Being The Perfect Therapy Client

Posted by What It Takes To Be Me in Abandonment Issues, Attachment, Coping Strategies, Expressing Emotion, Flashbacks, Psychology, Psychotherapy, Psychotherapy with A, Psychotherapy with B, PTSD/Extreme Emotional Stress Disorder, Rejection, Sef-Awareness, Sexual Abuse, Suicidal Ideation, The Therapeutic Relationship and tagged with a good client, abandonment issues, attachment, baggage, being adopted, being the favourite client, being the perfect therapy client, communication, EMDR, fear of rejection, finding a good match, finding the right therapist, identity, NHS, NHS Mental Health, private psychotherapy, psychoanalytic psychotherapy, psychodynamic psychotherapy, psychological assessment, psychotherapist coping with suicidal clients, psychotherapy, rejection, self-awareness, self-harm, sexual abuse flashbacks, TF-CBT, The Philadelphia Association, The Story of the Philadelphia Association Community Houses, the therapeutic relationship, therapeutic communities, therapy Monday, February 4, 2013

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

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

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

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

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

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

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

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

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

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

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

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

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

And that’s enough.

An Uneasy Dwelling – Delayed Reflections On Living In A Therapeutic Community

Posted by What It Takes To Be Me in Boundaries, Community, Diagnosis, Expressing Emotion, Family, Friends, Group Dynamics, Home, Illness, Psychotherapy, Reading and tagged with An Uneasy Dwelling, anxiety, boundaries, communal living, Community, community houses, Depression, family, friends, group dynamics, group meetings, group sessions, group therapy, home, illness, living in a therapeutic community, London therapeutic communities, London therapeutic community, moving on, Paul Gordon, Philadelphia Association, Philadelphia Association community house, Philadelphia Association community houses, psychosis, psychotherapy, psychotic, reading, reflection, shared living, sharing, sisters, The Philadelphia Association, The Story of the Philadelphia Association Community Houses, therapeutic, therapeutic communities, therapeutic communities UK, therapeutic community Sunday, June 3, 2012

It’s been a year now since I moved out of the therapeutic community I used to live in. And I’m still processing it. The ups and the downs, pondering what I took from my time there, what more I could have got from it, what I’m glad to have left behind.

I can say without hesitation that I don’t regret moving in there. I can also say that it is the most stressful living situation I’ve every voluntarily put myself in. With three group meetings a week [on top of my individual therapy sessions outside of the house] it’s a pretty full on experience. Even though I often made the decision to stand on the sidelines, to keep myself at a distance, it was a pretty intense way of living.

Would I have got more out of living there, had I been more invested in it? I don’t know. Maybe. I don’t rule it out. Certainly it made a difference to the sense of community within the house that I chose to not engage as much as I could have, to not push for communal meals, to not easily join in with the household. Yet, at the same time, it just never made sense to me to bring my worries and desperation to the house meetings, to be looked at by people, who – although I liked many of them – didn’t feel particularly safe with. [This, incidentally, is solely a reflection on me, – not on them.] To me, it always seemed like the natural thing to do, to turn to my sisters and the friends I have always been fortunate to have when things got tough, to turn to them for extra support. And for the things I felt I couldn’t necessarily share with them [for whatever reason], well, I had my individual therapy with A. for that. Bringing it to the group sessions, it just seemed a bit odd.

That is not to say that I never shared anything in the meetings. I did. But not on a regular basis. It tended to be only when things were really really bad and I just couldn’t hold my tears back.

So, what was it that I found stressful? Well, in part what I have just written about; the expectation to involve myself, to engage and to share, and the feelings brought up by the fact that it was an expectation which I always felt I would never be able to live up to. Part of that was, as I said before, down to the fact that it didn’t quite make sense to me to share difficult things in a group of people I didn’t really know that well. But, of course, there were more deep rooted trust issues at work, holding me back. Other people, who may also have had friends and family they were close to, didn’t feel the same level of reluctance to take the plunge in the group meetings, and were much better able to let others see their vulnerability.

