TW talk about self harm

My session with T today was much better than yesterday. Looking back, I kind of wonder if she planned on being more verbal due to how the previous session had gone. Whether she planned it or not, I found her increased interactiveness helpful. There were only two times where the silence threatened. One time I broke it, and the other time, I think she realized I was starting to really dissociate (I don't even remember why), so she broke it which was successful in pulling me back to just mild dissociation where I can still interact but just feel dead inside. I guess it's like my emotions are dissociated and my thoughts are a bit slow, whereas when it gets severe, it's more like my entire consciousness gets dissociated.

Anyway, she asked how I was feeling. I gave a dumb ******** response like "fine" which was obviously false since she at some point said she hadn't seen me this depressed in a long time. I think she was forgetting about how she was talking about me maybe needing to go inpatient just last month. I didn't remind her. We talked briefly about how this worsened depression is probably related to discontinuing my old antidepressant. I think she would probably like me to see my psychiatrist because I'm feeling so bad. She's asked like 5 times in the past 3 sessions if I think it would be a good idea. I told her why I don't see the point and feel like I might as well wait for my appointment that's scheduled for the end of the month. She's not one to insist, which I appreciate. I think it's probably just difficult because she can't really do much assuming it's a medication withdrawal issue. I do feel like she understood my reasoning for waiting, but I won't be shocked if she asks/suggests I see Dr. B earlier again.

On a related note, she asked me if I thought it might be necessary or better to do this med change in the hospital so I would have more support. I pointed out that I don't know how long I can expect to feel the effects of the withdrawal. In retrospect, my complex around being needy is triggered thinking about the hospital suggestion. I very rarely text her and she doesn't do email. After her response to my last text, I don't foresee circumstances where I will text her again. She asserted an implicit boundary in her response even though I don't burden her with out of session contact with any regularity, so I have to conclude that she doesn't want me to contact her unless I'm an imminent risk to myself. She actually never told me I could text her, so it's my fault for doing that. She didn't even give me her cell phone number directly; I got it because she texted me one weekend last year for a check-in. I think not giving me the number may have been an oversight, though, since when she had gone on vacation before I had the number, she said she would be checking her voicemail. I have since learned that she doesn't have access to her office voicemail remotely, so she must have meant her cell phone. But I don't know what the boundaries are and I don't want to talk about them, either. Talk about boundaries automatically makes me feel rejected even when I haven't transgressed in any way. I guess I feel like adults shouldn't need boundaries with professionals spelled out for them, and I'm terrified of doing anything that makes her think I need to be instructed on this topic. She has mentioned or insinuated that maybe I have trouble with boundaries, but it has always been in the context of me getting taken advantage of, not the other way around. I would be horrified if she felt she needed to have The Talk with me. For all I know, I'm a nightmare client and the only one who has texted her. I might be on the verge of The Talk. I don't want to think about that.

Now I actually feel like a bit of a bother for subjecting her to my sad sack self and making her support me in outpatient even though she's said repeatedly that "maybe" I need inpatient or residential with specialists. I mean, she's in a bit of a spot because there's no one in our city with experience in my diagnosis that she can refer me to. And she can't just abandon me because she thinks I need a higher level of care as that would be unethical so long as I'm not in imminent danger of offing myself. I also wasn't upfront about my diagnosis when I started seeing her. I deluded myself into thinking I could keep it under wraps somehow. She confronted me about what was going on eventually, but it was too late at that point to ditch me. I basically manipulated her into treating me and I feel really ashamed about that.

I seem to have gone off on a tangent there. Back to my session. She confirmed again that I wasn't self harming. I was relieved I hadn't gone home after our previous session when she asked me and done so. We talked about how I managed to cope with the urge.

She wanted to know if I think I deserve to be hurt, and if this is about blaming myself for things that have happened to me. I tried to explain that self harm doesn't feel like I'm doing a bad thing to myself. It feels like I'm taking care of myself and doing something nice. She asked where I thought that idea came from - that it was doing something nice. I alluded to how I had been abused by people in caregiving roles, and theorized that it had confused things for me. That hurting myself can feel like being taken care of to me. I didn't say this at the time because the words didn't come to me, but self harm feels like a loving act to me. Feels like I'm being kind and compassionate to myself, whereas when I don't do it even when I want to, I feel like I'm depriving myself of comfort. I intellectually know that's pretty ****ed up, although I did tell her I sometimes struggle to identify SH as a completely bad thing. She said I need to deny myself that sort of comfort. She gave an example of another negative coping mechanism - binge eating - and how that can be comforting to a person, but that it's ultimately harmful. I guess her point was that just because something is comforting doesn't mean that it's ok. I was a little bit resistant I think. I pointed out that my self harm only harms me superficially, unlike binge eating or something like alcoholism. I said this with the full awareness that I sounded delusional about this problem, but it's also true. However, I've never mentioned to her how one time self harm led me to having to have surgery under general anesthesia... so I kind of feel like a liar claiming I only cause superficial harm. But that only happened once and I don't want to alarm her into thinking this problem is so bad that I might cause a real and serious injury to myself, because that's not the case.

I brought up the fact that I hadn't self harmed in years before I moved to my current city. We discussed how badly I had decompensated after moving, and I admitted how it makes me feel like crap that I still haven't recovered. She tried to change my perspective by listing all the changes I've had to deal with since moving, including getting a new T and pdoc. I tried to see it that way, and it did help to know that she doesn't think it's ridiculous that I have had such trouble. Then I said that lots of people have bad things happen and they don't have the problem I do. She asked if I meant having the mental health issue that I have. I'm always scared when we're on this topic that she's going to say the actual name of the diagnosis, but she seems to be aware it's hard for me when she does that. I can't even seem to type it out today in this post. But it's basically the extreme end of the dissociative spectrum. Yuck.

I said I feel like a weak person. She said she wished there was something she could say that could help me not feel so bad about myself for having this problem. That was nice, but then she made some comment about how I have to convince myself and we all only have ourselves. So that wasn't as helpful because of course I know that and don't need a reminder that I have to figure out a way to fix myself. Makes me feel so hopeless and alone. She responded to my comment about other people having bad things happen and not responding in this way. She said she doesn't think it's helpful to compare. I thought, yeah, maybe it's not helpful, but it's true. Then she said that yes, maybe some people have bad things happen and react in a way that is less disruptive for them. But that there are also many people who do wind up with a lot of problems. I guess she would know since she has a lot of experience with people who have experienced child sexual abuse. I still feel pretty freakish, though.

It was a pretty good session, although I think my writeup sounds a rather negative due to my current depression. I seem to have written a lot about things she did that caused me distress. This is a reflection of how badly I'm doing because I'm usually not quite so paranoid, insecure, and hypervigilant.

I see her again on Friday. I am apprehensive that she's going to ask again if I have been self harming. I wish there was some way to distract her when she asks that question. I want to do it really bad, but I don't want her to be displeased or think I'm being willful.