I Hate the Therapeutic Relationship – C: Week 25
I don’t hate this bizarre relationship because I hate C – quite the opposite today, as it happens, but I’ll get to that later. What I hate is the power this one individual can have over me; he has the power to make me go about smiling, or, alternatively, to leave his office seriously contemplating throwing myself in the local lough.
I can hardly bear the thought that I am so spellbound by him. It’s even more annoying because he doesn’t consciously try to captivate my fragile consciousness; his mission in his interactions with me is to try and help me to manage being mental overall of course, but I very much doubt he sets out to influence my moods on a week-to-week basis. Yet he does. I would hate anyone having this level of control over me, let alone someone I don’t even bloody well know. Transference is a pile of shit.
Anyway, it was a good session, despite it being the first one I’ve had in a month. I was expecting it to be thoroughly unproductive, the way it had been the last time we were reunited after a lengthy separation (where we had to ‘get to know’ each other all over again), but it was actually fairly comprehensive. I was also surprised by the intensity of relief that I felt when I saw him again. After stating that I’d hardly missed him in this post, I now realise how much I actually did.
That didn’t mean that I wasn’t nervous though. It’s always odd after not seeing him for a bit, I tend to feel anxious each week anyway and I’d been up until 1.30am reading the Paul Gilbert book for my ‘homework’, and I was worried about telling C that I thought the suggestions therein were a pile of crap. Luckily for me, mindfulness and DBT weren’t mentioned directly at all today.
As ever, things commenced with the two of us staring at each other. I really, really wish he’d just take the lead sometimes. I understand why he doesn’t – he wants to afford me the opportunity to bring whatever’s on my mind to the fore – but I always feel awkward about speaking first. I could theorise as to why – he is he ‘authority figure’ and I don’t want to open my mouth without permission, maybe? – but it doesn’t really matter. Eventually, he recapped on what we had discussed in the last session, which had essentially been a mega-vituperation on my part about the failed meeting with VCB’s SHO.
So I told him about my meeting with VCB last week, and about the fact that she had increased the Venlafaxine. I sighed. “I understand why she can’t give me additional medication at the same time as she increases the dose of anti-depressants,” I acknowledged, “but I just don’t think it’s all I need.”
He enquired as to what it was that I felt I did need, and I advised that I felt mood stabilisers and anti-psychotics were probably necessary.
“But she’s a consultant psychiatrist and I’m a Wikipedia-qualified one,” I shrugged, “so what do I know?”
I thought about this later and am annoyed that I berated myself in this manner. I’m not going to sit here and say, “oh, well, I should be taking Seroquel and Lamotrigine plus Risperidone” or something. I don’t know the specifics of medications relative to the symptoms I present. But I do know how I feel, and quite honestly the VCB doesn’t; I can try to verbalise it to her, but words never really grasp it. The only ones that can begin to understand it are other mentals. In any case, C had once told me, when I whinged that he – not I – was the expert, that I was “the expert in myself”. I can agree with that, and so maybe the VCB should damn well listen to my wishes next time.
C must have responded with something to the effect of, “so you’re still not 100% satisfied with the service?” because I remember replying that I was waiting to see if she actually bothered to see me in six weeks as she said she would before I passed judgment.
He nodded thoughtfully. “And what about here?” he asked.
Uh-oh. I hadn’t prepared for that one. On the one hand, I can hardly say, “I am completely platonically [is that a word?] obsessed with you,” without feeling like the world’s neediest cock, and on the other, I can’t say, “sorry C, but there are times when I want to claw your fucking eyes out.” But there’s no point sitting on the fence and saying something vague and meaningless like, “it’s alright.”
So I avoided the question by pretending not to know what he meant.
“Well,” he started, “what would you like to achieve by coming here?”
Um…maybe not to feel completely mental/depressed/manic/like a freak all the time? What the fuck does anyone want to “achieve” in psychotherapy?
I committed that most cardinal of sins in C’s gospel, and came out with a load of intellectualised diagnostic analysis. In short, I said something along the lines of that as I understood it, bipolar disorder can only be treated medically, save for recognition of triggers and whatnot, but that BPD could be treated through psychotherapy, so I wanted to be able to control it, not have it control me. I made some sort of disclaimer in order to pre-empt the inevitable whinging about labels, but it didn’t really work.
He nodded in his characteristically musing way, and said, “OK, but in saying that I’m wondering if you’re avoiding how that feels for you?”
I wonder, can you have figurative (as opposed to literal, obviously) eyes? If so, then I rolled them. You’re nothing if not predictable, C. How does that feel. What are your feelings about that. How might you interpret that feeling. Feel this, feel that, feel the other [ooh-er]. I feel that feelings feel like something I don’t want to fucking feel.
