicide felt like an option, I might not be honest with her, might not share these feelings, for fear of what the consequences might be for my therapy? To this A. said that of course I would also need to think about whether or not I could work with her. This may have been meant to make me feel that this was a two-way street, but it only left me with the feeling that perhaps she was hoping that I would come to the conclusion that I couldn’t, thereby giving her an ‘out’. So, I said exactly what I was thinking: ‘I feel like I am being pushed towards terminating this therapy. And that is not what I want.’ To which A. said that I may need to take some time to think about all of this.

I was silent for a while, trying to come up with something – anything – that may be used to bridge the gap between what I felt A. was asking of me and where I felt I was truly at, and suddenly I remembered something D. – the counsellor I worked with before I started seeing A. – and I used to do when things were very difficult. We would make an agreement that I wouldn’t act out in any way between sessions, that I would always come to the next session to talk things through with her. And, because I had a huge amount of respect for her, I knew that if I did make that promise, there was no way I would break it. It’s just how I am. And, if I felt that I couldn’t make an honest promise, it wasn’t a case of ‘Well, then I can’t work with you’ but we would instead find some sort of middle ground, acceptable to both, and which, crucially, didn’t entail making false promises. I might admit that I felt unable to promise that I wouldn’t act out, but that I could promise that before acting out I would do X, Y and Z (ie call the Samaritans, speak to three different friends, do my nails, make a painting, write a chapter on my book, contact the crisis team etc).

Having explained this set-up to A. she initially wanted to know how that had made me feel and I told her that it made me feel contained, that it was a positive thing, this process of coming to a reasonable agreement, because it made me feel that I had some control. And also, that not only did I know that I wouldn’t break a promise I had made to D., I also felt confident that she knew I wouldn’t.

After a short pause A. said that she felt she had made her position very clear and that any promise would have to be for as long as we worked together, however long that may be.

It felt like she was pulling the rug from under my feet, like she was responding to my tentative suggestion of a possible solution, by immediately raising the bar, to make it impossible for me to make the promise she was after.

So, I left that session in a daze, feeling unsure if that was it, if that was the end of the road for our work together, not at all knowing whether her earlier ‘You may need to take some time to think about this’ extended only to this particular session, if she was expecting me to show up for session the following Wednesday, or if she wanted me to do my thinking at home, so she wouldn’t have to deal with my suicidality, which clearly could not be dissolved from one session to the next.

*

I am not meaning to make this storyline of my life into any sort of cliff-hanger, but I am exhausted and I need a break. There is a lot more to say about what has been going on in my relationship with A. and what has happened since this session, and I hope that in the next few days, I will be able to post an update of some sort.

Until then,

Be kind to your Selves,

xx

Being The Perfect Therapy Client

Posted by What It Takes To Be Me in Abandonment Issues, Attachment, Coping Strategies, Expressing Emotion, Flashbacks, Psychology, Psychotherapy, Psychotherapy with A, Psychotherapy with B, PTSD/Extreme Emotional Stress Disorder, Rejection, Sef-Awareness, Sexual Abuse, Suicidal Ideation, The Therapeutic Relationship and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

I know this is a bit like the London double-deckers; for a long time there’s not a single bus, and then there are five all at once. The Heinz Ketchup effect.. But, you see, one of my readers commented on the post I uploaded last night, and in responding to his comment I realised that it could well be turned into a blog post in its own right, so here I am again, updating my blog merely hours after my last offering. You’ve got to strike while the iron is hot and all that.. I hope you don’t mind.

Anyhow..
The comment was in reference to my mentioning that five years ago, following an initial psychological assessment, I was deemed to be too high risk and unsuitable for psychotherapy, and the commenter said that “From the posts I’ve read by you, you certainly seem like the sort of patient that therapists are delighted to have.” My initial reaction was to feel flattered by this comment, and I instantly thought that I rather agree, biased as I am; I do think I make a good client. I have a bit of a chequered past, quite a few things in my baggage – obvious material to work with so to speak – and I am also reasonably self-aware, rather analytically minded and fairly articulate. Not a bad prospect for a psychotherapist.

Then again, I am no different to any other psychotherapy client; I think we all want to see ourselves as good clients – interesting, intelligent people – who therapists are happy to work with. And we all wish to be the favourite client, the one our therapist is really looking forward to seeing, because we challenge them just the right amount without being burdensome or draining. [If you’re in therapy yourself, I’m sure you will know what I mean.]

Yet, having been turned down by the NHS for therapy I really struggled to find someone who was willing to take me on. Naturally I had to give up on the idea of getting free therapy on the NHS, but I figured that outside of The Service there had to be plenty of privately practicing therapists who would want to work with me.

