Trigger warnings for suicidal thoughts and mention of self harm. I’ve tried to avoid being specific or graphic, but be safe.
The night before I met Anna for the first time, I stood on the edge of a train platform and thought about jumping.
I hate seeing new people. There are lots of obvious, surface reasons for this: I’m slow to trust, unknown situations cause me anxiety, and when I get anxious, I dissociate and freeze and I can’t speak. But the deepest reason is very simple: every new person is a chance to get better, and every failure is proof that I never will. Anna was my fourth psychologist for the year, and my tenth mental health professional.
I’m glad I kept trying. Anna is kind of the therapist version of a cute kitten: when I tell someone about her, their response is usually along the lines of “Aw, I want her!”. She found out early on that I love animals, so she tries to bring her dog Sami to sessions as much as she can. I’m a country kid who hates being indoors, so sometimes we meet in the park for sessions, and she’s learnt not to wear her favourite pants, because I always want to sit on the ground and she obliges. I almost never show up without headphones in, so she relocated her stereo to her office and asked me to bring along a playlist to put on in the background – when I get dissociated in sessions, she turns up the volume until the floor shakes, and when I remind her that she has neighbours she just shrugs and says “so?”. She even has copies of my favourite poems so that when all else fails and she can’t get me to speak, she can read to me. She will tap into any positive thing she can, do anything she can to try to help me feel comfortable and safe.
She’s also been amazing in a more practical way. I’m blessed with a very involved and supportive GP (Serena), a psychotherapist in another country I see via Skype (Aisha), a kinesiologist (Jen) who has stepped way outside her role and been there for me through crisis after crisis, a psychiatrist (now out of the picture) and my managers at work who have dubbed themselves the “Jewish mamas” and provide me with hugs, scoldings, visits in the hospital, lifts to the airport and to appointments and warm, genuine emotional support. Until Anna came along, they all operated in isolation, and had never communicated with each other. She has connected with each and every one, and made them into a team – “the army”, as she calls them.
There’s always a ‘but’. The thing is, I haven’t worked out what the ‘but’ is. But I’m still struggling to connect with her emotionally, even though intellectually I know she’s everything I could realistically ask for in a therapist? But she’s not perfect? But I’m not trying hard enough? But no matter how hard she’s tried, she still hasn’t been able to bring me down from panic or distress? There’s only one ‘but’ I know for sure: but our relationship has been difficult.
I am not an ideal client. When I speak at all, my answers to questions are often one-word: “Fine. Yes. No“. I don’t express anger verbally, but I have a sarcastic eyebrow that makes it clear when I’m not impressed. Anna tells me I’m funny and kind and likeable, but that’s only until she tries to press me to talk about myself, and then I panic and shut down or get defensive and snarky. I’m not demanding, but I think that’s contributed to my difficulties with Anna – I think if I’d asked for more, it would have made her happier than my reluctance to reach out. I’m terrified of connecting, of being vulnerable, of being seen, and I can’t function in a relationship unless I’m the person who is needed, not the person needing. So far, most of our sessions have been focused on Anna trying to get me to talk, trying to prove to me that I can trust her.
About two months after we started working together, I was accepted into a DBT outpatient program, on condition that I make a crisis plan with Anna. I was vocally reluctant, because I had to prove that I didn’t want extra support from her, that if I called it was only because I had to, when really I’d rather handle it on my own, without her. Being needy isn’t okay, and I’m not needy. (Being needy is okay, and sometimes I am.)
She told me, over and over again, that she wanted to do it. That she wanted to be available, to be there to support me. That she knew DBT was going to be difficult, and we were doing it together. [To give you an idea, Anna and I were working on trying to do 7 seconds of mindfulness without me being triggered into self harm, but hadn’t succeeded. In my first DBT session, we did a 15-minute mindfulness exercise.]
I was afraid that after 12 weeks of contacting her whenever I needed to, I wouldn’t be able to go back to handling it on my own. I was terrified of doing DBT. But I had to try it. Whenever anybody suggests I’m not trying hard enough, it makes me furious. If I didn’t try this, then that fury would be pretty hollow.
