Tuesday, 26 June 2012

Getting stuck in the toilet at therapy

Last week I dissociated badly at the end of my clinical psychology session. I had been pretty detached during the session. Not much insight and little enthusiasm for talking about myself. I think I was struggling with this part of myself who doesn't think I have DID or any history of abused and the part that wants to move forward and get everything out in the open. So I felt anxious. I must have started to come round by the end of the session because I remember asking New Psychologist what she thinks happened to me given everything she knows about me now. I remember her talking in the way psychologists do (you know, how they tend to avoid answering questions directly?) about how in time, through processing it will become more clear to me and that it is perhaps a combination of things. She talked about what some of these things were. I remember her saying she is sure my childhood was difficult, or something and I remember she used the words 'must have been awful... pretty awful'.

I started feeling like I was spinning round, like I was sitting on a tiny roundabout... or maybe I was the roundabout. I closed my eyes and tried to hold onto the chair. NP asked me what happened if I opened my eyes... I tried it and found that I could see that I was in fact, sitting still in a chair and not spinning. But then the room started to move instead. I remember the boxes behind her going left, right, left, right, left, right.... everything going left, right... fast; not slowly. Fast. It was weird. I felt tears in my eyes. I felt far away, everything muffled... the need to close my eyes was strong. The need to disappear was strong. Fighting it is hard.

I remember that I could hear her calling my name over and over. I think she was clapping in my ears and clicking her fingers... but it seemed far away, not strong enough to help. This must have gone on for a while because I remember her going out of the room and coming back to tell me someone else was waiting to come in but I was stuck. I was half there and half gone. After a while she asked if Grace could come out to help. Grace hasn't been around in a long time. I tried to ask Grace to come but I couldn't find her. Then after some time I just suddenly found myself back, like someone flicked a switch and the light went on.

I grabbed my bag and headed for the door, apologising. NP was telling me about my next appointment but I didn't want to wait around in case I dissociated again. She called after me: "Candy, can you go into the toilet because you have some black mascara on your face?" I nodded and went into the toilet to find my face looking like someone had drawn stripes on me with black paint. I cleaned myself up and stood at the sink. My breath was coming too fast. I felt... I don't know what you call it. Grief? Pain? I needed to be present but I needed to go away. I must have spent a long time in the bathroom. I remember leaning over the toilet with my fingers down my throat and not being able to vomit because I had no food in my stomach. I remember vomiting up acid and it covering my hand and it felt smooth and slimy and smelt like having the flu as a child and vomiting up bile. I remember thinking how it felt smooth like semen and maybe I was vomiting up all the badness that's been put inside me ever. I wished.

It must have been a long time because then NP was knocking on the bathroom door asking if I was OK. I croaked that I was. Then she was asking me to come out and I said I was. Then she was knocking again and saying in a loud and put out voice that I needed to come out because the toilet was for use by everyone in the department and I couldn't stay in there. I felt afraid and mortified and wondered if I could climb out the window and never come back. I knew everyone in the department would have heard that because it's small. She used my name. I don't know how I'll show my face there again.

I wiped my face and washed my hands and got myself together and headed out the door as quickly as I could. I heard her saying: "See you next week" as I rushed out but I didn't look round or answer her. I got to my car and sat with my head in my hands for a long time. By the time I was together enough to drive home it was after midday. My session had started at nine thirty so I must have been dissociated for a long time, in the session, in the bathroom or in my car.

At home I sat staring at the TV for a while but by about 2pm I was exhausted. I rang the psychology department and left a message for NP to ring me as I realised I needed to check my next appointment time with her... I also wanted to apologise. Then I got into bed and slept for four hours solid.

That was last Thursday and I guess I've been a bit of a zombie ever since. I have been dithering about what to do this week. I really don't feel like going back for more. I just want to curl up and let it all disappear and never have to think about pain or the past or New Psychologist or T again. I don't have the energy for it. I want to just not go to my session this week but I feel it is wrong to just not turn up when she has to drive to get to my appointment in T's old office. She could be helping someone else. But I don't want to have to ring her either. Either she'll encourage me to come or she'll say that is fine and I think either way I won't be happy.

