Living Without Dying

Posted by What It Takes To Be Me in Acceptance, Being Alive, Coping Strategies, Depression, Expressing Emotion, Inner Conflict, Personal Growth, Psychology, Sef-Awareness, Suicidal Ideation, Suicide and tagged with actually dying changes everything, consequences of failed suicide attempts, coping mechanisms, coping strategies, Dr House, failed suicide attempt, house, live without dying, living without dying, nearly dying changes nothing, self-awareness, suicidal ideation, suicide attempt, Surviving The Present Sunday, May 1, 2016

My last post was in the main concerned with writing about what happened. This time I would like to talk about feelings. Or at least I would like to try to do that. I’m not sure that I will be able to, but I do want to try. So, here goes..

I know that I wrote in my previous post that my immediate reaction upon waking in the hospital was that I was glad that I had indeed woken up, that I was glad that I was still alive. And that is absolutely true. I was. In fact, I am. But, as always, things are never quite that simple and straightforward. Naturally there is a plethora of emotions surrounding the fact that I am still here today. And that is what I would like to write about today.

There were reasons for why I was suicidal in the first place, and surviving a serious intake of poison does not take any of those reasons away. All of the things I was dealing with before are still just as present now. In the words of the esteemed Dr. House: ‘Almost dying changes nothing. Actually dying changes everything.’

Although, I wouldn’t go so far as to say that I am back at the exact same place I was before, nothing has got particularly easier. Yes, the happiness about being alive does help, gives me some kind of energy to keep trying, to keep at it a little longer, but, that isn’t in itself a magic cure. In some ways, the very fact that I am happy that I survived actually complicates things. You see, for me, ending my life has always been a viable Out, a thought that has been been my constant companion throughout life; I genuinely can’t remember a time when I didn’t feel that if things got too bad I could always choose to get off the train.

But what happens when you wake up, having very nearly fallen off the proverbial train and you realise that you’re actually pleased that you didn’t? Well, it means that you are suddenly in a brand new and very special kind of Scary Place. You are in just as much unbearable pain as you were before, but suddenly you haven’t got that Out anymore. So, somehow you have to find a way to live, without the option of dying.

I am not saying that I have left the option of death as an Out forever behind – as I wrote earlier – nearly dying changes nothing – including that, I suspect. But, for now, this option has been moved from being constantly right there on the table, sitting right next to my tea cup, to being stuck somewhere at the back of a bottom drawer.

I am not naïve enough to think that I will never again find myself sitting there at the jumping off place with both legs dangling over the edge, but I am also in tune enough with myself to know that this feeling, the feeling of actually wanting to be alive, is very very different to anything I have ever experienced before following a suicide attempt. And, I am – or at least I’d like to think I am – wise enough to recognise that this is a significant shift in me. And that I need to use that shift in some way.

But, how do you live without dying?

Well, the honest truth is that I don’t know; I haven’t got an answer to that. I’ve never been in this situation before, and I don’t really know how to deal with this.

So, for now, I am following a very simple rule: take each day as it comes and make no major decisions until I have some distance, until I can look at what has happened with some perspective. And I think the best way to get to such a place is through maintaining an open and honest dialogue with those around me.

That – and lots and lots of therapy.

Do be kind to your Selfs,

A Much Delayed Update

Posted by What It Takes To Be Me in Being Alive, Coping Strategies, Defence Mechanisms, Depression, Dissociation, Expressing Emotion, Family, Illness, Personal Growth, Psychology, Psychotherapy, Psychotherapy Breaks, Psychotherapy with P, PTSD/Extreme Emotional Stress Disorder, Sef-Awareness, Self-Harm, Sexual Abuse, Suicidal Ideation, Suicide and tagged with consequences of failed suicide attempts, crisis team, Depression, Drayton Park, Drayton Park Crisis Centre, Drayton Park Crisis House, Drayton Park Women's Crisis Centre, Drayton Park Women's Crisis House, effects of childhood sexual abuse, ethylene glycol, expressing emotions, psychotherapy, psychotherapy breaks, recovery, suicidal ideation, suicide attempt, talking about suicide, talking openly about suicide Monday, April 25, 2016

It has been such a very long time since I last posted anything on here, it feels all but impossible to try to catch you all up. And maybe it’s not really the most important thing in the world that I do? If you’ve been following this blog for a little while, you’ll probably already have some idea of what sorts of ups and downs you might have missed in the last few months. After all, there is nothing new under the sun. And if you have only just arrived on my site, well, feel free to hop on board as you are.

So, I’ll just begin with where I am at now. Literally.

