Sep 30 2010

Writing Class Week 4 – A Turning Point

The last time I flew was in 1997. We went to Disneyworld, and my husband decided a year in advance to start planning the trip. That was one of the worst years of my life. I didn’t realize it at the time, but the anxiety was constantly under the surface, trying to work its way out. I had a horrible time on the trip, and when we landed back home I felt as happy as I had felt on the happiest days of my life. That is when I realized how anxious I had been for the previous year. I didn’t fly again for about 5 years.

It’s ironic that I was a travel agent in my life before having children. I worked for the National Geographic Society, making travel arrangements for the staff. I issued so many tickets; every day multiple people were flying to a variety of places around the world. I was so desensitized to every aspect of air travel. I was frequently given free tickets and opportunities to fly to exotic destinations for weekend getaways. I had no trouble dropping everything at a moment’s notice to take a cab to an airport, get on the standby list, and fly wherever that plane was going. I visited some amazing places.

But then something changed. I never figured out what it was, but I have been told that it is a frequent occurrence for women after they have children. The survival instinct kicks in, and being in a plane 30,000 feet in the air is not a recipe for survival. I have an anxiety disorder, and have since I was a child, so it doesn’t come as a surprise that I would develop a fear of flying. I would force myself to fly, but the pre-anxiety became debilitating.

In 1999 I happened to find a wonderful therapist who specialized in anxiety, and even more specifically, travel anxiety. I never knew such a professional existed. It was a major turning point in my life when I met Jean. I actually went to see her because my son, who was 9 years old at the time, needed a therapist for his phobias. But after visiting with her week after week I realized that perhaps she could help me as well.

Jean’s MO was individual and group therapy, to desensitize people from their fears. I learned how airplanes work, what every sound means, what every motion means, and even some physics like the Bernoulli principle. The idea is that knowledge is power. After the education came the visits to the airport, and back in those days one could even take a little tour through an actual airplane. After the visits came the call to the airline to make the reservation, and then Jean would come pick you up, take you to the airport and get on the plane with you to fly somewhere. (In some cases it was more like Jean would push you onto the plane.) Her airline of choice is Southwest which flies out of BWI, and it is my favorite airline to this day. Her clients would fly to Providence or Norfolk, short flights and easy airports to maneuver. You would have lunch and fly back.

My goal was to make my trial flight in the fall of 2001. Unfortunately, that was a disastrous time for everyone, and my goal of flying was put on the back burner. People who were comfortable flyers were now terrified. Tours through airplanes were out of the question, no one could even get past the main terminal into the gate area. Our group expanded, as routine flyers discovered they were having trouble getting on a plane. The fact that I had a friend who was on the plane that flew into the Pentagon did not make things any easier for me.

I continued attending the group sessions every month, but I was feeling discouraged. My children were at an age where it would be fun to visit new places and do new things, but my fear was holding us back. Our road trip to Hilton Head, although a beautiful destination, was marred by the 10 hour drive each way. Thank goodness someone invented a way to put VCRs in minivans. We were the first family on our block to buy one of those!

In April of 2002 my children and I went to the Tidal Basin to see the cherry blossoms. I threw our bikes in the back of the van and away we went. It was a beautiful day, not a cloud in the sky, and a soft breeze was blowing. As we biked along the Potomac River, I could see National Airport across the water. I was far enough away that I couldn’t hear the planes, but I could see them taking off, one after another. They looked like they were floating, they were so graceful. I couldn’t feel their power from the other side of the river, just their flight into the air so softly and smoothly.

That week I got fed up with my phobia. I couldn’t wait to the do the airport visits, to sit with Jean and make a reservation, to figure out when our calendars meshed so that she could fly with me. I got online, decided I would go to Atlanta because there was a shop in the airport there that sold bath products and makeup that we didn’t have here in our area, and made a reservation. The next day I drove out to the airport, parked in the daily lot, and got on a plane. I flew to Atlanta, shopped for an hour, got back on another plane and came home. It was terrifying. It was liberating. It was totally terrifying.

I went back to my flying group the next month and told them what I had done. The response was stunned silence, then smiles and laughter. To this day I am supposedly the only client who has made a trial flight in this fashion. I have since learned that there is more than one way to overcome a phobia – including desensitization and immersion. I am definitely an immersion kind of person. I finally decided to graduate from the flying group in 2009; I had traveled a few times a year, alone and with my family, and made what I consider a long trip – to Las Vegas. I flew over the Grand Canyon, and took a road trip there, a place I had never thought I would ever see. I felt that graduating would finalize the significance of this turning point for me.

To honor my new ability to fly without fear I did something I had been thinking about for 10 years, I got a tattoo. My tattoo is a dragonfly, which is what had I always known I would get, but I didn’t know why. Once I began flying again it all became clear – the dragonfly symbolizes power, freedom and lightness of being. The qualities that I finally achieved by overcoming my fear.

