(My Therapist Says) I Am A Dog With Cancer

I think I’m going to stop seeing Aisha.

She was the first psychologist I ever saw. I’d been self harming for over a decade by then, but had never spoken to anybody about it, and she patiently sat through session after session of silence, waiting for me to feel comfortable enough to talk. It’s been over 18 months now, and when my emotions are so overwhelming they start spilling out in snark and snippiness with other people, she’s the only safe person I can break down and cry with.

But she isn’t here. She’s literally on the other side of the world.

I only started Skyping her because she was my friend/boss/surrogate father R’s therapist, and R was the one who talked me into trying therapy – it was just convenient to set me up with her because he knew she was good, I guess. By the time we realised I really needed to see someone on the ground who could work with me more fully, I was too attached to just snip the apron strings, and instead it became a case of finding a local psychologist and then slowly weaning off Aisha. Very slowly – I’d been seeing Anna for 8 months and nobody was anywhere near thinking it was time to transition away from Aisha.

But right now, I’ve got a knife and I’m hacking at those strings. I can’t tell whether this is coming from a wise place, or whether I’m being reactive because I feel abandoned, because she didn’t reach out to me after Anna quit and I’m hurt and sad.

Back when Aisha had been seeing me for a few months, she told R to think of his relationship with me as adopting a dog with cancer – to treat me with love and compassion, but not get too attached, because I’m probably going to die. I’m not supposed to know that, but I do.

To be clear, she has never, ever let that thought show in our therapy. She has always been optimistic and encouraging and told me to have hope for the future. But knowing that she thinks (or thought) that I’m not going to make it just makes everything seem disingenuous. It hurts, and it makes me angry, and I don’t really know why. I should be glad that she recognises how profound my emptiness is, that she can see how much I hurt and struggle. But only a very small part of me is glad.

I think she’s amazing at her job, and I love her. But I have some reservations. Like when she went away for four months last year with less than two weeks notice (even though it’s scheduled travel that she does every year), at a time when I was self-harming so badly I needed surgery and had lost other personal and professional sources of support. Like the fact that it generally takes upwards of two weeks for her to respond to simple (e.g. scheduling related) emails.

And I wonder about how much she discloses to me. This was a huge difference between Anna and Sue – I knew virtually nothing about Anna, so I couldn’t ease into session with 5-10 mins of small talk about her life the way I do with Aisha. It has definitely made me more comfortable with Aisha, but I do wonder if this is sidestepping part of the work by taking the spotlight off me.

In addition to what’s happening in her everyday life, here are some of the things Aisha has told me:

1. Her first husband was emotionally cold and didn’t express any feelings when his mother died. She left him when he started hitting her kids, and then later called Child Protection on him to restrict his custody of them – he suspects it was her but she’s never told him.

2. She started therapy when she was 28 and used to have major troubles saying no, so much that she’d white out in session when her therapist would get her to say it. In her early 40s she woke up with a body memory of what had happened to her. She’s had bad personal experiences with psychiatrists and she doesn’t trust them.

3. After her first children were born she had major postpartum psychosis and had recurring thoughts about killing her babies. Her three children are all autistic.

4. Her mother had very unrelenting standards and she has a terrible inner critic.

I feel uncomfortable about sharing this with anyone, even anonymously. I just want to work through all of my confused thoughts. I feel honored and proud that she shares with me. A lot of me loves it. But it also makes it harder for me to trust her judgment, because sometimes I think she sees so much of herself and her kids in me that it’s hard for her to see me. And I wonder whether the advice she gives is biased by her history. For example, she’s the one who set me up with Anna. At the time, I was looking for a psychiatrist who did psychotherapy, not a psychologist, and I made it clear I didn’t want to see Anna, but Aisha had connected with her and R pressured me into it so I went. Was the resulting shit storm influenced by her personal dislike of psychiatrists? I don’t know, but I wonder.