Tuesday, 12 June 2012

Dissociative struggles during a therapy session and coping strategies

While stirring the teabag in my cup today in the kitchen, I thought back to my clinical psychology session last Friday morning and wondered to myself what in the world I have been doing going to therapy for the last three years and nine months. Three years and nine months of my life attending sessions first every other week and then in recent times weekly and there is nothing wrong with me in the slightest. I thought through the phone call I planned to make to New Psychologist and what I would say: "I won't be coming to therapy this Friday, or any other, because I have been making up that there is anything wrong with me. I was never abused. I don't have alters or depression or anxiety or anything else wrong with me. I was just acting. I'm sorry for wasting time."

I realised that my psychologist would more than likely ask me if this was the 'non believing' part of my system and that she would suggest that my view may be temporary and that I keep the appointment. Then I imagined her suggesting that it's a lot of energy for someone to put into a lie for what benefit? Then I thought to myself that someone who would go to so much trouble to lie about having dissociative identity disorder should surely be in therapy anyway because clearly that is not healthy behaviour, so I dismissed the notion of making that phone call and with the intention of 'coming clean' at the next session and settled on the sofa with my tea to catch up on Big Brother.

This kind of thinking happens to me from time to time and New Psychologist has pointed out to me that it occurs clearly in relation to certain triggers. She feels that spending time with my mother is highly likely to trigger a switch to this non believing part, mainly because my mother puts a lot of energy into trying to convince me that any problems anyone in our family has are genetic and not because of anything that could have happened to us.

I believe that I am more likely to switch to this part when I am working, mainly because it's much easier for me to function if I am in denial about any of my issues. Today though, I feel the disbelief was a reaction to what happened last Friday in my therapy session. I felt strange right from the start of the session. I didn't want to talk and struggled to engage in the conversation. I don't know if something NP said eventually triggered what happened but about half way through the session I began to have strong physical sensations of something in my throat that was making me gag or cough or something. My heart was racing and my breathing went weird and I was scared, really scared. It's hard to describe. I knew where I was still but I couldn't focus on what NP was saying and I couldn't bring myself out of what was happening. I didn't understand what was happening either.

New Psychologist was helpful. I could hear her calling my name and reminding me that I was safe and that I might be having a memory of something but that it wasn't happening now. She also asked if I could look at her so that I could connect with her and know that I wasn't alone with it. I wasn't able to look at her though. She moved nearer to me and clapped her hands and called my name. I normally get really anxious when either her or T move near me but I was so involved in what was happening and scared about the feeling that it didn't matter to me that she was close. In fact it might even have helped a bit because I did feel less alone. She got me something from my bag: some smelling salts that she gave me a few weeks ago (MacKenzies Smelling Salts: they're for sinus relief actually and contain ammonia and some kind of menthol and sniffing it is like someone squirting a mixture of old style hair dye and toothpaste directly into the inside of your head. It really gives a shock. She thought they could help me if I was having flashbacks and I've been using them to help ground myself) and held them under my nose. I could smell them but even though they're strong it seemed faint and far away. I think they did help a bit though and after a while I felt my body calming and the sensations becoming less frequent. New Psychologist asked me to look around the room. She pointed out things on the walls, colours etc and then when I was more with it, asked me the date and where I was etc. Sometimes things like that really haven't helped but this time they did.

It helped that she continued to talk to me while it was happening. T (my usual psychologist) tended not to say much during times when I was having these awful episodes of dissociation and often I was screaming to her inside my head for her to help me, but not able to speak to ask. I think I'll tell New Psychologist that actually. Maybe she can pass on her wisdom of how to help to T for when she comes back.

