***As usual, please be aware of possible triggers, in this case re: self-harm, dissociation and sexual abuse.***
Wey-hey! We’re now into double figures in terms of sessions with Paul, so I can now save characters in my review post titles! I’ve always been a pedant like this; single digit numbers ought by linguistic convention to be expressed in words; double and higher numbers in figures. Seeing deviations from this render make me murderous. An over-reaction, you say? Maybe. But doesn’t everyone have a few foibles over the correct use of the English language? Along with things like double negatives, and the use of the word ‘like’ to express something that was said rather than something to which the speaker is comparable, this is one of mine.
Anyway, I was meant to see Paul on Monday 20 December, but if you follow me on Twitter or Facebook you’ll be aware that he was snowed in that day and couldn’t make it to work. Part of me was relieved – I was exhausted that day, and therapy seemed like too much to take – but part of me was irritated in the extreme. It’s only fucking snow. To be fair, the bloke that left the message on my phone to advise me of Paul’s absence did say that I could ring them and speak to a counsellor if I was in distress, which was a nice offer. I didn’t take them up on it, of course, but I was grateful to have the option given to me.
The missing of that session means that the last time I saw Paul was 13 December. I saw NewVCB two days later, and I’ll include a brief overview of that meeting here too.
Paul: Week 10
Things commenced, as they usually do, with Paul warmly enquiring as to how I was. I told him that I was OK, which was true at the time, but of course this session was in the almost-immediate aftermath of a major psychotic and dissociative episode and I knew (with a slither of regret) that I needed to tell him about it.
“I’m OK,” I repeated, “but…well, I was not so OK the other day.”
“Oh dear,” he replied, raising his eyebrows in apparent curiosity, but with evident and sincere concern in his voice. “What’s going on for you?”
“You tell me,” I laughed bitterly. “I don’t remember doing most of it.” I paused, and tilted my head in thought. “Apparently I was completely insane on Friday.”
I told him about the harassment from ‘They‘ during the day – one part of the whole nasty business that I do recall fairly well – and mentioned how my mother had been so distressed by what she saw that she saw that she’d started babbling on about getting doctors out, the underlying threat being that she felt I was worthy of assessment under the Mental Health Act. If that was her thinking, I can’t really blame her. It was a pretty nasty episode.
I proceeded to explain to Paul my bizarre behaviour of that night. About how I was apparently muttering the words to the theme of Dad’s Army on a constant loop for about half an hour, and about how Aurora manifested and un-manifested in two nano-second switches, and about how when I woke up on Saturday morning I was covered in cuts I don’t remember inflicting upon my self.
Curiously, I didn’t (and don’t) feel able to refer to her as an alter in front of him. He doesn’t like diagnoses (and has been exasperated in the past when I’ve made reference to ‘disorders’, particularly those of a dissociative nature), so maybe that’s why, but whatever the case, rather than tell him that I switched to the child alter, I said that “the child part of me started talking to [A].”
Paul asked me what it was that Aurora had to say, and after apprising him of the two or three set terms that she employed, I accused her of being “shockingly melodramatic” for her claim that Suzanne, Paedo’s granddaughter, had seen one of the incidents of sexual abuse. I clarified what had actually happened: Suzanne merely caught a very brief glimpse of something, which almost certainly looked innocuous to her then-innocent mind.
Paul said, “it’s interesting that what ended up happening was that the child came under attack. Your mother, seeing you deal with psychosis – the voices representing a primitive, angry part of you – wanted to have you sectioned. That’s being hit by her anxiety. And you’ve done the same: you can’t bear your own anxieties either, so you start cutting at yourself.”
I looked at the cuts. The stupid bitch – for I assume it was her in control at the time of the ‘attack’ – had inflicted them upon my arms, about which I was really annoyed. I self-harm on my upper legs and my abdomen, where no one can see it. She clearly wants to draw negative attention to me, and I resent that considerably. However, the most frustrating thing of all is that the cuts are so fucking shit. It’s obvious a child is responsible for the bloody things (no pun intended), because no adult desirous of inflicting harm upon themselves would have done so so shoddily.
