Happy World Mental Health Day (what’s left of it). Alter Ego wrote a few words about the subject, though Pandora won’t – simply because she has to do this post instead. I celebrated World Mental Health Day by driving down the coast with A and spending a few lovely hours walking around the gardens of an old period mansion. The place was littered with cunts, it being a sunny Sunday (that rarest of things), but it was nevertheless tranquil and relaxing, and at least temporarily encouraged my mental health, thus fulfilling the desirous ideals of World Mental Health Day. I am sunstroked and very, very tired now, but it was worth it.
Unfortunately such tiredness does not lend itself particularly well to reviewing a therapy session, particularly when it’s your first one with a new person. I’ve been staring at this screen for the last 20 minutes, and don’t know what to say. I suppose it’s worth noting that Paul is very different from C, yet in some ways he is quintessentially similar. Although he noted that the therapy provided by Nexus is meant to be “counselling” as opposed to “psychotherapy”, he still talked considerably about more psychodynamic concepts such as transference. And, as noted in the assessment session, he has a specific interest in mental health issues (we can probably fairly assume that rape / sexual abuse does not always lead to mental illness in the way that yours truly exhibits it, so not all Nexus clients will have such difficulties).
He is a normal looking, if overweight, middle-aged bloke. He and C are physically similar in that they’re both short and bespectacled – there, however, end the similarities. They are completely different in every other physical respect. C, although balding when I last saw him, still had his lovely fluffy brown hair that I always had to fight not to to ruffle. Paul is almost completely bald. C was ridiculously thin – he could have fitted into one of my thighs about 18,000 times. Paul is fat and jolly, and – and I don’t know if he realises or not – always has part of his midriff showing owing to his shirt buttons being pulled beyond normal stretching. I found myself wondering if the fact that he is so much older than C would make ours a more appropriate relationship. If there is to be some form of parental transference, then surely it is not best directed at a man who’s maybe six to 10 years my senior, as C was (and, I assume, is) – better directed at a man in his 40s or possibly even 50s, who’s old enough to be my fucking father? I don’t know. Perhaps the transference towards C was more fraternal rather than paternal at times, which of course complicated matters – I mean, he’s wasn’t my fucking friend. Anyway, I am blathering.
Although C would often have betrayed aspects of his personality and life outside of my time with him, he did so almost accidentally, or perhaps quite subtly. Paul, in contrast, spoke openly of his other clients (within the confines of confidentiality, of course) and wears a big fat wedding ring. These things would have driven me into a jealous rage with C; as it presently stands with Paul, I couldn’t care less – well, if anything, I welcome his candour and expressiveness.
I don’t remember exactly how the discussion commenced, but I do remember we’d gone up several flights of stairs and that Paul – being not insignificantly sized – was very out of breath. I recall also a small flicker of delight in that I wasn’t particularly thus stressed, which is testament to having lost a lot of weight in the past year or two.
He directed me to a small, attic-esque, pastelly room. For a second, I felt incandescent fury that it was not the room in which my assessment session had taken place (I hate change, it unsettles me), but he was rabbiting on genially about something or other, so he was forgiven and the room change forgotten. He said, “we take this at your pace. You can speak as slowly or as quickly as you like about the issues that brought you here, or you can talk about something else entirely. You can talk about the bloody football if you like.”
“I’m a Newcastle United fan,” I replied drolly. “I’m not sure that that would be a good idea.”
Paul chuckled, and said that he was a Birmingham City fan, so he empathised with my plight. I withheld from him the information that I don’t like Birmingham, preferring as I do both Wolves, West Brom and Villa. Still, it was interesting to finally place his accent; my guess had been the Midlands somewhere, but with a twang. I wouldn’t say he sounds like a typical Brummie, but you can hear something of it in his voice.
It is an inherently weird thing to sit opposite a person you have met only twice and make reference to occurrences in your life of which you have hardly spoken to those closest to you – and yet, paradoxically, it seemed perfectly normal to do so at the time. That is the nature of a functional therapeutic dyad, I suppose, so that alone is encouraging.
The conversation was definitely of a ‘first therapy session’ ilk, but was nonetheless wide-ranging. Paul spoke to me in a thoroughly adult way, as if he felt that I was his intellectual equal. At one point he said something like, “I’m using all these terms assuming you know that they mean…”
“Yes,” I said, “it’s so refreshing to not have someone patronise me in this arena. Thank you.”
He nodded and said, “you see, I was listening in the assessment session.”
And so he must have been, because he also regarded me with a familiarity that new therapists don’t tend to do.
The issue of self-blame came up. He told me that he had a client who sat down with him in her first session and said something to the effect of, “this is all my fault.”
I said that I knew how she felt, then went into a self-cross-examination on the issue. I told him how I would vehemently deny the claims of fault of others I know who have been abused, and how I would try to comfort and reassure them that they were guiltless in their horrific situations – but how, in the same breath, I would call myself a fetid, disgusting, seductive, evil little whore.