Sep 29 2010

An Email to Dr. Riggenbach

Friends, feel free to add, delete, change, edit, etc. All comments will be accepted! I think it may be too sarcastic, but I don’t really intend to send it, so it’s ok. And by the way, I received an email from my t, J, today saying that he was sorry that we did not discuss this brochure yesterday, but that he thinks there is a lot to discuss. This made me anxious and I wrote back to him asking if I should be worried. He replied that there is nothing to worry about, but he thinks this opens the door to discussions of how therapists feel about their clients, how I think he feels about me (ugh, don’t want to go there), and my perception of how others see me.

So here we go:

Dear Dr. Riggenbach,

I am writing about your seminar entitled “Suicide, Parasuicide and Other Out-of-Control Behaviors.” I am not a mental health professional, however I am a mental health patient, and I am involved in the mental health community through my volunteer work on the county crisis hotline and national suicide hotline, and as a court appointed advocate for a foster child. I recently had the opportunity to read the brochure for your seminar and I would like to pass along my thoughts.

First let me say the graphic of the noose on the cover of the brochure is quite eye-catching. It really is representative of what comes later on in the copy of the brochure. As a patient who has experienced suicidal ideation, and as a volunteer who works on a suicide hotline, I would say that this picture can also be quite upsetting to someone who might come across it unexpectedly.

Let’s move on to the content. The six bullet points on the cover run the gamut from professional to sensational. Evidence based treatment strategies, individualized treatment planning, and the decision to hospitalize are indeed important areas to address in your profession. The next three points seem to be written in a less objective professional manner, actually veering into quite judgmental language. I know I can’t compare the small amount of training that I had in order to become a crisis hotline counselor and court appointed advocate to the years of training that you had in order to become a Ph.D psychologist, but in my training it was continually stressed to us that we should not be judgmental of those with a mental illness. When you use phrases such as “Address therapist hopping and other problematic behaviors”, “Manage splitters and other manipulative clients”, and “Take control of therapy interfering behaviors before they take control of the session!” it seems as though you are viewing your clients in an unempathetic manner. It reminds me of the puppy training class I went to with my dog, where we learned to “manage” their behavior, take control of them, show them who is boss!

I am sorry that you have clients that frustrate you with their seemingly endless threats or gestures of suicial innuendo, cutting, burning and other self damaging behaviors. That must be difficult for you. I have not attended your seminar, so I don’t know the ways that you “manage” these frustrating clients. I do see that you explain to the attendees the 21 skills that promote effective episode management, and you discuss behavioral strategies for dealing with “manipulators” and other “treatment savvy” clients. It is so good to know that you will teach other professionals how not to get their “buttons pushed!”

Let’s talk about treatment savvy clients for a moment. I suppose you are referring to those clients who actually research their symptoms, their disorders and their illnesses. This seems like intelligent behavior for a person who is suffering from any disease – mental or physical. If you had heart disease or cancer would you not want to learn as much as you can about the treatment for your disease? Why should it be any different for a client suffering from a mental illness? It is, in fact, particularly important for those of us who have mental disorders to be savvy, because frequently our disorders cannot be diagnosed with blood work, CT scans, or surgery. Much of the diagnosis process is dependent on us, on what we share with our clinicians and how well we can express our feelings and thoughts.

And how about those “therapist hoppers”, well, that is just shameful. Because if we had a brain tumor we would just call the first practitioner that we find on our insurance company’s list of neurosurgeons and have him cut our heads open. With no regard to his experience, his areas of expertise, his background, and his ability to relate to us. And the fit between a mental health professional and the client is so much more important to the resolution of symptoms than the fit between a neurosurgeon and a brain tumor patient. How many therapists does a client have to see before they are considered to be “therapist hoppers?” I would like to know, so that I don’t get put on the mental health professional blacklist.

I take particular notice of the statement that your seminars routinely receive the highest marks in terms of professional knowledge, practical application and entertainment value. Entertainment value! Are the mentally ill so frustrating to the professionals that it is necessary to entertain them in order to educate them?

Perhaps you would like to hear some entertaining stories from the other side of the fence. How about the story of the foster child I work with, who was abandoned by his parents at birth and spent the next 16 years in foster homes in which he was neglected, emotionally, physically and sexually abused. You might consider his behaviors manipulative, out of control and problematic. However, I see a human being whose childhood was ripped away from him before it even began, who has been abused by people who should have cared for him, including the mental health community, and who has no idea how to form an attachment to another human being. This is a person to whom abandonment is a way of life, and he knows no other. I bet he would push your buttons!