In reality it took me quite a few months to find a therapist. I had to go to many ‘first appointments’ and found myself being repeatedly rejected. Many of the therapists I saw, said exactly what the NHS assessor had said; that I was simply too high risk, what with my recent serious suicide attempt and my habit of using self-harm as a coping strategy. And I can understand that. I imagine it can be quite challenging – scary even – to work with, and in a sense – be responsible for – a client who may well choose to down a litre of anti-freeze rather than turn up to session. Naturally, not everyone will be up for that. But, at the same time, the way I always saw it – and I would always make this clear at assessments – I’ve always seen therapy as the way forward for me, the thing which will eventually help me manage my past in a more positive way, and also – while I have many times become depressed while in therapy, I’ve never made an attempt to end my life when I’ve been in therapy or had counselling. That has only ever happened when I’ve not had a place to take my thoughts and emotions, when I’ve felt I’ve not been able to share what’s going on for me.

The other reason given to me, when therapists declined taking me on, was that they felt they simply didn’t have the experience they needed to be able to work with someone with such a complex background. There are quite a few aspects – issues, if you will – to work on; I was adopted, so a high potential for major attachment and abandonment issues and possible identity crises. I was sexually abused and suffer from intense flashbacks of this, and so more than one therapist said that I should probably look for someone who specialised in this area, perhaps a therapist trained in EMDR or TF-CBT. I have one parent who is gay, I have another parent who has struggled a lot with the rollercoaster that is bi-polar disorder. So lots of different things to work on in therapy, perhaps too many, for some.

I also suspect, although I don’t know this for sure, that I probably came across as someone who might be a bit of a handful to manage in session, because I happen to be ridiculously well read on the theory of psychotherapy, particularly psychoanalytic and psychodynamic therapy, which was also what I wanted to do. I am not someone who will hold back on commenting if I feel that the therapist is ‘text booking’ me. And also, there is a definite barrier to get through; the fact that I often, knowingly or unknowingly, intellectualise and theorise in order to not have to deal with actual emotions. Hiding behind my theoretic understanding of things, so as to not really have to deal with anything. I don’t do it so much anymore – in fact, these days I tell myself off if I notice that I am slipping back into this pattern – but five years ago, that was certainly something I did a lot.

In the end, having tried for a good few months to find myself a therapist and failed, I asked the house therapists in the therapeutic community I had recently moved in to, to set me up with one of their trainees, because I felt I would never be able to get anyone to take me on on my own.

Long-term readers of this blog with remember that this turned out to not have been a great idea, as the person who was ‘assigned to me’ wasn’t a particularly good match for me and the chemistry just wasn’t there. Having thought it through, I ultimately decided to terminate with her, as I felt that I could probably carry on seeing her for years and still never get what I wanted from our work together. It wasn’t a decision I took lightly, but, I always felt it was the right decision for me. I’m sure B. – my previous therapist – is a great therapist; she just wasn’t the right one for me.

As it turned out, I actually managed to find a therapist that seemed a good fit for me before I had even let B. know for sure that I was going to move on. Almost as if by magic, I had completely by chance contacted two different therapy organisations, both of which A. happened to be affiliated with, and already the first time I spoke to her on the phone, I felt she could be the right person for me to be doing this very important work with. Going for my first initial appointment with her I was nervous, but also felt decidedly positive. I had a good feeling about it.

I have since asked A. how come she decided to take me on – thinking about the many people who had turned me down – and, although she slightly dodged the question in her funny little way, she did say that she never considered not taking me on. I am still not entirely sure why that was, but maybe she saw it somewhat similarly to how I saw it; I seemed like someone she could work well enough with me to give me a chance.

We’ve certainly had our moments over the years, A. and I, and I know that I can definitely be more than just a little challenging at times, and not always in a nice way, but I do think that we speak similar enough languages to be able to communicate well and to work things through. I also know that A. can stand up to me, and that she won’t be cornered or pushed around by my intellectualisations or red herrings, something I really appreciate. In fact, only the other session, she was challenging me and I commented that she’s asking very difficult questions, to which she responded Good! and we exchanged a quick smile across the room.
And I think that illustrates our relationship quite well.

I don’t know if I really am that magic Favourite Client, and by now that doesn’t even seem all that important anymore, but I do feel that we have a decent enough relationship that I could be.

And that’s enough.

xx

Talking Openly About Suicide

Posted by What It Takes To Be Me in Countertransference, Family, Friends, Psychology, Psychotherapy, Psychotherapy with A, Suicidal Ideation, Suicide, The Therapeutic Relationship and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , ,

I hadn’t meant to leave it this long, but life got in the way, in a very real fashion.

Two weeks ago my life was turned upside down; a decision was made about me which affects my entire future. It was made by someone who doesn’t know me and without meeting with me or even letting me know that this decision was being made –.