“They’re not even done properly,” I spat contemptuously, almost to myself, prompting him to ask what ‘properly’ would entail.
“Look at them!” I almost-shouted in disgust. “They’re so fucking superficial. They’re obviously done with something blunt. They hardly even break the surface; it’s pathetic.”
“Maybe she was just making a point,” Paul shrugged.
I looked away in disgust, and we sat in silence for a bit. Eventually he asked what ‘They’ had to say, and I told him the specifics.
“What I don’t get though is that on Friday they were especially strong and vicious, but they didn’t try to persuade me to do myself in,” I said, still puzzled by the state of affairs in question. “I mean, I was at my most vulnerable, they were at their most vicious – it was a perfect opportunity, and they didn’t take it. I don’t understand it.”
“Maybe they don’t want you to die any more,” he replied philosophically.
“But why?” I went on to muse on this briefly, concluding that “maybe they think my existence is my punishment.”
After a few moments of silence, Paul said that he was trying to work out how experiencing all this stuff must have felt, ultimately stating that it must have been “bloody terrifying, especially losing time.”
I agreed that that was indeed the worst bit. “At least with the voices, I know what happened and can be to some limited extent in control of it. This losing time thing ends up without my having any control over it, and that’s disturbing.”
We spent a few minutes discussing the strength of the psychotic elements of the incident, with Paul concluding that ‘They’ were angry because they felt threatened. “What’s threatening them?” he asked.
“I suppose my hypothesis would be that it’s you,” I suggested, embarrassed for some reason by the statement. Was I concerned that I was expressing some sort of inappropriate transference therein?
“But they’re not shouting at me,” he pointed out.
“No, they’re not. And I’m stunned to say that, as yet, they haven’t even mentioned you. That’s very odd. They used to despise C, my previous psychotherapist.”
We spent some time discussing the minutiae of how ‘They’ regarded C, the specifics thereof being fairly immaterial to this discussion. The point was, Paul opined, that in their abject hatred of C, they were trying to undermine my relationship with him.
I felt that this was a fair assessment of the matter. “If someone came up to me, started throwing insults about, and then claimed it was because of a voice in their head, I would laugh in their face,” I admitted. “Even though I have direct experience of the same thing. I just think that to have to put up with such abuse must be a really horrible thing to be on the receiving end of, regardless of how unavoidable the reasons may be.”
“OK,” Paul began, “I’m wondering why they don’t seem to hate me in this fashion. “Is it because I don’t threaten the same way he did, or are you in a different ‘place’ at the moment, where you feel less threatened by this work?”
“I’m not sure that I’m qualified to make this judgement, but I will anyway. My sense of it is that in 10 weeks, you and I have done more useful work than C and I did in over a year. So to that end, I don’t understand why ‘They’ are not really pissed off – what is there for them to like in such intense but hopeful work? I suppose it must be your second point – maybe I’m simply more ready to deal with these issues now. I wasn’t for a very long time, but I think I am now.”
“In a way, psychosis is about psychological splitting,” Paul observed. “And perhaps ‘They’ themselves have engaged in that process; C was the bad object, so I can be the good object.”
I wasn’t entirely sure what to make of this. I would have thought that anyone who was trying to help me, regardless of their success, would have been a ‘bad object’ to ‘They’. ‘They’ hate me. My being helped is not something that they should welcome.
Anyway, he went on to say that in his opinion, everything that was happening for me “in this moment” made sense in historical context.
“The voices, the splitting, the separation of yourself,” he explained. “I don’t think it’s ‘psychosis’ if it makes sense. I think when you’re so overwhelmed with self-hatred, it’s easier for someone else to hate you. What would they get from you killing yourself? They would die too. So it’s about your annihilation.”
I sighed. “I’m seeing my consultant on Wednesday,” I told him. “I’m concerned that if I tell her about this episode, she’ll just through more Seroquel at me. I’m already taking 600mg of the horrible stuff daily. For someone who apparently doesn’t suffer from schizophrenia or bipolar type one, that’s a not-insubstantial dosage.”
“While we’re on that subject,” he began. “I’d like your permission, please, to contact her…”
[...my heart sank...]