How about my friend who was sexually abused as a teenager by her parent’s best friend, and when she tried to talk to her parents about this, they wouldn’t believe her. So the abuse continued until she was old enough to run away. And as an adult her life began to erode due to the trauma she experienced as a teen. She could never trust anyone long enough to let them help her, she tested every professional she encountered, until she finally found one who showed her kindness and empathy and was able to help her work through her past abuse.

In conclusion, Dr. Riggenbach, I have found your brochure to be extremely insulting and degrading. Any mental health patient who reads this would feel judged, belittled and betrayed by the professionals who are supposed to be helping us. I don’t suppose you subscribe to the Rogerian tenets of “unconditional positive regard” and “empathetic understanding”. That is a shame, because those simple concepts go a long way towards helping clients feel understood. I really hope that there are clinicians who don’t subscribe to your manner of thinking and talking about your clients, but when any mental health patient hears a professional talk about them in this manner it is very discouraging. There is such a stigma against mental illness, even in the 21st century, and to know that even the professionals who should be caring about us and who should be understanding of us, are actually intolerant of us, find us manipulative and out of control, and need to be entertained in order to continue treating us, makes us feel very defeated.

Sincerely,

Harriet M. Welch

Sep 28 2010

Therapy Recap 9/28/10

Today was a good session. I think I did well. I think J did well too. I came in with that brochure that I was writing about yesterday and he asked me what it was. I told him it was something to talk about if we had time, it wasn’t very important.

I asked if we could have a do-over for last week. He said he thought last week was a do-over from the week before. I said that last week was talking about our session from the week before, but I don’t think it went very well. I asked him how he thought it went and he said he thought it was fine. That we spent some time talking about what I think and how I feel about what other people think of me. And I told him that part of the session went well, but the part I thought didn’t go well was our discussion of the session from the week before.

I told him that I feel that sometimes we are having a conversation instead of therapy. He asked me what is the difference, in my opinion, between a conversation and therapy. I answered, “Therapy is therapeutic.” Yes, therapy is a conversation, but it is not standard conversation that one would have with a spouse or a friend. Not most spouses or friends, anyway. I think many of us in the blogworld talk to each other in a therapeutic manner, but in real life our friends and family don’t.

So I told him that when we were discussing his “last minute bomb” from two weeks ago, I felt that I tried to explain it in the email and I thought I did a good job. But when I tried to talk about it last week I got confrontational and antagonistic and then I felt that he got defensive.

He replied that he did not feel any confrontation or antagonism from me and that he didn’t get defensive. (I love that response: I’m not defensive!!!) Let’s look up the definition of defensive, shall we? Here’s a good one:

excessively concerned with guarding against the real or imagined threat of criticism, injury to one’s ego, or exposure of one’s shortcomings.

How about this?

made or carried on for the purpose of resisting attack

Or:

rejecting criticisms of oneself or covering up one’s failings

Those sound good. But J said he was not defensive, he was offering an explanation. We discussed this for a bit, how I would like to be better at communication without getting people defensive, etc. He told me about five times that I was not confrontational or antagonistic. He asked how I felt and I said that I think we must be in separate rooms, talking to different people, because we both have such different views of what went on.

Then you will be so proud of me, I said, “I didn’t want an explanation, I wanted to talk about my feelings.” Yay me! That actually shut J up. He doesn’t normally get so quiet in response to things I say. So we talked about how I felt after his last minute bomb. And how it affected things for the next few days.

Which led to me talking about the writing class. I told him that I felt that he was not interested in hearing about my writing class. He said, “I am!” Another less than stellar response, but I persisted. He really should be paying me, I think, to teach him proper responses. I said, “I am trying to use ‘I statements’. I feel that you are not interested in hearing about the class.” He said, “Why wouldn’t I be interested in hearing about the class?” I said, “I don’t know. I am not a mind reader.” He kind of laughed at that. I continued, “The evidence I am using to come to this conclusion is that a few weeks ago I told you about the writing class and how anxious I was about it and how I wasn’t sure I could do it and you never asked me about it. And last week I wrote you an email and told you how horrible it was when I tried to share my writing and you didn’t say anything about that either.” He didn’t really have a response to this, you can’t argue with evidence I guess.

But this just led into a conversation about the writing class. I told him all about it, and the people in it, and how nice they were, and just everything. And how I’m still writing and how everyone wanted me to come back and how I’m not going back. I told him about people in online forums who make a big deal about leaving and say everyone is mean to them and they are never coming back, and then everyone begs them to stay and then they stay. And then the whole process repeats again in a few months. I told him I didn’t want to be one of those people who quits and then returns when everyone begs them to. I told him it was manipulative. He said he didn’t think I would be manipulative if I went back and I told him I didn’t even want to give the appearance of being manipulative. He said, “I’m not trying to convince you to go back but…..” and then he would tell me why I should go back.