Our first experience of the crisis plan in action could crudely be described as “go hard or go home”. It was three weeks in, the longest I’d been without self harming for a while. I’d been triggered in DBT that morning but kept putting off checking in with her, kept trying different skills and hoping I was going to get better, wanting to call her but not wanting to be on the phone with her, my head getting fuzzier and the panic rising and rising. When I finally called her at 6pm (after an hour of “in 10 minutes I’ll call her”), I couldn’t communicate at all, even to push a button on the phone to let her know I was there.
She stayed on the phone with me for two and a half hours, at times swallowing tears, by the end begging me to tell her where I was so she could come get me but promising to stay on the phone all night if she had to. Right before I called, I’d texted her a photo of the self-harm tools sitting in the shower with me, and she knew things were bad. During the whole call, I spoke two sentences, both in the last fifteen minutes: “I don’t want to go to the hospital” and “I don’t know what to do“.
After half an hour of talking to me without a response, she called the police, but she didn’t know where I was and thought my home was rented through airbnb, so she was simultaneously talking to me and coordinating a police search involving contact with all the other members of my “army”, the managers from my work, a friend and even the friend’s mother – everyone she had contact details for and every place she thought I could be. In the end, the police came to my house, and when I didn’t answer the door, they called in the rescue squad and broke in. They took the phone from me immediately but didn’t hang it up, and she listened while they called an ambulance and tried to keep me conscious until it arrived.
I’d taken an overdose and self-harmed while we were on the phone, and I needed to be in the hospital but so desperately didn’t want to be there, alone and sick and hurting. I was curled up, eyes closed, listening to every female voice outside the curtain, waiting and hoping to hear hers – she’d told me on the phone that if I had to go to the hospital, she’d come, and I believed her. At 10.45pm, I felt like I couldn’t wait any more, and my inner child took over and texted her: “I want to go home“. When she texted back 10 minutes and told me it would be okay and she’d come see me tomorrow, I was…god, I can’t find words for how that felt. It was like she’d tricked me and betrayed me, but I still wanted her there.
And close to midnight, she showed up. She’d brought me a stuffed dog (“I can’t bring you the real Sami, so here’s your own“), and I don’t even remember much of what she said, but she rubbed my arm and laid her hand on my hip and she was there. She didn’t stay long – they were about to start stitching me up and she gets squeamish about needles – but she came. And the next day, once I’d been admitted to a ward, she came again.
I still don’t think I fully understand how awful an experience it must have been for her. I have so little intrinsic belief in my self-worth that it doesn’t naturally occur to me that people might be upset by situations where I’m in pain or in danger. Even once I recognise it, I can’t feel it. But it must have been hard.
You would think this situation would build trust, right? How could two people go through something like that and not feel closer, more connected? But we didn’t get better, and I kept getting worse.
The three weeks between here and Christmas were filled with thoughts of death. I was overwhelmed and I felt like it would never get better.
After months of trying, Anna finally convinced my psychiatrist and my GP to prescribe me Naltrexone to combat the compulsive thoughts of self harm, but she was worried that it could make me more suicidal, and asked me to check in with her for 10 minutes via Skype every day. I’m so grateful for all of the support I have in place, and I know how lucky I am to have them, but I was averaging three appointments a day along with trying to maintain enough hours to constitute a four-day work week, and I felt like I was suffocating.
I was triggered and anxious all the time, and each session was just piling on top and escalating me more and more. I wanted to curl up until it all went away and I was too foggy to be able to think about what I could do to change the situation. I didn’t have enough time or space to do anything I enjoyed, anything that would make life worth living.
On a call with Aisha, I burst into tears almost the moment she picked up, and sobbed and repeated “I can’t do this any more” until she contacted Anna and told her to call the police. The next week, Anna and I were texting for our required post-DBT check in and I told her honestly how much I was struggling. It worried her so much that when I stopped replying for 20 minutes, she called the police.
This was intense. For both of us. By our last pre-Christmas session, I think we were both exhausted and burnt out. It might have been different if the increase in intensity had corresponded with me opening up, sharing more, if she felt we were making progress, but if anything I was more closed off, more easily frustrated – we hadn’t been working together long enough for me to feel safe with her, and the despair that came out as tears with Aisha came out as sullen quiet with Anna.
It was our last session before Christmas, the last for four weeks. It wasn’t a good session, but it wasn’t awful – with some pushing, I was able to answer questions about my brother reappearing earlier in the year, and about my grandmother being proud of my brother’s job but not mine. But it was obvious that I didn’t want to be there, and she was reacting to that. In a brief, almost accidental conversation while I was paying, things went sideways.
