The Parting of the Ways – C: Week 20
For a variety of reasons I simply haven’t had the opportunity to blog about my most recent session with C to date, so, with it now being the septiversary of our last meeting, it seems appropriate to try and do it now before my memory of the meeting dwindles further.
Last week was weird, because for once he actually opened the conversation, rather than just fucking staring at me for 140,618 years, waiting with futility for me to express my thoughts. He wanted to know how I had coped the previous week without him, and what plans we were going to put in place in case (or rather when) I go batshit mad during his annual leave which will be ongoing until 20 August (might as well be 2079 to me right now for all the closer it seems).
I was encouraged by this: I thought he was going to explain the procedures that the CMHTs have in place to deal with attached-to-shrink mentals in the absence of said shrink. Which of his colleagues should I contact in an emergency, who should I get it touch with should I need general advice, blah blah.
Was he fuck! The exercise, and frankly most of the session, was a load of naval-gazing, useless dross.
“We need to formulate a plan,” he declared. It seems his idea of a plan has four progressively mental points in the key of D:
- Mental: DBT Distraction Plan
- Quite mental: Discussion About Being Mental
- Very mental: Doctor – Either LGP or Out of Hours
- Suicidally mental: Death Avoidance – Casualty
He didn’t use this stupid ‘D’ thing; that’s of my doing, because it’s equally fucking patronising to the whole bloody ‘plan’. I actually laughed in his face about the discussion bit.
“Who the fuck am I going to discuss this with?” I asked. He reminded me that the first time he’d been unavailable for a session I called D, my best mate, to expunge myself. I don’t think I was keeping this blog then. Not sure. It was a while back anyway.
This is true, but whilst D is mostly aware of the issues that have given rise to my mental health issues, I really don’t want to discuss them in detail with him. He reads this blog from time to time, but I’m quite analytical here, not off-my-head mental, so even though the material here may well be disturbing to normals, they don’t get to hear or actually witness what it’s really like. I need to protect people from it.
I said so to C, who by virtue of his chosen career has de facto committed himself to hearing about and witnessing disturbing behaviour.
He asked could I not speak to A, then.
Yes, I can, as it happens; he bears witness to many of the worst moments and is certainly aware of the others. In fact, of late, I’ve noticed many of our conversations have been about my being mental – I think I’m trying to forge some sense of identity by being obsessed with my madness, but that’s an entire other post. The point is talking to A doesn’t always alleviate the problems; not that it’s specific to A though, talking to anyone doesn’t make a difference, at least depending on the type of episode anyway.
Yet still C wanked on about it. The Samaritans then. Lifeline. Some such 24 hour crisis line.
This was winding me up to fuck, so at this point I expressed my annoyance yet again through a cynical laugh. This didn’t go down too well – not that he criticised me, but just because he’s the one trained to be perceptive doesn’t mean that he is the only one that actually is perceptive. I could sense an annoyance, or at least a confusion, at my reaction to his suggestion.
I explained that whilst I had every admiration for the volunteers operating these services, recognised their well-meaningness, and in principle fully supported them, that I had not found them helpful in the past. To be fair, I was overplaying my use of them, letting C believe I’d called them a number of times when in actuality it was only once or twice. But when you know something isn’t helpful (or indeed is), then you do.
He hides it well, you know, but I sensed exasperation. I said the point was that I cannot talk to anyone other than him, and to a lesser extent LGP and Dr C, about the darkest things. Even then the discussions are abstracted, formalised or structured by me so that I can avoid talking about those things that I wish not to discuss (or at least discuss them in a ‘safe’ way). In front of them, I don’t behave in the angry, frenzied, self-destructive way that I often do otherwise, and that I frankly long to do in front of them at times. I try not to express emotion, and when I do I either force myself to desist from it or end up apologising for half an hour for my failure to control myself.
Simply put – it’s hard to talk to anyone.
