Those that follow the Twitter stream that I have allied with this blog will know that I did not intend to write a blog today (LATER: yesterday). I was feeling a bit low after CVM called me this morning to report that her father had sadly died early this morning (LATER: well – technically now yesterday morning). However, sitting here brooding won’t do either her nor me any good, so I decided to go ahead and write it anyway.
CVM is very much in my thoughts and I wish I could do something to ease the pain of her and her family. I am publicly sending my sincere condolences here. <3 xxx
I know that I have an annoying tendency to open these posts on C with, "today was weird," or some such. Well, Thursday really was strange. It was totally bizarre. C was evidently puzzled by certain directions it took, and when I told him at the end that it had been “weird,” he actually responded by saying that it had, indeed, been “different” (for what it’s worth I feel reassured rather than invalidated by this).
I’m not sure if the written word can adequately convey the oddness of the session, because although it can look disjointed, it would take a better writer than I to convey the sudden and sharp shifts in mood, the nuances of the spoken tones, the randomness and subtlety of the non-verbal communication that took place. Nevertheless, as ever, I shall try.
It was very much a meeting of three parts. During the first – I dunno? – maybe 10 or 15 minutes I sat there petulantly, stubbornly avoiding his gaze and giving one word answers (at best) to any questions he posed. For once he had the decency to open proceedings, and not piss about waiting for me to do so. He said he was aware that part of me was attached to “here” (this annoyed me, though I did not say anything to him – I am not attached to his fucking office for Christ’s sake, I am attached to him!) and that I was concerned about the cessation of therapy. Wow, insightful. I’m absolutely profoundly impressed, Dr fucking Freud-Einstein-Mary Poppins.
I’m ranting about him now for stating the obvious, but I also got really pissed off when he strode into the territory of conjecture. He said he was also aware that I was unhappy that I only had 50 minutes of his time each week and that I was annoyed that I couldn’t just turn up or phone him or whatever outside that time.
This sent me into a rage. At no point have I ever said such a thing. Struggling to control my anger, I snarled that his comment was unfair, and that he was putting words in my mouth. I asked him to exemplify exactly when I had made these assertions to him.
He admitted that I hadn’t, and moved on, but I think I now realise where he got this from. Some months ago – I can’t find the relevant post offhand, sorry – I had asked him who I was meant to contact in an urgent situation (because if my life depends on it I still want to avoid the fucking Crisis Team). Could I have a CPN, a social worker – anyone at the two CMHTs based at C’s hospital? I don’t remember his answer but it was some nonsense about ringing Lifeline or the Samaritans. Yeah, thanks C. So he had obviously read this request – a reasonable one, in my view, given that CMHTs are meant to be multi-disciplinary and he is only one tiny part of them – as a demand for his attention outside of our sessions. This was profoundly irritating. If he had failed to understand my question, then he should have asked for fucking clarification.
Anyway. To follow on from the uncertainty of the last couple of weeks, he brought up the matter of how long he can continue to act as my psychotherapist. Apparently, he can offer 10 week blocks, with four weeks at the end to deal with the closing of the relationship. Fair enough? Well, no, not really; he can only offer me two of these blocks – ie. 24 further weeks (beginning on Thursday 10 December) in total. Now, that will amount to something like 57 total sessions (including the three assessment sessions at the beginning and the four ‘leaving’ sessions at the end) which ostensibly sounds fair enough. Unfortunately for me, BPD is well known to take a very minimum of a year to treat properly, and usually three or four.
I didn’t tell him this as, in the past, every time I’ve made reference to my diagnoses he’s come off with (or at least inferred) some crap about fixating on labels. Heard it all before, C. So instead I asked what I was supposed to do if things weren’t adequately improved by that point.
He said, “I would expect you to have made progress by then – I feel you have made progress.”
Great – I’m so glad one of us does. Most reassuring. I pressed on. “But what if I haven’t?”
He said something suggesting that I shouldn’t be expecting cures from psychotherapy, at which point I interrupted him by telling him I didn’t even believe in cures and, in fact, didn’t especially want them. My question, I insisted, was in the context of alleviating the worst of the psychological pain and providing me with coping mechanisms and greater understanding that I could take onward in life. What if that had not been achieved within his stated timeframe?
I honestly don’t recall his answer, but there was a strong inference in whatever it was that if we were unable to progress by then that there was effectively nothing he could do for me (an assertion with which I do not agree, but what do I know – I’m just the stupid mental that sits opposite him).