I was due to see a consultant psychiatrist the next week, because my psychiatrist wanted to call in a second opinion. Given how overwhelmed and suffocated I felt and how much trouble I was having with finding the words to speak to the people I already knew, the idea of seeing someone new was awful. Because of my history with psychiatrists, it felt almost impossible. Anna asked how I felt about seeing the new psychiatrist, and I shrugged. When she asked if I was going to talk to her, I answered honestly: “I don’t know“. I don’t ever make commitments I don’t intend to keep, and I just don’t ever know in advance whether I’ll be able to speak or whether I’ll be so overwhelmed and triggered I can’t.
Her response was harsher than I expected: she gave me a lecture, including statements like “Why do it if you’re not really going to try? You’re just trying to prove it didn’t work.”.
This hurt. It really hurt. Anna has told me over and over again that she knows I’m trying so hard. When she visited me in the emergency department after I took an overdose, I only remember one thing she said – when the doctor came in, Anna told her “she’s trying her guts out“. It felt like she was defending me, protecting me, and it felt good.
More than that, it’s the thing that keeps her around. When we first started working together, she told me that that’s why people want to work with me – because they can see how hard I’m trying. I didn’t realise it until now, but subconsciously, I guess that must have been part of why it hurt so much – because her telling me that I wasn’t trying sounded like she was telling me that her reason for being my therapist was gone.
I was also angry that she jumped straight to assuming ‘the worst’ (that I was effectively sabotaging myself), when being open with a psychiatrist has some genuinely frightening associations for me. Earlier in the year, before Anna was around, I’d seen a psychiatrist – my fifth for the year – and I’d been really optimistic that she was finally going to be the right fit for me.
But at the end of our initial consult, she told me she couldn’t see me. The thought of going through it all again, finding another potential psychiatrist, telling my story again to someone new, was horrible, but the really painful part was that I’d actually been open and cooperative and hopeful and she still didn’t want to work with me. For the first time I couldn’t pin it on being sullen and not talking or being late, and it felt like there had to be something really fundamentally wrong with me as a human being for nobody to be willing to see me more than once.
I’d self-harmed badly immediately afterward, so badly I’d ended up needing surgery. On the train on my way to see the specialist (who told me I needed a skin graft within the week), I opened a letter from a close friend, the only who knew about my self harm, telling me that she couldn’t support me any more because I wasn’t trying to get better. That night my dad was in town and we were having dinner and going to a concert, so I had to bury the hurt and fear and act normal.
Aisha was away – she’d been gone for a month due to illness then back for two sessions, and was away for another 11 weeks, which was planned but because of her illness I’d had less than two weeks notice of it, and I was pretty pissed off. In an unfortunate coincidence, Jen was also away for two weeks, and I sent her a text and asked her to call me the next day but she forgot. Surprisingly, I was secure enough that it didn’t bother me in the sense of doubting that she cared about me, but I wasn’t secure enough to contact her again, and it meant there was nobody I felt I could tell.
Going back to see the same surgeon who’d earlier told me treating me was a waste of time took a huge effort, having the operation – my first – was very scary, being in the hospital was so difficult that I came ridiculously close to self harming while still in the Burns Unit, and the recovery once I got home was also pretty shit, both in the normal ‘waking up in a puddle of blood at 2am’ sense and the less-normal sense of being unable to handle the transition from being in constant pain to starting healing, and needing to self harm so I was in pain again. It sucked.
So. It felt pretty awful to be told that I just wasn’t trying, when really the prospect of seeing the psychiatrist was activating some pretty traumatic memories for me that I needed some support around. Last time things had gone terribly with a psychiatrist, I’d had no support to deal with the fallout, and I needed to know that if things went badly this time, Anna was going to be there for me. I got the opposite.
In context, it all makes sense – she was trying so hard to help me and it wasn’t working, and she jumped to a conclusion based on frustration. But god it felt terrible. Even now, looking back and understanding, it feels terrible. Especially since we weren’t going to see each other for four weeks. It felt like if she wanted me to come back, she wouldn’t have said those things to me right before I left.