“…because I’d just like to say that I know that you’re finding things difficult right now, and just double check that she’s OK that we’re still working together.”
“She’ll say ‘no’,” I said, my voice laden with substantial regret.
When he asked why, I decided that honesty was the best policy; perhaps NewVCB might have insulted the ability of the counsellors from Nexus in her wariness of my attending them, but that was her issue, not mine. So I told him what she said in September, namely that she felt the psychotic nature of my reactions to issues in therapy were likely to be “too strong” for Nexus to deal with.
Obviously, in the case of Paul, this could not be further from the truth, and I told him that it was my view that he was clearly far more experienced in this specific type of symptomatology than the likes of C, for whom NewVCB had had “a lot of respect”.
Paul replied by giving me a brief verbal CV. He trained at a therapeutic community organisation specialising in people with really severe psychoses, and quite often was the lone supervisor of the house(s) over weekends. “It was lovely,” he recalled, his mind wandering briefly in happy nostalgia.
Much as I have psychotic episodes, I doubt that they could be classed as “really severe”. They are usually transient, rather than florid, and furthermore I mostly retain at least peripheral rational awareness during them. “I suppose I’m a bit easier to deal with then,” I laughed, though without much humour.
He said, “you’re a pleasure to deal with.”
That took me unawares. What the fuck is remotely pleasurable about being with me, especially in this dubious context, and why would he want to give me the satisfaction of knowing it?
I was kind of mortified to find myself blushing slightly. I don’t deal well with compliments – I never have. “Don’t be silly,” I told him, looking down, beyond his gaze.
“Why is that silly?” he inevitably questioned.
When I didn’t immediately respond, Paul smiled in a rather satisfied manner and said, “yes, that was a big challenge for you, wasn’t it?”
“Well, not really. I can’t see how listening to this infernal whinging for 50 minutes every week can be anything other than a pain in the arse. But then…well, I have to spend every minute with me. Not a huge deal of fun.”
“You can’t be that big a pain in the arse,” he retorted.
“How many years have you and A been together?”
Such a sly question. “Nearly eight,” I admitted.
“So, he can’t think you’re that much of a pain in the arse.”
Paul raised an eyebrow sternly at me. Not in a Fuck You, You Back-Talking, Defiant Cunt sort of way, but in the way a decent school teacher or even grandparent might do, as a sort of friendly warning that pressing further was pointless and/or damaging.
He said, “I look forward to the 50 minutes I spend with you each week.”
My visceral response would be to contest such a statement, but instead I heard myself thanking him. He nodded warmly in response. Was it possible that he actually meant what he was saying? That he actually did enjoy working with me? But, if so, how could that be?!
Randomly, he brought up my mother again, before I could think of something to say to him. He said that my mother’s inability to ‘contain’ what has happened to me was, somehow, hugely significant.
“It’s a strange one,” I admitted, citing the dichotomy between her history of not believing me regarding what happened with Paedo versus how nice she had been on the day that I’d gone so horribly psychotic.
“What would have been the best thing she could have done that day?” he asked. I didn’t know.
I thought about it for a long time, but could only come up with the answer of “ply me with Zopiclone and send me to bed.”
I told him so. “Think of it in terms of a child’s needs,” he pressed. “What does a child need when it’s hurt or poorly? It needs to be wrapped up and have its pain taken away, doesn’t it?”
Does it? I heard myself make some foreign-sounding utterance of acquiescence, but the truth is that I don’t know. I don’t know anything about children, nor do I particularly wish to. I have never even been one, except in a sort of official, census-gathering sort of way. Well, not unless you count bloody Aurora, anyway.
In any case, his point was that I should have been comforted, taken care of, protected even from all this bad stuff – a “reasonable request”, apparently, both in terms of the abused child and in terms of my ill adult self, given that I am still my mother’s daughter.
I elected to defend my mother. “She didn’t know Paedo was fucking me,” I told him. “And she’s dealt with hideous trauma in her own life, and…”
“You’re putting this big adult head on again,” Paul interrupted.