He nodded knowingly, and said that to cope abused children frequently internalised the situation they found themselves in. I don’t remember how he put it exactly, but it was to the effect that if one can blame the self, then it is easier to deal with than to accept that such heinous behaviour actually exists out there in the ‘real’ world. I suppose there is some truth to this in my case.
He then talked about how Paedo had almost externalised his attitude; he, for his own survival, shifted the blame to me (thus, of course, reinforcing my own sense of it). Paul claimed that Paedo acknowledging his culpability (as opposed to mine) would be a fate way too enormous for him to cope with at a psychological level, and to that end to him any wickedness present in the whole thing was (to him) mine, not his.
This led to an interesting, pseudo-academic discussion on the nature of the paedophile versus that of the victim versus that of the general populace. Paul claims that, non-diagnostically speaking, we all to one extent or another exist on a plane between ‘schizoid’ and ‘depressive’. In this typography, the ‘schizoid’ is a ‘phantasist’ (‘ph’ as opposed to ‘f’, apparently, because it should not be equated to something enjoyable). In these non-diagnostic brackets, ‘schizoid’ refers to two things. One, the abuser deludes him or herself into thinking that they have not acted of their own accord – the child has ‘seduced’ him/her (clearly delusional, to Paul’s mind). Two, the child him or herself has essentially agreed to that – they were the one in the wrong (again, delusional).
The ‘depressive’ position, Paul argued, was one of existential realism. “Oh God, he raped me!” or “Oh my fucking God, I just had sex with a child! I’m such an evil cunt!” He emphasised that neither the schizoid nor the depressive were diagnostic in nature – simply referential terms – but I pointed out that Paedo has some unspecified psychotic disorder (which I personally believe to be schizophrenia, but what the hell do I know). I asked Paul if, if we stretched the schizoid-depressive continuum, we could come to a psychosis-depressed diagnostic continuum.
Upon my pointing out that Paedo is a paranoid psychotic, Paul said (whilst noting that diagnoses are officially beyond his capability) that it was entirely feasible that Paedo’s psychoses – especially given their relatively late life development – were related to his abuse of me. He asked me if I was familiar with the Fruedian theory of psychosis. I said that, broadly speaking, I was – but that an explanation of his position would nevertheless be helpful. Essentially, what Paul next shared with me is explained here; in hideously rudimentary terms, aside from the afore-referenced continuum of the schizoid-depressive scale, “hallucinatory psychosis could be considered as the expression of an imaginary maintaining of an early reality whose loss the ego finds unbearable” (in other words, Paedo deludes himself so far from his reality than an unreality becomes, without medical intervention at least, his norm. This, in Freudian terms, is catalysed by the enormity of his actions as an active paedophile/child sex abuser).
I listened to this discussion with a rapture bordering on intellectual orgasm as Paul referenced Melanie Klein, the id, primary narcissism and other psychological terms. (Please note that my reference to ‘orgasm’ does most certainly not refer to an attraction to Paul. It does, however, denote unquantifiable delight at being treated as an intelligent and knowledgeable human being).
We talked for a bit about dissociation, and how it was only through previous therapy with C that I had developed half of the knowledge that I now have about what was done to me as a child. I told him about my mother’s various defences of Paedo (which, he noted correctly, further reinforce the whole ‘it’s my fault’ beliefs). I told him that I’d always known stuff happened – I’ve had clear memory of one rape plus several instances of ‘inappropriate touching’ (such a benign term) for almost as long back as I can remember – but I knew, even though I didn’t always consciously recall or verbally acknowledge it, that there was more to it than that.
Paul said, “that’s the genius of the child sex abuse survivor.”
This piqued my rather cynical interest. I asked him to explain.
“I was on a training course a few years ago,” he said. “The first thing the facilitator did was point out that our clients – ie. survivors of sexual abuse – are geniii.”
I longed to correct ‘genii’ to ‘geniuses’, but I respectfully refrained. Instead, I asked how this was so.
“You dissociated it,” he replied emphatically. “Others dissociate to the point of an entirely new personality. Others compartmentalise these things in a less distinct form. Yet others see is as if they are viewing it through a veil. Others again just…I don’t know, tolerate it? Some – and I’m guessing you [he guessed correctly] – employ a number of these and other methods to cope.”
“So?” I protested. “You do what you do to get by.”
“But,” Paul pressed. “You, and children like you, were put in unbearable, infeasible situations. To have stayed on the right side of sanity is, in these terms, a really major achievement.”
I laughed. “I am not sane,” I told him.
This led to a discussion of diagnoses. I told him how I had first realised there was something wrong with me about the age of 13 or 14, when I was visiting my grandfather in hospital. The hospital had a sign up regarding a major depressive episode; to qualify, you had to meet five of nine symptoms across at least two weeks. I had had nine out of nine for months.
This in turn led to another brief discussion of my mother and her refutation of my claims about Paedo. I told Paul about having been in pseudo-analysis, CBT and hypnotherapy, as well as having been seen by a child psychiatrist. I also detailed my various diagnoses – major clinical depression when I was 14, social anxiety when I was 17 or 18, BPD when I was 25, psychotic and dissociative symptoms later that year, and complex PTSD when I was 26.