I am at home, very slowly trying to allow my body to recover from the hell I have recently put it through. I suppose you could say that I had been on a slippery slope to nowhere for a long time, and a number of weeks ago, my therapist started a referral for me to go to Drayton Park. I was already with the crisis resolution team at this point, struggling enormously with trying to keep myself safe. Being at a very low point, the only way I could really manage was by taking sleeping tablets. Paradoxically not to kill myself, but to stop myself from doing so. Perhaps not the best way to manage, but it was all I could do at the time. The referral to Drayton Park took longer than usual for a number of reasons that I won’t bore you with, and being asleep most of the time while I was waiting was the only way I could think of to stay safe. After all, if I was knocked out there was no way I could actually act on my suicidal impulses. Right?

A little over a week later I was finally given a place at Drayton Park, and that felt like such a relief. But it wasn’t all smooth and simple. The depression and the suicidal ideation, the flashbacks and the urges to self-harm came with me. And, although I have stayed at Drayton Park about a million times [OK, maybe not a million, but certainly enough times to feel at home there] this time felt like a distinct travel back in time. You see, the only room available was the one room I have always dreaded being put back in; the room I stayed in during my very first time at Drayton Park. Yes, I have stayed in other rooms there more than once with no problem, but this one holds some particularly bad memories for me; this is the room I died in. And this time it isn’t an exaggeration – I was found lifeless in that room, and while I have no actual memory of it, I was told by the doctors in ICU that I had been clinically dead for a number of minutes by the time the managed to bring me back.

The reason I was found lifeless in that room all those years ago was my own. I had brought a substance into the place that I shouldn’t have, and being the kind of person who – owing to deep seated psychological issues – is far more afraid of being found to have broken The Rules than to tell staff that I was afraid of what I might do, and that I needed help, proceeded to ingest said substance. So, this time around, being back in that room, I was overcome by memories of standing in front of the mirror in the bathroom swigging pure poison from a bottle, quickly followed by a handful of Smarties to mask the bitter taste, looking at myself, hoping to die.

This time around I used my one-to-one sessions at Drayton to talk about these memories, about the sense of being thrust back in time and the feelings evoked, and I was immediately and repeatedly offered to switch rooms. But, me being me, I thought there might be some therapeutic value in being able to stay in the same room, look at myself in the same mirror, but having a different outcome. I thought that the feelings brought out by staying in this particular room might be used for healing, for psychological growth, even. Sadly, I seem to have completely forgotten that the reason I was back at Drayton in the first place, was that magnetic lure of release from life – and that I wasn’t strong or stable enough to do this kind of work at this particular time. And it proved to be a costly miscalculation on my part.

Prior to admission to Drayton Park I had purchased another bottle of a similar but far more lethal poison, and it was still sitting at home, waiting for me. Thus, part of the objective of my stay this time was to get me to a place where I would be stable enough to be able to safely go back to my flat and pick up the bottle to hand it in to staff, without having the urge to down its contents on the way back. I was working very closely with both P. and staff at Drayton to get to this place, we talked about my feelings, about the reasons for those feelings and how best to keep me safe – we really were doing everything possible to get me out of this perilous place I had been perched at when I first arrived.

Admittedly, at first there was a fair bit of pressure for me to bring the bottle back at the earliest possible opportunity, but this plan was thankfully changed, when I – with the help of P. and staff who have known me for a long time – were able to to explain that bringing back the Bottle before I was ready to do so wouldn’t necessarily make me any safer; I’d just order another one online, or I’d feel pushed to act out in some other equally dangerous way. [Having a severe nut allergy means that I am never further than a chocolate bar away from having the means to end my life]. Instead we planned trial runs to my flat where I would go into my flat but not into my bedroom [where the bottle of Poison was kept]. I’d pick up post or a change of clothes, but there was no expectation that I bring the poison back. This worked. Twice. In fact, during one of my visits home I managed to – relieved of any pressure to perform, so to speak – bring back the anti-sickness tablets that were also part of my suicide plan. It was hard going back to the flat; in spite of our best efforts to have strong safety plans in place and in spite of never staying longer than ten minutes, I never quite felt safe.

Partway through my stay P. went on leave, as did K. This meant that most of my usual safety net was no longer available to me. And that, too, was hard. Destabilising, is the word that comes to mind. I knew that I would not be able to stay at Drayton until they were back from their respective leaves, and that didn’t feel good at all. So, fear of going home – having still not been able to hand in the Bottle – intensified. Towards the end of week two I was asked to make a Week Plan, to add structure to my stay, which I did. Knowing how hard it had been the two previous times going back to the flat, I only planned visits home for every other day, so as to not overwhelm myself.

