Things are going more and more downhill in session. Every one over the last few weeks seems to end up brimming over with hostility and defensiveness from both sides, and last week was no different. I think he is finding me an increasingly difficult patient. I am certainly finding negotiation of the therapeutic relationship increasingly difficult, so I suppose in that sense we are equal, but things scream of inequity at the moment. Where once we felt like equals, albeit in a strangely asymmetrical partnership, it now feels like the balance of power is weighed strongly in C’s favour. He said to me once, several months ago, that he was “not my teacher”. Well, he isn’t teaching me anything, that much is true – but I constantly feel like a naughty schoolgirl to his authoritative headteacher. That isn’t fair.
I’m not really sure what to say about this session. I was completely mental in it. I tried to tell him exactly how I was feeling, but my ability with language epically failed me, and the necessary words failed to flow. I did keep trying to convey to him that I was experiencing what I thought was akathisia – however, not at any point did I use that word. Stupid, yes? Why not just tell the man that I suspected I was afflicted with this phenomenon?
C is not a psychiatrist, so I cannot expect him to be an expert in the finer points of side-effects of psychotropic medication. Nevertheless, as a mental health professional, I was expecting him to be familiar with this particular thing. I wanted to hear him say the word ‘akathisia’ of his own accord, and he never did. I was testing him, I suppose. In my (rational-ish) view, this is completely preposterous; he may be an insightful psychologist, but he is not a mind-reader, and akathisia is notoriously hard to identify even by psychiatric experts. However, C himself has defended my tendency to test him in the past. He seemed to think it acceptable to test him for six months before finally opening up to him about some of my many issues.
And therein lies another thing that has been bugging me. I say something I consider to be stupid. I go into a self-hating rant about my perceived stupidity. C listens, then eventually starts defending me.
The flip side: I say something that I believe to be perfectly reasonable. C listens, then eventually dismisses what I have said.
Obviously this is a gross generalisation. Not all strands of conversation result in this kind of reaction, as previous entries on my therapy sessions will attest. But it is certainly not unknown.
Anyway. C told me that I have to “take responsibility” for myself. Hmm. Does that mean that it was my irresponsibility that led to my complete doolallniess on Thursday? Surely that is terribly unfair. I don’t go around consciously choosing to go off my head, do I? I talked about my desire to kill myself a lot, and said that I genuinely didn’t know if I could continue to control myself in that regard. Obviously he thinks I can, because clearly he fucking knows what it’s like to exist in my head.
He exemplified by saying that I always turn up to therapy on time, and that when I tried to do myself in a few weeks ago, that I took myself to hospital (though he failed to acknowledge that I only did that when it became apparent that my suicide attempt was not going to be successful). To that end, he believes that I am perfectly capable of controlling myself. Oh yes, I may get overwhelmed “from time to time” (!), but I am still in control, or at least I can be if I take some fucking responsibility for myself.
I turn up to therapy every week on time because I am forced out of bloody bed by A or my mother each Thursday morning. It is a struggle each week, and I can only manage it with others’ help, and I want their help because I had thought – up until recently – that this process was a vehicle full of promise of some semblance of recovery. Being there is not about whether I am “in control” or “responsible”; it is simply something I have to do. A bit like eating. I don’t always want to do it, but something within me compels me regularly towards it, meaning that with help, it can be achieved. And believe me, in the last few weeks even such simple, everyday things actually do feel like an achievement.
I admitted to C that I didn’t trust myself because I’ve done something pretty daft – bought 100 Diazepam from some dodgy online retailer (yes, it is indeed probably rat poison. I don’t care, so don’t bother to point it out). He kept asking me if I was intending to overdose on it. I said that Diazepam ODs don’t kill people, but he protested that that wasn’t what he’d asked. I said that no, I was not intending to overdose. He asked me to guarantee that, and I said I couldn’t guarantee anything – for example, I didn’t know that I wouldn’t be blown to South Africa by a hurricane the next day, but that my perception was that on the balance of probability it wasn’t likely.
