thoughts on today’s therapy

It was my second-to-last session with TM today. It ended up really good.

I remembered her wanting to get the assessments out-of-the-way (TSI-II & BDI2), so after the greeting, I mentioned them. She had them waiting next to my chair, along with some journal entries and my timeline to give back to me. I was glad she remembered.

We joked a bit, and kinda chatted while I did the assessments. She busied herself looking up some more quotes for an activity she wanted to do together either today or next session. As I handed the assessments in, I told her that some questions were answered with caveats, but then I suddenly forgot any of the examples (Now I remember that the question around feeling punished on the BDI2 I answered scoring low because it’s not so much that I feel I am punished, more so that I “should” be punished simply because it’s “right”… There was also a question on violence on the TSI-II that I answered high because it was vague, and I acknowledge responding violently towards myself… That one we kinda talked about and she knew why I responded like I did. I answered the suicide/death questions honestly: that I always think about dying, but don’t always have a plan or intent)… I told her I’d be interested in comparing the scores from the first time and now. I know I have a really skewed self-assessment much of the time so I wouldn’t mind seeing it on paper… that & I’m a huge dork around this kind of stuff, so it also holds great academic interest.

I think at about this point TM told me something that blew me away… She reminded me of one of our first sessions, where I refused the descriptor of “therapist” when she had mentioned it. She said she understood where I was coming from (because I never did finish my MA or internship), but that I seemed more insightful, compassionate, and understanding of the therapeutic process than a lot of therapists she has known… ???!!!!???? I think I was in shock and trying to digest that for a good 5 minutes afterwards. I have no idea what topic we moved on to, because I was still reeling (in a good way) from that huge compliment. I was actually so shocked, I didn’t even deny what she was saying… Maybe I could then go back at some point and be a real clinician? That could be cool… It might have been just before she said this that we talked a bit more about my last hospitalization at IOL. She had mentioned the PDoc incident where he threw a stapler or hole puncher at me, and how that was something she never expected to hear happening in a hospital. I brought up that yeah, while it sucked, I’ve had time to process it more. He may have been triggered, or feeling really helpless, or scared, or frustrated (or all of the above) when he did that. It certainly does not excuse his actions, but it would make them understandable. After all, G behaved much the same way: always angry, yelling, violent, abusive… For a lot of years, I had no clue why he was so awful. Then one day we had a more in-depth conversation. He revealed some of his own abuses and traumas. He also said he did not recall being as abusive and horrible as we remember him being… It didn;t excuse his behavior, but it brought an understanding of his motivations. I could empathize. While I am trying my hardest to break that cycle, he was just repeating what he knew…

Anyway… Oh, another thing that I was kinda blown away by from TM was her opinion that I do not fit a bpd diagnosis. She started out asking me why I had self-reported that dx when I first started therapy with her. I honestly don’t know. She is the first therapist I’ve ever volunteered that dx to. Others have either come to it on their own, or been told by a referring therapist and then decided it did not fit. Part of my reasoning was that it had been relatively soon after I had read through my disability records. Most of those had bpd as one of the diagnoses (of course, they also said I was hopeless & bound to live in residential care for the rest of my life unless of course I killed myself first. One PDoc went so far as to say I he did not expect me to survive the next 6 months… and that was oh… 5 years ago now? So I guess I have to take all of that with a grain of salt. TM reminded me that hospital records reflect the worst of my recent history. She also reminded me that they will often pad dx so that insurance companies will continue to pay (I’ve been witness to some “creative billing” in my professional experiences). I’m not sure why I was surprised that TM would say she disagrees with the bpd diagnosis, but I was. She said the “cornerstone” of a bpd dx is unstable relationships (and according to what she read to me from the DSM-V, this is accurate to their wording), which neither of us see in my life. Yes, there’s a fear of losing people, but only because I actually have lost a lot of important and close people in my life. It’s not so much a fear anymore as an expectation… It’s also something I was overtly taught while growing up. And sometimes the people closest to you will hurt you the most, so a difficulty with trust is understandable… She reminded me that while I may be able to check off some of the bpd traits, it makes a lot of sense given my history… Maybe now I can hold on to that longer. I know Dr. C is of the opinion that I do not fit a bpd diagnosis. We had talked about it a long time ago because of my experience with LKB and her insistence that I was bpd & just needed to learn to accept that fact. Aside of Dr C though, no one else had openly and pointedly spoken to me about bpd vs. trauma. I know even D eventually saddled me with that diagnosis. I’m not sure De agreed, though I never asked her. TL and I never spoke about diagnoses either. It was kinda nice to get confirmation from TM as well that my resistance to the bpd label has merit… Personally, I think the whole disorder should be removed completely. I’ve yet to meet someone with a bpd dx who does not also have a trauma history. Bpd comes with SUCH a stigma (which can also lead to an excuse for not working to change the thoughts & behaviors both on the therapist’s end and the clients… think of how you would feel if even the professionals felt you were hopeless) that it’s more a detriment to any person with the dx. I don’t see how it helps the understanding of behavior or attitudes, it simply labels them. I would much rather have an understanding and hope than a mere label… Kinda like labeling someone an alcoholic without taking into account what it’s used to cope with.

Ok, sorry, went off on a soap-box tangent there. So, yeah. Session with TM was good. We laughed and also talked about heavy stuff… Part of me wonders if TM has found me online somewhere. She sometimes brings up things that I have only ever mentioned online either here or in one of the support forums I use. I might have to ask her that next week. At this point, I don’t think I would care since I won’t be seeing her after next week anyway, but if I had found out something like that sooner, I would be censoring more. I already catch myself being careful what I post if I know someone in real life will see it. This blog is written with sensitivity to my wife and my mom having access… There’s something to be said for anonymity and honesty. I’m very careful in what I reveal to others because I have had it twisted and used against me. I’m careful what I write both online and in a physical, paper journal… I actually no longer keep a paper journal because too many have gotten their hands on them and read them without permission… But whatever. I would be interested in how TM thinks to bring some of the stuff up that she does if she hasn’t found me online. Maybe I talk around it enough, or I mention it without realizing it? It’s too much of a coincidence with a lot of the stuff in timing and wording for her to just come up with it out of the blue. Maybe I’m leaving her more messages than I realize? I know a few times I had thought of leaving her a message, but don’t recall doing it, then she mentions the next session that she got my message(s)… Hmm.

I had meant to ask her today if it would be ok if I call once I am settled after the move. It feels less needed now that I know I will be seeing Dr. C again, but I rarely get the chance to update a therapist on how something went after a termination. I get the boundaries of the relationship. I know it won’t go beyond this termination, but I’m hoping to be able to let her know that things went well, and my idea that I will do better back up north and away from the constant triggers is one founded in reality… I know I would love updates on some of my past clients, though that is me. I’m not sure if she would want one… Dunno though unless I ask.