Then we got into some good stuff. I was proud of J for coming up with some good insights. He said that one of the most important things for me is having my feelings validated, and here I was, in a class of 10 wonderful people, who are supportive and validating my feelings and I back off. That was an eye-opener. I told him that it’s wrong to show your feelings. He asked me where that was written and I told him that it wasn’t written, but it was taught to me by my mother. That everything always had to “be fine.” He asked me if it is wrong to show my feelings, and I said, no it is not, but it feels like it is. Then he brought up mature, adult Harriet vs child Harriet. I told him if I saw child Harriet on the street I would throw her under a bus. He asked, “What about adult Harriet?” I told him I would like to meet myself to see what I think of myself, I really wonder. He said he feels the same.

He said sometimes mature adult Harriet does good things like setting strong boundaries for the woman I work for, but then I feel guilty. I guess that is child Harriet, who thought for some reason that everyone else’s needs come first. I told him it is hard to get past all of that child stuff.

I actually got emotional two times during this session – tears in the eyes, but not crying. That’s major progress for me. It’s taken two years.

So then we were done and I had the brochure about the suicide seminar and I said I have this thing, and he said he got the same brochure in the mail yesterday and he was going to look into it. I said, “So you can learn to manage your treatment savvy clients?” Then I threw it in the trash and said goodbye and thank you and left. When I got to my car I realized that he thought I brought the brochure because I thought he might want to do that seminar. So I quickly emailed him from the car and told him the reason I brought the brochure was because when I read it, it made me feel physically ill, and was he really thinking of going?

He emailed me right back, and said that when I left he took the brochure out of the trash and read what I had highlighted. He said he didn’t read it when it came in the mail yesterday, he just saw the title. He told me that he never goes to seminars offered by that company and he would like to talk to me next week about this brochure. He said “I don’t like how they talk about patients!” I was so relieved I started to cry. I wrote him back and said that when I saw the brochure I hated him, which is so irrational, but I pictured him sitting around with his psychologist buddies drinking a beer and talking about their manipulative, out of control, therapist hopping, treatment savvy clients. I also told him that our session today was really helpful, and I thanked him.

So I am going to write an email to the suicide seminar guy. You all have to help me. I’ll write it and post it soon.

Sep 27 2010

Manipulative Clients

My boss’s father was a psychologist. He died two years ago and my boss has all of his mail forwarded here. He gets lots of brochures about seminars and lectures for mental health professionals – these things are going on all the time it seems. MHP’s always need continuing education credits I suppose, but it seems like a real money maker too.

Anyway, he got a brochure today that is really bothering me. It is for a seminar entitled “Suicide, Parasuicide and other Out-of-Control Behaviors.” Topics include:

Treatment Strategies
“Help! When do I hospitalize and when do I not?”
Address “therapist hopping” and other problematic behaviors
Manage “splitters” and other manipulative clients
Take control of “therapy interfering behaviors” before they take control of the session! (Punctuation is theirs by the way.)

Inside you can read the following:

“Many clients can frustrate you with seemingly endless threats or gestures with suicidal innuendo, cutting, burning, or other self damaging or destructive behaviors. Do I ignore it, Do I intervene, If so, how, Help! are common cries of professionals working with populations with such manipulative or impulsive behavior.”

Then there is a list of objectives, some of which include:

Discuss behavioral strategies for dealing with manipulators and other “treatment savvy” clients at various levels of care.
Discover how to not get your “buttons pushed”! (Punctuation theirs again.)

This is actually making me nauseous. Could this be any more judgmental? Is suicide an out-of-control behavior? I suppose some might think so, others might think it is a valid solution to a painful life.

Manipulative clients, splitters, therapy interfering behaviors, therapist hopping, seemingly endless gestures of cutting, burning or other destructive behaviors, treatment savvy clients, button pushing. Wow. That’s all I have to say. Wow. And I’m nauseous.

Sep 26 2010

Just a Quicky

I’m out of town, visiting my aunt for the weekend. It’s been really nice, my cousin has been here too. She is 27 and pregnant so we’ve been doing baby shopping. I’ve been opening up a little about stuff to my aunt, because she has been through much of the same crap as me – with kids, husbands, mothers, etc. She is only 9 years older than me, and she remembers a lot from my childhood and it is interesting to hear her perspective and her memories. I’ll have to write more about that.

But I do want to say, in regard to the writing class, that I appreciate everyone’s encouragement. You ALL want me to go back, I realize that. But I am NOT going back. I feel like I have let everyone down, the teacher, the other people in the class, and all of you. You have given me great reasons why I should continue, but I CAN’T and I am NOT going to return.

I’ll write more about that, but for now I just want to say to everyone who has encouraged and supported me – I’m sorry.