“You’re analysing, understanding everything – except what the child felt.” His tone was sympathetic, but nonetheless distinctly authoritative. Why is it that all therapists hate rational, considered, intelligent thinking? C did too, though he was easier to seduce into certain intellectual discourses, probably because I was (for a patient) fairly well-versed in some of his favourite subject areas. “Just remind me,” Paul continued, still in this teacher-tone, “of what age you were when all this took place.”
I was surprised by the question, because I thought he ought to have known the answer from previous meetings. I realised as soon as I had said, “between the ages of five and 10, if memory serves me,” that he did know the answer; he was getting me to acknowledge the reality verbally in order to make his point. Which was the usual cack that a child doesn’t understand these overwhelmingly horrible things, can’t/doesn’t rationalise his/her responses to them, that they feel dirty, shameful, guilty.
“And what does that damaged child, going back to Mum, want?” he asked.
“Comfort,” I responded flatly, as if he had defeated my I don’t give a fuck attitude, leaving me metaphorical adrift at sea.
“And if the child can’t get it, what happens?”
I struggled to find a term that seemed like a fair approximation of my views/feelings/whatever on the issue. I said, “I’m thinking that the child looks for an alternative way to cope – I know, I know – that’s not how it feels [I shot him a droll glance acknowledging my disgust in using the word].”
“You’re standing there, in front of Mum, having been through what you’ve just been through…”
I quietly thanked him for avoiding the actual terminology for the experience to which he was referring.
“…you’re in a lot of pain, you’re terrified. What do you do with all that nasty stuff? The fantasy is that Mum wraps you up and takes care of you. The reality is that your voice has been taken from you.”
I tried to think of some witty retort about extra voices being given to me, but I couldn’t think of any such quip before Paul spoke again. I would have made a terrible Oscar Wilde.
“Forget alternative ways of coping – what do you do with all this pain and fear?”
“Push it away, I suppose. Hide it somewhere. I don’t want to use the word ‘forgotten’, because I don’t think any of it has been entirely forgotten, but you know what I mean.”
“Freud said, ‘nothing is ever forgotten’,” Paul interjected.
I nodded. That seems like a reasonable assessment of how the human mind can often work.
“So it seems to me,” he went on, “that these feelings of misplaced guilt, shame, self-disgust and so on become the perfect breeding ground for these belligerent voices.”
“It’s self-destruction, isn’t it?” I suggested. For a while I verbally pondered on the idea, then found myself laughing at the fact that I tried to strangle myself at the age of nine. It’s not that suicide is funny, but the fact that I thought strangling myself was an even vaguely possible method of doing myself in is, to me, darkly amusing.
Paul does not agree. He said that someone so young being in so much pain is far from hilarious. He asked me what I would have thought if had it been another child. He was right; it wasn’t funny.
We had a brief philosophical discussion on the use of humour as commentary on traumatic and unfortunate events. We concluded that it was a coping mechanism and, to use his term, that it stops people having to “engage”.
He thinks this is key to my current difficulties. I strategise, plan and disseminate all thing, all of the time, in order to avoid engagement with what Aurora/I went through, and how that (a) made her feel and (b) makes me now feel. However, ‘They’ don’t want to disengage; they’re there to remind me of what really happened, apparently.
“No matter how well defence mechanisms work, they always have side-effects,” he said. “Neurosis, dreams, whatever. And in your case, psychosis.”
I was interested to note that he had alluded, however briefly, to the subject of dreams. I decided it might be worth discussing a few of my recent ones with him.
The one I told him about in most detail was the one where I had infiltrated an abuser’s gang, but in doing so had unfortunately ‘acquired’ into my own ‘possession’ children and animals that were in line to be abused. I accused myself of “self-serving narcissism” by being horrified when being caught by the police, rather than having a reaction of relief that the victims were going to be made safe.
“In your eyes, you’re ‘guilty’ of the abuse,” Paul replied. “It’s one of the things that your defence mechanisms is protecting; your disgust about being an apparently guilty person. Whatever happened to you, you seduced them. You were so powerful, after all [a wry head-nod]. You made them do all these things that they didn’t want to do. All these men could be seduced by your power.”
“If only that had happened later in my life,” I quipped, unable to help myself. Maybe I can be Oscar Wilde after all.
