Tag Archives: termination

Liiight buullbb…

It hit me the other day why I would have dreamt about De recently: we terminated on July 1st (4 years ago), and she left for her new job. 

That makes sense now…

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:(… last session with TM

Said goodbye to TM today… It was a good session, but I didn’t really say any of what I had hoped to tell her.

We colored and did pictures. It was good. I’ve spent the rest of the day feverishly sorting and packing… and I may or may not have utilized alcohol as a coping skill as well.

I can’t believe the move is in 2 weeks. I have exactly 14 days to get my shit together. It’ll happen, but I may panic a few more times along the way.

I keep wishing I had said more to TM today. I keep trying to find the right words so I could at least leave her a message, but I don’t have the words. I mentioned as much to her today; that I don’t know how to say thank you and convey the totality of what that means… and I didn’t ask her for a hug, though I really wanted to. I again couldn’t find the words. She had all this stuff in her hands, and I had stuff in mine and… well, I didn’t ask. She even asked if there was anything else, and I just said “no”. We had already gone a few over, and I didn’t want to keep her longer in the hallway as I struggled to form the question.

I did ask if it would be ok to call and update her though, and she said that she would like that.

Sometimes I really hate the finite nature of a therapeutic relationship. I’m also aware though, that it wouldn’t be as safe without the boundaries in place. It just sucks at times like these…

 


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.


the safety of a doorknob disclosure

With the end looming for my therapy, I find myself wanting to spill all sorts of info to TM. I’m not sure why. I suddenly have questions and thoughts and I want to ask her a whole bunch of stuff about my abuse and ptsd and self-harm… why can I only muster this resolve when I’m moving on to someone else? It’s like it only feels safe enough to bring all this up when the threat of having to see the person again is over. I am suddenly realizing I trusted her enough to express this stuff, but I kept freezing and getting scared before. I always worried she would hate me or use what I told her against me in some way. I didn’t think she would actually do those things, but I feared she might… Now I want to get as much support from her as possible, only it’s too late because there isn’t enough time.

These are the ultimate doorknob disclosures. They are all the big things I was scared to address, but now I desperately want to find support around… :sigh: Will I ever learn to do this while there’s still time to talk?

 


Dear TM…

Dear TM,

Now you are seeing the hopeless mess that I can become. I don’t like that you will remember me this way. I don’t like that we are ending on this note. I’d prefer you to think of me as someone who can figure shit out and make it in life (coz someone needs to believe that about me. I certainly don’t)…

I’ve put up walls b/c I need you to be a stranger right now. I need to be able to leave without feeling completely crushed about all the losses. It’s not just you I have walls up around. It’s the house, and the state, and mom, and the dog and cats, and art time with my friend, & everything… I’m only going to allow myself to miss the beach. That is all. Everything else is too raw and too painful.

I still want to ask if it would be ok if I called you once I’m settled again… I was going to ask if I could call you on the anniversary day, but it will end up being the day we leave. I will need to concentrate on driving and hanging with the wife… I hope she knows she will have to do the first leg of the journey, the one that gets us out of the driveway and away from this neighborhood. I’m not sure how to say goodbye to all this…

Maybe the IOP will work out? I’m not getting my hopes up, because I don’t have faith in them billing for copays, but at least I can go to the intake without having to pay anything that day. Then we can go from there. The little kid in me wants to keep seeing you as much as I can before I go, but the other part of me sees the heaviness of the depression and knows I would be better off with more support…

I really have no idea what I’m doing, but I know I will come out the other side. I always do.

Please don’t actually hate me, just maybe let me think you do for the moment.

Pieces,

sj


5 am, we meet again.

It’s 5 am. I’ve been awake since 3:30 after having fallen asleep around midnight… this has been a trend for about 3 weeks now, interrupted only by me remembering to take benadryl a few nights here and there (when I don’t have to function at all the following day). This insomnia is certainly not helping my depression or functioning.

If we weren’t in the process of referring out and termination, I probably would have reached out to TM about the increasing lack of sleep. Now? I dunno. I can’t get over feeling like there’s a boundary there I need to keep to. We are ending. Reaching out for anything other than scheduling feels like a big “no-no”…

I keep coming back to frustrations around a lack of support. I’m guessing the IOP will not work out due to finances. I don’t want to ask TM to extend our sessions until I leave merely for support. She’s got limited availability as is, I don’t want to keep wasting her time… that leaves me with trying to muddle through on my own.

I’ve thought about reaching out to friends and family for support, but I feel like a huge bother. There were a few times I wanted to talk about stuff with L, but she’s got so much on her end, it’s not fair to bug her with it (and I’m not totally sure how to talk about it). I had tried to process Wednesday’s appointment with TM, but she quickly switched back to talking about whatever was going on for her that day. I didn’t attempt to revisit. I know, my fault. I should be more assertive in wanting to talk, but I feel so defeated and overwhelmed, I’m not going to beg anyone to sit through my struggle to articulate things; not TM, not L, not anyone. It’s just all pointless.

Part of me wants to call insurance today to see what can be done in terms of accessing additional support, but I really don’t like asking for favors. I don’t want the hospital program to do anything out of the norm for me. I don’t want to bother TM with anything. I don’t want to ask for more. I’ve taken plenty already, I should be good with all this… only I’m not. I’m coping on the outside and crumbling on the inside. My internal resources are running dry again. Bed is looking more and more inviting 24/7/365… there’s other things that are yet more inviting, but they are not an option despite being on my mind all the time…

I just have to get through this move, then I can worry about what to do up there again. I gotta get through this move…


Treatment up in the air

TM and I talked about treatment options again today. I was able to be honest with her about not knowing if my depression would get bad again, or if I could handle things till the move.
I also told her I wasn’t sure what would be the best course of action for my current supports… we tossed around ideas, and ended on me attending the iop intake next week. Hopefully I will get a better picture of both the program structure and whether or not it would make sense for me to go. She’s ok offering me at least 2 more sessions at the moment.
There’s so much wrapped up in this move, I’m not totally confident I won’t crash, but I also don’t want to make a crash happen by expecting one…
:sigh:
I also have to figure out treatment for after the move. Dr C has not returned my calls, so I’m not counting on her to be able to see me. I put out feelers to a few other people in the mean time… I really don’t want to have to go through all this again in a few months after I get up there.

TM and I also covered a bit of the details I gave her to read last week. I’m not sure I got anything out of what we talked about. Maybe I need to ask her to let me read it out loud next week… it would cause a lot of anxiety and triggers, but it also helps in the long run… I dunno. We might not have time though.

Might still want to cover that homework I had given her maybe 2 months ago. We never did anything with it, and it feels unfinished. If I’m admitting all that, I need a bit more closure on it with her, but what we covered today was triggering and unsatisfying. It didn’t bring the closure I had hoped, partially because my walls are up. She felt like a stranger today instead of someone I trusted. I’m not sure how I can go from feeling safe with her until the moment we talk about termination, then she’s suddenly someone I have no connection to… it’s frustrating. :/