Earlier this year I woke to the sounds of a furious man yelling, banging and crashing and a woman screaming. I ran downstairs (in my pyjamas) to physically intervene, without calling the police, who fortunately arrived just as I stepped in between him and his girlfriend. I was, and still am, horrified that of an entire apartment building of people, most of whom are not 125 pound women with the upper body strength of a soggy bowl of cereal, I was the only person who showed up. I asked around and was even more upset to find that every one of my friends, family and colleagues said to call the police and not to intervene. So I asked Aisha, and she said I did the right thing, and that somebody has to step in and do something. That’s the answer I wanted. But I wonder. Her answer was so starkly opposed to everyone else’s, including Jen’s – is that influenced by her own experience with domestic violence?

I know that every therapist is going to be influenced by their own history. I’m never going to be able to take anyone’s opinion without examining it myself. Really, knowing something of her background is helpful because it helps me be aware of where some of the pitfalls might be. But it’s hard, sometimes. I don’t want to second guess her, but I do.

The care she has shown me is so humbling and has really touched me so many times. She used to cry after every session with me because she was so worried about me. Maybe she still does. I love that she cares so much, even though it feels weird, too. Even when I’ve been furious with her for repeatedly cancelling sessions, not responding to me, going away on short notice, I’ve felt secure in knowing that I matter to her.

I feel special. She’s told me that I’m the only person she breaks the rules for. She tells me she’s proud of me, and she signs her emails with “Hugs”, or sometimes, “Love”. She cries for me during sessions and she gets angry with my parents. No matter what I bring to therapy, she’s always calm and always accepting – if I’m cutting during session, if I’m completely silent for an hour, if I get up and walk away or ignore her and start texting – it’s okay. She has never got defensive and never been frustrated with me for not wanting to try something.

So why would I want to quit? Well, I don’t, really. Part of me wants to be able to crawl into her arms and hide my face in her neck and stay there. But at least I feel mostly numb about it right now. There’s pain and fear and need underneath it, but the numb goes pretty far down. It has to happen at some point, so why not now, when it’s going to hurt less? In a couple of months she’ll be going away again anyway.

I don’t know. I don’t know what to do.

(My Therapist Says) I Am A Dog With Cancer

Fuck Everybody

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It’s been over three weeks since I saw Jen. Over four since I talked to Aisha. That’s my choice, and I’m so mad at them for it.

The day Anna sent me the first termination email, I forwarded it on to Aisha and Jen, with a simple ‘FYI’ at the top. I didn’t want to talk to either of them, felt angry and oppositional at the thought of even being near someone who would want me to talk about my feelings, but I wanted some empathy and caring in a safe, contained way. I wanted an email that said “I’m so sorry, Rea. I’m here whenever you’re ready.” Just that.

It’s been 11 days, and neither of them have responded.

Mostly I’ve been ranting inwardly about how there’s absolutely no possible excuse that could justify Aisha not getting back to me because no competent therapist could possibly not realise that after being abandoned by another practitioner, their client absolutely had to receive affirmation that the therapist cared for them and was still here for them. But that argument is really just avoidance. I’m trying to skirt around owning my feelings by saying that it’s always wrong in every situation and therefore the impact on me is beside the point, she’s clearly a monster, case closed.

It hurts. I feel like I’m a little girl who fell off her bike and is on the ground wailing, blood dripping from both knees. I could get up and hobble over to my mother and tug on her sleeve and she would probably give me some affection, but I don’t want that. I want her to come over and pick me up. But I’ve been sitting alone bleeding for too long now. If she comes, all I’ll do is hit and scream because there’s too much hurt for her to comfort.

I just don’t understand. I know they both care about me. Why would they just let me disappear for weeks? Part of me feels stupid – maybe I thought they cared more than they actually do. Part of me is terrified and devastated that maybe they understand me so little that they don’t even realise how upset I am about Anna quitting, or they think they should just give me space until I decide to come back to sessions. Part of me is furious that maybe they’re trying to train me to directly ask for help, that they’re choosing this moment to withhold any response until I tell them exactly what I want.

Fuck them. Anna has her faults. Too many of them. But if Aisha had quit, and I’d sent her on the email, she would have been in touch within hours.

Fuck Everybody

To Close Our Work

On Wednesday, Anna sent me an email response titled ‘To close our work’. Just reading the subject line flooded me with so many emotions. It felt like she’d closed a door in my face. After I’d spent 8 months gradually getting to know her, trust her, reach out to her, in the space of a week she’d decided to terminate therapy, and two email responses was the only processing she was willing to give me. More crudely, I’ve spent over $10,000 in out of pocket costs for therapy with her – is that really all she owes me?