Anyway, C said this was about my inability to ‘do’ empathy. I asked what the hell ’empathy’ had to do with it.
He said, “you despise the emotional side of yourself so much that you don’t allow yourself, or feel unable, to empathise with others, would you agree?”
“Not entirely,” I replied, “but in the main, I suppose the answer would be affirmative. Why?”
“You can’t empathise with others because you can’t empathise with yourself. I think that has to be one of our goals here, to allow you to gain, or regain, that sense of empathy.”
I protested that I didn’t want it, I don’t do emotions, I like to be rational, this arse shouldn’t come into my life, thank you very much, the end.
C wanked on and on about emotions for a while. I do do them, of course, he contended. He didn’t say this, because labels are so evil and unhelpful, don’t you know, but of course the cornerstone of a diagnosis of BPD is an inability to regulate emotions properly, thus you go mental.
So, he concluded, my emotions are clearly very strong, and my lack of empathy for myself is profound. “For example,” he said, “you carved ‘hate’ into your body. Don’t you think this is a way of expressing a strong emotion, without expressing it in a ‘normal’ fashion?”
Once more I laughed in his face. “You think ‘hate’ is bad?” I sneered. “You want to see some of the stuff that’s been added since!”
He raised his eyebrow and said, “you say that with almost a sense of glee.”
“Well, I’m getting the sense that you delight in self-harm – it’s a further, and outer, manifestation of your self-hatred. You mask ithe hatred well outwardly, for the most part, but you need to confront it eventually, in ways that aren’t self-destructive, in order to get over it. Thus, you need to be able to empathise with yourself.” He also stated that carving things such as ‘hate’ into myself was a form of punishment for feeling emotions. He seems to think that’s at least partly why my mood improves after self-harm; I am sated because I am punished and have got what I deserve. Probably fair, admittedly.
“Yeah, whatever,” I said, “but the point is, cutting is quick, and it works.”
“Maybe so, but it is self-destructive.”
I shrugged. I mean, he’s probably right in the sense that it is an outer manifestation of something I don’t generally express in other outward ways, such as through talking. It certainly is self-destructive, though I don’t really see how that matters, but still, how could I argue? I simply told him that I genuinely cannot foresee him being able to get me to ’empathise properly’ – not in the manner that he means, anyhow.
An interesting side-note is that I’ve observed from re-reading parts of this blog that I’ve (unconsciously) stopped putting words like ’emotion’ and ‘feelings’ in quote marks (except in circumstances like the immeadiate foregoing where they are necessary to denote they’re not active nouns in the sentence). I told C this, laughing that he must have made some progress with me in this particular area. Interestingly, he did seem mildly encouraged by this.
Anyway. We discussed suicide ideation for a bit, in relation to the stupid plan of action for when I go doolally in his absence. He said something like, “…if you start thinking about suicide…” at which point I interrupted him, yet again with a sneering laugh, stating that I thought about suicide every hour of every day.
He asked why.
I said because I want to not exist.
He replied, in my view rather confrontationally, “so why have you not done it then?”
“Cowardice,” I responded instantly, without a mere second’s hesitation. I’m fairly sure he was expecting some humming-and-ha-ing, but I’m already well aware of the answer. I’m too fucking pathetically scared.
I did concede that not all shreds of altruism are lost amongst my endless waves of narcissism; in part, I haven’t topped myself because I know it would annoy A, Mum and my friends (plus – in my view, oddly – the family, but who cares about them). But the main reason, selfish or otherwise, is simple cowardice.
He didn’t quite seem to know how to respond. I think this was one of many points where he irritated me intensely by silently staring at the floor for what seemed like eons, with his index finger ensconsced thoughtfully over his mouth. Eventually, this pissed me off so much that I said, “you do realise, don’t you, that I’m trying to work out what you’re thinking? Isn’t that a role reversal?”
“Do you mean,” he enquired, “that you think you feel like the therapist?”