But on the very first day of following my Week Plan I knew I wasn’t stable enough to be able to go home, even for a short visit. It was one of those very bad days with lots of flashbacks and thoughts of how much better things would be if I were dead, so, I switched days on my planner, did my Tuesday plan on the Monday. And it would have worked out fine, except the next day was just as iffy as the previous one, safety-wise. I wanted so badly to be able to stick to the plan, though, since otherwise there would be fewer opportunities to go home before actually being discharged. And I knew discharge would be coming, whether or not I had brought the Bottle back.

I want to pause here to make something perfectly clear: there was absolutely no pressure from staff for me to go home that day – none, zero, ziltch – and that is really important to understand – they were all working hard to keep me safe. All pressure to go home that day came from me, and me alone. But, in the end I did decide to push on through. And that turned out to be a near fatal mistake.

When I first got to the flat on that third trial run I felt anxious, but sort of within the realm of what I could manage. So, before entering I rang Drayton to say that. All was good, I sat in the kitchen for a bit, I even wrote an angry note to my flatmates about the washing machine not having been fixed during my two week absence. Everything felt normal.

And then suddenly it didn’t.

I know that I went and took a sleeping tablet in desperation. At the time I really thought it was just the one, so, that is what I told staff when I called them in panic. They stayed on the phone with me until I was out of the flat and I got a taxi back to Drayton. I saw my main worker when I got back, and prepared to go to bed [after all it was a sleeping pill I’d taken]. We agreed that they would check on me every hour, just to make sure I could be woken up, since I have a history of taking overdoses in a state of dissociation, and I couldn’t say with 100 per cent certainty that I hadn’t done so this time, too. [Entering a dissociated state is actually far more common than you might think, especially for people who have suffered severe abuse and have used dissociation as a coping mechanism all their lives]. About quarter of an hour later I knew that I must have done more than just taking a single pill, because I was feeling nauseas and drunk and was losing control over speech and movement. So, I went straight to the staff office and knocked on the door. [This is, incidentally, the exact opposite of what I did that very first time at Drayton]. The last thing I remember is lying on the sofa in The Quiet Room with a member of staff next to me, being told that an ambulance was on its way.

I woke up in hospital. I knew immediately that I was in hospital, because nowhere else on earth are you met with those cold harsh lights, and those ugly tiles in the ceiling. That is my first memory. My second one isn’t so much a memory as a feeling, a feeling of immense relief that I was alive, that I had in fact woken up. And I knew that was a big deal. Every other time I’ve woken up in hospital I have felt nothing but sheer anger that I hadn’t died, wondering what I had done wrong, thinking about when I could do it again.

I spent a number of days in hospital being given antidote every twelve hours. And that was one of the most scary experiences ever. The relief of being alive soon wore off, and the fear of not knowing whether or not I would actually live – and what that life might be – took over. I knew that things were bad, really bad – not just from the vast number of tubes coming out of my body or the urgent frequency with which blood tests were taken day and night – but by the fact that when I tried to ask doctors and nurses would I be OK, they avoided eye contact and would generally mumble something along the lines of Let’s not worry about that right now, sweetie.

It wasn’t until the very last day, the day I was due for discharge, that I finally found out the truth of just how close it had got. I didn’t ask the doctors or nurses this time because I didn’t trust that I could deal with what they might have to tell me, instead I reached for the journal folder at the foot of my bed. And there it was in black and white. Multiple organ failure. Prognosis: poor.

Of course, by the time I read those journal notes, I was out of immediate danger, but it was still a shock to see it. This was what I had done to myself.. I had put kidneys, heart and respiration at serious risk. When the first tox screen came in they didn’t think I’d live, and if I did I’d likely have reduced function of at least some of those organs.

I have now been at home for about two and a half weeks. I am extremely fatigued and am sleeping most of the time. Any little thing exhausts me. I have had follow up tests and the results are not great. They aren’t anywhere near as bad as they could so easily have been, but I am also not recovering at the rate the doctors would have hoped. So there will be more tests to come. In short, I still don’t know the full extent of the damage I have done to myself.

But, I am alive.

And I have a lot of feelings about that.

I hope that I will be able to write more about those feelings soon. –ish.

PS. I want to make a special mention that I have chosen not to share what has happened with my immediate family, in an effort to spare them pain and worry. At least until I know for sure what I am dealing with. So, should you be someone who knows me in person – and knows my family – please make sure to keep this information to yourself. This blog is semi-anonymous, not for my sake, but for the sake of those close to me. It is also a place where I can safely share my feelings, and that means a lot to me.