On the ferry home from seeing the new psychiatrist, I got an email about scheduling from Anna that opened “Hi Rea, I hope the session with the psychiatrist went okay and the petulant part of you was able to sit quietly in the background“. Before I was hurt. This time I was furious. I hated her lecturing, but at least it took place before the session when it had some chance of influencing the outcome if I was just being petulant and not trying. But this was after the session, and I couldn’t see any reason for her to say that, other than venting her frustration at me.
She’d told me she was around during the break if I needed her, but I didn’t contact her at all. After some time and space, I was feeling so much happier and more grounded, and I was ready to see Aisha and Jen again. But every time I thought about walking into a session with Anna, I immediately started feeling angry and defensive and trapped and miserable. I’m one of those people who can be in the middle of an argument with a friend and remind them of that thing they said back in 1997 – I can hold a grudge forever, and I didn’t know how to get past it.
Thankfully, WordPress taught me how. I stumbled onto Sirena’s blog, and Rachel’s, and their stories of rupture and repair told me that it was okay to be angry with my therapist, even if I knew she was trying, even if I hadn’t been perfect either. That it was normal to be angry. That it was good to be honest – that I was supposed to be honest. And that sometimes, when you’re honest, it can get better. Things can heal.
It gave me the permission to tell Anna that I didn’t want to come back, and why I didn’t want to come back. (I also shared some photos of me holding a monkey, but that’s just how I am). It wasn’t just the psychiatrist isAnna – it was mistakes and misattunements, promises broken and fears. It was my own shortcomings, not just hers.
I think it helped.
She replied that she knew she had lectured me about talking to the psychiatrist, and she realised it was extremely unhelpful and hurtful and that she was truly sorry, and that she now gets how inappropriate it was to ask whether I’d been petulant with the psychiatrist. She defended herself on some points, made suggestions on others, and we talked about how to work together better. We made a time for a session the following week, and I was nervous, but I wasn’t dreading it. Maybe part of me was looking forward to it.
And then things got fucked up again.
To explain this, I have to step back. Animals are one of the happiest things in my life – whenever Aisha is looking for something positive to use as a resource or a metaphor, it’s always a field of puppies or an island of kittens. I volunteer at an animal shelter once a fortnight, and I’ve desperately wanted to do foster care for kittens through the shelter, but I rent and I’m not allowed to have pets. Just before Christmas, when things were so, so bad and I was trying to clutch a friend’s cat and sobbing like a child when it bit me, I decided to hell with it – I was going to take a risk for once, and I was going to do foster care. If I got evicted, I got evicted.
I got my first two kittens at the start of January, and named them Everest and Dinky. That day was the happiest I’ve been in a long time. Both kittens immediately decided I was their mother, but Dinky was the clingiest, most adorable little duckling of a kitten. She was never more than a few centimetres from me at any time, to the point that she tried to get in the shower with me, and if I stood still for too long without picking her up, she would climb up my leg. She curled into my neck when I went to bed, and she came to me the moment I woke. I gave my whole heart to that tiny little baby.
I was more productive at work than I’d been in a long time, taking initiative rather than begrudgingly doing the jobs I was assigned, and (in their assessment and mine) I had the best sessions I’d ever had with Jen and Aisha that week. WordPress had given me the tools to talk to Anna about the ruptures, but the kittens gave me the confidence and the strength. I committed to sharing more in therapy, and I felt like I’d turned a corner, like things were going to get better. I risked asking Anna for a Skype check-in before our first session back the next Thursday, because I wanted to introduce her to them – to share them with her.
Then on Saturday night, I came home from dinner, and Dinky was under my bed, dead.
I completely fell apart. Harder than I ever have before. I’m not prone to big emotional reactions. When I was 18 and my mother told me she had cancer, I gave her a hug and a kiss and five minutes later, at her request, went to work and did my full shift. When my nan texted me during a class to tell me that my very much loved aunt had died, I sat through the rest of the session before going home and going quietly to bed, without telling my housemates what had happened. But when I picked up that little body and realised she was dead, I lost all the control I usually have over myself.
