Tag Archives: honesty in therapy

therapy today (really long-winded… sorry)

As much as I was dreading today’s session, it actually went ok.  I was able to tell TL that I seemed to have developed a lot of anxiety around therapy. I was able to tell her that I was in no way shape or form interested in having to be the one to continue to seek out additional services for myself (she pictured it as being “empowering” while I simply see it as a chore.  People here don’t like to return calls, answer their phones, or generally be helpful in any way when it comes to a client securing services for herself. I was a bit snotty about it, for which I feel like an ass, but I was able to let TL know that I was really tired of phone calls and playing tag with people. I was tired of begging for help for myself, and I just had zero energy or motivation to do any of it.  She seems ok with being the one to make the calls after we each explained our positions on the subject… I just wish I hadn’t been such a jerk about it)… I had hoped for some more structured and therapeutic groups, but apparently she is ok with simply having social things going on.  I told her I was not likely to go to many of them, as I had done that search myself and come up with little that seemed interesting.  I was not able to tell her that I really need something with more accountability, someplace I would be missed if I didn’t show, and someplace I could be more genuine (less “smiley-happy-normal-chick” and more of the “I-really-hate-the-world-and-myself-right-now-chick”), and find more support… She even asked if this was the kind of “extra help” I had asked about, but I wasn’t able to be honest about it.  I think part of me is still really scared about what that may lead to.  I’m still really bent on not wanting any reason to be inpatient here, especially when all they do is trap you and drug you. There’s no therapy, no support, and they treat you like you know nothing about anything.  Currently, I need more therapy, not less…

We then switched gears and TL plowed through the rest of the intake packet that I am assuming she is under pressure to have finished asap. Most agencies give therapists a month in which to complete them, and this would be the end of said month.  I say this not only because she was pretty bent on finishing it, but also because she was willing to stay nearly an additional hour to make sure she got through it all.  I’m really hoping she did not have another client in that time slot (I doubt it, because she was aware of when and how far we were going over time).  She tried to get some goals out of me, but I think I spaced. Had I been thinking more clearly, I would have identified wanting to deal with the loss of De (and other losses) as one of my goals.  I would have also told her that I need help keeping afloat at this point. She suggested animal therapy, and we covered the expressive arts therapies possibilities too.  She is open to focusing on some art therapy activities next session. She also asked about music therapy (which I said I was open to, though not all that sure what it entails).  We talked about my personal goals in life, which brought up a way to try to convey how hopeless things feel at the moment.  She also asked about how things had gone in school, and when I felt that things changed.  I realized that (at least in the moment I was speaking about it), I did not feel any connection to any of my accomplishments.  I had originally said I did not remember them, but that wasn’t accurate. They simply did not feel like my accomplishments.  I told her about promotions at work, excelling in school even while I was falling apart. She countered that I clearly had remembered them, because I spoke about them to her.  I had to clear up that they did not feel like things I had done, though I know of them because of my resume, my transcripts, and people’s stories about my successes.  I wasn’t able to pinpoint the emotion behind it at the time, but now I recognize it as feeling like a fraud.  Looking back, I feel like I must have cheated, or had someone take pity on me to be able to move ahead.  I don’t see how any of that could have come on merit…

We talked about a bunch of other stuff too, but I don’t totally remember all of it… too mundane I guess.  We ended with her reminding me she needs to ask about my safety (I had disclosed suicidal thinking and planning in our first meeting, and since then she does a safety check-in each time).  I felt like I was watching myself talk to her from behind a curtain.  Words spilled out of my mouth that I had no intention of uttering in her presence… It was very disconcerting (actually, it happens a lot with her. I tend to say more than I mean to say, and feel like I have little control over what comes out). I not only admitted to a plan, but told her what it was(?!). She checked in on the barriers to that plan, and I was honest about them. They are some very real barriers, and likely will not disappear any time soon.  I admitted that since I came up with the more solid plan, the urgency to follow-through had dissipated.  I think it’s just a “security blanket” of sorts at the moment. I know as long as the option is there, any overwhelming situation can be escaped.  If that option is gone, everything feels a whole lot bleaker and more hopeless… We ended with an appointment made for next week, and a plan to try to get me to that Yoga class on Wednesday… I’m currently feeling very resistant to the idea, but things may change by Wednesday.

