Sunday, 3 July 2011

Dissociating by getting stuck: is it under my control?... and what happened next...

Alright, enough procrastination! I will now tell you what happened in the clinical psychology session of last week. Ironically... (or is it ironic? My husband gets on his high horse about people using the term 'ironic' when the situation isn't actually ironic, which makes me nervous about using the word incorrectly and being scoffed at by all the intelligent people in the world... anyway, ironically or not....) this ending of the procrastination is in itself a way of procrastinating from some study I should be doing for work. Best to do this though before this week's psychology session.

Just to give you a recap in brief of what had been happening previous to the session to set the scene... I'd had a difficult few weeks because of:
  1. becoming aware of an apparent wish of some part of me to be dead (the 'becoming aware' part involving me being an observer of the act of preparing for a hanging on numerous occasions)
  2. Some general internal chaos and a feeling of 'me' being dragged along behind while the other alters were on some kind of mission to break free.
  3. having dissociated badly in the previous psychology session (which I talked about here) and feeling generally crap as a result of that
  4. My T emailing me to see how I was after the dissociating badly in the session and then failing to respond to me at all when I told her I was not good; on the edge and really scared because of my thoughts and actions, hence leaving me feeling angry with myself for having thought she cared and trusting someone against other parts' better judgements and also leaving me no better off in the current crisis that I was in (which I also wrote about in this post).
  5. work being really, really, really stressful (that has now eased off a bit, thank goodness)
So, I went along to therapy last week with all my parts in tow and all of these things hanging over my head. I always look forward to going to therapy but once I get there become really scared and anxious as my alters stir up inside and because of the potential threat of what terrible thing T could do to me or make me talk about. Sometimes she has an agenda for the session, sometimes she asks me what I want to talk about. I usually prefer it when she has an agenda as it takes the pressure off me a lot, but this week I did not like her agenda. 

She started off by stating, in a manner that seemed to me to be quite short, that the last session had run very late over time (because of me being stuck to my chair) and that we needed to sort out the 'dilemma'. She said that it's stressful for her and unfair on the caretaker who was waiting to close up the building. She said we could consider moving the time of the sessions to a different time of day but that it doesn't negate the fact that over two hours is much too long for a session (it should be an hour and a half) and that if she saw me earlier she'd probably see other patients afterwards and that she 'certainly wouldn't keep them waiting'. She said that she understands that it's a struggle for me when I am in that state but that it is in my control on some level because it is another part that's stopping me from leaving.

Now, these are all fair points and she had a right to raise the issue. But it seemed to me by her tone that she was quite annoyed with me and that despite acknowledging that it is another part that is causing the difficulty, that she feels maybe I could just try a bit harder if I really wanted to not be a nuisance. As a result, I instantly went into 'defensive mode'. If I am accused or confronted in a negative way I have an immediate reaction of a sort of closing off. It's like we are all living in a fortress. I try to keep the doors open and one or two people hanging around outside, but at any sign of attack, everyone runs inside, the doors go up, some parts go into hiding while others take up position in their stations ready to defend. I think she picked up on this pretty quickly as I went silent and probably didn't look too happy. My heart was hammering in my chest, my vision blurred, my head spinning. Someone inside was saying: “Lift your bag and make a run for it!”

T was repeating the aforementioned points and saying she hoped we could discuss it together and I was hearing: “I hate you! You are a horrible patient! You are trying to manipulate me by staying longer in the sessions. You are selfish and just want more time and you can't have it because I only get paid to see you for x amount of time. I don't care about you any more than that. In fact, there's probably not even anything wrong with you, you're just looking for attention!” Of course, that is not what she said. That is just me being over-sensitive. 
My silence continued. She asked how my parts were feeling about her having raised the issue. I told her I felt she was angry with me and she agreed that she got the sense that I thought she was and that I was annoyed in return. Well observed T (I probably had it written all over my face though)! She told me to stick to the facts of the case so I told her, that the fact was that she seemed annoyed. She didn't say she wasn't but she wanted to know what it would mean to me if she was angry (typical psychologist!).