“That’s patently ridiculous,” I said, but in quite a nice way. “I suppose I’m asking if you think I play mind games with you.”
“Do you?” he asked.
“I think so, yes.” I told him I felt there were times when I challenged him, whether overt- or covertly, to work me out, or answer difficult questions, or respond to deliberately provocative statements.
“‘Mind games’ isn’t the terminology I’d use,” he said, “but if you want to call it that, fair enough. I think you’re testing me, is all. You want or need me to prove my competence, understanding, whatever – basically that I’m worthy of your trust or time.”
I agreed with this. I told him that he would, of course, have worked out by now that I had very strong defences built up and thus have big problems trusting people until they’d proven themselves trust-worthy.
“Consider yourself lucky,” I smiled. “I do trust you – yet I don’t know you at all.”
He asked how I felt about not knowing him; I responded by stating that “this relationship is asymmetrical of necessity.”
“Perhaps,” C said, “but that doesn’t mean you don’t find it strange.”
“Of course it’s strange,” I replied, waving my hand dismissively. “But I can deal with strange. I’m strange. My life is strange. Strange is normal to me.” Fair is foul, and foul is fair, hover through fog and filthy air… [Macbeth, Act I, Scene I, if memory serves].
I don’t remember really what that led to, so the next few issues I remember raising were my ongoing problems with my cunt office, although that rant was brief, though I then launched into a major invective regarding the situation with Dr C. Well, I say it was ‘major’ – it was, but it was also very measured. I did say to C that I was extremely angry but I couldn’t go on about it too much as I risked behaving in a “psychotic pacing ranting fashion” and that I didn’t want to do that “in front of him.” I did say that I was sick of the pillar-to-posting I’d experienced under the care of the NHS for over a decade, and that it was particularly frustrating that when things actually looked like they might be moving forwards, I was yet again rejected. I whinged that when I needed Dr C most, due to the problems with my medication causing serious and frequent mixed episodes, it was the time she chose to abandon me the most.
[Alas. It is now Friday 7th, thus I didn’t get this published on Thursday 6th, the septiversary of my last meeting with C, as I had planned. Apologies.]
The truth is, I was hoping C would contact Psychiatry and tell them that my self-harm is getting worse and my suicide ideation is out of control, which I think it is, given that most people don’t seem to think about suicide and death all day, even if they are rather batty. I mean, he had most of Thursday and all day on Friday to contact them before he went off on his stupid fucking leave. But he made no such offer, and a week has now passed without my having heard from them, so it’s evident he made no such contact.
What do you have to do? What the fuck do you have to do? Do I need to run into a busy shopping area pointing a shotgun at my head or climb, very publicly, to the top of a tall building with the threat of jumping, to convince them that this is fucking serious and that I need help? Nobody gives a fuck. No one. I’m sure most of C’s silences during this session were him fantasising about 5pm on the Friday when he’d be free for over two weeks.
Anyway, before the end of the meeting, he returned to the wanky Four-D Perfect FoolProof Anti-Suicide Plan.
“Look,” I said. “I promise not to be dead in three weeks, OK?!”
He looked over his glasses at me in that strange enigmatic way he sometimes does. “But you’re promising me, not yourself,” he mused.
“So what? The effect is the same, isn’t it?”
Essentially this relates back to my lack of self-empathy or some such bollocks. Whatever, who cares. He asked me to definitively agree a plan of action with him before I left. I should have tried a new mind-game and pretended (or, more accurately, admitted) that I didn’t agree with anything he was saying so as I could have made the session overrun, just to see what he did or said.
I did say, and in fact although I didn’t mention it above I had said it earlier, that the problem with any of this stuff is that by the time you’ve gone mad enough to need it, you’re far too mad to do it. Fairly simple concept, yes?
“In advance,” C said, “write it down. You’ll then have something tangible to which to refer.”
“It doesn’t matter,” I protested. “The entire house could be wallpapered with plans for what I should do when I go mental, but when I am mental none of it matters.”