Sep 24 2010

Writing Assignment Week 3 – Health & Body

Most of who I am today can be attributed to issues of illness and dying. I can’t remember a time in my life when there wasn’t someone around me, myself included, who wasn’t completely healthy.

I mentioned my father’s illnesses, and my sister’s allergies and asthma, which frequently had her rushing to the hospital. My father’s illness was not as chaotic, it was a low level current, constantly pulsing through our home and affecting our family. His physical ailments caused emotional struggle for my mother, and occasional outbursts of anger towards my father. She was not a person to show weakness, and she liked to be in control and in charge. What had to be done, got done. But she must have been frightened at times. She never talked about this with me though.

When I was 5 years old I was hit by a car. I was across the street at the neighbor’s house; they had six children and there was always something going on over there. But I had to use the bathroom, so I needed to go home. My dad was standing in our driveway and he yelled out to me that it was safe to cross, so I made a mad dash into the street. Just then a car was coming and I crashed right into it. It wasn’t going fast, and the driver stopped immediately. I remember being very confused, lying on the ground, feeling like the breath was just knocked right out of me.

Back then doctors made house calls, and a neighborhood doctor happened to be driving down the street. My parents flagged him down and he came into the house. Someone carried me in, probably my mother. He checked me out and said everything was fine. He said, “No broken bones.” I remember that statement as clear as if it was said this morning. I was shocked. I had no idea that those hard stick-like things in my limbs could possibly break. How could that be? And what would happen if they broke? Would I collapse into a heap? Would I die?

From that day on I vowed to take extra special care of myself so that my bones would not break. I never asked anyone about this, nor did I ever tell anyone about my worries. But I was always very careful. I even changed the way I slept so that I wouldn’t lean my head on my arm, lest the weight of my head break my arm. I sleep like that to this day.

I developed a terrible worry of illness and death. I was always checking to be sure nothing was hurting me. In middle school I read a book about a boy with a brain tumor; I had never heard of a brain tumor before. I was terrified and every little pain in my head led me to believe that I had a tumor and I was dying. I would lay awake in bed every night crying myself to sleep because I was convinced that I would be dead soon.

Around this time I started to have panic attacks. I also thought these were a sign of my impending death. No one could explain what I was feeling, and my mother often dismissed my attacks as allergic reactions to one thing or another. Since I never spoke of my worries, no one was aware of my anxiety. I also had a problem with low blood sugar, and an irregular heartbeat, which caused panic attacks, which then caused more irregular heartbeats. It was cyclical – and I don’t know which came first, the panic or the physical symptoms.

This illness/death phobia continued throughout my 20s and 30s. I would have episodes that would last 3 to 6 months or so, in which I was convinced that I had a fatal disease. I would actually develop some of the symptoms of whatever disease it was that I thought I had. Lupus, cancer, aids, multiple sclerosis, melanoma. I would go to doctors, but not obsessively. I would ask for tests, I would be extremely anxious, I would get emotional and cry. None of them ever suggested that I had a problem with anxiety, and none of them ever found anything physical wrong with me.

My father’s illnesses continued to get worse, and he passed away when I was 37 years old. The last 5 years of his life were the worst for me as far as my health anxiety was concerned. The anxiety spread to other parts of my life as well. I developed a fear of bridges, probably because of all of the time I spent traveling over the Delaware Memorial Bridge on my way to see my dad in the hospital or nursing home. I wouldn’t let my children eat hard candy or popcorn; grapes had to be cut in half, hot dogs into small pieces. I was constantly checking their carseats and bicycle helmets, and their cribs and beds to be sure they wouldn’t collapse or have spaces big enough to catch their heads.

My health anxiety finally improved through the wonders of psychiatric medications. My fear of death has abated tremendously as I have gotten older. Ironically the closer I get to death, the less I fear it. The thought of being dead doesn’t bother me anymore, however being ill and unable to function physically or mentally still worries me. I would never want to go through the 8 years of hospitalizations, surgeries, nursing homes, and rehab that my father endured. I never want to be an invalid.

I still get emotional when I think of people I love getting sick or dying. The fears I had as a young child, afraid that my mom or dad would die and leave me, have never lessened. Growing up surrounded by illness, and feeling the need to never be a bother to anyone because everyone was so busy with the sick people, has shaped my psyche more than I ever thought anything could.

Sep 23 2010

Absent from Writing Class

Last night was my writing class, but I didn’t go. I had emailed the teacher earlier in the week to tell her that I would not be going anymore, and she felt very bad. She said if it is because of the person who wants to video the class she will gladly cancel the video. But it wasn’t that at all. She told me that some people cry through the first three classes, and then they feel better. And that great friendships usually result after the class is over.