I was quite surprised when he laughed heartily, given as humour (if it can be so termed) is apparently such a debilitating defence mechanism of mine. He did acknowledge that through his laughter, and I apologised for my flippancy. Nevertheless, I was slightly impressed with myself for being able to make him laugh. Go me.
We discussed dreams a bit more, and he encouraged me to keep a dream diary (which I’ve been trying to do, but it’s so very difficult when you wake up from them, especially when they’ve been frightening and/or vivid). One of the things that apparently struck him as I talked about the dreams was my insecure attachment; that there was nobody I could ultimately trust for security, and that I, too, fail at every hurdle. “So it’s everybody’s fault,” he said. “Except the abuser’s, that is.”
I berated myself for apparently blaming my mother for a lot of stuff at both conscious and unconscious levels, but was once again advised that I was wearing my adult head. To a child, a mother is omnipresent. Apparently Aurora did not understand that her mother wouldn’t see what Paedo was doing, or would not somehow automatically know. “That little girl” expected her mother to come and rescue her, apparently.
I must stop using the word ‘apparently’.
I rambled for a few minutes on the ‘normality’ of the situation. At what point did abuse become normal for me? How would I know that it was somehow strange and inappropriate for adults to have sex with children? If you don’t have a frame of reference, then does it simply become your normality?
He noticed that my ability to articulate what I meant was lacking, an inability to say certain words or phrases being one of the more somatic effects that he has observed in me before. He thinks it’s significant because the whole thing centres on an failed communication; I was unable to express my pain as a child, and as an adult (in physical terms, at least), my anger or frustration is depicted by slashing my arms or turning psychotic.
“I was thinking about the incident you described to me last week,” I told him. “The one where the lady had seen this bloke raping a child, and that the most disturbing element of it for her was that the child knew what she was doing. I was thinking about how much that wasn’t dissimilar to my own case.”
“To give you back your own words, ‘it hurt, but not as much as it should have done’,” he returned.
There was a pause during which we both considered the implications of such a statement, then he said, “children who are repeatedly abused have to learn how to keep their abusers happy, for the sake of mere survival. Unhappy abusers do even more vile things. So I would imagine that there were times when you became what they ‘needed’ you to become: a sexually active child.”
He relayed some stories of which he had been apprised by the police of sexualised children, which made me feel physically sick. I don’t remember gyrating my hips when men came into the room like one girl he described, but I do recall reacting in some deeply societally inappropriate ways. I do not want to get into the specifics of that here, and neither did I convey it there.
We talked a little about some tangentially related issues, but then he checked the clock, saw that we were over time, and sighed. “I always find that these sessions pass so quickly,” he said regretfully. I agreed.
“Do I have to be concerned right now?” he asked, in reference to suicidal ideation and other serious mentalist issues. I appreciated the fact that he assumed that I was capable of being honest with him in my answer.
I assured him that I was (relatively speaking) fine.
We talked briefly about my upcoming appointment with NewVCB, and he reiterated his experience in the arena of severe psychosis. Apparently he trained under quite an eminent psychiatrist too. I began to feel more confident that I could talk NewVCB round, and we parted on the usual convivial terms. Unfortunately, due to the bastarding snow and bastarding Shitmas, I haven’t seen him since. He is due back tomorrow, thankfully.
Despite having felt reassured by Paul’s employment and training history, as well as my own perpetually positive experiences with him, I was still worried that NewVCB was going to be annoyed that I had gone to Nexus against her expressed wishes. On the other hand, I was enraged that I was meant to have seen her in fucking October, and here we were half-way through December. I had hopeful visions in which I stormed into her room, righteous indignation pulsating through my veins, accusing her of being just as useless and ineffective as the rest of the Trust and demanding answers. The fantasy made me smile, but mainly for ironic reasons. I knew that I would go to the appointment shaking, sit quietly in the waiting room for a few minutes, and then submit to her like some kind of little lapdog.