No arguing with that, then. That’ll be it. The end. Finito. Fuck you, SI. In response, I just sat there looking at the ground for a while. It’s difficult to articulate how I was feeling. It was a veritable cocktail of fear, dread, hurt, anger, bitterness and depression. I fought, ironically using the breathing exercises that C had so fervently espoused, against tears and rants. I fought them because I didn’t want to give him the satisfaction of knowing that this abject rejection completely fucking cut me to the core. But he knew. Of course he did.
After a minute or two, he proceeded with that usual question of ultimate annoyance, “how do you feel about that?”
One thing I’ll say in his defence was that at least he was completely straight for once. Often he dodges and dives from material that he doesn’t really want to bring up with me for fear of setting me off (or such is my supposition for why he avoids it), but on this occasion he was upfront and honest, and through my anger and hurt, I felt appreciation for that. I told him so.
He told me to think about this over the next week (“but not so much that you end up ruminating on it” – as if that wouldn’t happen!) and bring all of my thoughts and feelings on the matter to him in the next session. He said, “you’ll probably feel anger, frustration…”
Once again, I got really mad at him for putting words in my mouth, so he desisted from that angle of probing. Whilst it will indubitably be the case that I am angry – I already fucking am – and whilst it was indubitably the case that, in an ideal world, I could phone and/or meet him outside of scheduled sessions, how dare he presume any of that. If he wants to know my thinking on these matters he should fucking well ask me – it’s not like he’s never asked before. He shouldn’t just assume that his suspicions are gospel, regardless of the probability of their accuracy.
During the silence that ensued, I fought a mental battle with myself. One side was crying out, “but that’s another six months! You should be grateful!”
The other responded, “the NHS has failed you yet again, SI. They are ignoring all research on your diagnoses.”
For once, the negative side was, I am convinced, the more rational. BPD takes a long time to properly treat. It is as simple as that.
Finally I said to him, “why do you do this job?”
I knew he would respond with a question, and indeed he didn’t disappoint.
“Can you tell me why it is it important for you to know that?”
Once more, I knew he would fail to answer, and instead question me again. Once more, I was correct.
“But what is it that gives rise to that curiosity?”
I laughed cynically in his face. “Just answer the fucking question,” I demanded. “Please.”
He looked away and appeared thoughtful for a minute. Eventually he said, “because I think it is of value.”
I nodded non-committally and waited for the backlash.
Well, apparently my questioning his decision to practice clinical psychology ties in with my intense rage towards him / the health service (because that couldn’t possibly be fucking justified could it? Oh wait, it could!) and my assertions last week that he was a ‘headfucking sadist’.
I winced. “Yes, sorry about that,” I muttered awkwardly.
“No, no,” he insisted. “You should bring that anger with you.”
I ignored him and said that it must be something of a nightmare to spend an hour with me every week.
He sort of laughed and said that I have to spend all the time with myself. (This could be read as an invalidating statement, which it shouldn’t be – there was more to it than this, but I don’t recall the specifics. Whatever the case, the point was actually made more sympathetically than I’ve made it sound).
“Yes, that is a disability,” I mused. “But honestly – I’ve been such an angry child here recently, it must be shit for you.”
I saw his eyebrow quiver slightly at my use of the term ‘angry child’. Excellent. It had been intended to pique his interest.
“I’ve been reading about schema models recently,” I proclaimed, triumphantly.
This is where part two of the discussion began. Let’s call it Intellectualise my Mentalism.
The other week, when I was convinced my therapy with C was coming to a dramatic and premature halt in January, I rushed to the Yellow Pages looking for suitable therapists. I was looking primarily for practitioners of psychodynamic therapy, as I have been receiving from C, because it’s the only type that I have found remotely effective to date. However, I was open to exploring both schema and gestalt therapy, having read quite a bit on both, and found practitioners of both in the vicinity. As two major studies have demonstrated its effectiveness for all symptoms of BPD (unlike stupid DBT), I have more faith in schema therapy, even though it does involve some wanky (if apparently advanced) CBT, for which (as you know) I have no time, so – convinced I was in imminent danger of abandonment from C – I Googled “Schema therapy borderline personality disorder” and came up with this book. On a whim, I bought it.
The book contends that people with BPD have five main strands to their character:
- The healthy adult (the authors admit this seems an unlikely component, but make the reasonably fair point that many with BPD are not always going mental. Not that they put it quite like that, of course).
