there is a very strong self-destructive force in you

I went back to see Alina on Tuesday. It felt wrong to call and cancel after she’d gone out of her way to see me, and even if we couldn’t work it out and she wanted to refer me on, I didn’t want to end things with her telling me I had to leave, and with me walking out. I didn’t want her to think I was seething in a corner somewhere, downing shots and throwing darts at a photo of her face.

So I went back. We had an appointment scheduled, and I assumed that if our last session was The Final Straw and she wasn’t willing to see me again, she would have had her receptionist call and cancel my appointments. I was wrong.

I arrived at 2pm, and she was with another client. I sat in the waiting room for 15 minutes before I’d constructed enough of a poker face to ask the receptionist, and my cheeks flamed red as I lied unconvincingly that I must have got the wrong day, and stumbled out the door.

I don’t even really understand why I felt – feel – so ashamed. She was unprofessional enough not to communicate with me before booking over my timeslot; how is that my shame? But something about it feels so cringeworthily pathetic, to turn up thinking she would be expecting me, when she’d crossed me out and moved on.

And I felt angry. Who is she to assume that she knows me, to be so sure that I’d just walk off and not show up again?

In the two hours between that debacle and my appointment with Nikki, I cut and burnt, and I really wasn’t in the mood for therapy. I was feeling even more guarded than usual, which basically means I threw a couple extra alligators in the moat to back up the catapults. I didn’t tell her what had happened with Alina, because I dreaded being asked how I felt about it.

I’d wanted to talk to her about working on my belief systems around pain. We only have 8 sessions left now, and if we keep just going through my history, I’m going to walk away feeling like I’ve dug up a mess of bones without any time to clean them up, lay them out neatly and bury them back in the ground. I’m worried about boring her by focusing in on one narrow thing, but I think that’s the only way to leave believing that it was worthwhile. So why didn’t I bring it up? Yes, I was very shut down after what had happened with Alina, and trying to initiate a conversation with Nikki about goals felt abhorrent and impossible. But therapy sucks anyway. Why am I suffering through it in near-silence and getting nowhere, instead of pushing a bit harder, suffering a bit more and maybe actually changing something?

So far, Nikki is following the well-trodden path of psychologists before her. She wants to know what will help me feel comfortable; we’ll go for a walk next week; I should bring Everest along to a session. She asks to see my arms, is distressed at the extent of the scarring, and both sessions run at least 15 minutes over time. She says she’ll make calls, talk to people, try to get more help for me, but says that doesn’t mean she is getting rid of me; she’s more than happy to keep seeing me. I like her, a lot, and if I could afford to keep seeing her I would. But there is nothing that makes me think this person could help me change my life. Can anybody?

The next morning, on my way to work, I got a text from Alina – the receptionist had told her I was there.

I am sorry that our meetings ended in such way. And I am sorry for misunderstanding of what has happened on Friday. I was looking forward working with you although we both know it would not be an easy path. But you said last Friday that you were not ready to sacrifice with staying on line and checking your e-mails while you are at therapy sessions, in fact you said you were choosing e-mails over therapy and left in the middle of the sessions. So I interpreted all of it as a sign that you were not ready to commit to therapy. And as much as I regret that out attempt to work together has failed this time, I also know that I could not do anything else. We know that there is a very strong self-destructive force in you and without clear boundaries and limit setting we will not achieve anything. I think you know that you need a strong therapist, but then you are fighting it at the same time.”

I got angry, I cried, I cut myself, and then I started wondering whether she was right. Not about her retelling of what happened – I certainly never said I was choosing emails over therapy! – but about me sabotaging myself. Did I walk away from somebody who was inflexible and arrogant enough to be certain of her own assumptions, or did I throw away an opportunity to work with someone great because I was too willful and stubborn and convinced that I was right? Or like most things, does the truth lie somewhere in the middle, and if we’d both bent a bit we could have connected?

I don’t know, but I want to. I felt so outraged that she was claiming I was uncommitted and self-destructive when my conscious motive for picking up my phone was to regulate, to stay calm enough that I could stay in the room with her, in therapy.

A little too outraged, perhaps. Usually when I feel that fired up about something, it’s because I know there’s at least a glimmer of truth in it, and I wish there wasn’t.

I’m a bit at sea. There’s no rush, I keep reminding myself, but if my conception of a ‘good’ therapist is completely different to what I actually need to get better, then it doesn’t matter how long I wait. They could land in my lap, and I’d throw them back into the sea.

there is a very strong self-destructive force in you

I’ve Been Quite Busy (Falling Apart)

I’m so angry and sad and despairing and I need to hurt myself but I just don’t want to.

I guess I should start at the beginning.