In the end the appointment passed quickly; I don’t think I was with her any more than 15 minutes, and it could have been a good deal less. The key thing about it, though, was (as noted here) the fact that she profusely apologised, unsolicited, about not having seen me as planned in October. She said that she really had no idea what had happened, but that she guessed it was attributable to her secretary having been off ill for quite a while, and the replacement temp being unfamiliar with the systems.
She said, “if this ever happens again – and I sincerely hope it doesn’t -please, please phone and ask to speak to me, and I’ll sort it out.”
I regarded her with slight incredulity.
“You do know that you’re allowed to phone me, don’t you?” she asked, her brow furrowed.
“No…I didn’t actually,” I admitted.
“Well, you are. So long as you don’t ring every few hours like some of my patients, it’s all part of the service we offer.”
“So,” I began, my head tilted in thought, “if I’m in some sort of crisis that’s not quite Crisis Team crisis, I can contact you, can I?” I’d rather contact Satan himself than the Crisis Team, mind you, but I withheld that piece of information from her.
“Of course,” she said, nodding emphatically. “That’s what we’re here for.”
I suppose I shouldn’t have been surprised – I mean, what are they paid for if not to treat their fucking patients – but meh: I was surprised. It would perhaps have been helpful if someone – C, OldVCB, Mr Director-Person, anyone – had at some point advised me of my rights and limitations within Services, but I am assuming that for most of them that would have been too sensible a course of action.
And so the discussion eventually fell to Paul. I told NewVCB that I was offered ongoing therapy with Nexus well before I had expected to get it (true), and that the Nice Lady That Works for Nexus had gone to a lot of trouble to ensure that it the treatment was with Paul specifically (probably not true). I said that, knowing I had no immediate appointments with her, that I had to make what I felt was the best decision in the circumstances, and that it had been to go ahead and take up their offer of therapy with Paul.
All through my little soliloquy she nodded acceptingly, tilted her head in interest, and half-smiled in reassurance. In short: she didn’t mind that I had done what she told me not to do. She appeared to understand and accept that for the most part I retain some semblance of rationality, and am thus usually capable of making my own decisions about what I feel is best for me.
I told her, in brief, of how I felt that Paul was “virtually written for me” and then relayed to her the information he’d given me about his training.
NewVCB was impressed. It turns out that she does outreach work with the organisation in question, and has very high regard for the work that they do.
I told her that Paul was interested in speaking to her regarding our work together, and she said that although she was now more than happy for me to continue seeing him, that she felt it would be useful to be in touch with him anyway so that all involved in my immediate care were on the same wavelength.
Inevitably, I had to tell her about the dissociative/psychotic episode, but as with Paul I was very reluctant to detail the childlike speaking as a manifestation of an alter. To that end, I played it down grossly, but I was honest with her about ‘They’.
However, ever-fearful that she would suddenly change her mind about Paul, I started blaming the incident on the triggering nature of Christmas rather than on being an unfortunate by-product of therapy. I was honest about how depressed I’ve been over the last few months, but again attributed to the season. Though perhaps that is an accurate explanation for it, I don’t know.
She said, “I’d rather not make any medication changes at the minute, Pandora. I think it’s possible things may be easier after Christmas, and would prefer to see you in January before I make any decisions on whether to modify doses.”
This was music to my ears. I hate medication increases, especially with evil Venlafaxine which sends me round the bend for several weeks until I adjust, physiologically and mentally, to the higher dose. I confirmed that I was happy to wait and see whether or not any medication changes were necessary, and that was the end of the appointment really. She assured me that she would definitely see me in January, and that if I didn’t receive an appointment letter within a fortnight, to phone her to avoid another silly mess. She apologised again for the fuck up.
I did indeed receive the appointment letter, and am due to see her again the week after next.
As I was leaving, I wished her a happy Christmas. I was grateful that she didn’t insult me by returning the wish.
Right, that’s me finally caught up with all major appointments. I feel cautiously fortunate, for once, in having the personnel I do ‘caring’ for me. Paul is an extraordinarily insightful and intelligent therapist, and I actually do feel like NewVCB gives a fuck about and wants the best for me. Not everyone has those kind of luxuries in this bollocks of a system.
Anyhow, if you are still reading this dirge, you have done well and I salute you. Goodbye.