I tried, with absolutely no success whatsoever, to describe what it’s like when I’m psychotic, or panicking, or experiencing a mixed episode. I couldn’t put it into words, but the point was that even though I may maintain some small awareness of rational issues that exist outside my head, that I did not have the cognitive functions to actually put any such things into practice.
“What do you think the answer is then?” he asked, again in what I felt was a confrontational manner (though I could just have been paranoid – who fucking knows).
“Valium and sleeping pills,” I declared.
His concern was instantly piqued and he went to protest, but I pre-empted it by saying I wasn’t talking about overdosing on them (I know from the suicide newsgroup that there’s practically no chance it would fucking work even if I tried), but rather about knocking myself out for a few hours in the hope that by the time I woke I’d have returned to my default state of quasi-sanity,or at least vague rationality.
He seemed cynical of this. I don’t remember what if anything he actually said, but I got the distinct message from him that drugs were only part of the answer, if even that.
We were running out of time, and he kept pressing me to work with him to formulate the stupid plan. In exasperation and to just fucking pacify him I finally said, “right – distraction, discussion, GP and casualty, OK?”
“Yes,” C replied – relieved, I think – “but you may want to add layers in between. Remember the breathing exercises as well, for example, or specific distractions of your own.”
Well, as it happens I don’t fucking want to add ‘layers in between’, because I don’t think the bloody thing is of any adequate use anyway, unless someone is acting on my behalf (in stages three and four anyway). But fuck it, I just nodded.
He said, “our next appointment is 20 August. Do you want an appointment card?”
I said yes, as I would be wont to forget that, as each day runs into another when one is a dolescum. He wrote it out and handed it to me. I was irritated in the extreme to observe that he’d written “Dr C. J.” on the front of it.
I have been seeing you for twenty weeks, C. That’s about five months. I FUCKING KNOW YOUR FUCKING NAME.
I got up and wished him a pleasant holiday (though part of me was secretly hoping he spent it in mild misery with ((non-fatal)) swine flu or something – but only part of me ;-)), and he thanked me. As I left, I said, “take care.” I was offended by the fact he merely said, “bye” and didn’t reciprocate. Funny how silly, meaningless little things take on such importance in the therapeutic setting.
This post has made it sound like I am absolutely raging with C and that our last session was a confrontational battle of wills. Neither of these are really true; it comes across differently on ‘paper’ than it really was, and of course I use this blog as a sort of secondary therapy where I can rant and rave all I like with (mostly) anonymous impunity. I can castigate C to the high heavens here; even though my annoyance at him can be real, it’s also somewhat tongue-in-cheek and in any case my feelings towards him vary from day to day, maybe even more frequently than that. Stupid transference.
I’ve managed relatively well without him thus far. I’ve not been in good form by any means, but when am I (except when hypomanic)? My only real major episodes were last night and part of today, but there were precipitating causes – the McFs, perhaps unsurprisingly – and that’s a story for another day, for it is now 1.40am in the UK and I must draw myself away from the computer. It’s my first night of the tri-weekly sleeper-fast and I need to try and relax somehow in a perhaps futile attempt to get some rest. Due to the almost certain insomnia of the next week, I have a horrible feeling that the coming seven days will not be much fun, but we’ll see.
This entry was posted on Friday, 7 August, 2009 at 1:32 am and is filed under C, Psychotherapy with tags anxiety, bipolar 2, bipolar 2 disorder, bipolar disorder, bipolar II, bipolar II disorder, borderline personality disorder, bpd, clinical depression, countertransference, cutting, depression, Dialectical Behaviour Therapy, hypomania, insanity, insomnia, madness, major depressive disorder, mania, manic depression, mental health, mentalhealth, mindfulness, panic, panic attack, psychiatry, psychology, Psychotherapy, self harm, social anxiety, suicidal thoughts, suicide, suicide ideation, therapeutic relationship, therapy, transference. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.