[/rant] Where was I? I said that I wasn’t trying to avoid how that feels for me; I was merely using the diagnostic terms as short-hand for a particular set of symptoms.
“But you’re still conceptualising it,” he argued. “Can you tell me the specifics?”
I hate it when he gets me in a checkmate situation. Other than saying ‘no’, I had no means of avoiding the question.
But then I get angry with myself, because in this type of situation I then try and answer the question in a rational, robotic sort of way, and if he were then to accuse me of avoiding something in doing that, he would be right. But I just can’t make myself be more expressive with him. It’s all very well for someone to say, “oh you just have to do it,” but fuck that, I can’t just switch [whispers] emotions [/whispers] on, at least not so ostensibly as to make them obvious to C (or anyone else for that matter). It’s just so far removed from my normal character that it’s presently inconceivable to me.
Anyhow, I told him that my goals were (a) to be able to functional socially because I either overcompensate with people by behaving in a manic and frankly arrogant fashion or I panic like fuck and completely withdraw into myself, and (b) to be able to return to work (though almost certainly not to my present job after last week’s OH, but that’s another story).
“That’s been my primary motivation,” I said. He went to reply, but I had taken a second or two to think about this so I interrupted and said, “look, do you know what – it isn’t. My primary motivation is to stop feeling like shit all the time.”
We discussed the social and work situations in a bit more detail, but there was little of consequence in these conversations, bar C’s perception (which is probably accurate) about my terror of scrutiny (more on this again later), but for some reason (I can’t remember the entire session with absolute clarity) the conversation eventually returned to the VCB.
C said, “she called me shortly after I last saw you. I said that you had valid reasons for being dissatisfied with her service…”
Ha! Hahaha! Up yours, VCB! This made me very pleased. I interrupted him and said, “yes, she made reference to the fact that she knew I had been upset. I expected an explanation and an apology, but I got neither.”
I don’t remember his specific reply to that, but what he did say is that he continued to VCB that I had had “an extreme emotional reaction” to her negligence (for that is what it was). He continued in this vein for a few minutes, searching for words. Pleased Me disappeared a bit.
“What you are trying to say, in a convoluted and roundabout way,” I spat, “is that I overreacted.”
“Um…well, I guess so, yes,” he reluctantly conceded.
“Hmm. Perhaps so,” I admitted, “but if that’s true, then there were a hell of a lot of people that also overreacted.”
He winced a bit. “I don’t like the term ‘overreacted’,” he said. “It’s invalidating – it implies you didn’t have good reasons to feel disappointed and dissatisfied, and you did [pleased again]. It has negative connotations. Can we not call it that?”
I prefer to call a spade a spade, and he knows that, and in this case I am of the belief that the spade was called ‘overreacting’, not ‘experiencing an extreme emotional reaction’ or whatever label of wank you wish to apply to it. (Christ, I am still surprised by the level of physical disgust I feel at using the word ’emotion’). Nevertheless, he was supporting my viewpoint in a way, whilst not wanting to condone the use of a carving knife – which I suppose is all he can do.
“I don’t choose to go completely mental, I just do,” I protested.
“Of course not,” he reassured, “but you recognise it when it starts though.”
“We go round and round in circles on this all the time, C,” I sighed. “I know I say it all the time, but self-harm is quick and it works. As for doing something as elaborate as I did that day, it was reflective of how I believed VCB [not that I called her that to him] felt about me. Not that I felt that later when I was more rational, but you know what I mean.”
“There’s a few issues here. Firstly, I don’t want you to think that I am sitting here completely condemning self-harm out of hand..,” he enforced this point a few times, then continued by saying, “I don’t think that [openly condemning self-harm] would be…helpful.” Which obviously means that he does condemn self-harm but just doesn’t want me to know it.
“Secondly,” he went on, “everyone around you seemed to have a major reaction to this appointment – if you can begin to recognise your negative symptoms, and you have this support, is there something more meaningful you can do with them?”
“A suggested calling the Stephen Nolan show,” I said, apathetically. “But I’m unsure as to what extent I want my mental health difficulties broadcast all over Northern Ireland by an obnoxious, odious git [said git being Nolan, not A]. A was still the most rational amongst the triumvirate of him, Mum and me, though.”
I thought about ranting about VCB on this blog. “It was suggested that I write a strong complaint and/or go to an advocacy agency by people that read my blog,” I told him, in reference to these comments.
C’s ears pricked up and he suddenly seemed quite animated. “Yeah!” he exclaimed, with evident enthusiasm. “I think those are both really positive ways of translating that intense anger and disappointment.” He babbled on about the advocacy services for a bit (well done, cbtish and bourach – C loves ya!).