Later in the session Little C came out to speak to New Psychologist. This is the second time she has spoken to her now. I don't know what age she is but I am guessing between three and five. She's very cute and I am lucky enough to be able to observe a lot of the time when Little C is out. She wanted to show NP a picture she had drawn and her special box of things that she had brought (it has things like stickers, postcards and pens in it). I guess Little C could feel the sensations in her throat as well because she got quite upset and told NP something about a 'thing' being 'put in there'. NP asked Little C a bit about it but LC didn't want to say too much, except that it wasn't nice. NP asked if Little C knew who it was that put it in and LC got upset and couldn't answer. She told NP she shouldn't ask that. She said that Adam does it sometimes. NP told LC that she was glad to hear her say she shouldn't ask and that it was good that she said that because... something to do with her not knowing NP well enough yet or something, and that it was OK. Then LC changed the subject and started talking about more fun things.

It's hard to write about this guys. On one hand I feel detached from it and thinking over it just makes me feel more confused about why I would have 'acted' this way. On the other hand part of me knows how real it all is and was and that is an extremely difficult thing to acknowledge. It doesn't take a genius to figure out what the sensations in my throat were a memory of when combined with the information that Little C shared about it. It's too hard to accept that something like that could have happened to me and it raises painful questions like the ones NP asked... and that's why I end up in the 'non believing' state that I was in today.

After my session on Friday I was in a lot of pain, all day. My neck, back, hips, legs and head were aching and sore. The headache lasted all weekend. Today was the first day it was mostly better and maybe that was because of the switch to not believing it anymore. Maybe it's just a way of coping sometimes. I guess there is progress in that sometimes now, when I'm in that state, I can acknowledge to myself that there are other times when I definitely know I haven't made this up and I am more content to 'sit with' the feelings and not get too dramatic about anything.

Saturday, 2 June 2012

A tale of two therapists

Things are winding up with New Psychologist as T's return is imminent. When I first heard she was returning I was over the moon, as you'd imagine. T had been my psychologist for three years before she left at the end of last year and if you have read some of my blog posts this year you may have picked up that New Psychologist and I didn't exactly get on like a house on fire. Although in recent weeks we seem to have managed to reach some kind of stability in our relationship... well we haven't had any more arguments and she has stopped constantly interrupting me; it didn't mean I wasn't still very happy about the prospect of going back to work with 'my T'. I've been thinking about the differences between the two in their approaches and that is what I am going to ramble about today...

The two therapists are very different in their approaches but I like aspects of both. They both have ways of working that I find really helpful. If I could take what I like from each of them and combine them into one therapist I would be flying. T is an extremely good listener. She really listens. I mean, there's listening and then there's really listening. She doesn't just try to look like she's listening, she really takes in what I'm saying to understand it and reflects it back to me in a way that makes it seem so much clearer. What goes on in the head of someone with DID is likely to be complex, so I generally don't understand it myself or if I do, don't feel capable of putting it articulately into words.  I mumble and stumble my way through attempts at trying to express what's going on in my head and T listens and gets inside there with me and we figure it out together and then she puts it into lovely words that make me look at her in awe and wonder how she 'gets' me so well. I feel understood and well, if you have DID you will know how rare and special it would be to feel understood. If you don't have DID, you may be able to appreciate how it might feel for someone who lives their life with stuff going on in it that would make the average person back away in dismay and avoid you for fear of what a crazy person like you might do to them if you told them about it all (I have learnt that lesson: some people just can't handle that kind of information).

So yeah, T understands and it's great... and that is really important for me. I can't emphasise how important that is for me. I wouldn't swap it. But at the same time, as well as being understood, I need help to change. I need actual techniques and tools used with me. I'm not saying T doesn't implement these: she does. She's been helping me move towards EMDR and I could write a list of the ways in which she has helped me (I keep meaning to do that actually). I don't really mean 'but' when I say I need techniques. I just mean, I 'also' need techniques and this is where I like New Psychologist's approach. She is all about techniques, tools and evidence based practise.

New Psychologist is not such a great listener. She certainly can be a good listener when she wants to be. Sometimes I have felt she is listening attentively, but she is also extremely analytical and sometimes I can almost hear the cogs in her brain going as she tries to analyse what I am saying before I have even gotten to the point of what I'm trying to say. That's not bad in itself except that I do feel it sometimes gets in the way of her actually hearing what it is that I'm saying. She has at times been so quick to want to tell me the meaning behind things that she hasn't actually let me finish. It's like I start to tell her something and she thinks "Ah yes, I know this one" and wants to give me the answer, but she doesn't always get it right. At best this is off putting and makes me lose my train of thought. At worst, it is infuriating. I do really, really, really like hearing insights though and being invited to hear what her analyses of things are.