- Detached protector – this mode sees the patient protecting the harmed brats that form part of her consciousness.
- Punitive parent – “everything is my fault” mode. Must punish myself. I am usually pretty good at this, especially in session.
- Angry or impulsive child – furious, mainly as a defence mechanism. It is convinced it will be fucked over. It is also angry that its needs / rights are not met. (I am a walking stereotype).
- Abandoned or abused child – alone, no one cares about it, whinges, cries, blah de blah.
I told C that today I was the protector. I was avoiding his questions, getting irritated when he probed me – classic protector traits, according to the book.
We had a discussion around the whole concept of schemas, schema therapy and its development, which to my amazement resulted in him bringing up the term ‘borderline personality disorder’ in a completely unsolicited way. He went on to explain the schemas seen in BPD in more detail, to the absolute delight of my ears and my mind.
Feeling that we were on something of a discursive roll, I presented him with a print-out of this post from Kathy Broady’s blog. I had analysed the piece bit by bit in terms of its applicability to me.
I pointed out that it was written by a DID therapist, however, and that therefore it might not all apply directly to me.
He sort of shook his head and said, “there’s a debate in psychiatry and psychology as to whether or not DID and BPD exist on a continuum. At the very least, there’s often an overlap of symptoms. So therefore I’m sure some of this stuff can apply.”
(For the record I think I’d identified about 18 of the 20 signs Kathy listed as being applicable to me to one extent or another. Fuck! Is there more I don’t know about?!).
Satisfied with this response, I gestured for C to go ahead and read the list. Not wanting to sit there like a numpty whilst he read it, I stood up and looked out the window.
I could see out of the corner of my eye that he was looking at me, puzzled. I turned to him.
“What, am I not allowed to stand up now?”
“Well, yeaa-ahhh, you are,” he began, doubtfully, “but I’m just wondering why you’re standing up.”
“You’re reading that, so I’m going to look out the window,” I replied.
“I think you’re trying to distance yourself from the material in this article,” he told me. “It would be better if you sat down and faced it.”
So, the mere gesture of looking out the window is reflective of an entrenched tendency to avoid confronting one’s problems, is it? Well, fuck me, I’ve heard it all now. I was going to argue, but decided against it, not really seeing any point. I made an arm gesture of “you win” and sat down, internally laughing at how absurd I felt his deep reading of my meaningless action had been.
C read the list – to my annoyance, he read a lot of it out loud – then paused on one particular point. I don’t remember which one it was, but I’d provided an ‘analysis’ at the end along the lines of, “I do this, I do that, blah de blah.”
“Blah de blah?” he queried. “What does that mean?”
“I don’t know,” I said. “It’s just flippancy.”
“Yeah,” he agreed, “but where does that flippancy come from?”
“It’s stylistic,” I argued (I’m sure most readers of this blog will agree that I have a penchant for flippant remarks). “It’s just my writing style. You haven’t read any of my writing…”
“But…” he went on.
Enter stage three of the session – the mad, maniacal bit.
“Right,” I said authoritatively. “You don’t believe me that that’s how I write? Well, let me show you.”
From my bag I pulled out a print out of this post, my (latest) rant on the NHS. I began randomly reading some of the more colourful parts of the rants, in a deliberately exaggerated and dramatic voice. When I finally drew breath at the part where I talked about reading Grey’s Anatomy at the age of five, the completely befuzzled C interrupted me, exclaiming, “what’s happening here today?!”
He looked completely bemused, and on reflection I can’t say I blame him. It was a bit of a random tangent.
I defended myself on the grounds that I wanted to demonstrate to him that the flippant comments he’d seen on the trauma list were sod all in comparison to the flippant comments made by me elsewhere.
“But,” he said, metaphorically stroking his chin, “we’ve been all over the place today [I'm not sure that he phrased it quite like that]. For the first while I thought you were quite upset, quite agitated…now I’m not sure what you are…angry? And in the middle we perhaps intellectualised matters a little.”
“Oh fuck, I’m sorry!” I cried. “I led you into that.”
“These meetings are a co-construction,” he insisted. “I’m just as culpable for any straying off course as you are – we just have to be careful not to head into intellectual territory too much.”
He pondered for a minute and, referencing point 10 on Kathy’s list of trauma signs, said, “your rush to apologise just now ties in with that.” He noted that I had commented on the list that my self-blame wasn’t excessive because that for which I blame myself is, in fact, my fault.
“You do realise, objectively, that it is excessive, don’t you?” C asked.