On Tuesday, my session with Alina was mostly about safety planning.

You told me that you came to therapy because you are afraid that you might kill yourself. And I think you’re right; I think you might.” It hung heavy in the air for a moment, then she continued. “So, I need to think about how to set limits on behaviour that is going to interfere with therapy.

She asked whether I’d had any discussions or agreements with previous psychologists about what needed to happen if I had urges to self harm or commit suicide, and I explained the crisis plan I’d been required to enter with Anna as part of the DBT program; if I was imminently about to hurt myself, I had to call her, and if I wasn’t able to start talking to her within half an hour, she would call the police.

Alina contemplated this for a moment. “I certainly would not think that it would be right to call me. Not because I don’t want to know, and not because I won’t care, but if I’m on the other end of the phone line then there is nothing that I can do.”

That first sentence hit me pretty hard. It would have been different if she’d said ‘not helpful‘ or ‘not a good idea‘, but ‘not right’ felt so harsh. I felt ashamed that I’d agreed to do it with Anna, that that had been wrong, and somehow chastised and rejected, even though I hadn’t suggested or even wanted a similar arrangement with her.

The safety plan Alina decided on was that every time I self-harmed, I would have to go and see my GP, and then my GP had to send me for psychiatric evaluation by the hospital. That wasn’t up for negotiation: “We can do work only under these conditions. When I see you next time, you will have to make a decision.”

I was so angry and upset that for a moment it took all my focus to remember to breathe. This plan is not going to keep me safe. Making me miss work and lose income every time I hurt myself is not going to help me stay stable. Making me go through all my history with a strange psychiatrist every time I hurt myself is not going to keep me safe. Last time I was in the emergency department I smashed my head against a concrete wall 28 times before a staff member came in and yelled at me to stop, and they sent me home a few hours later anyway, so really, the chances of them admitting me against my will just because I cut myself are slim to none.

“I guess my question is, since you said you accept that I’m probably going to keep self-harming for a while, why do you want me to be assessed every time I do?”

I think we need to treat each event of self-harm as a potentially life-threatening event and you need to be assessed. That’s one thing. Secondly, I think you need to know that people take it seriously. And I think GP makes it too comfortable for you. She’s nice, she’s supportive, she talks probably very loving to you, stitch you up, tell you goodbye, give you a hug, say ‘be good’. It’s all very comfortable. So you get double comfort; initially when you’re cutting, and then when you get stitched up.

This made me feel awful. I feel awful, reading back over it. Firstly, she’s wrong. I haven’t had many experiences that are more horrible than having to expose fresh wounds after an emotional crisis and then deal with the physical pain of having them treated. I like my GP, a lot, and I have taken comfort from her, but it’s a terrible process to have to go through. And I understand that she wants to avoid reinforcing dysfunctional behaviour, I do, but the logic behind going You know what, I think your GP is making you feel better after you’ve been in emotional crisis, so I think we should instead make the process as horrible for you as we can is just awful.

I went home, crawled into bed, and sobbed while I thought about which method of self-harm I was going to use; if I was going to be threatened out of doing it after Friday, then I had to at least do it once or twice before then.

On Wednesday, I met the psychologist, Nikki, and went home to calculate my savings and try to figure out how to afford to see her long-term. (The answer: I can’t.)

I really liked her. That doesn’t mean she’d be able to help me, but I felt comfortable. (Ish.) She was warm and empathetic and attuned, and the only time we went far enough out of my comfort zone that I froze up and started getting flashes of blood, she verbally acknowledged “I’m pushing you too hard too soon” and shifted topics.

On Thursday, when I arrived at Margaret’s, she had no idea who I was. She didn’t have me booked in for an appointment, but was willing to slot me in in the afternoon.

And she surprised me. She said she’d been thinking about me, and she’d gone to a monthly meeting of psychiatrists and asked them for advice, and they’d recommended I come off Effexor and start taking Seroquel regularly, and suggested that neurofeedback might be helpful for me. She was still as blunt as an old axe, but softer somehow, and I told her how much I’m struggling with work, and with my relationship with R, and I cried when I told her how much I hate having to be in therapy.

And then I went home and held my arm over the stove with the hotplates turned to full, because now I liked Margaret and I was going to have to decide between her and Alina, and I didn’t know what to do or how to choose and it might be my last chance to hurt myself before I had to contract with Alina the next day and should I even agree to the contract and what am I going to do?

The answer, as it turns out, is fuck shit up royally.

After I’d spent every evening this week flooded with thoughts of self harm brought on by the conditions she’d set out on Tuesday, she didn’t even mention them today. At the start of the session she described my self-harm as ‘attention-seeking‘, but when I pointed out that in the first 13 years of self-harming I only sought medical attention once, she was surprised and let it go. The only condition she set is that I call the crisis team if I’m about to act on a suicide plan.