“Yes, fair enough,” I agreed, “but what do you want me to do? Be fucked over and not have some immediate reaction? Do you want me just to immediately say, [puts on robotic voice] ‘I shall now phone Rethink and forget the fact that I am actually quite upset now’?”
“Of course you’re going to have an immediate reaction,” he acknowledged, again. “But can we develop tools to take the edge of that, so as you can get to the point where contacting Rethink is viable?”
Why, yes C, yes we can. We can use a knife. Simples! But in this case I didn’t bother to argue; I knew he wanted to say more, and we can revisit these so-called tools and play our little circular game again pretty much any other week.
“A third point [re: above comments on VCB] is that when you’re feeling less emotional [FUCK THAT FUCKING WORD] you feel differently about how you’re perceived. Is it possible that there’s part of you trying to empathise with or reassure yourself?”
I made some cursory reply, then sat staring at the (empty) noticeboard behind his desk, stroking my chin in a stereotypical exposition of thought.
After a few minutes he unsurprisingly enquired as to what it was that I was “mulling over in my head.”
What I was considering was whether or not I should tell him about Tom. The references to a ‘reassuring me’ reminded me of Tom – as I had stated in the relevant post, it was my prediction that C would say something like Tom represented my empathetic, understanding self.
I told C that I was mentally debating whether or not I should tell him something.
He asked about the content of the psychic debate.
Me 1: He’s your psychotherapist, you stupid cunt – just tell him.
Me 2: Go and fuck yourself. If I tell him, he’ll be appalled and he’ll hate me.
1: Don’t be so bloody stupid. Do you honestly think he hasn’t seen worse?
2: How the sodding blazes should I know? I can’t take the risk.
1: LOL. Come on, it might benefit C to know this.
2: No it won’t, he’ll hate me and then he’ll abandon me.
1: Look, he fucking won’t. This is his job!
2: Yes, and it’s also his job to refer people who are disconnected from reality to relevant experts. He’ll be all nice to my face, then he’ll close the door as I leave and he’ll go, “Jesus Christ, I’ll have to palm that fucking nutjob off onto someone else!”
1: If you honestly think that, then you really are disconnected from reality.
“So,” C began, “you think it might overwhelm me?”
“No no no,” I insisted (no doubt he was reminded of all the stuff about me protecting him). Then, tentatively, “I just…I don’t want you to think I’m any more of a freak than you already do.”
He laughed at this, which I took to be a reassurance; he obviously thought my contention that he thought I was a ‘freak’ was silly which in turn, presumably, suggests that he does not think that.
“And you think it will ‘benefit’ me?” he queried, apparently a little perplexed by this contention.
“It’s not going to benefit you personally,” I answered cynically. “It’s not going to enrich your life [he laughs]. I mean that it may benefit you in terms of your interactions with me.”
He probed a little bit more, and I answered his questions honestly but with deliberate omission of reference to Tom. His interest was particularly piqued when I said, “I have a theory as to what you’d say about it if I told you. I’m not sure if I agree.” Eventually, the poor man just sat there looking completely confused.
Is this a tactic? The last time I completely confused him by avoiding telling him something, I later felt so totally guilty about it that I apologetically confessed all in the next session. Maybe he’s pieced that together. Maybe not. Either way, it worked; I felt bad about bewildering him, took a deep breath and said, “I’ve got an imaginary friend now. He’s called Tom.”
I don’t remember his exact reaction, but he did say something acknowledging – without judgment – Tom’s ‘existence’.
I hummed and ha-ed a bit then told him that, “I was employing childish terminology to avoid saying the words, ‘I’ve started hearing a voice’.”
A long and, I think, fairly productive discussion ensued.
He asked how I “experienced” Tom. I didn’t know what it was that he wanted know by his use of this term and asked for clarification.
He said, “well, if someone came here and asked me, ‘how do you experience your interactions with SI?’, I might say, ‘we meet once a week, we talk about things that are troubling her, I ask most of the questions…'”
I interrupted and added, “…’and she fails to answer any of them…'”
He laughed, and then sort of gestured for me to continue.
I tried to explain the same stuff that I had done on my last post here, the one about Tom. I even told him about the debate in the comments section of said post, wherein my commentators and I discussed whether or not Tom was a psychosis, and whether or not I did believe, deep down, that he is real.
cbtish had provided what I thought was a good analysis of the reality, or otherwise, of Tom. I told C that, in sensual terms, Tom could be considered as real as anyone that I encountered.
“But,” insisted C, “I’m not experiencing him.”
“Here’s not here at the minute,” I argued, being deliberately obtuse.
