I just am... what?

So in the middle of a month-long hospitalization (which ended about a week ago), t told me she thought we ought to find me another therapist. Her arguments were not unreasonable (e.g. I am quite sick but she can only see me once a week reliably b/c she works for a public clinic, she I work for the same small hospital system which has occasionally led to s**tty/awkward moments, etc.) but it still felt really awful.



But during our session today she said, “I’m having a very difficult time finding someone who is able to see you 2-3x/wk and is reasonably close geographically and is willing to work with your insurance/HR department to make a single-case agreement... so how do you feel about us returning to our former frame and continuing to work together?"

I had not been expecting that at all... and after sitting quietly for a while I said, "I'm not really sure how to respond to that." I told her how even though cognitively I understood her arguments about why switching providers could be a good idea (and even agreed with some of the arguments), emotionally I experienced her suggestion as rejection/abandonment and felt angry/hurt in response. (It also stirred up this thing I have about feeling like I'm too needy or "too much" for people.) And those feelings are still there--it feels like there's a crack in the foundation, and I'm not sure about what to do about the crack. (We were going to have to deal with the crack whether or not I switched ts, but it's gonna be more important and more difficult if she and I stick it out.) I had expressed snippets of these thoughts and feelings to her over the phone in the hospital but it had been hard to have a real conversation (in part because our phone calls in the hospital were never very long--she always had to go after 5-10 min).

I felt like she was able to hear and understand that. She said something like, “when I was considering making this suggestion to transfer your care--and talking with your inpatient psychiatrist and my supervisor about it--I lost sleep over it. And I don’t lose sleep over patients--I can’t, as a trauma therapist, if I want to continue to do my job. But I knew that no matter how I presented it, you would experience it as rejection/abandonment. I would've experienced it that way in your position. Ultimately I decided to push it forward as an option because I truly do believe that you would benefit from more frequent therapy than I'm able to provide. I hope that you can hear me when I say that, as much as one person can empathize with another, I understand how this has felt and continues to feel. I'm hoping that with time you might be able to learn to trust me again." So that made me feel like she understood and cared about my hurt/anger, and that she was able to tolerate my negative feelings towards her.

[I'm getting real tired so this might start making less and less sense going forward]

Interestingly, she also said that she believed that some kind of break was inevitable between us, that we were always bound to come to a point where I felt like she wasn't giving me enough. I disagreed in part b/c the emptiness inside me feels less like "I need a larger amount of the affection/attention/love that you are already providing" and more like "you have not yet figured out how to solve the lock/find the key and get close enough to the vulnerable part of me to figure out what is missing and how to provide it." [Side note: we had a laugh when I said, "I'm uncomfortable with how phallic that metaphor came out... didn't realize it 'till it came out of my mouth, but there it is."] Anyway... ultimately I quirked a smile and asked, "you think I was always bound to feel that way because I have holes in my pockets?" (A phrase stolen from Yalom re: patients for whom no amount of love and affection will ever be enough; I'm pretty sure t and I have used it in the past.) She corrected, gently, "because you have holes in your heart."

We also talked about how part of me wants to stay sick in order to punish her (and/or to keep her around--sh**'s complicated). How sometimes when I SH it feels like I am doing it not to hurt myself but to hurt her. (Admitting to that part made me squirm--I think I said, "I know that's super ****ed-up--very cluster B.") She had an interesting take on that which I'm not sure I agree with--she said, "I think it means you've internalized me, at least somewhat. It means that in those moments you're not alone, that someone is witnessing your pain." That just seemed sad to me, and I said so. In part because we are all alone, ultimately.

Anyway. I am now quite tired and need to sleep but wanted to get down the bones of the thing before time swept them away.