Running Up That Hill

Posted by What It Takes To Be Me in Acceptance, Infertility, Psychotherapy, Psychotherapy with P, Sadness, Suicidal Ideation, Suicide and tagged with A Deal With God, acceptance, And I'd get Him to swap our places, And if I only could, Be running up that road, change, childhood sexual abuse, childlessness, ending one's life, Extreme Emotional Stress Disorder, failed suicide attempt, flashbacks, I'd be running up that hill, I'd make a deal with God, infertility, Kate Bush, lack of change, Lack of hope, not having children, Post-Traumatic Stress Disorder, psychotherapy, PTSD, Running up that hill, sadness, sexual abuse, sexual abuse flashbacks, suicidal ideation, suicide, suicide attempt, With no problems Monday, December 29, 2014

’And if I only could
I’d make a deal with God
And I’d get Her to swap our places
I’d be running up that road
Be running up that hill
~ With no problems..’

I’m not sure what Kate Bush had in mind when she wrote that song, those lyrics, but they really speak to me. I feel I’ve been running up that hill forever now, getting nowhere. It isn’t getting any easier, and I really wish there was a way to swap places, to make that deal. I’ve been running up that road for so many years, but nothing has changed. Lots has happened, but nothing has changed.

Last night was the 21st anniversary of the very first time I tried to end my life. I was seventeen and I didn’t know how to make the abuse stop, didn’t dare communicate what was going on – what had been going on for as long as I could remember, because I didn’t know what would happen if I did. So, at the very end of my mother’s 50th birthday I swallowed a cocktail of random anti-depressants, mood stabilisers, sleeping tablets and painkillers. This was before the internet, before you could google your way to the perfect concoction to put an end to your misery, and as a consequence I survived.

I woke up to a whole new world. One where – in a flurry of activity – suddenly lots of people knew about the abuse. Social services got called in. I remember so well how the head of social services – who just happened to be a close friend of the family – told me that ‘No one is allowed to make you do anything that you don’t want to do. Ever.’ Except, of course, that I would have to talk to the police and I would have to go to court, whether or not I wanted to, because those were not things I had the choice to opt out of.. You see where I’m going with this? Something happened, but nothing changed.

I’ve been in therapy for years and years and years by now, and although I firmly believe that talking about what happened – in a safe environment with a therapist sensitive to my needs [as opposed to at a police station or in a court room] – is key to ultimately reducing the traumatic re-experiencing of abuse that I am faced with every time I have a flashback, it feels as if that day is very very far away. Hardly even a blip on a distant horizon.

I know that if I manage to find a way to keep running up that hill – because, trust me, therapy can be such an uphill run – my day to day life could be greatly improved, in terms of the amount of flashbacks I suffer, in terms of being able to make and keep plans, in terms of feeling more in charge of my life. And that would be great. It really would.

But then there is that other thing. The Not Having Children.
No amount of therapy can change that. I could do therapy every day for the next two thousand four hundred and sixty-eight years, and that fact would simply not change. People are forever telling me that ‘No, that wouldn’t change. But, you might change. You might feel differently about it.’

Only I know that I won’t.

This is a wound that cannot heal. There are constant reminders to keep that wound open and bleeding. Three people in my life are currently pregnant, due at various points next year – so I already know that 2015 will be another year of Everyone Else having children. Another year of tears burning my skin as they roll down my face. Of a pain so sharp it shreds my soul from the inside..

And the problem is that every year is going to be A Year Like That. Until it turns into endless years of Everyone Else Having Grandchildren. And I can’t face a life like that. I just can’t.

Even if I managed to somehow accept that I won’t have children, I just can’t accept a life without them.

I will try, as I have been trying. But, I know that one day, soon, I’ll run out of steam. And I’ll stop running.

It is sad.
But it is what it is.

Twenty-fourteen – A Year Of Changes & Challenges

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

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

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

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

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

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

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

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

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

And our relationship grew a little stronger.

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

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

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

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

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

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. :)

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!

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 An Email To My Therapist, anger, anxiety, asking client to promise not to act out, attachment, boundaries, choices, countertransference, Drayton Park, Drayton Park Crisis Centre, Drayton Park Crisis House, Drayton Park Women's Crisis Centre, expressing anger, expressing emotions, expressing negative emotions, I can't work with you under the threat of suicide, promises, promising not to kill oneself, promising to not act out, promising to not become suicidal, psychotherapist coping with suicidal clients, psychotherapy, Putting Feelings Into Words, rejection, suicidal ideation, suicide, suicide attempt, talking about suicide, talking openly about suicide, the therapeutic relationship, therapist coping with client suicide, therapist coping with suicidal client, transference, ultimatum, Where Do We Go From Here? Monday, July 29, 2013

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.