I’d been trusted to take care of her, and I’d killed her. Something I loved without reservation was gone. I was going to lose my friends at the shelter and my contact with the animals – after killing one of their kittens, I could never go back. I was going to have to move from the apartment I loved, because I could never be happy there again with her ghost in the shadows. Somehow I was going to have to collect myself enough to go to work the next week and to be normal with my little cousin when she came to stay with me. She had died alone, without me, maybe in pain, maybe crying. I’d thought maybe I could be happy, I’d opened up, and then everything had fallen apart. Even at the time I was judging myself for having such an intense reaction to an animal dying, but the truth is that I can cope with hard things, things that maybe other people might have trouble with. For me, this thing was just too hard.
I found myself in the bathroom, my first reaction to seek out my self harm tools, but I remembered the crisis plan – I’ve made an agreement. I have to stick to it. I can’t do this. A friend came and tried to hold me, but I was inconsolable, on the floor wailing, and he took Dinky’s body and left.
After over an hour of pure hysteria, I called Anna. It was 11pm, and she didn’t pick up, but she’d told me that if it was a crisis then I had to call even if it was 3am, so I called twice more, then went back to the bathroom. She called me back just in time.
The call lasted a minute, just long enough for me to tell her that I needed to be admitted and I needed her to call someone. Until now, she’d never heard me cry, and even through my hysteria I could tell she was taken aback at how distressed I was. She called the police then called me back, and I was sobbing and coughing and choking so much she thought I’d cut my throat. This time we were on the phone for less than two minutes, and the moment the police knocked on the door I hung up. There was nothing petulant or distancing about it – I was just in tunnel-vision survival mode. I’d called Anna. She’d called the police. The police were here. She’d done her job. I had to answer the door.
I kissed Everest goodbye, and they took me to hospital. I spent a pretty awful night in the emergency room. It was the first time I’d ever been without self-harming first, so it was the first time I’d had to try to cope with the experience without first having regulated the emotions that were sending me there in the first place. Anna sent me a lovely text at 11.40pm, just as I arrived at the hospital: “Rea, call me anytime and if you’d like me to come to the hospital I will…If I can do anything else to help I’m more than happy to“. Part of me wishes I’d asked her to come, but at the time, I didn’t want to see anyone. I just wanted to be somewhere safe and quiet.
It was a long night, and I hadn’t calmed down at all by the next morning. I’d spent 4 hours sitting in a chair, knees pulled up to my chest with a blanket over my head, sobbing. When they’d tried to move me from the chair in the waiting area to this one, I’d been dissociated and frozen and couldn’t move, and the male nurse had grabbed my knees and tried to forcibly uncross my legs – I was thrown into a panic attack and tried to curl into a ball, and he took my upper arm and pulled me to my feet, telling me “We’re trying to help you, but the way you’re behaving is not appropriate“. At 5am I got a bed and got a few hours of sleep, but when I woke up I fell back into despair, and started banging my head against the concrete wall, more than 30 times. Another man walked in, but I was facing away from the door, and when he yelled “Stop it, Rea!” then walked out again I was caught off guard, and I panicked again.
A few minutes after this, Anna texted to tell me that she’d spoken to my friend and knew what had happened, and was wondering how I was doing. I still wasn’t speaking, and hadn’t spoken to anyone since I arrived at the hospital, but I might have replied. I might have, except for the last line.
I’m still bothered that this upset me – it’s just semantics, and I know she was just trying to express empathy. I wish I could have taken the message with the care she intended it to have. She said “I know how painful that would have been for you“. And it made me angry, because she didn’t know. How could she? Until it happened, I had no idea how painful it would be for me. I’m sure she had no idea that I was thinking about having to move, that I was worried about the visit from my cousin, the friends who were dropping by to see the kittens, the interview I was supposed to be doing on Wednesday.
It feels so unfair to Anna. If she’d said “I know that would have been so painful for you“, I wouldn’t have been angry. It’s such a minor difference. But I couldn’t stand her telling me that she knew how painful it was. My initial reaction was to text back “Fuck you“. I’m relieved that some healthy adult part of me stopped that. Instead, I just didn’t respond.
Later that afternoon, my friend texted me to tell me that he’d taken Dinky to the vet for an autopsy, and her death wasn’t my fault. There was no trauma, no poison, nothing she could have choked on. It was something congenital, or maybe fading kitten syndrome. Something I couldn’t have helped. I was still devastated, but slowly, I started to calm down. 20 hours after I entered the emergency department, I spoke for the first time, and 24 hours after I arrived, I was released.
