I wish our session before your vacation had felt less painful. I don't have a huge fear of abandonment, but I've nonetheless been fearing just that since last week's session and that was really reinforced today. I think I assumed that it would be more obvious than it was that talking about how maybe you're not helping me would amplify my feelings. Part of me feels like you should have known that. I mean, I texted you several times over fear that you're about to retire and this afternoon I literally texted "don't leave me." So... did you really have to start talking about me seeing somebody else? Especially right before you go on vacation, which you know I'm struggling with?

Maybe I'm completely overthinking this but the more I think about it, the more I feel like you're fed up and hoping to get rid of me and make me think it was my idea.

You cried because it's just too frustrating to watch me be stuck, not because it makes you sad. You wouldn't be frustrated if you didn't care, but I just can't believe you would cry because you're sad for me.

Or did Dr. S say something that made you feel bad? I know she thinks meds can't help and that I need to be working in therapy, but I think that's easier said than done. Just because there's nothing more she can think of with the meds doesn't mean therapy must be capable of helping me. Sometimes neither can help. And the person she wanted me to see is a CBT therapist. Tbh, I feel like that could go extremely wrong, especially right now. Challenging my thoughts and feelings would make me feel even more misunderstood, helpless, and hopeless. I fundamentally disagree with the CBT idea that my suffering is due to cognitive distortions and changing my thoughts is the answer. My thoughts are not distortions, they are well supported by the evidence. You don't get to call unpleasant realities cognitive distortions just because they feel bad.

Anyway, following our session I've decided to go ahead and order the substances I've self-prescribed. I probably would have anyway, but it's also true that I feel under pressure from you and Dr. S and that isn't helping. I feel like I can't be honest about how I'm doing because neither of you can accept that this is the way things are right now.

I feel really alone and it has nothing to do with your vacation. If I wanted to feel punished for disclosure, I wouldn't need you and Dr. S. I could just tell my family if I wanted to feel alone, misunderstood, and blamed.