I was choking on tears while I read through it. It was a much nicer message than the last one – she acknowledged that she doesn’t have the skills to help me and that she knows that must be devastating for me, and she apologised. But that mostly just makes me angry. She wrote a nicer email because I walked her through exactly what she had done and needed to take responsibility for. So she is either just parroting what I wanted to hear, or she genuinely didn’t have the awareness to recognise her role in the situation and how the termination was going to impact me and acknowledge that before I spelt it out for her.

I do believe that this objectively sucks, but I’ve also been struck with the realisation of how intensely my reaction is linked to transference. The phrase that keeps stirring my emotions back up is “I’m so sick of always having to be the grown-up – I’m so angry that she basically made me terminate my own therapy because she couldn’t face the fact that she can’t help me until I directly asked her to think about it“. For days I kept ruminating on this, and the fury was so big it felt like it was going to explode out of me somehow, that I was going to start hitting and kicking like I did when I was a child because I just couldn’t hold it inside me any more.

When I stepped back, and asked myself what I meant by “always having to be the grown up”, I realised I was talking about my mother. Of course I was. I mean, the therapist uniform should be a t-shirt that says “This is about your mother“. Emotionally, I’ve always had to play the adult role with my mother, to the extent that when someone gives her a compliment and she starts running herself down, I step in and coach “Say thank you” and she complies. Like Anna, my mother cares about me but has no idea how to help me.

I’ve been filled with a lot of rage this week, and not just at Anna. When my brother (who is probably the most important person in the world to me) texted me to ask how my day was, I told him to fuck off. I wanted to physically push anyone who got close to me, lash out at anyone who wanted to talk about anything meaningful. Anna has shut the door and I don’t want her to open it again, but I’ve been kicking it, beating it with my fists and screaming my rage. I’ve sent three brief but abusive “fuck you” emails, telling her she has no idea what she’s doing and she shouldn’t be a therapist. And I have zero remorse.

The other thought that has been poisoning my emotions is how far she has “set me back“. That it’s going to take weeks to even go back to Aisha and Jen, months before I’m ready to see another psychologist, maybe years before I can trust a therapist again. I’ve been outraged that she has damaged me, that she has “wrecked” everything, all the progress and the effort I’ve made.

One afternoon after work, sitting in the park with Everest, I asked myself calmly “So what?”. It wasn’t a dismissive, critical statement, but a genuine question – so what? And my answer is that it sucks, but in the whole scheme of life, it doesn’t really matter if it takes a year before I’m ready to go back to therapy. It has consumed me so much, been so intense that I’ve fallen into the belief that therapy has to be happening and it has to be working or nothing is okay and everything is hopeless. In reality, I’m only 25. Assuming I survive to be 26 (and so far I have an impeccable track record of staying alive), then what does it matter if I take some time off and spend my therapy money on a trip to Hawaii instead? It isn’t ideal and this betrayal has affected me and will affect my therapy in the future, but it just isn’t worth being so angry about.

I have a long way to go. I’m still sad and angry and I miss her and hate her. I still want to cut up the stuffed dog she gave me and set fire to it, and I want to send her a photo of a puddle of blood and tell her This is what you did to me. I want to break things and cry, I want to be held and I don’t want anybody near me ever again. But it already hurts less than it did six days ago. Hopefully it will hurt a little less tomorrow.

To Close Our Work

Lies My Therapist Told Me

I told myself I couldn’t respond to Anna until at least the next day, once I’d had a little time to calm down. That lasted an hour.

I got her email while I was at work, and barely managed to hold it together long enough to get through the rest of the day. Once I left the building, I started crying before I even got to the end of the street, and kept crying all the way home.

In my heart, I was sure that she was going to step up and we would keep working, keep trying. I’d picked the day that would be the most convenient for a session, and mentally set aside the clothes I was going to wear. I’d thought about which goal I’d pick for us to focus on moving forward. She committed to me, over and over, that this was long term, that nothing could make her go away, and I thought this was just another bump in the road.