“No no no, it’s my fault. It’s my fault,” I contended. “Just now I seduced you into that discussion on academic psychology. It was my fault, I’m sorry.”
Readers, why – WHY?! – did I have to use the word ‘seduce’? Why? A dozen other words would have sufficed. It just rolled off my tongue, as hyperbolic metaphors often seem to do.
He raised his eyebrow and narrowed his eye slightly. “Seduced?” he enquired.
Fuck. FUCK. FUCK FUCK FUCK! Now he thinks I want to fucking fuck him. Fuck fuck fuck.
I felt my cheeks turn red in utter mortification and in my rush to defend my use of the term, on the grounds that it was figurative, probably made an utter tit of myself – thus reinforcing any belief he might have that my transference is of an erotic nature.
Fucky fuck, shit and damn. I did try my best to explain what I’d meant, but I was flustered, and in any case it probably looked like a case of the lady doth protest too much. So eventually I gave up, looked down and gestured for him to continue to read the trauma list.
Thankfully for once he had the grace to do as he was told and not press me. He read on in silence this time, and when he’d finished I asked him if he thought the points included were applicable to me.
He said that he thought they were, and indeed that a lot of it had already come out in therapy and that we were beginning to address those issues.
He handed me the list back, and I read over it. For some reason I then went into a dysphoric but energetic rant against myself, telling C that I was “nothing but histrionic” for thinking any of the list was applicable to me, and indeed for bringing it to him.
He listened to and watched me in a kind of bewildered way. Perhaps he’s not that familiar with mixed states.
“Well, this has been weird,” I declared.
He cleared his throat, as if for dramatic effect. “It’s certainly been…” – he searched for the word – “…different,” he acknowledged finally, with a slight wryness I thought, which I found bizarrely reassuring.
“I was nervous about telling you about the schema book,” I admitted to him, rather randomly. “I’ve always got the feeling from you that you think to so much as mention a diagnosis is to fixate on a label.”
“Not necessarily,” he began. “It’s very important not to fixate on it, indeed. You mustn’t allow yourself to be ‘built’ around a diagnosis. But it can have benefits, yes.”
“I’ve found it helpful,” I said. “For one thing it’s enabled me to connect with a range of people who have been a great support network.”
“Good,” he declared. “No, I have no problem with diagnoses. It’s just important that you know that it’s not ‘borderline personality disorder’ that comes into this room, it’s [my name].”
I nodded. I think I do keep a sense of perspective on the diagnoses; if someone asks me about myself, unless it has been directly in the context of mental illness, I’ll usually tell them I’m a rock bird with a love for reading, writing, pubs, sci-fi and Newcastle United. The illnesses are part of me, and I am not ashamed of having them, but they’re certainly not the whole story.
As I was about to leave, C asked me to think over the prospect of there being a maximum of 24 weeks of the process left in order for us to discuss it at the next session. He all but begged me to “bring the anger with [me].” I protested that I couldn’t do so with absolute impunity, as I couldn’t face being heard screaming at him by those in the offices adjoining his.
He looked extremely taken aback at this, which I still don’t fully understand. I have social anxiety for Christ’s sake, does he honestly expect that I can allow anyone but him to be party to my rants? In any case, his secretary phoned today. Having convinced myself at the weekend that he was dead (whilst simultaneously reckoning that he wasn’t dead, but nevertheless believing that he was), I was horrified about what she had to say. Mercifully, so far C is not dead and will see me on Thursday at the normal time – just not in the normal place, due to building work. He is temporarily moving back to VCB’s stomping ground.
In a way, it’s worse to lose it with him there than in his own office. The office in which I suspect I will meet him is next door to the one VCB shares with other psychiatrists. These cunts all have it in their power to section me should I really lose it, which is hopefully unlikely but frankly not impossible, especially with ‘They’ still hovering about from time to time (though wouldn’t you know it, the anti-psychotic has seemingly killed Tom. Just my luck to lose the ‘good’ psychosis and retain the ‘bad’). On the other hand, an advantage of this location is that the building is attached to the day bin and adjacent to the actual bin, so hopefully they’ll be used to having crazies losing it on them fairly often.
As for now, I don’t know what I think. The argument is still ongoing in my head – More NHS Fuckovery, I’m Calling an Advocacy Service vs. Well, It’s Another Potential Six Months, Be Grateful. The truth is I feel both at the same time. A little bit positive, but more than a little bit lost.