I don’t feel quite ready to write about the details just yet, because I am still trying to process it. Also, it is excruciatingly painful to think about, hurtful far beyond anything I have ever experienced before. If this decision were to stand.. well, it is truly major, life-changing, stuff, and has hit me straight in the heart.

The past two years I’ve been on a very specific path, and now someone has taken an enormous, big, black boulder and placed it on what was already a twisting, winding and steeply uphill path, completely blocking my way forward. And, sadly, this is not a stumbling block that I can simply scale or find an alternative way around – I am completely and utterly dependent on the person who placed it there to remove it.

Therapy has been challenging since my last post. The honeymoon is definitely over. For both A. and for me. But in a strange way, that is probably for the better. Although this has required me to be braver than I have ever been in my therapy before, has pushed me to open up more than I ever have, in spite of the very real fears I have regarding what that will do to A., it hasn’t been without benefits; two weeks ago, after three and a half years of seeing A., I cried for the first time in session. It wasn’t a massive cathartic kind of outpouring of raw emotion, but it was real and naked.

In today’s session I made myself be brave again, forced myself to talk about something that is incredibly hard to talk about, something which isn’t easy to broach in an open and honest way.
The last two weeks, ever since that boulder cut off my way forward, I have been carrying a piece of paper in my journal, which I have been wanting to give to A. but haven’t quite had the courage to do it, because of what the implications of handing her that piece of paper are.

For whatever reason, when I first began seeing A. she never asked to have my personal details – you know – address, next of kin, contact info for my GP – the usual stuff. She has had my email and mobile number, because I’ve emailed and texted her a few times, but no more than that.

Since this boulder was dropped in my way things have been, well, pretty dire. It wouldn’t be unfair to say that my life has been hanging in the balance. And although I am trying to challenge this decision that has been made, it has also forced me to consider the possibility that it may not be changed, no matter how many valid reasons there are for that to be done. And, everyone who is close to me, who knows what this is all about, also realise that if that were to happen – if that decision were to stand – well, it would amount to having the one thing that has always meant more to me than anything else being taken away from me. It would mean taking all hope from me.

And without hope, I can’t live. I don’t think anyone can.

I have talked to A. about this in session; that if hope is taken from me, I can’t go on, and I think that she, too, can see that this is a very very serious situation. I have told her that if what is about to happen were to happen, I would come to session and I would say goodbye – and it really would be goodbye. I have talked about ending my life before, and it’s never been done lightly, but I think this time, it is almost tangibly different, and I think it is obvious both to myself and to A. that there is a very real risk that this time, it could really happen. And, I think that the thought of that scares her, that it really scares her. I think it scares her nearly as much as it scares me.

So, today, when I finally gave her that piece of paper, a piece of paper which doesn’t look like much to the world; some contact details written on the back of a random re-used calligraphy practise sheet, it was a key moment in our work together. I explained to her how I had wanted to give her this piece of paper in the last two weeks, but that it has just felt too hard, because, of what went along with it; the reality that if I were to go missing – as many friends and loved ones as I have, and as often as I talk to them – my sessions with A. are really the only things which are regular enough to trigger a definite knowledge that something was amiss. The way I put it to A. was that, were I to not show up for a session – having not missed a single session in three and a half years – and, were I to not get back to her, should she ring to find out where I was, there would probably be good cause for concern; just reason to suspect that I have taken drastic action to end my life, that this time I probably won’t be coming back.

A. went quieter than she ever has when I was saying this. I mean, she doesn’t talk a huge amount generally, but this silence felt completely different, felt like she was holding her breath, unsure of what to do with this. Frozen. Not uncaring or distant, but in a paralysed kind of way. All the colour completely drained from her face. And it really frightened me, because I’ve never experienced A. reacting in that way to anything I’ve said in all these years.

I can understand it; as I’ve said many times before, therapist or not, she is only a person like everyone else, and having worked with me for as long as she has – as closely as she has – of course it would be extremely frightening to hear me, in so many words, put her in a position where she would be responsible for raising the alarm that I may have killed myself, to make the decision to send police round to my place.

I know that having a client kill themself is every therapist’s worse nightmare, and yet, the nature of their chosen profession means that they necessarily have to find a way to stay with a suicidal client, in the hope that they will never have to deal with an actual suicide.

I truly regret having to put A. in this position; it was not an easy thing to do – I care about her, deeply – of course I do – and I worry immensely about what it may do to her, were she to have to actually do what I am asking of her.

But I had to have that conversation with her. There was no way around it.

I did make it very clear that I am not going to kill myself today or tomorrow or even at all, unless I know that all possible avenues of having this decision, which has brought me to this very sharp edge, have been exhausted. That I would not do it without knowing that all hope has been truly extinguished.

I’m not sure that made A. feel any better, but, maybe, at least for a little while, she can rest more easily.

Maybe I can, too?

xx