Well, I don't plan to dictate to you my entire memories of the conversation (I'm sure you will be relieved to know) but it kind of went on that way. Me in silence, feeling like I was going to die off and seething with anger that she thought it was in my control to be able to get up and leave during those horrible episodes of whatever is going on and her going over the same statements about how she wanted to understand why some part of me doesn't want to leave the sessions and what I thought could be done to fix this problem. 
Her statements pissed me off for a number of reasons: one, is that they assume that some part of me doesn't want to leave and that I as the 'host' or whatever, would know if and why this was the case and also what would change it. Secondly, I felt angry that it was me who was being 'told off' when it's not 'me' who is causing me to be in that state. During those times, I feel so separate from myself. I am like an outsider, willing the other parts to let me back in or get up and leave. I was angry with her for holding 'me' responsible and angry with the rest of me for getting me in trouble when I spend my whole fucking life trying to be 'good' and 'normal' and blend in despite being full of a whole rainbow of nutters who are all bursting to get out and live in a way which would be conducive to losing my job and any relationships I currently could claim to have a feeble grasp on. 
I wasn't so much aware of the next reason for my anger at the time, but on reflection I know that am angry about it: I had been feeling like my alters were moving forward without me. They were learning or I was learning to let them be independent of me in communicating with T. The perceived attack of last session sent them scampering away back into hiding. Then she wanted to hear what their thoughts and feelings about the issue were. By this stage they were so far away, there was no chance of anyone communicating with them. I think Little C had already had her confidence knocked a few weeks before and given that I think it could be a part that is in great distress who has been trying to communicate with C during times that I am dissociating, they then felt castigated for having caused so much trouble. I feel this could be a big setback in the already possibly hopeless task of trying to learn to trust that people aren't going to hurt us.

T continued to want me to talk about the issue throughout the session. I don't think she could really understand how impossible it was going to be for me to be able to have the insight or let my guard down enough to talk sensibly about it. I tried going out to the toilet to pull myself together but it didn't help: every time she tried to raise the issue again I felt my heart rate rising and my vision going again. I kept trying to explain how I was feeling and she kept saying: “does that mean we can't have a conversation about it?” So frustrating!

On reflection in the time since the last session, I have been asking myself the question: “Did I have justification to believe she was quite short in her tone and manner of raising the issue or did I just perceive it to be that way?” In honesty, I really don't know. Maybe she was nervous about raising it with me in case I did react badly and this came across to me as blunt. Maybe it was just my wrong perceptions and that's all. It is important to me that she is not angry, because if she is, it suggests she really doesn't understand how out of my own control the problem is. 
I didn't want to leave the issue hanging without any attempt at trying to fix things though, so I sat down and wrote T a letter explaining what was going on for me when she confronted me in that way and then, what I felt we could try to do to help prevent the sessions from running over time in future. I also told her how I had felt about her lack of response to my email a few weeks back. I felt my suggestions for what could help were feeble (because if I had better ones wouldn't I already be trying to use them?). I still feel angry too. I guess I also feel, she should be the one with the answers. Surely I'm not the only person in therapy who experiences dissociation? Well, if there are others then can't she find out from some source what can be done to help? I sent her the letter by email anyway, although part of me feels she cares so little that she probably won't even bother reading it. Another part says, who gives a fuck if she doesn't. She raised the issue so if she doesn't read it, it's her loss. 
I have been feeling numb for the main part since the session. In the glimmers of emotion I have had over the last week or two I have noted 'fear' about going the next session which will be on Wednesday. I know that my anger is still not far from the surface and I also feel the part that thinks 'to fuck with therapy' is not far away either. I have also sensed feelings of 'loss' and a disappointing feeling of reconfirmation that no one could ever see anything good in a person like me and that I should have never hoped for anything different. I haven't seen the kids around much as I mentioned here, but I have a sense that they are feeling pretty bad for getting in trouble. Pan might be angry, but that's just a guess as I haven't seen him. I think they are hiding.


Pandora said...

I don't think you are being oversensitive - I think anyone in therapy would have reacted badly to that. Regardless of whether her points are valid or not, she could have handled if way better than she did.

I used to get angry with my old therapist a lot, often for similar reasons (his perceived lack of interest etc). I think you handled things remarkably well in comparison to how I used to react to him!