Why bother with this line of questioning? They don’t put borderline freaks in the bin in the UK anyway, probably because they opine that we’re all going to do ourselves in eventually anyway. I suppose he has to be seen to have asked all this wank so that if I eventually succeed in catching the bus, there will be no culpability at his door. Oh well. I suppose one must be grateful for small mercies; the psychiatrist basically told me it was good that my suicidal ideation was so strong. Means I’m feeling things, apparently. Yay.
Anyhow, C told me that “his stance” was that I should throw the Diazepam out when they arrive so that I am not tempted to take them all. I laughed in his face.
“I spent $80 dollars on them,” I sneered. “That’s what? Fifty, fifty-five quid? As if I’m going to bin something that valuable.”
“I know it’s a lot of money,” he started, “but compared to the value of your life…”
Something inside me snapped. How dare he comment on the value of my life? How very dare he? He may know some of my dirty little secrets, and he may know whatever elements of my personality that are portrayed for a measly fifty minutes a week, but that doesn’t mean he knows me, not really. He doesn’t know what I’m like socially, at home, how I was in work – none of that. He hardly knows me at all in many ways. Yet he thinks he can comment on how valuable or otherwise my life is? No way, mate.
Well-intentioned? Yes, maybe. Indeed, probably. But if he existed in my head, if he were around me like A is, then he would know that as a general rule my life is meaningless and empty…completely worthless. Ergo, any supposition of its supposed worth from him was always going to serve to irritate.
I shouted at him that he knew nothing of the value of my life. I don’t remember how exactly he responded but I think he tried to press the point, leading to more incredulity from me.
He said at one point that I had to decide “what I wanted” from this therapy, thereby implying that he feels it is meandering along with no real point, just like I do – but on top of that, the question was loaded with connotations of me failing to pull my weight in the process. That annoyed me, because I think that despite my difficulties in motivating myself to attend every week, I have managed to do so, as he himself had noted. Does that not suggest commitment to the therapy? It was an exasperated question on his part, which did not have any point to my mind. He, as a trained and, I assume, experienced, psychotherapist, ought to have the answers himself, especially as this was something we have discussed several times. I want to be able to have as normal a life as possible and not go mental every few fucking seconds. Does it take a brain surgeon with a secondary qualification in rocket science to understand that?
I find it really rather sad to write such a negative entry about C. My instinct about him has always been very positive, even when the therapeutic path ahead has seemed foggy and indistinct. Even when commentators here or people in my offline have been critical of him, I’ve been resolute in my belief that he has been and is the right psychotherapist for me. I think I still think that, but things have been so murky in the last few weeks that part of me is beginning to question it. Everything was fine, more or less, until about Christmas. Is that because I’ve been really mental since Christmas? Why can’t he deal with that? Or is it because it was just before Christmas that he announced the end of the therapy? Why won’t he explain that?
Maybe I do need to take responsibility for myself, but to be quite frank, my inability to do so is one of the many reasons that I’m in therapy in the first place. So that’s an issue. Another one is that I am not the only one that should be taking responsibility for me. I am under NHS care for that reason, and yet none of them want to take that upon themselves, not really. The only one that I really believe gives half of a damn is my GP, who has consistently been a tower of strength and support.
According to my psychiatrist, I am meant to be grateful that C is willing to treat me at all, because I have personality disorder. Um…sorry, no. C is doing what he is fucking paid to do. I met him several months before I had received a diagnosis anyway, and if my Trust doesn’t have the specialist facilities for PDs, then that is not my problem. They should provide treatment in line with the philosophy on which the health service was built with the resources they have, and I find it insulting that I am meant to consider myself privileged that they are only half doing so.
And as for what I want out of therapy…well, there’s the obvious general point stated above, and I suppose there must be specifics thereof, about which I’ll have to think presumably, though I’d like to do this in conjunction with him. But I’d be grateful for your thoughts on this, readers. What exactly is the point of psychotherapy? What is it for, what is it meant to achieve? And does it even actually work?
Your comments, as ever, are most welcome and encouraged. I’m sorry that I’ve been lax in replying to them on other posts of late. I will try to change that as from this post.