I am so, so devastated that she’s given up on me so easily, and I am so angry that she thinks that 400 word email is all she owes me after all the promises she’s broken. But I’m so sad that she’s gone. I keep having flashes of the moment I looked up from my hospital bed in the emergency room and saw her standing there, at midnight, holding a stuffed dog for me. Of her sitting next to me while I cried, and reaching out to wipe my nose. Of walking with her through the park, barefoot. It’s almost like she’s dead, in a way. I keep thinking of everything I’ll never get to tell her. After pressing me to call child protection, she won’t be there for the fallout. I’ll never get to say goodbye to her dog. She’ll never wish me a happy birthday again. If I’m admitted to hospital again, she won’t come. And I want her.

Part of me regrets ever sending that email. Regrets not just going back to another session and telling her my plan and moving forward. It’s so angry with me for letting her go away when I could have stayed quiet and kept her. Another part of me knows that the way she’s handled this situation proves that she is not a skilled therapist, however caring she is, and continuing to work with her probably wouldn’t have benefited me in the long run.

I was in bed, sobbing, feeling so much grief and anger pressing on my chest. I had to get some of it out, and I couldn’t let her get away with that bland, no-big-deal email. I wanted to tell her that this isn’t a pleasant, shake hands, lovely to meet you parting, but a gut-wrenching devastating completely derailing betrayal, and I want her to own that. So I got up, and I sent her a rapid series of short texts.

“So much for all your promises. It might be “a bit hard” to start from scratch with someone new? Fuck you. I can’t believe you’re making me do this again. You kept telling me this was long term and I thought you were going to be my last therapist.”

For a little while after I sent them, I felt a little calmer, but then a different part of me took over and sent her an email. I think the abandoned child has been texting, and the angry, ruthlessly logical teenager has been emailing.

“Hi Anna

I wish I didn’t have to do this, but I feel I need to hold you to account one last time.  Your email seems to be avoiding the real point.  The ideal may be for me to work with a single psychiatrist/psychologist, but if you were capable of continuing to work with me, then the best approach would have been for me to start seeing one of them while still seeing you, and over time decide whether I wanted to transition across to work solely with them.  In our last session you recognised that it’ll probably take me months to find a psychiatrist, and that’s on top of the months (years?) it’s going to take me to come to terms with this failure and loss of trust enough to try again.  That is not ideal.

Perhaps my truth is different to yours, but I believe if you were really being honest, your email would have said something like this:

“I have come to realise that as much as I have wanted to support you, I don’t have the skills to be able to help you.  I recognise that my inability to support you effectively and the mistakes I have made have given you additional burdens and have been painful and difficult, and I am truly sorry.  I also realise that my request during our last session was inappropriate and I apologise for that.  I know that starting again with someone new will be really difficult for you and I wish you didn’t have to go through that, but in the long term I believe it is in your best interests.  Even though I committed to working with you long-term, I would be doing you an injustice if I wasn’t honest about this, because you deserve to get the help you need and through no fault of yours, I am not able to provide it.  It’s unfair and it sucks and I’m sorry.  

With that in mind, I think the most optimum way for you to get the help you deserve…”

I am very, very upset about how this has turned out, and very angry with you for letting me down.  Despite everything, I still like you, and I would prefer to end with pleasant well-wishes, but this experience is not pleasant.”

I managed to get through some work for an hour or so, and then sobbed for the rest of the evening until my whole face ached. The vulnerable child was remembering everything kind she’s ever said to me – “I’m right here and we’re going to do this together, okay? I’m definitely not going to leave you. I’ll stay on the phone with you all night if I have to. Can you tell me where you are and I’ll come get you and sit with you? Please, Rea, I want to be there with you.” – and desperately wanting her back. The angry child wanted to punish her for how much she’s hurt me, and wanted to send her a text telling her that when I kill myself, I hope it haunts her forever.

I finally fell asleep after 1am and woke again at 4, and it wasn’t long before I was crying again. I got up, and the children each sent her a text message:

“All I asked you to do was start putting my feelings ahead of yours and start working with me instead of talking at me. If that’s so impossible for you to do then you shouldn’t be a therapist.”

“I didn’t want you to quit, I just wanted you to do better and I hate you for giving up on me so easily.”