T is not so open about what she's thinking. She listens, reflects and asks questions but she doesn't often give her own views. I had thought this was how all psychologists work actually, but New Psychologist doesn't work that way at all. She informs me. She says things like 'what you're saying would tend to match with what people who have experienced x, y and z tend to report'. Then she will back that up by telling me about this or that research study and how so many percent of people with this or that experience that or this and so on. I like that. It helps me to understand things better and it gives me confidence that she knows her stuff. I can also ask NP questions. I don't tend to ask T questions, mainly because she doesn't offer views really so I don't like to ask for them. NP is very keen to give her views so it's easy for me to ask her for information or views.

She also does A LOT of background reading and comes with tools and techniques that she has read about which are used for people with trauma histories, dissociation etc. She gives me practical advice on things to try. At the start this was not helpful. Remember how I was devastated about losing T and I really just needed someone to listen and tell me that they understood that I must be feeling rough? New Psychologist's approach was to do none of that but to tell me I needed to find internal resources to cope and then to suggest I try things like 'having a bath', 'watching some TV' or 'painting my nails'. I was feeling frustrated because I just wanted a listening ear and some support and besides, I felt I had been doing those things to try to cope already and found it patronising. Now that I am in a better place emotionally than I was at the start of the year, the practical techniques and things I can do myself at home to help me cope with difficulties are really helpful.

New psychologist and I have also been discussing attachment disorders and how my history and descriptions suggest that I have an attachment disorder of the disorganised variety. This is something I have been sure about for a while myself after reading a small amount about these but it's been interesting and helpful to be able to talk about it with a psychologist who can hear my descriptions and feedback her views about it. I might talk about this more in another post because I think it's also relevant in relation to my feelings about T.

Other things I have noticed about T compared to New Psychologist and vice versa are: T has an excellent memory. It amazes me how she remembers such details about me. NP's memory is not poor, she seems to have an ability to remember facts and statistics and can quote these with ease but her memory for details about me is more average. Probably still better than many but not as great as T's.

I like NP's approach to talking to alters. She directly asks if I can get a certain part to come out and I have found this helpful. T doesn't do that. Although she's made it clear that she is happy to talk to any parts, she doesn't ask for them and although I know that's probably more the advised way of doing things, it doesn't help me to let them out, given that my natural tendency is to try to hold them back and appear 'normal'.

Lastly, and I think this is a big one: T sees the best in people. You kind of learn that from talking to her. She respects me in her way of talking and relating to me without questioning what I am saying ie, if I describe a situation or incident, she goes on the basis of what I am saying being what actually happened. With NP, she hears what I'm saying but shows that she is thinking that what I am saying is only my judgement on what happened. She questions my statements and says that maybe it wasn't that way but that's just how I perceive it. This really pisses me off because I am not the kind of person to just see everything from my own perspective and I try extremely hard to always be objective and if I'm describing situations to stick with the facts or at least say that I am guessing it might be this but I could be wrong. I don't need that kind of intervention to help me be reasonable and I find this disrespectful because it seems she just assumes that I would have unrealistic perceptions or biased views. T believes whatever I say, or if she doesn't she doesn't confront me in that way. She also shows that she believes there is good in everyone. I get a sense from NP that she is more suspicious of everyone. It's like you have to earn NP's trust, whereas T is more of the view that she will trust you until you give her reason not to. I really like T's positive outlook on things.

Although I will miss NP's very intellectual approach, her shared analysis and her use of various tools and techniques which have greatly helped me manage some of the troublesome day to day aspects of DID such as flashbacks and unhealthy grounding behaviours as well as the chronic fatigue symptoms, I am looking forward to getting back together with T and the sense of a trusting relationship and respect.