Another thing that was probably more stressful than I even realised at the time, was the constant stream of visitors to the house. Visitors who came to our meetings with a view to possibly join our household. This was a part of life in the house that I never got used to and always felt distinctly uncomfortable with. It was one of those things that made the place feel a lot less like it was my home as opposed to only being the place where I happened to be living.

People would come, share their story, share of themselves, [or in some cases not share] and we were, I suppose, meant to get a feel for whether or not this was a person who could fit into our house, who might benefit from moving in. It probably doesn’t sound particularly stressful, but it really was. Especially the decision making process, where – in theory – residents were said to have a big say in whether or not someone was invited to join, but which in reality often felt like a humongous and never-ending pressure to get new people in. Often at a time when all you really wanted was to find some headspace for yourself, to settle in the group you were already living with. I remember more than one meeting where one of the house therapists would say something along the lines of the process being about all of us reaching some sort of consensus about whether or not a person was suitable for our house, and in the next breath would not-so-casually mention how we needed to be X number of people living in the house for it to be financially viable. No pressure, right. :þ Also, I always took issue with the fact that the question “Is this someone I can live with?” seemed to be second priority to “Could this person gain something from moving in?”, which, it could be argued, sent the message that the gain of a person joining far outweighed the potential rise in stress level of those already in the house.

Clearly, there were times when the reluctance to accept new housemates were motivated less by worries about how a new person might impact the household negatively, and more about a strong wish to hold on to what was familiar. But, then, is that so strange? For a person to build a home, there arguably needs to be a level of familiarity and stability. A stream of new introductions allows little space for that.

Stressful was also the particular mix of people in the house at any given time. Without going into detail about any one individual, the people staying in the house – at least for most of my stay there – could be broadly grouped into either dealing with depressive and/or anxiety related issues, or difficulties which fell somewhere along the more psychotic end of the mental health spectrum. And, as housemates were supposed to support one another [rather than relying on the house therapists – who only come to the house for the meetings – to sort things out] it at points felt very much like the first group was responsible for the latter group.

It isn’t easy walking through the door, never knowing what you might be walking in to. I’m not going to say that I was in any way the person who most often ended up keeping track of others – I wasn’t – but, there were absolutely times when I had to drop what I was doing in order to help settle a very agitated housemate or, once or twice, call the police because someone had taken off, stating they were going to kill themselves. And I think this way of always being on the ready to put fires out, to some degree stopped me from being able to explore my own issues more. [Not the only reason for this, of course, but one of them.]

One of the really invaluable, yet hard bought, lessons from my time in the house, was having to seriously think and feel through what boundaries meant to me. Which ones were important to me, which ones did I feel able to be more flexible about? I had to work at asserting myself, when I felt the boundaries were being stretched beyond what was OK for me. Regular readers will remember that my decisions to ultimately leave the community came down to – in part – feeling that I needed to make a stand for myself, to not just go along with boundaries being pushed, but to recognise that what I feel OK with, or not, is important and worth holding on to. But of course, this was an ongoing battle, this getting a feel for when it was important to hold on to my way of living my life, yet at the same time question my reasons and motivations for doing so. When was there a valid reason, and when was I simply being stubborn and resisting change? When was it a case of me being the rebellious teenager I never got to be in my own family, when was it the adult me refusing to see things from another person’s perspective?

While I was staying at the house, one of the house therapists published a book about the community houses run by the Philadelphia Association. I made the conscious decision at the time not to read it while I was still living there.

Having now lived away from the house for nearly a year, I have read it, and I have to say that it’s a book well worth reading. I found it very interesting to read about the history of the houses [which I had some idea of, even before moving in, but, again had chosen to not explore too extensively], and how the philosophy behind the houses has altered and varied at different points.

I think it’s an honest book, even though I at times found myself smiling at the discrepancy between the idea of the community houses and the reality of them. At least from my point of view.

Anyway, if you are interested in reading the book for yourself, click the link or picture below.

If you would like to read about my time in The House: entries written between January 2009 and July 2011 were written while I was staying in The House. The first post I wrote having moved in is called “On My Own – An Entry About Finding New Ways To Cope“.

An Uneasy Dwelling by Paul Gordon

An Uneasy Dwelling
by Paul Gordon

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