I hope you get things sorted with her and are able to start trusting her again. Easy for me to say, but even so, wishing you well.

Bloody therapists.

Take care

P x

JustEliza said...

Hello Candy,

I can sense you are quite defensive right now. I've picked out at least 3, maybe four, defenses in this blog post alone: dissociation, intellectualisation, displacement! These defenses exist because we find it difficult to cope with / sit with the emotions we're experiencing. In order to progress in therapy, we need to find different ways of coping.

With that in mind, I hope you are finding ways to relax and treat yourself compassionately. It takes time for the adrenaline rush to wear off and it's easy for the rest of the day(s) to become clouded by such strong feelings.

Your therapist certainly needs to take responsibility for managing the hour (aka not triggering you or pushing you into crises), just as it is your responsibility to identify your defenses and do everything you can to overcome them.

That said, her mistake and your reaction to it is an absolutely brilliant thing to happen, precisely because it is so difficult for you. A therapist is more than a counsellor: she is supposed to ask you the hard questions, push past your defenses, and challenge you. And if you don't feel safe enough for her to do this, you should be working on building that trust: which is what you did in writing the letter, acknowledging how her behaviour hurt you. I completely understand that you struggle to be vulnerable with this Tx when she has already told you she is leaving. But can you be vulnerable with your husband and share all of your feelings with him, just to try how how it feels to share them(not to solve them or make them go away or to rationalise them and so on)?

You have every right to be angry at her mistake. There is nothing wrong with being angry at your therapist and expressing that anger. This is said knowing full well that when I was in your situation, I nearly went psychotic trying to cope with telling someone I was angry. I know how easy it is to become overwhelmed by such strong and complex emotions, to not trust anyone to understand them, and to be so angry at myself for not coping... that the only real solution was to dissociate. You are learning to do things differently, and it is very hard. Many people wouldn't try so hard, but you do because you value your hard work.

I wish I could lend you my (meager) strength to you for working through this issue, because I know when you do you will be so much better for it -- more confident, more stable, more integrated with your emotions, and more trusting of your therapist (if she steps up!).

I have confidence in you!

Candycan said...

Pandora: Thanks for your comment. It's reassuring to hear that perhaps others would feel the same way. In some ways I feel I am just making mountains out of molehills: I don't trust my own judgement! I am still working my way through your blog from the start; still in 2009! But its very interesting reading and we are alike in many ways in our experiences of therapy.

Eliza, it's very interesting what you say about defenses: what are intellectualisation and displacement defences and how do I show them?
Thanks for offering your strength, I hope you are right that I will be better for working through this. Sometimes it's hard to know exactly how to do that!

JustEliza said...

Displacement is separation of the emotion from the original object -- aka, expressing it here but not being able to express it to the Therapist.

Intellectualisation is separation of the emotion from the thoughts -- aka, focusing on the actions and not how you feel about them.

Obviously you already know your primary defense: dissociation.


For example, in this situation your Tx asked you about YOUR feelings, but instead you talked about HERS:

"My silence continued. She asked how my parts were feeling about her having raised the issue. I told her I felt she was angry with me and she agreed that she got the sense that I thought she was and that I was annoyed in return."

So your Tx pushed you to recognise how you felt about it, but still you resisted answering. So the anger grew (why? because she couldn't read your mind?) . I said displacement because you were able to perfectly explain yourself in the blog post. I wonder what would've happened if you had done the same for your Tx in that situation?

Finally, post-situation you continue to focus on her feelings and whether your interpretation of them was justified. In actuality, the greater insight is from YOUR feelings. I wonder if that is a sort of defense as well? At the very least, it's a practice that is keeping you from progressing in therapy.

I don't think anything you've written is inappropriate or wrong. You are perfectly rational in your thoughts on the situation. I'm very glad you were able to write that letter, muchless share yourself so personally here, but if I were your therapist I would indeed be pushing you to reprioritise expressing your feelings. From your posts, I can tell you are ready to make that leap.

How did this week's session go?

Meronym said...

My roommate is also really sensitive on the use of the word 'ironic', to the point I've just quit using it because his definition and mind seem to somehow be at odds, even when reading the same definition out.

I think it's great that you can express all these feelings on your blog and get support from others.