I cried all the way to work today, and all the way home. It’s so shocking and abrupt that I don’t know how to even start dealing with it. A week ago, she was telling me that we needed a psychiatrist to support our work, not to replace her, and she offered to set up 4 or 5 appointments with different psychs and come with me to each. And now she’s gone. How did she go away so quickly?

Tonight I sent her another email:

“Let’s talk some more about this pathetic excuse for a termination email, shall we?

“Whatever happens, I’m not going to go away.  I’m not going to go anywhere for a long time.  I’m committed to this.  I want you to know that.” 

Apparently this wasn’t true, but I believed you.

“I’m not going to get it right all the time, but I am willing to own it and try to do it better next time. Having you calling me on it is a good thing.  It’s not going to make me stop working with you.”

Apparently this wasn’t true either, but I believed you.

So when you were writing that email, what made you think you didn’t owe me an actual explanation of why you’ve abruptly decided you can’t work with me any more?  Not “I think it would be optimal for you to work with a single psychiatrist”.  The question was never about the most ideal way to do therapy, it was whether you can help or not, and a week ago you were offering to come with me to see a psychiatrist, not suggesting that I see one instead of you.  Why did you think I didn’t deserve an explanation of why you can’t offer the help I need?

At the very, very least, why didn’t you think you owe me an apology?”

It’s been over 24 hours, and she hasn’t responded to any of my messages. Today is her day off, so she doesn’t have any other clients.

Through all of this pain and anger, I’m still holding out hope. Hope that she’s going to come back and say “You’re right, I made a stupid, terrible mistake. I was wrong to give up on you and now I know you want me, I want to keep working with you. I’m so sorry, and I’m going to make it up to you.” A lot of me really believes that’s going to happen, and it’ll all be okay. Because she promised.

Lies My Therapist Told Me

Terminated

Hi Rea

I’ve taken a bit of time to get back to you, as I’ve been considering what you’ve said and the work that we have done to date. I agree that this year our therapy has been disjointed and just really focused on containment. However, I also think I am not able to offer you the help that you really do need. Over the course of our work together, it has been clearer to me that the most optimum way for you to get the help you deserve is to work regularly with a single therapist, and in my opinion, this should be a psychiatrist that can help you with meds and also psychotherapy. Another alternative is for you to become an inpatient in a dbt clinic where you can get the benefit of a team approach. I know that probably neither these options are something that you will like, but in my professional opinion it feels that they could give you the best chance of living a life that you can enjoy.

I really do hope you connect to the psychiatrist we tried to get you into. I am also giving you the names of two others that also do psychotherapy.  I’d be happy to advocate on your behalf if it would help in facilitating you to get into any of these services.

I have also notified the mental health crisis team at [hospital] and they have a list of psychiatrist they can tee you up with.

I have enjoyed getting to know you. You are a highly intelligent, creative and caring person. I wish you all the best and I hope that you will consider trying to work with a good female psychiatrist, even though the start may be a bit hard for you.

Kind regards

Anna

Terminated

Bit The Bullet (And It Didn’t Break My Teeth)

This afternoon at work, I spontaneously decided it was time to get in touch with Anna. I’ve had the email drafted for a week, but it’s been sitting unsent. I think I was waiting until it felt less important.

The next few days are going to be hard while I wait for a reply. I’ll keep myself distracted, but it’ll be in the back of my mind, and I’ll check my emails more frequently than usual, feeling a little sick with nerves each time I do. When I see a reply, my stomach will drop and my whole body will go cold. I’m terrified she’s going to tell me to find a new psychologist, and I’m terrified that she won’t and I’ll have to go back and sit in that office and talk about this stuff.

I’m not sure which is worse.

Hi Anna

Before I bring up last week, I would ask that you reflect on the things I’ve already given you feedback on and consider whether you’ve made an active effort to work with them:

  • Safety
    • Showing me how the windows open
    • Sitting on the floor
  • Communication
    • If I’m angry/frustrated about something, suggesting I take a break on my phone for a few minutes and then trying to discuss the issue
    • Asking me to share something each week
  • Regulation
    • Starting to introduce an activity like colouring or cards so that we may be able to use it when I’m activated

In terms of supporting me – you’re getting in your own way.  When I reached out to you because I was dreading the end of DBT, the session became about your guilt around your limitations.  Last week when I was self-harming and struggling to function, the session became about your anxieties around your own struggles with my therapy.  I so appreciate how much you care, but you’re not leaving a lot of space for me.