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 anxiety, asking client not to kill herself, asking client to promise not to act out, attachment, being too much, boundaries, countertransference, Depression, Drayton Park, Drayton Park Women's Crisis Centre, Drayton Park Women's Crisis House, end of the road, expressing anger, 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, honesty, I can't work with you under the threat of suicide, I solemnly swear never to be suicidal again, promises, promising not to kill oneself, promising to not act out, promising to not become suicidal, psychology, psychotherapist coping with suicidal clients, psychotherapist wanting to end therapy, psychotherapy, rejection, suicidal ideation, suicide, suicide attempt, talking about suicide, talking openly about suicide, termination, the therapeutic relationship, therapist coping with client suicide attempt, therapist coping with suicidal client, therapist wanting to terminate therapy, transference, uncertainty Sunday, July 28, 2013

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,

Safety, Anxiety, Boundary Blurring & Progress

Posted by What It Takes To Be Me in Anxiety, Being Alive, Boundaries, Creativity, Expressing Emotion, Expression Through Art, Inner Conflict, Psychology, Psychotherapy, Psychotherapy Breaks, Psychotherapy with A, Sef-Awareness, Self-Disclosure, Sexual Abuse, Suicide, The Therapeutic Relationship, Transference and tagged with anxiety, boundaries, Boundary Blurring & Progress, boundary-blurring, breaking people, childhood sexual abuse, crisis resolution team, crisis team, Drayton Park Crisis Centre, Drayton Park Crisis House, Drayton Park Women's Crisis Centre, expressing emotions, expressing negative emotions, expressing through art, inner conflict, mental health crisis resolution team, professional self-disclosure, psychotherapy, psychotherapy breaks, safety, self-awareness, self-disclosure, sexual abuse, sexual violence, sibling sexual abuse, suicide, suicide attempt, the therapeutic relationship, therapy, therapy breaks, transference Monday, July 8, 2013

An Implosion of Emotion

I know this update is long overdue – in fact, there may well be enough in my head for two separate posts – but, let’s begin where my last post ended, and we’ll see where it takes us.

Following my near lethal excess intake of ethylene glycol and subsequent hospitalisation I was finally discharged a few days later. Sort of. I was discharged back into the care of the crisis resolution team, pending an assessment at the Drayton Park Women’s Crisis Centre.

The assessment was conducted a few days later, by two members of staff who I knew from previous stays there. This was probably a good thing, not only because they were already aware of my background, but also because they knew that I have found stays there in the past very helpful by way of turning a negative trend. In other words, they knew that if offered a place I was reasonably likely to make good use of my time there. So, having asked me if I wanted to come there, I was told they would offer me a one-to-two-week stay, with a review at the end to see whether or not the stay should be extended.

So, on Wednesday 5^th of June I took up residence at the crisis house. I have to admit that it felt a little like taking a trip back in time. The last time I stayed there was in 2011 and before then it was in 2008, if memory serves, but in many ways the place hasn’t changed at all. My artwork and poetry was still on the walls in various places around the house, in fact, even a little note I’d written and stuck on one of the doors during my first stay, asking people to please not slam the door, was still there. Other things that very soon clicked into place was the very special rhythm of life that exists in this place: house meeting, one-to-one, lunch, massage/therapy/art/going out, one-to-one, dinner. Also, just as during all of my other stays there, save the first one, I had to agree to allow staff to look through my bags each time I entered the house. This is not a general rule for everyone who stays there, but something specific to me, because during my very first stay there, back in 2008, I brought a bottle of anti-freeze in and then proceeded to drink from it at carefully planned intervals in a bid to end my life. Thus, as a result any subsequent stay at Drayton Park has been conditional upon my agreeing to have my bags searched. And, ever since then, I have always gone along with this, as I genuinely want to use my stay there in a positive way. Also, in fairness, there is quite a lot of give and take, even with this condition; some staff would definitely ask to have a look in my bags, but some would be happy to just ask me to tell them what I had brought back, and others still simply asked ‘Have you brought anything back that you shouldn’t’?

I ended up staying at Drayton Park for three weeks. It was extended by a few days past the original leaving date, because of something which happened between A. and myself in my final therapy session before she was due to go on leave and which created a bit of a crisis on top of the original crisis. Having spent the session talking about how near I got to dying, and the fear that it’s not quite enough to nearly die, but that I would have to actually die for it to make a difference to my parents, and battling it out with myself whether or not they truly care about me, I finally turned to A. and asked her ‘Do you care?’