I’ve mentioned how wonderful the people in the class are – warm, genuine, honest, caring. After last night’s class I have gotten some emails from some of them. One of the guys, I’ll call him Saul, is in his 70’s. He wasn’t at the first class. He is the only other person in the class who is Jewish and he is from New York, so I felt a connection with him immediately. He is funny in that New Yorker way. We had to go around the room and talk about a body part of ours, and he chose his hair. He is currently bald, but he described how he was as a young man with hair. When he was done I said, “Saul, I love your baldness, but I have to say you have amazing eyes.” He said, “Really? What are you doing after class?” It was so funny. I am usually attracted to brown eyes, my husband has beautiful intense brown eyes – they make him look intense, even though he isn’t at all. But Saul had blue eyes – they were quite incredible.

So today Saul sent me a note, it said, “Harriet, DON’T DROP OUT. Emotion is OK. Who will admire my eyes for the rest of the term?”

Another woman in class wrote to me to tell me she missed me, and she has a book that she would like to send me.

Then I got an email from another woman: “You add so much to our writing class, you must come and part of the group. You have been very brave to open up to us—some of us are not ready to be so candid about our lives. You express yourself beautifully and all of us can learn from your writing and your experiences. See you next week (that is a command!!)”

See, aren’t they nice people? There is no way I can go back. Of course I would love to go back and just listen to all of their stories, but that is not the way it works. There is no way I could have done last week’s assignment, it would have been even more emotional than the week before. There isn’t enough klonopin in the world to keep me stable enough to read what I would have written for last week. And I want to write honestly and from the heart, I don’t want to write surfacey stuff just so I can be in the class. That wouldn’t be authentic. I only knew them for two weeks, but I miss them.

Sep 23 2010

What Did I Do Wrong?

Here is one of the many things I am ruminating on. At my t session last week J brought up something in the last minute that really got to me. I hadn’t been feeling anything the whole session, which is typical for me, but right before I was going to leave he said something that really hit home, and it hurt. Not that he was trying to hurt me, I don’t mean that. What he said was exactly right, but hearing it said out loud was painful.

Then I sent him an email and I tried to explain to him how I felt. Here are my exact words from that part of the email:

Are you understanding this? I’m terrible at explaining myself. And then the worst part, the part I really did feel. Which happened in the 45th minute of the session as I was about to leave and you said the thing about the bigger picture, and how I frequently feel invalidated, and how I live with it every day with my husband. And
it’s true – every day. Even today, when I got home late and he asked
if I was working late, and I told him that, no, I was at my writing
class. He said, “Oh yeah, I forgot about that.” So when you said
that, I felt the dagger go in. Ouch. I definitely felt that. But it
was time to go. So maybe no daggers to the heart in the 45th minute
anymore? But I am glad that you brought that up. That made me feel
understood, and that is something I wish I could explore more in
depth. I don’t know if I can, but I wish I could.

I didn’t mean to criticize him, I was just trying to explain. When we had our session this week, he didn’t mention this, but I wanted to bring it up. And when I try to express my orally it doesn’t work very well, so I think I must have sounded accusatory. I said something like, “And then you had and go and bring up something painful right before I was going to walk out the door.” I know I am a terrible communicator, but this is therapy, right? So I get a pass? I guess not.

This is when he got defensive and said, “Well, that is when it came up. At the end.” And I said, “You brought it up, not me.” (Again, I am being confrontational.) And he said, “I don’t watch the clock and think ‘oh it’s 11:30, I better mention this now before the end of the session.’” I asked him what I was supposed to do, I had this painful thing thrown at me and it was time to go, and now what? And he replied, “I didn’t know you would react that way.” And then I apologized for reacting that way, which he said wasn’t necessary.

This whole discussion is bothering me terribly. Firstly, I tried to explain myself in the email in non-confrontational way. Secondly, he didn’t bring it up the next time I saw him. Thirdly, I brought it up, but badly. Fourthly, he got defensive. Fifthly, we didn’t discuss the actual issue of what he originally brought up and we both ended up annoyed, or frustrated, or feeling bad about myself in my case.

What would have been better? Well, it would have been nice if he had said, “Let’s talk about the part in your email where you describe how you felt at the end of the session.” And then when I would do that he would say, “So when I made that comment you really felt the pain.” Just to acknowledge what I was trying to explain would have been helpful. I didn’t ask for or need an apology, or any excuses that “I didn’t know you would react that way.” I don’t see how saying that could lead to a productive conversation.

If he had acknowledged that what he said was painful to me, I would have felt comfortable to continue on and tell him why it was painful, how I felt during the next couple of days, how it affected my other interactions with people, how it led me to think that maybe I am better off without my husband, all kinds of possibilities. But what he said caused me to shut down. I feel like it is my fault, though, for going about this conversation in a confrontational manner.

