It wasn’t one of my better days.
I wasn’t even supposed to have a session with Anna last week. At the start of the year, we’d agreed on no more than two therapy sessions a week to make sure I don’t get overwhelmed and flooded and suicidal like I did last year. I hadn’t realised that my DBT group counted as a therapy session, though, meaning that I was going from seeing Anna twice a week last year to once a fortnight this year.
But after working 40 hours in three days, I was exhausted, and I slept through DBT. I felt terrible when I woke up – I was disappointed I’d missed it, and I was scared that Anna was going to take it as proof that I wasn’t trying. But most of all, it meant that there were only two sessions left until the end of DBT, and the end of the crisis plan that’s stopped me self-harming for the last 3 months. Part of me is counting down the days, and another part is terrified of what I’m going to do to myself.
By the time I went to my sign language class that night, I was so flooded with anxiety and thoughts of self harm that I couldn’t follow what was happening. So, trying to reach out and do the healthy thing, on my way home I texted Anna for our required DBT check-in and told her I was having a hard day. She offered me a choice of two session times the next day, and that was that.
I wish I hadn’t gone. I took Everest, and we had quite a few light-hearted moments (like when Evee got up on the table between us and started drinking out of Anna’s glass, or when she bit her toy monkey and it started screaming and she ran away and hid under the couch), but I left feeling much worse than when I came in.
We’re still stuck in a bad dynamic (of my creation) where she opens the session, she talks at me, and I contribute when she gives me an opening. She knows about my fears about the crisis plan from Jen and Aisha, and she went straight to problem-solving mode, suggesting 24-hour supervision by a friend on the day DBT ends, and an agreement that if I start self-harming “badly” that I be admitted to a private hospital.
From a practical perspective, these were rational and necessary suggestions. From an emotional perspective, I felt silenced. I didn’t want “Here is what you should do“. I wanted “How are you feeling? That sounds awful. I’m so sorry you have to deal with this – it’s not fair.” I needed my fears and my conflicts heard and understood and affirmed before I was ready to talk about and commit to safety planning.
I have no doubt it came from a place of caring. And some of the things she said were lovely – when she was talking about me going into the hospital, she said that for her and Aisha and Jen, it was like me having to watch Everest cross the road with my hands tied behind my back, and that because they’re not a hospital they don’t have a team to hold me, and they don’t know that every night I’m okay, that I’ve been fed and put to bed and looked after. Hearing that really threw me. It never would have occurred to me that she cared about any of that, and it was uncomfortable but nice to hear.
The thing that really triggered me came on my way out the door. She told me that it was pure chance that she’d got my message last month the night my kitten died, and that as a sole practitioner she can’t be there 24/7 – her ultimate point being that from now on, after 6pm she wants me to call emergency services instead of her.
The reality of her limited capacity to respond is not exactly news to me, given that I suggested putting limits on her availability back when we were writing the plan. I sent her an email requesting some boundaries:
“It would also be helpful for me to have some parameters around when I can contact you and the process you’d prefer (e.g. 9am-9pm Monday-Friday, text first and ask if I can call….or whatever).”
Her response was this:
“Re contacting me… its going to be anytime. You will be in crisis… so I’m not expecting you to hang on. If I gave you a time frame it would be sort of like saying to a heart patient (if I was a heart Dr) if you are having a heart attack only contact me between the hours or 9 to 5. Try texting first. if I don’t respond fast ( ie within 30 mins). Ring. ( I may be asleep).”
So when she told me that 6pm was now the cutoff, I felt pretty angry and frustrated: “Oh, you can’t be available all the time? No fucking kidding! Why are you explaining this to me like it’s something I don’t understand? I’VE BEEN TELLING YOU THIS FROM THE START!”
It really worries me that even though I foresaw the potential issues with unlimited availability and raised it with her, she didn’t recognise it could be a problem until I was actually put at risk. Again, I’m sure she had the best of intentions. But I need to trust that she knows what she’s doing if I’m going to do this work with her, and that means that next session I need to tell her about my concerns.
I hope I can do it.