At this point A., rather than to answer my question, opted to abruptly end session. Yes, we were out of time [although I didn’t know that when I asked the question], but the way she ended it felt very different to how she normally ends sessions, and it is also not unheard of for her to allow a session to overrun by a minute or two, to ensure a better ending to a session.

I left session feeling very upset and unstable with a single thought pounding in my head; that it was more important to A. to stick to the rule of not answering a direct question than to ensure I was in an as safe as possible place, going into a break which she knew would likely be very difficult, given what had been happening in the last few weeks, coupled with the fact that I had in that session expressed that I was feeling very anxious about how I would manage during the upcoming break. Needless to say, it was an incredibly painful thought to be stuck with..

In my one-to-one back at Drayton Park I managed to voice some of my thoughts about the way the session had ended, how I had interpreted it and alternative ways as to how A. might have responded to me which would have felt better [without her being unfairly pushed to give an extensive answer right then and there, at the end of the session]. All this made me question my and A.’s relationship and also made me realise that there was a lot of disappointment stuck inside of me about the fact that she hadn’t contacted me while I was in hospital to find out how I was doing [or if I was even still alive].

Because of this, my keyworker at Drayton Park and I, made the decision that rather than me going home on the day before therapy was due to resume, my stay would be extended until the Monday after, so as to give me some time to stabilise, should the first session back go very badly.

There was another incident while I was staying at Drayton Park, which had quite a big impact on me: in one of my one-to-ones a member of staff disclosed to me that she, too, had suffered abuse. This may seem quite an alarming thing to disclose, given that she was staff and I was staying there to deal with a crisis, but in the context, I can definitely understand why it was made and I have absolutely no doubt whatsoever that the intentions were good, that it was meant to be helpful. But, as I said, it did have an impact on me. Not so much what I was actually told – I have heard stories like that before, have even done some volunteering on a sexual abuse helpline and I can deal with it – but it was more my own reaction to the boundary blurring that caused a lot of anxiety. It made me second-guess myself, in much the same way I used to do during the abuse I suffered: was this OK or not? Was I overreacting? Ought I tell someone? What would happen if I did? Would I even be believed? What if I had just misunderstood what had been said? All of these questions were bouncing around inside of me, as I struggled to decide what – if anything – to do with it all.

Just by chance the social worker from my shul happened to ring as I came out of the one-to-one, and I told her what had just happened. She wasn’t particularly impressed by the self-disclosure, and immediately got it that, while in many ways not that difficult to handle, it had triggered a lot of other feelings and fears, among them the very acute sense that no one can really cope with hearing my story. She said that of course it was up to me to make the decision, but she thought it might be a good idea to talk to the manager at Drayton Park about this incident.

I thought about it for a while, had another one-to-one with the person during this time, but just felt entirely unable to act; the echo of fears from the past and the wish to not get anyone into trouble were simply too strong. So, at first I said nothing, in spite of ever growing anxiety and also feeling worried that this person might end up making similar disclosures to other women coming to the project, some of whom might not be able to handle it.

A few days later, someone from the CRT came to meet with me and the person who was assigned to work with me that day. It was just a normal review, as the plan was that – unlike other times I have stayed at Drayton Park – rather than to just go home and have no formal support in place, I would be discharged back into the care of the crisis team. At the very end of the meeting the person from the crisis team asked if there was anything else I wanted to talk about, and I made the decision then and there that this was a good chance to get to talk it over. I asked the person from Drayton Park could I please have a word alone with the crisis team, and once she had left the room, I explained what had been disclosed to me and the anxiety it had evoked. I made a point of not telling her who the person was, as it seemed irrelevant at that point; I mainly just wanted to get it off my chest and perhaps get some insight into what self-disclosure policies were generally at work within the NHS. She said – in that oh-so-typical-NHS-way – that she would need to bring this up with her own supervisor and that she would get back to me about it, but also encouraged me to have a word with the manager of Drayton Park, who I know reasonably well and have decent rapport with.

A few more days passed and I heard nothing from the CRT. The anxiety was still very present and I began worrying about having to work with this person again, because, even though I didn’t feel burdened by the factual things she had disclosed, I knew I would always feel aware of the risk of triggering things for her etc etc. I still didn’t feel sure about going to the manager, but in the end brought it up – still without mentioning the name of the member of staff in question or when this had happened – with the worker at Drayton Park I felt most comfortable with.