I think next week I might bring this up. Maybe I can say, “I know that sometimes when I am feeling badly about something that has happened with someone, I approach them in a critical, confrontation way, and it makes them defensive. I think I do this with you as well. I think it happened last week with you as a matter of fact, and I’m wondering if we can go through that conversation again so that I will know how to do it better next time.” Does that sound good?

Sep 22 2010

Pdoc Update

After I left t, I went directly to pdoc. She was my old pdoc, and I stopped seeing her in March 2007, only due to financial reasons. Her charge at the time was $180 per session (45 or 50 minutes, not sure) and that was every 3 months. (Now it is $200 per session, but I only have to pay 25%). I only went for med checks, but she liked a long session. Then I found a pdoc in my insurance plan and I saw him every 3 months for 10 minutes and paid $20. But he has been stingy with the meds lately, and I was checking my insurance company’s website for different pdocs and saw my old pdoc listed.

So I went in and we caught up. First she said I looked a lot different, which I do. I’ve lost 30 to 35 pounds, depending on the day, I’m three years older. I told her that I am a lot healthier physically since discontinuing the anti-depressants – no more high blood pressure, high cholesterol, etc. And I’m running, and I have an almost full time job between my paying job and my volunteer work. A lot has changed.

She says she does therapy now, she doesn’t do med checks anymore, but she made an exception for me because I am an old patient. We talked about what has been happening in my life, and I got emotional. I used a tissue, yes I was crying. It’s so weird, I cry everywhere but J’s office. Not sure what that means. She said I seem different, that she doesn’t remember me talking about things the way I did yesterday. But we did have the insight that I was on Zoloft or Lexapro the whole time, and I had no feelings really. She said when she saw me in the old days I was much more surfacey.

She senses some depression, but I adamantly refuse to start taking any anti-depressants. I told her about the intrusive thoughts, and she said I had never mentioned that in the three years I saw her. I know I kept that a secret for so long, and J was the first person I told about it.

I think it was easier to talk to her because of my 2 years of practice with J. I’ve been thinking it will be so hard if I ever want to start fresh with a new t, because it will be so difficult to tell my story all over again, but I think I now realize that it will actually be easier because I’ve told it once. That was an eye-opener.

So I told her about my anxiety, and my difficulties with sleep. And I lied to her. I’m sorry. I know it is wrong, I blatantly lied. I told her that I take 1mg of klonopin every night, because that is what I wanted her to prescribe. And I told her I take one or two klonopin every week or two during the day when I am feeling very anxious. So she prescribed me 30 1mg klonopin.

But actually my current pdoc prescribes me 15 .5mg klonopin per month, or every three weeks if I can sneak in a refill. And I split those in half every day. So I am really taking .25mg every night. It’s really not enough, because I have such trouble sleeping, which I told her, and when I need a klonopin during the day I have to dip into my stash. And my stash is getting smaller and I want to get it back to what it should be. I didn’t tell her that though.

So I am sorry I lied.

As for the sleep, her reason was “menopause.” I swear, being a middle aged woman has its problems when seeing doctors. Everything is blamed on menopause. But as far as I know there is no cure for menopause, so can’t she give me something to help me sleep? What did she prescribe? Trazodone. I used to take that and it did nothing to help me sleep. She may as well have prescribed Skittles. At least they taste good.

And she was concerned that I am still seeing my other pdoc and am I doubling up on my prescriptions? Which is a valid concern, because I may do that. Then I thought, maybe I should see her for therapy. We discussed my therapy with J. I told her that my current pdoc said that I need cognitive behavioral therapy, and J said that it ignores the complexity of human behavior. She says she agrees. She is a lovely woman, her voice is very soothing, I actually feel emotion in her office. My concern is what if I don’t like her as a pdoc, then what do I do if she is my therapist? I think it is best to keep the two separate.

And last night I took my .25mg of klonopin at 10:30PM, was tossing and turning until around 12:30AM, fell asleep, then got up at 4:30AM and tossed and turned, and I guess I fell asleep again at around 6:00AM, but my alarm vibrates at 6:30AM. The sleeping problem is really starting to get to me, and I don’t think anyone can really help. Why can’t I get something to really help me sleep, is it that difficult? Well, at least now, with the 1mg klonopin, I can split them in half and I’ll be doubling my dose every night, and have some to spare. And she wants me back in a month.

And of course I am still processing my t session. I think my insight for the week is that I will never feel good about myself as long as the two most influential people in my life – my husband and my mother – don’t feel good about me. One doesn’t care if I live or die and nothing I do is good enough for the other. The feelings of wanting to be dead are rearing their hideous heads again, and it is too soon. Usually I have been on a 3 month cycle with these feelings, but the last time I felt this bad was sometime during the summer. I don’t know, maybe it was June, and that would be 3 months. I was having a lot of suicidal ideation at the beach, and I think I went in June. It just feels too soon.