“Yeah, but you know what I mean.”
“Yes, but you take my point. I may know he’s not real, but he certainly seems real to me. An objective reality – if such a thing exists – may be different from my subjective reality, but I can only experience things subjectively, just as you can only experience things from your subjective position.”
He nodded, then grinned in rather cavalier fashion, and said, “we’re going to have to get a philosopher in here.”
“There’s no need,” I chuckled, “I already subscribe to solipsism.” (Kind of).
“The thing is, people have this perception that those who hear voices hear persecutory voices,” I continued. “Tom isn’t like that. He’s…nice.”
I paused, disgusted with myself for using such a pathetic and inadequate adjective. “I’m sorry,” I told C, explaining why. “I’m trying to avoid bad language – you know [whispers] empathetic…reassuring [/whispers]…”
“…understanding…” C added, humouring me by also whispering, with a slight sardonic smile. I nodded.
He mused for a minute or two, and then he said – wait for it – he said, “maybe Tom’s a part of you.”
I threw back my head and laughed heartily – perhaps maniacally.
“I knew you would say that!” I shrieked, jabbing my finger at him. “I knew you would!”
He smiled broadly, but nonetheless he was clearly a little bemused. I regretted behaving so oddly shortly after doing so and managed to calm myself.
“I don’t know, maybe you’re right,” I conceded. “But why he is a bloke in his 30s? Is it because I don’t get on with people my own age? Is it because I don’t get on with myself? Is that why my mind wants to invent random people to hear?”
(An aside – is Tom trying to emulate C? Is he like a permanent, completely-my-own C, unlike the real C? I didn’t suggest this to the real C, of course. But Tom’s characteristics, insofar as a disembodied voice can have characteristics, are not totally dissimilar to those of C).
He shrugged. “There’s any number of theories,” he said, “but all that really matters is that you’re experiencing it.”
C was rather taken aback to hear that Tom is outside my head, perhaps seeing this as a refutation of the suggestion that Tom is ‘part of me’ (not that I think that does invalidate that idea especially). I complained that I have a running commentary between at least two voices in my head at any one time, but these are clearly me arguing with myself. Of course, this – in at least a rudimentary form – will have been quite obvious to him before now.
We also spent some time discussing the delusions to which I alluded in the ‘Tom post’, in particular the hidden video camera thing and my fairly recent accusation to A that he was colluding with GCHQ. He asked if I believed with 100% conviction that these things were real in the moment.
Regarding the GCHQ allegation, at the time I would say I believed it with the strength required in a criminal trial, ie. that I believed it beyond reasonable doubt. As far as the video cameras went, I believe(d) that one “on the balance of probability”, in the moment.
“And you believed the day of the problematic psychiatric appointment, with absolute sincerity and however briefly, that VCB [not that he called her that] hated you,” he said.
“It’s like the time you told me about the sun watching you.”
“Yes. But why do I care what people think of me? Why?”
I (literally) rolled my eyes. “But that’s too big a discussion for now, isn’t it?”
“I’m afraid we are going to have to leave it there for now,” he told me. “But we’re back to once a week now, we have eight sessions left of our current contract, and I don’t think there’s any gaps from my side before Christmas.”
Yay! Assuming that he holds to that, that kind of makes up for the annoying month-gap that I’ve just been through. I am (pathologically) worried that the sessions will come to an end after the eight sessions in question, but he did assure me last time that we would spend at least four sessions preparing for any end to my psychotherapy, so at least if he gets it into his head that I’m well enough to be discharged (not that I think he’s that stupid), I can disabuse him of that idea in advance.
Anyway, although we didn’t directly achieve anything – how can you in one session – I felt we covered a lot of ground today (well, yesterday now – it’s 1.40am on Friday), and I am quite pleased that I was able to get up the courage to discuss the psychotic symptoms with him. And I am reassured by his reactions to same.
So I like C today, but as I said, it’s rather disturbing that he has such power over me. Such can be the nature of therapy, I suppose, and indeed of transference. Better, though, to experience that and see some sort of strong alliance between us, than to feel nothing other than ambivalence about the process.
This entry was posted on Friday, 9 October, 2009 at 1:38 am and is filed under C, Moods, Psychotherapy with tags anxiety, bipolar 2, bipolar 2 disorder, bipolar disorder, bipolar II, bipolar II disorder, borderline personality disorder, bpd, clinical depression, countertransference, delusions, depression, hallucinating, hallucinations, hypomania, insanity, madness, major depressive disorder, mania, manic depression, mental health, mentalhealth, panic, panic attack, psychodynamic psychotherapy, psychology, psychosis, Psychotherapy, social anxiety, 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.