Two days later there was a knock on my door. It was the manager wanting to talk to me, so we went into a meeting room. She explained that the CRT had been in touch with her, as well as the person I had talked to two days earlier, and she just wanted to talk it all through with me and see how we could best resolve this. I asked her if she knew the specifics of what had been disclosed, and she said that she had assumed that it was to do with a staff member’s own experience of sexual abuse, so I confirmed that that was it and also told her who the person was. I then went on to explain that I really didn’t want anyone getting into trouble over this, that I could cope with the actual disclosure and that I could absolutely see that it had been well-meaning, but also that it had set in motion a lot of left-over feelings about ‘telling on someone’ stemming from my childhood and feeling unsure whether or not I could trust my own ability to judge what was and wasn’t a boundary crossing. She reassured me that this type of self-disclosure should not be made, that even if it was done with the very best intentions at heart, staff members should know not to cross that line. She then suggested that the three of us have a meeting to make it possible to move forward. I agreed to this, thinking in secret that I wasn’t at all sure if I would be able to do it.

By the time we were due for our meeting my anxiety about it was through the roof, feeling intensely worried that the person would for whatever reason deny having told me what she had, or say that I had completely misunderstood, that it hadn’t happened the way I said etc etc. Of course, I can easily see that this wasn’t in any way congruent with the knowledge I have of this person – she’s someone who I have always found to be exceptionally straight and fair, but that this was really more of a transferential re-experiencing of what I went through when the abuse I was subjected to came to light and social services made the decision to press charges against my brother whether or not I wanted them to.

The meeting in itself was.. well, truth be told, awkward and uncomfortable for all present, but – ultimately – a good thing. And, as much as I would rather not have had this experience, one very positive thing did emerge: the knowledge that I acted differently to how I did as a child. In spite of not feeling entirely sure that what had happened was wrong, the fact that it didn’t feel quite right was enough for me to speak up.

And,THAT, I think, is very very valuable.

I am aware that quite a few readers arrive at this blog having googled ‘Drayton Park Women’s Crisis Centre’, and so I want to once again re-iterate that in the interest of protecting other people’s identity I use creative licence. Thus, if you for whatever reason feel you know who this member of staff is, I can assure you that you are more than likely going to be wrong, as enough details have been changed or omitted to protect that person’s identity.

Always end up doing a lot of art when staying at Drayton Park

I’m Alive, I’m A Mess

Posted by What It Takes To Be Me in Being Alive, Depression, Dissociation, Friends, Illness, Inner Conflict, Medication, Music, Psychology, PTSD/Extreme Emotional Stress Disorder, Suicidal Ideation, Video and tagged with crisis team, dissociation, Drayton Park Crisis Centre, Drayton Park Crisis House, Drayton Park Women's Crisis Centre, ethanol, ethylene glycol, ethylene glycol overdose, ethylene glycol poisoning, friends, Heather Nova, I'm a mess, I'm alive, mental health crisis resolution team, music, music video, overdose, overdosing, suicidal ideation, suicide, suicide attempt Tuesday, June 4, 2013

It’s been a physically and emotionally exhausting few days and I really ought to be asleep right now. It’s 4.30am at the time of writing, yet, inspite of being tired in the extreme sleep evades me.

Things have been shaky in the last few weeks, to say the least. A lot of flashbacks, and on top of that I’m on a hormone triggering treatment which makes me even less stable than normal. We are talking an emotional rollercoaster of going from blue skies to pitch dark in seconds flat, up and down, round and round. Not an enjoyable ride in any way, shape or form.

And at some point in the midst of all that my poor impulse control won over the utilisation of coping strategies; I decided that having a bit of ethylene glycol would be a good idea. I think it was only a tiny amount to start with, certainly less than a mouthful. I knew that was a really bad idea, and the following night when I felt the urge I rang the mental health crisis resolution team under whose care I’ve been the last three weeks (with a break in the middle, where I went to stay with my sisters). It was about 1am when I rang and talking seemed to help; by the end of the call I had agreed with K., (the person who was working the night shift), that I would come in to see them at ten that morning and bring the bottle of ethylene glycol for safe disposal. That felt both scary and good. It’s kind of hard to explain, but there is something about having the means to kill myself readily available that feels like a safety net of sorts, something that gives me a feeling of being in control. Twisted logic, for sure, but there you have it. But, it also felt good, the idea that someone would relieve me of this deadly stuff,would, in a sense, save me from myself.