Her rules around contact out of sessions are no texts and no phone calls unless it’s logistical or to inform her that I’ve been hospitalised. I can send her emails, and she’ll read them but she won’t reply. And that’s okay, I don’t think I need more than that, but I was still upset.

I was so proud of how hard I was trying today. When she asked again what my goals are for therapy, I took out my phone and went back to the list I posted here, and I went through almost all of it – I only skipped food and body issues. I’ve never given a therapist an answer to that question before, and I’ve never looked at something I’ve written down to give a really comprehensive answer to something.

So, all of the groundwork was done. She put down her pen, and said “And now we begin“.

The silence stretched on, and she was just looking at me. I started feeling panicky, and like I was about to cry, and the room was too small and I didn’t have enough space and I needed to calm down. So I reached down to my phone, which was sitting on my chair, and I opened my work email.

Alina asked me what I was doing, and I told her.

Are you testing me?

I thought about it for a moment, to make sure, then said “No, just giving myself a break.” Checking my messages or looking at photos was a strategy I always used with Anna to calm down when I needed to, and if she could see I was struggling then she would suggest it to me.

How would you feel, if I checked my email?

If I wasn’t talking to you, I wouldn’t mind,” I said, honestly. There’s something companionable, to me, about sitting quietly with someone while you both do your own thing.

So it’s like me punishing you?

No.

If we are here in therapy, it’s just you and me; there’s nothing else between us. That’s sabotaging, what you’re doing. So we should put that into our contract. No other activity in session, apart from being in session.

I can’t commit to that,” I said, softly. It’s not that I disagree with her point, and I agree with it as something to work towards, but I’m not there yet. It just feels like too much. I don’t know her and I’m not comfortable with her and if I feel like I need to look at a photo of my cat and take a minute to breathe and calm down so I can try to keep going and keep shoving my hands down my throat to pull out some words, is that such a big deal?

Then I can’t commit to therapy,” she retorted immediately.

Mmm. That’s fair enough.”

Is this what you want to do?” she asked.

Not really,” I said, and there were tears in my voice. “But it’s do this or leave.

Well, that’s your decision, but you will have to leave, then,” she said.

So I did. There was still half of the session to go. I don’t think she was wrong to call me out, but to make me leave? I don’t think I did anything wrong and I feel like she’s not giving me any space for this to be hard and I hate her, even though I don’t. Everyone expects more of me than I’m capable of doing and I can’t.

 

I ran out of Effexor four days ago and only got a refill today, so I’m in withdrawal; nauseous, sweaty, dizzy and aching. My head is heavy and my body is light and there is nothing behind my eyes. And I keep thinking that Everest is dead, even though she’s sitting on my shoulder.

I’ve Been Quite Busy (Falling Apart)

Better Than A Poke In The Eye With A Sharp Stick, I Guess

I couldn’t get up. My alarm went off, and I stayed in bed. The bus I was supposed to be on left, and I was still in bed. I felt frozen, and like there was something squeezing my chest. When I finally got up, my knees were shaking.

In the back of the taxi, I watched Timon dress in drag and do the hula (Arrrrre you achin’ [yup yup] forrrr some bacon? [yup yup]) over and over, imagining the psychiatrist as the hyenas, trying to make myself laugh. But when we arrived, a whole new source of dread struck me – when I tried to pay the driver, my card declined. I was already a few minutes late, but I stood outside the building trying to decide whether to go in. It wasn’t like I didn’t have the money – I’d just got a new card the night before and they’d cancelled my old one – but the idea of explaining to the psychiatrist or the receptionist that I couldn’t pay today was so unbearably shameful I almost turned around and went back home. I went in, but the anxiety clung to me.

I was right to be afraid I was going to cry. I didn’t, but I wanted to. Alina is pretty shrewd about abandonment pain; the moment I handed over the list of psychiatrists I’ve seen, she zeroed in on the number who’d referred me on after a single session, and questioned me about how painful that had been. (“A bit frustrating” was all I was willing to admit to, but she saw the truth on my face.) Later, when Anna came up, she poked the sore places again.

“Twice a week for 8 months, and she sent you an email saying she doesn’t want to see you, she can’t help you. Do you think she was angry at you?”

The question I heard was ‘Are you one of ‘those’ BPD clients? Were you too demanding? Did you burn her out?’

No,” I said, but with a slight upwards inflection that betrayed some uncertainty.

Why can’t she help you?

