Today's T session might make more sense with the e-mails from Monday/Tuesday. Warning: these are really long!
Me (Monday night):
Hi Dr. T,

I have really mixed emotions about today's session--unfortunately, the negative ones are winning out at the moment. I feel like on the one hand, you're saying I can share anything with you, that it's safe, that you'll be accepting, that you're not going to reject or abandon me for any of several possible reasons I listed today (not getting better fast enough, not having enough problems in the first place, etc.). All of that feels very reassuring.

Yet on the other hand, I'm getting a very different message. That I shouldn't rely on you for support, that it's not OK to feel attached, that I need to keep my distance. Confusing things like: page 1 of Google is OK, page 2 isn't. Finding comfort from a stone I bring into the office and sit on the table for a bit is OK (I opted not to do that today, despite your offer, since I didn't want to take a chance of it becoming uncomfortable); finding comfort from a stone that you already have in the office and hand me isn't OK.

I have no idea when I'm going to cross a line. I know you said you'll be honest with me, but that's not particularly reassuring when I feel at any moment I could break one of your rules that maybe you don't even realize is a rule until I break it--the stone, for example. And I have no idea what else will potentially be an issue (and maybe you don't either.)

Or like today, at a few points (and then riding home) I felt fairly connected to you. But then I thought to myself, wait, that probably would not be OK with you, so I tried to shut it off. Because you say I'm supposed to connect to other people, not you. Even though you're the person I'm spilling all my darkest secrets to. How am I *not* going to feel some emotional connection there? And maybe some attachment/transference stuff? Yes, it's a professional relationship, but I feel therapist/client is unlike any other professional relationship out there in the sense of emotional intimacy (albeit one-sided).

It's like if I'm feeling things, then trying to suppress them...how is that so different from some stuff I dealt with from my parents? I'm afraid some of your reactions are just reinforcing some of the negative messages I got as a kid/teen.

I generally like working with you. But I hate dealing with some of these fears and emotions with regard to you, then not knowing how you'll react if I talk about it. With Dr. Ex-MC, I often felt I couldn't talk to him about transference/attachment stuff because he was my marriage counselor (yet for the most part, when I did talk to him about it, he was very accepting--until the end). With you, I feel like I can't talk about it because it seems you're more comfortable talking about [gross bodily functions] than about transference and attachment...

Can you work with me through some of this stuff? Can you make it feel more OK to talk about? Can you help me feel safe with you? I feel like that last question was part of what my last e-mail asked, but to me, we never fully addressed it today (though maybe you think we did, since you reassured me about a couple things?)

Charge accepted if you opt to respond in detail (slightly preferred, but if you'd rather talk in person, could either do that Thursday, or if you have something earlier, let me know.

Thanks,
LT
Also me, later that night: Sorry, just one last thing. I think maybe your holding up the stone to me today to verify which one it was--that may have been kind of triggering. This stupidly hopeful part of me thought for a split second maybe you'd offer it back to me, especially because you said you didn't recall how you'd acquired it (so you had no particular emotional connection to it). So it sort of felt like you were dangling this potentially comforting thing in front of me, then taking it back again. I'm sure that wasn't your intention, but it felt that way a bit.

Dr. T (Tuesday morning):
LT,
I appreciate your concerns. Even while our session was happening I had expected that there would be a lot of loose ends and unclear issues that we would need to come back to either by email or at our next session. Regarding your other email about the stone, I'm sorry for the confusion and if my picking it up was hurtful to you. Not my intention, but I can see how you may have expected me to give it back to you at that moment as I reflect on the conversation with hindsight - which is, of course, 20/20. At this point the whole stone-as-a-connection concept has become muddled to me and I think I will need to talk to a colleague or two as a way of helping me make sense of my thinking and your needs/request.

In reading your thoughts on attachment/connection, I think that you're taking a black and white mindset to something that is more nuanced. Of course you are allowed - and in fact supposed to - develop an attachment, bond, connection, and/or feelings towards our relationship. That happens in all relationships. How that connection plays out and gets expressed, and the boundaries of what is or is not healthy, appropriate, and/or reasonable in that relationship, is profoundly important. The roles that each person plays in the relationship in some ways dictate those boundaries. For example, the attachment of a teacher to a student has different rules than that teacher's relationship to a spouse, his/her boss, or the doctor that is treating him/her for a medical condition. Those relationships can be closer or more distant depending on a lot of factors, but that is independent of the fact that there are boundaries/rules. Those rules are sometimes simply understood or unspoken - for example the relationship between a server and a customer - but in other contexts parts or all of the boundaries are rigidly articulated - like doctor-patient. Some of those roles allow for dual relationships, some do not, and some only under certain circumstances. In almost all cases dual relationships can be problematic.

I think that the most successful therapy outcomes are only possible when a client feels that their therapist cares deeply and take a serious investment in their problems. There is a closeness and intimacy that can develop within the confine of the therapy room. Some people find the limits of the therapist/client relationship frustrating and will invalidate the connection because of the limits placed on it by the clear boundaries expressed in our ethic codes for the protection of both the client and the therapist.

It's been my experience that you can have both - closeness and also boundaries. In fact, I'd argue that all healthy relationships have both closeness and boundaries. Actually, I think boundaries help with the closeness when those boundaries are thoughtful and support both people mutually. For example, I have a client with opposing political views to my own, and he will sometimes try to engage in discourse on the subject. I hold a strict boundary with him not to participate in that conversation, although he is welcome to share his beliefs if that's how he wants to spend his time. It is my belief - and the belief of other therapists - that the boundary protects both of us. I think there are - or will need to be - boundaries over what you share with your mother, or at least boundaries within yourself when it comes to your expectations and how she responds to you. Those boundaries would help you feel less hurt/rejected, and as a result would make it easier for you to feel emotionally close to your mother. She then benefits from feeling closer to you.

My concern for our work together has centered around some of your past relationships that have ended badly. There seems to be a theme of boundaries getting blurred, or perhaps the closeness you feel becoming complicated in a way that ends up unraveling the relationship. I very much want for this therapy experience to be different in that regard. I want you to be able to feel cared about and to trust my investment in your wellbeing, and for you to feel a connection to me as your therapist. I also want you to be able to feel good about the boundaries of our relationship and for your attachment, bond, and expectations to comfortably stay within those rules/boundaries. Additionally, I want you to be able to have full, rich, close, loving and dependable relationships with the people in your life outside of the therapy room - and most importantly with yourself.

Hopefully this makes sense to you, and when we talk more about it later this week we can continue to gain clarity. If you want to meet earlier than Thursday I do have time on Wednesday - right now I have 12:30 available.

(I ended up taking today's slot and canceling tomorrow--will write up today's later, but think it generally went well.)