Two hours later I once again felt myself plummeting into darkness and I picked up the phone again, since I had found it helpful the last time, and talked again to K. for some time. I may have come across somewhat incoherent because she asked me if I had ‘tasted’ any more of ‘that toxic chemical’. I said I hadn’t but in the same instance shot a glance at the plastic bottle and it was immediately clear that there was a whole lot more than ‘less than a mouthful’ missing. Alarmingly, I genuinely have no recollection of downing a large amount of this sickly-sweet substance. In fact, and I said as much to K., I wasn’t even sure if I had actually drunk it or maybe just spilled it. Or when this had happened. Still, as there was certainly more than a lethal amount missing from the bottle I agreed to let K. call for an ambulance – but, not before saying ‘Can you wait half an hour to call so I can have a shower first?’, to which she calmly explained that having a shower at three in the morning when you have potentially consumed enough poison to kill yourself was hardly a priority. So instead I started stuffing things into bags: iPad, iPod, mobile, chargers, clean underwear, toothbrush, EpiPen, my journal, a random bunch of puzzle cubes and even my prayer book. I have no idea where this sudden organisational skill came from, I normally have to write lists to make sure I don’t forget things when I pack a bag, but there I was, five minutes later, fully equipped to spend a long time in hospital, should it come to that. Then I told K., who was still on the line with me, that I was going to go outside to wait for the ambulance, promptly grabbed my bags and made it down two flights of stairs and out onto the pavement outside my house.. where I laid down to sleep while I was waiting for the ambulance to arrive. K. kept talking to me, trying to convince me that while it was OK to lay down, if I was too dizzy to stand up, I really needed to stay awake.

The paramedics arrived and got me into the ambulance with some difficulty as my legs refused to carry me properly. They asked a tonne of questions, all of which I answered in something of a drunken stupor. K. had already told them what I had taken, which was probably a good thing as they would more than likely otherwise have assumed I was just another overly refreshed Saturday night party-goer, and might not have realised that time was pretty darn critical. Also, I had brought the bottle with me so they could see exactly what I had drunk and how much was missing. I mainly just remember babbling like crazy in the ambulance before passing out, and the paramedic pinching at the nerves on my shoulders over and over to get me to stay awake.

In A&E I was first put on a drip of pure ethanol, which is one of two antidotes to ethylene glycol poisoning, followed by a number of rounds of Fomepizol. Hurt crazybad, I can tell you that much for nothing. (Imagine the sting of cleaning a wound with rubbing alcohol, and then imagine that kind of stuff going straight into your bloodstream, and you’ll get a fair idea).

The side effect of this, having bare spirit pumped into me was that I got drunker than I have ever been in my life. I’m not someone who drinks particularly often, so I have a very low tolerance to alcohol, and here they were giving me as much as they could based on my weight. Suddenly absolutely everything was hilarious beyond comprehension. I was giggling and rambling and apologising left right and centre, trying to explain that They were making me drunk. In the midst of that I decided that sending a text to let people know I was in hospital was a good idea, only – I discovered later – the text made very little sense, and I managed to send it to a whole bunch of people I wouldn’t knowingly have sent them to.

At one point a friend of mine, having seen my text, rang me (this was as I was being wheeled into a ward, still apologising profusely for my drunkenness) and all she got was me laughing, unable to explain what had happened. Later, when she came to visit me, she said that it wasn’t exactly what she had expected when she called to hear if I was still alive..

Whilst being drunk was not all that bad, it did mean that I was sick a lot. I have a sneaking suspicion that there was a miscalculation as to how much ethanol they were giving me, because last time I was rushed to hospital for having done something very similar (that time, completely on purpose), I remember screaming in pain as the ethanol went in my arm, but I don’t remember being drunk, nor being repeatedly and violently sick.

I had to stay in hospital for a day and a half, on constant drip, most of the time in both arms. It’s still too early to say if I have done any permanent damage to my kidneys and if so, what the extent is, all I know is that I my vision is extremely blurry and I have been sick a number of times even this morning.

I am out of hospital now, back under the care of the crisis resolution team, but as neither I, nor they, think it’s a good idea for me to be on my own just now, an assessment has been set up for later today at Drayton Park Women’s Mental Health Crisis House. As regular readers will know, I have stayed there in times of acute crisis before, and have found it helpful in turning a negative trend, so I really hope that following the assessment they will offer me a place.

Sorry for making this a somewhat long-winded entry, but I think I just really needed to get it all out.
I think I am still a very long way away from truly absorbing how close I got to dying, and writing is often the best way for me to process things.

Do be kinder to your Selves than I have been to my Self.

Much love,

PS. If you are one of my many wonderful friends who received my drunken text and who tried to get in touch with me later, but couldn’t get through and didn’t hear from me: something went wrong with my mobile and I could only send texts, not receive them, and incoming calls only worked sporadically. So, please don’t think I was ignoring you, I simply didn’t get your messages and consequently didn’t know to respond to them.

For some reason this song is playing in my mind. (Although the title of this post is actually from another Heather Nova song).

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