Because she cared too much and she tried too hard, I think. Because she liked me and she wanted to help me, and when I didn’t get better she was frustrated and lost and she couldn’t separate herself from my own sense of hopelessness, and it overwhelmed her. Because she was always reaching for me, asking me to text and email and I almost never reached back, and she was afraid I was more attached to Jen and Aisha than I was to her, and she felt useless and insecure about what her place was. 

She just felt stuck, I guess,” is what came out. Alina wasn’t satisfied, but she moved on.

“I don’t think I have ever seen anybody who overdosed at 13.”

I shrugged. “I don’t think it’s that uncommon.”   

What I was saying was ‘There is nothing special about my pain’, but she seemed to hear ‘You don’t know what you’re talking about’.

“Probably not, I’m just saying I haven’t seen anybody. Or maybe I did, but usually the people that started that early, they don’t function that well later in life. But you finished school very well, you went to university, you are working, you have good friends…so I’m just a bit sort of puzzled I guess.”

I didn’t really know how to respond. Normally I feel proud that I’m resilient, but the way she was talking, it didn’t seem like something to be proud of – just another way I’m different, another reason I’m hard to treat. And I felt torn, because part of me felt frustrated and disappointed that again I’m a puzzle, that she couldn’t understand me, but the rest of me knows how much I hate psychiatrists assuming they know me after one session, and I know that I prefer humility in confusion to arrogance in certainty.

It was inevitable that at some point, the topic of my wrist was going to come up.

“Why did you break four of your bones?! That’s not normal, you know.”

“I don’t know – the thought just popped into my head, and…” I started to trail off, and she interjected immediately, strongly.

“What do you mean?!”

“I don’t know – the thought came into my mind, and I couldn’t stop thinking about it until I’d done it, so I did it.”

She looked down at her papers for a moment, shaking her head. “Listen. It puzzles me, the way you talk about what has been happening to you. I need you to start feeling and thinking about all this stuff. It’s almost like you’re telling me ‘You know what, I don’t want to think about it, I’m just doing it, and I have been doing it for a very long time and I probably will continue doing it, but I’m not thinking about it’. What do you think is wrong with you?” I sat silent, not liking the question and not knowing where to even start answering it, and she interpreted: “You’re not telling me that.”

“Mmm.” I felt stormy, misunderstood, outraged – I do think about it! – but I knew I wasn’t giving her any reason to believe there was anything deeper behind my bland, monosyllabic responses.

“Okay. You are a difficult case – you know that, don’t you?”

“Yeah,” I agreed immediately, confidently, owning it so I could pretend there was no shame in it.

“Why do you think you’re a difficult case?”

“Well, I’m not that great at communicating, so that makes it more challenging.” 

“Well, I think you’re communicating. You might not be talking, but I think you are communicating.”

Touché. She definitely won that round.

 

Later, she circled back to my broken wrist, and my parents’ reaction.

“Did mum cry? Did they give you a hug?”

“No,” I said with an incredulous half-laugh, giving her a flat, warning look.

“Did they say ‘oh my god, what happened?'”

“No.” I upped the intensity of the stare, and she conceded.

All right. Okay.” She stopped, took in a deep breath. “Whew. You’re a funny girl.”

Her tone wasn’t unkind, exactly – it felt impersonal. Like she’d already given up on trying to understand why I might be reacting that way, and had concluded that I didn’t have any feelings she could hurt.

So. She goes on holidays in three weeks, and she offered to see me 4 more times before she decides whether she can work with me or not. (I took this as “You’ve got three weeks to start talking and start showing some insight or you’re out, kid“.)

I prickled at some of the things she said – like when she described my (beloved) schizophrenic uncle as “disabled” and summarised my foster brother’s home as a “bad family” – but I’m trying to look past the phrasing to the intent. She’s blunt, but I didn’t sense disrespect or dismissiveness. The way she spoke to me in general wasn’t overtly compassionate, or exactly kind, but I heard some gentleness in her tone.

I don’t think she will ever be the kind of psychiatrist who will sit with me on the floor, take me to the park or blast rock music during sessions. I can’t picture her holding my hand, or sending me a text, and I don’t think there’d be much laughter or banter between us. I feel grief about that. Seeing Alina made it very real; I am never going to see Anna again. And with Alina, I feel very much that it’s my job to convince her, win her over. I feel like I’m on trial, and I miss the safety of Anna. Her priority from the start was to make me feel comfortable, to do whatever she could to win my trust. That was uncomfortable, but this is harder.

I’ll go back next week, and I’ll try to share more, and I’ll hope she’ll be kinder. But I hate this. I hate it.

Oh, and – no big surprise – when she asked what I want to achieve in therapy, I said “I don’t know“.

 

Better Than A Poke In The Eye With A Sharp Stick, I Guess