I was coping, but retreating, feeling like I’d opened up and the world had slapped me in the face. I cancelled all my sessions for that week, with Aisha and Jen and Serena, and I didn’t show up to my DBT group. I was still too raw to talk. On Tuesday the 12th, I contacted Anna for the first time since Saturday, thanked her for her support over the weekend, and told her that I wasn’t seeing anybody that week and I’d need to cancel my session on Thursday, apologising for the late notice.
She replied “Thanks for letting me know. Also I’m away next week and only back on Thursday the 28th of Jan. Enjoy your time with Lyndon [a friend who was visiting]. Warmly, Anna.”
That hurt. It meant missing two weeks of sessions, but she wasn’t leaving the door open for me to respond. I didn’t begrudge her a holiday, but it felt weird that when we were scheduling our first session back after the break, she hadn’t told me she was going to be away for the following two weeks. I get why she would respond that way – it would be understandable if she felt that I’d pulled away from her, that she’d reached out to help me and I’d used her then cut her off, and she was distancing herself from me the way I distanced myself from her – by stating what she was doing and not leaving any room for discussion. But it hurt, and it felt personal. My first impulse was to throw my phone at the wall, and if I still had a $20 phone that could survive a nuclear holocaust, I would have.
I replied immediately “Thanks – enjoy your break“, and settled in to seethe, but then realised I needed to clarify what was supposed to happen with the crisis plan. When we were writing the plan back in November, she’d told me that she might take a week off in January but that she still really wanted to be available by phone, text and email, that she was committed and she was signing up for this with me, that we were doing it together. I’d pointed out that she might need a break, but she said no, that she wanted to be there and that she was willing to do whatever it takes. Given her retreat from me, I didn’t feel confident that this still applied.
And it didn’t. I texted her: “To confirm, if the crisis plan needs to be enacted between now and the 28th I’ll contact Jen instead of you?”. Maybe I should have asked her what she wanted to do about the plan, but that felt too vulnerable. I read her intention from her message about going on break, and I wanted to beat her to the punch, but maybe the punch wouldn’t have come if I’d approached it differently.
She replied: “Yes, I think that’s best. However, if you can’t get Jen, you may have to ring 000 or the crisis team yourself…is that doable?” and then suggested that since I can’t speak if I’m really distressed (i.e. in a state where I’d need to call emergency services) I record a voice message to play to them with my name, date of birth and what I need.
My chest hurts when I write that. She promised to be there for me and that we were doing this together, but now she isn’t willing to even be the second point of contact. No matter how reasonable it is for her to need a breather, no matter how much I’ve contributed to her frustration and her need to distance from me, the part of me that let myself need her and latched onto that promise feels abandoned, and it feels terrible. And I’m angry – after all her questioning of my commitment to the plan, all the times she told me she knows I’m going to break it, I stuck to it even when I hurt so bad I was on the floor screaming, and she didn’t.
It’s not fair. It makes sense, but it’s not fair.
She gets back from break in three days. We don’t have another session scheduled, but will probably make one for next week, eight weeks since I saw her last. And I’m struggling to decide what to do.
At first I was going to tell her how it felt to get that message. I even wrote an email, explaining that I understood, but letting her know that it hurt me and surprised me, and asking that if she needs to break an agreement in the future, it would help me if she could acknowledge that it’s happening and explain why. But then it started hurting less, and I started to empathise with her more, and I decided I didn’t need to send it, that maybe I can bring it up some time in session, but that I can go back without sulking, without needing to talk about it to repair the rupture.
I still think it’s important. When I think about it, it still hurts. But I believe that any criticism will make her feel like I’m pulling away again, that she ‘can’t do anything right’, and that the way for things to get better is for me to come towards her in a positive way.
And I am making an effort to remember all the good things. I once mentioned a picture book I like, and she read it. She listens to my playlists between sessions. She wants to connect with me, she tries so hard to connect with me, and it must be frustrating when I can’t talk to her. When the police arrive and I hang up the phone. When she offers to come to the hospital and I don’t reply. Maybe it even hurts. I think if I remember that, I can keep the angry part quiet.
With all that’s happened, I still have this quiet, hidden belief that it’s all going to be okay. That we’re going to work it out, and she’s going to help me make things better. I hope I’m right, but I’m afraid I’m not.