The message I got from you on Wednesday was: ‘I don’t know what to do – you go figure it out and tell me how to fix it’.  I’ve figured things out on my own my whole life.  If we’re going to work together, we have to work together – you can’t hand responsibility over to me like that.  You especially can’t hand responsibility over to me like that when I’m overwhelmed and barely managing to cope with the responsibilities I already have.  Probably you’re right that I needed some time to think about what’s going to work best, but this was obviously a planned conversation on your part, and I would expect somebody in your position to approach it in one of the following ways (or similar):

“I’m worried that working with me hasn’t been all that helpful so far, and I was wondering if maybe we could talk about some of the things we’ve tried so far and why they didn’t work, to see if we can figure out how to do things better.”

“I’ve been thinking about how I can support you, and there are a few options I was hoping we could discuss to see what works best for you.”

Both of those would have left scope to start the conversation and give me some specific options to consider and formulate some thoughts around before we met again the next week.  One option is for us to pick a specific focus (like self harm, or my relationship with my family, or a particular goal or belief system) and build sessions around that; another is for us to have ad hoc sessions where we discuss whatever’s happening in life at the moment and whatever issues/memories are coming up; another is a mixture of the two, whether structured (e.g. alternating sessions, 10 mins at the start of each session on current issues and the rest on our focus area) or just alternating as required.  Given that you have more experience with therapy than I do, I imagine you can also think of other options.

I would ask that you think seriously about whether we should keep working together.  That’s a frightening thing to write, because the idea of having to start over and look for another psychologist again is pretty devastating.  I very, very much don’t want to do that.  But I also have to be adult enough to accept that I can’t keep seeing you just because you’re nice and you let me bring my cat to sessions if you can’t actually help me.  I don’t really see myself getting better, but I might as well at least try.

My preference would be that you let me know via email if you think it’s best for me to start looking for another psychologist.  If you think one of the options I mentioned above (or another option) is workable for us, then let me know and we can discuss at a session.

Thank you for all the support you’ve offered me.

Rea

P.S.  Everest is Queen of the Park now.

 

Bit The Bullet (And It Didn’t Break My Teeth)

I’m Being Petulant (And It Doesn’t Become Me)

I still haven’t spoken with Anna, or Aisha, or Jen. And the mental health crisis team is still pursuing me.

They started by just calling and texting me. I didn’t answer. They escalated to coming to my apartment building (but couldn’t get in), leaving me letters, and voice messages saying that if I didn’t allow them into my home to speak with me, they would call the police. (They didn’t.) They threatened to contact my family, then called one of my friends to see if I’d spoken with him, and openly admitted they were breaching my confidentiality by even contacting him.

This makes me angry, on a number of levels. The worst part is, I know my anger isn’t really justified, so I don’t even get to self-righteously enjoy it. Somebody (either Serena or Anna) referred me to them, and so they have to take some steps to check in on me. But I hate that I have no choice but to engage with them; that a normal person can refuse to pick up a phone call they don’t want to answer, but I can’t. I hate that even though I know they have female staff, every phone message and request to come into my home has been from a male. I hate that there’s no way for me to text them back to decline their offer of services, even though they can text me, because I find talking on the phone anxiety-provoking at the best of times.

Today, when I was on my way out to meet with my boss, a man was standing at the front door of my apartment building, banging loudly. I opened the door and smiled at him, and he apologised and went inside. A minute later, he literally ran at me in the street, having belatedly realised that the chick covered in scars was probably the person he was there to see.

I said: “I’ve got somewhere to be“, and kept walking, and thank god he didn’t keep following. But it upset me a surprising amount; I was fighting back tears, and feeling panicky, like my home wasn’t safe anymore. It’s usually a place where I can hide from the outside world, but now the outside world is coming in.

I know I’m being ridiculous about this. If I called them, spoke to them like a mature adult and allowed them to make a home visit, they would probably stop pursuing me. But I’m being petulant because I don’t want to and it’s not fair.

I’m Being Petulant (And It Doesn’t Become Me)