I really miss having the ability to write after session and have my therapist read it before the next time we meet.  I keep thinking I want to bring it up to her, but it’s another thing I am writing in a reaction to on her part, and it will be rejection (mostly because I know that there is little out-of-session contact allowed/encouraged at the agency, and I know all written communication must be filtered through the supervisor. I’m not sure I want 2 people having access to what I write, especially since I don’t know the supervisor). It made things easier with De though.  It gave me a way to be able to express things I wouldn’t have been able to speak, and to process things at my own pace rather than within the hurried hour.  I might bring it up to TL at some point, but I fully expect to first hear “I will have to talk to my supervisor” and then hear “it would not be appropriate, see if you can bring the important stuff in with you the next session”… :/  …back to really missing De again.  I had told TL that I did not think there had been one day in the past 2+ months where I had not cried. It came up in response to something that made her try to tell me crying was ok, and can be healing… She seemed a bit incredulous about the statement, as if it was impossible for me to be that depressed (because I didn’t present that way to her most of the time? because that level of depression for that long is pretty uncommon? I don’t know)… At the end of the session, she brought up the fact that I had mentioned Ativan was the only thing that seemed to really help (especially lately). She asked if I would be interested in meeting with the psychiatrist at any point in case I was interested in getting a “more thorough evaluation”. I had told her that I had met with the guy once, and I was under the impression that he either could not or would not prescribe the Ativan to me, and that he hadn’t really been helpful in coming up with anything else.  She pushed a bit, but seemed ok at leaving the idea to marinate for later.  I had told her early on that meds and I do not get along very well (much like DBT and I). I reminded her that even the Ativan only worked because I had not taken it with any real regularity over the past 3 years.  I would like to have more on hand because it helps immensely with the flashbacks and impulsiveness, but I highly doubt that the ARNP (he’s not actually a psychiatrist, but a psych nurse with prescribing privileges) would give it to me. Most doctors will not prescribe benzo’s unless they know you, and know you do not have a drug problem.  Even on the inpatient unit, the psychiatrist initially refused to prescribe me any while I was there.  I had to beg him and underscore that I was ok with him not prescribing anything for after discharge, but that I really needed it at the time to help make my stay more manageable… It’s not a drug often used to calm flashbacks or impulsiveness, but it is one of the only fast-acting meds that can dull all of that for me.  I wouldn’t mind talking to this guy if  I thought I could get a script from him for it, but I doubt it. And I really don’t want to have to go through the hassle of trying to remember all the meds I have tried over the years, and all their out-comes.  TL suggested that he may be able to suggest something I have not yet tried, and that it may work wonders.  I stifled a laugh… I had tried every drug and class of drug that they even remotely thought might work to stabilize me back when I was in the hospital more than I was out of it.  They had come to the conclusion that I was hopeless and the only course of action left to take was ECT… I refuse to go down that road again…


Honesty in treatment

I’m a believer (most of the time) that honesty in treatment is the key to making any progress.  I say “most of the time” because sometimes my fear gets the better of me and I want to hide the ugly or scary parts of myself.

In an attempt to “just breathe” and get through the weekend, I tried to take a step back from myself for a moment.  I opened up my journal and started to write a list of what I get from my behaviors and actions.  I wanted to be as brutally honest as I could be with myself, so I resolved not to show it to anyone.  I wrote all the contributing factors down no matter how shameful or embarrassing they may be.  I was originally going to make it a cbt/dbt-style exercise with pros & cons, and some challenges to the reasons, but I eventually decided to stick to simply listing the reasons.  I am not necessarily in a place to objectively challenge any of those thoughts or beliefs, so I didn’t want to torture myself further by trying (honesty can be scary, especially with all the judgements flying around in my head).  I came up with a pretty comprehensive list.  I think I covered everything I get from my behaviors. I even managed to cover some stuff I do not like to admit to myself that I get, but I wrote them down in an attempt to be brutally honest with myself.  I find myself very stuck in therapy partly because I cannot get past the shame and embarrassment of a lot of things.  I’ve made some progress with De on some of the shameful stuff, but there’s heaps more back there still.

My problem comes now in the sense of urgency I feel at needing to talk about this stuff.  I’m afraid that if I don’t talk about it right now, in the moment, and to someone who can follow-up with me on it, I will lose my drive.  I will find ways to talk myself out of the reasons.  The thick walls of shame will fly back up in a flash, and I’ll be stuck again.  My hope is to be able to talk to De about all this, but there are boundaries in place over extra contact (boundaries that I desperately need right now).  I have to wait until Tuesday to talk about it.  Intellectually (and from a professional perspective), I totally get this and know I should wait.  The little kid in me is having an emotional shit-fit however.  She’s stomping her feet and dying to beg for a chance to address this in the moment.  I’m trying to calm her down.  I know I cringe at admitting most of the list to De (a professional I have grown to trust), let alone anyone else I may not know or that may not have the professional perspective.  I know this needs to wait to be addressed in an emotionally safe environment, but damn I wish it was now.  I am trying to compromise with the emotional side of myself.  I wrote it out where De will be able to see it and know it exists, but I have asked her not to read it.  I am trying to commit to myself to leave it up where she can see it, and to trust that she will not read it before Tuesday (I have no reason to believe she would not do as I ask).  I know I need to address this stuff to be able to move past it, but I also know shame can cripple me in it.

On one hand, it’s really good that I have the freedom to show or hide from De whatever entry I need to.  It helps me censor myself and practice self-containment.  On the other hand, it allows me to hide things I may need to address but am too ashamed of  admitting.  My ability to communicate is ever-evolving.  I am still learning balance.  I’m hoping the blog helps with that.  I know if it were something I could not edit (like an email after it is sent), I would drive her and myself nuts more than I already do. I think honesty is incredibly important in treatment, but so is self-control on my behalf.  With the blog I am learning that I can be more honest when writing, but I am also learning that there are some things I need to learn to reign in.  I am able to spill a lot to her, but also go back and hide things or reveal things after the initial emotional spillage.  As L reminded me this morning, sometimes things need to “marinate” before being addressed. I’m grateful De puts up with me and my alternating emotional explosions and implosions (sometimes she gets way too much info, other times I am unable to give her anything at all).  I’m learning the balance with honesty also.  Right now, I am at the stage of needing to be able to tell her everything and be taught what needs immediate addressing vs. what can wait… I hope she doesn’t hate me for this learning process. She only has to put up with me for another 2.5 weeks anyway (I know, not an excuse to completely lose my shit right now)…

::deep breath:: the process of learning things as an adult that I never learned as a kid is incredibly trying and painful… and way more difficult because as a kid, it was expected that I didn’t know this stuff.  As an adult, I should know better by now and be past these little hissy-fits.