It feels like the only way I can feel better is to be dead. I know that doesn’t make any sense. But I am stuck with my husband and my mother, and I love them both, but I can’t do anything to make my husband care about me and I can’t do anything to make my mother think highly enough of me. Being dead seems like the best and easiest solution. I’ll never feel better about myself, never.

Sep 21 2010

T and Pdoc and Bears, Oh My

So I had my usual visit with J today, and then a visit with my old/new pdoc right after. I didn’t feel it with J today at all. The whole session was disjointed, it didn’t really flow, there wasn’t a focus. He mentioned my email from last week, and I said, “The one that I asked you not to respond to?” He claims that he didn’t, that saying “I got your email and we can talk next Tuesday” is not responding. Which isn’t what he said, but I didn’t want to seem nitpicky.

He didn’t understand what was wrong with what we talked about last week. He really didn’t get it. He thought when I said, “I’d leave my husband in a second” that I was ready to move on to taking steps to doing that. I guess it does sound that way, doesn’t it. I really am trying to see things from his perspective. I told him that if I leave it may be 10% positive, but there is the other 90% – leaving behind 24 years of my live with my husband, splitting up my family, financial concerns, etc. He seemed surprised about that. Maybe he hasn’t been married long enough to get it.

And then I brought up the fact that right before I was going to walk out the door he said, “This brings up the larger issue of what we have talked about so much – your feelings being invalidated. And you are living with this every day.” And how that was really painful to hear, and it was terrible to leave with that being the last thing I heard.

He was totally un-empathetic about this. He said, well that is when it came up, at the end of the session. I told him that he brought it up, not me. And he said, “Well I don’t look at the clock and see it is 11:30 and think ‘I better say this now’”. I said that if he comes up with some insight at the end of the session and it will be painful can’t he restrain himself and save it for next time? And he responded, “I didn’t know that you would react like that.” So then I apologized. He asked what I was sorry for, and I said, “For reacting like that.”

I don’t know, that seemed totally screwed up.

Then the conversation led back to the issue of how I am too hard on myself. I said that maybe I have too high expectations of my husband, and I am not objective. He said he didn’t think that. I asked him if his wife had to have a CT scan because her doctor thought she might have a pulmonary embolism would he ask her about it when he got home from work? He said he would probably go with her. I asked why and he said, “For emotional support.” He said it is not expecting too much to have one’s spouse ask about their CT scan or to ask if they are dying.

He asked about my flying group, but I can’t remember why now. I told him how I had a certain reputation in the flying group because I did my trial flight differently than anyone else ever did, and I became like a “legend”. Everything in group about me was always dubbed, “in typical Harriet fashion.” This is a long story, but in the end what it comes down to is that if it was anyone else who did what I did I would think they were great and courageous, but since it was me I feel like it’s wrong and stupid.

Then we got onto how I am stuck. I am stuck with this negative mindset about myself. We got to how the important people in my life are invalidating. He asked me who those people are, to make a list. And I said it is my husband and mother. He said, that is it? How about your kids? We were totally misunderstanding each other at this point. He thought I was making a list of important people, and I thought he meant important people who invalidate me. When we got that straightened out I said that my list of important people is my kids, my husband, my mother, my aunt, I suppose my sister is on there somewhere. I really almost started to cry at this point. I don’t know why I got emotional here. I don’t think he noticed, we just moved on.

I just didn’t feel like today’s was a good or a productive session. I told J that I called the bank and it feels like a mistake, that I wasn’t ready to deal with that information.

One good thing was that he responded to what I said in my email, when I said that he seemed happy to be problem solving my issue. He said he thought a lot about that, and he doesn’t feel like he is “happy” to have this problem come up, or that he likes this type of discussion more than something else. I was glad he gave it some thought, that means a lot to me.

He didn’t mention anything about the writing class. He really isn’t interested in that at all obviously. I had told him the week before I signed up and how I was really anxious about it, and he never asked me anything about it. And I told him in the email what a disaster it was last week, and he didn’t mention it. Oh well.

I’m going to go back and read about my sessions prior to the last two, because I was feeling somewhat connected to J before last week. Something happened and it’s not working right now. I’m glad I write about my sessions because I can go back and see that there are some good ones.

This is already long, so I will write about new/old pdoc tomorrow. But I was really emotional during pdoc’s session, and I just feel really really fragile right now. Like if a breeze blows through the room I’ll shatter into a million pieces and I’ll never be put back together again. My reaction all day was “I’m going to tell J next week that I’m done with therapy. If we are still talking about the same thing as we were 2 years ago, if I am that stuck, what is the point?” I’m just going to get through the initial yuck of post-session emotion and revisit this thought later in the week.