There was a discussion around how I felt about the various diagnoses. I said that I was “content”‘ with most of them – but that I was “uncomfortable” with the borderline applicability.
“I hate it!” he said definitely, underlining the disgust he had shown in the assessment session. We discussed how it is so often unfairly applied to women who psychiatrists can’t be arsed to take seriously, and how it is viewed by mental health professionals in general (this is one such example, although mercifully an extreme one).
I went on to say that I believed it had been fairly applied to me, but that I knew that anyone that got it – fairly or otherwise – was treated like shit by the health service simply because it was there. He asked me what symptoms applied to me, and as I rhymed them off he sort of laughed and said, “in other words, entirely understandable coping mechanisms for unbearable traumas.” Against my erstwhile better judgement, I was forced to agree.
“But,” I said, “to avoid that particular stigma – and also because it’s actually true – on the occasions on which I do talk about what’s wrong with me, I try to emphasise the C-PTSD diagnosis rather than the BPD one.”
“Good,” he said. “You want to show that something bad was levied at you, rather than by you.”
“Exactly,” I agreed.
I confessed to him that when I’d been recovering my memories about all this stuff with C that I had had hallucinations of Paedo etc etc etc. Bearing in mind NewVCB’s concerns about Nexus’ apparent inability to deal with this sort of thing, I tried desperately to underplay it. To my considerable interest, however, it turns out that Paul is more than familiar with traumatic and dissociative psychoses. He asked me to detail my hallucinatory and delusional experiences, and to my own surprise I felt comfortable enough doing so.
“Yes,” he said, “it’s bad – but I’ve seen a lot worse. I once worked on a ward that was essentially full of trauma survivors with psychotic symptoms. I remember one man ‘acting out’ all the things that were done to him all night.”
Ha! Fuck you, NewVCB (even though I quite like you). C’s better equipped to deal with Mental Me than Paul is, is he? I rather think not.
I commiserated. Paul talked a bit more about it and essentially said that if I was “going doolally” (my term, but he claimed to quite like it – he also, allegedly, liked my self-styled “rambling”) I had to bring it into the room with me. It was at this point that he started talking about transference and how I should bring that with me as needs be too.
What surprised me about this was not so much his allusions to transference in itself, but his references to countertransference. He freely admitted to me that he had another client who, through her behaviour outside the dyad, brought this element of “please like me” into the room with her. “It’s not that I independently dislike her at all,” he said, “but such a positive reaction as elicited in me by her is clearly transference. It’s not necessarily a bad thing; we just need to be aware of it.”
I laughed. “I am wholly aware of both the beneficial and nefarious effects of transference,” I said.
“Yes,” Paul said, smiling. “I reckoned you of all people would be.”
He gave me one of the ‘how depressed are you’ questionnaires to fill in, and I found myself trying to justify my apparent good mood in front of him with the pathetic woe I was detailing on the form. He told me not to be discouraged, but to at least be aware that, fragile as I was and as I am, I have been “strong enough” to approach him and his organisation about my multifarious issues.
“I’ll get you to fill it in again in four or five weeks,” he advised. “Don’t be surprised or disheartened it it goes down notably at that point.”
I laughed out loud, and he asked why. The date was 4 October 2010. “I was going to kill myself today,” I announced melodramtatically. “I had my finger on the “buy now” button below the helium canister on some website or other. I was going to hook it to an exit bag and off myself at some remote location in my poor car. But something stopped me from going through with it. I dragged my finger away from that button.”
“Well, I’m very glad of that,” he said, apparently with the utmost sincerity. ” But please bring that – any suicidal ideation – with you to these meetings,” he pressed. “If you’re suicidal, you need to tell me, you need to give us a chance. We need to explore it, but I will not report it unless you are in imminent danger.”
I nodded my agreement.
Eventually the session came to an end. It was of 50 minutes’ duration, the same as the NHS sessions were. He followed me down the stairs; I went to give the receptionist a payment, but she all but ignored me, to my not inconsiderable chagrin. However, I realised that Paul was still standing beside me.
“I’d like to make a donation, please,” I said to him with a distinct lack of confidence. Why is it that donating money always feels awkward, no matter how worthy the cause?
“That’s great,” he replied. “How much?”
“Are you sure?!”
“Quite sure, why?”
“That’s incredibly generous of you,” he almost-gushed.
“Well, take advantage of it now,” I laughed. “I won’t have any in a few weeks!”
I was only half joking, but whatever the case: I feel that they deserve anything I can give them. It’s early days, and damn all is assured. But as Paul said, “I look forward to seeing you next week, Pandora,” as I left his company, I couldn’t help but feel hopeful and encouraged.
Is it a cure? I very, very much doubt it. But can he provide a path to semi-tolerance of life, at least on an interim basis? I don’t know – but the signs are encouraging, and for now at least that is enough. The fact that I am almost looking forward to tomorrow’s meeting with him is potentially deeply telling indeed.