[fullsassahead]

I hope this thread makes sense. I've been thinking about starting a new thread for a while, but I've been fearful to. I feel like I don't make much sense.

I have been seeing my T for about 4-ish months. Maybe a little bit more. I do see her, for the most part, twice a week. In terms of my reasons for seeing her, I have an eating disorder, anxiety, PTSD, OCD, and a dissociative disorder. I'm also really in need of inpatient/residential care, but it is not possible at this point in time. So, we are trying to create as much structure as we can within an outpatient setting. And, with that comes rules.

I guess I'm having a hard time accepting her rules. Nor do I know if it is normal to have so many rules come from a therapist. I suppose it's important for me to acknowledge that the fact that she is setting rules isn't upsetting to me. Rather, I have never experienced healthy structure, guidance, and discipline before. And, I am struggling with not rebelling, acting out, and testing her.

I feel like I fight everything that my therapist says. Not intentionally - it just happens and some of that is due to my emotions feeling out of control and some is due to my dissociating. I am ashamed to admit that I act like a brat at times. But, I'm not sure how to let go and trust her. And, I think I am fearful that she will set rules only to not follow through with them or consequences. Obviously, that is something that I experienced in my past and I measure my safety by consistency. She has not let me down thus far and has continued to say that we will figure things out together, but I'm scared to let my guard down. So, I resist and avoid. But, my behavior isn't helping anything and I wonder if others have dealt with something similar and can offer support or advice...

I'm happy to share more about what the rules look like, but I am still scared to submit this post and I'm unsure as to what is important to share or not.

Please go ahead and post more, we're listening and interested.

[atisketatasket]

I'd like to see the rules, too, if you feel you can post them, otherwise we can't really give advice in a vacuum.

Are there other relationships you have in which rules are set and you have trouble following them?

[BrazenApogee]

My T has a lot of strict rules. I hate them and like them at the same time. I have similar problems.

[Waterbear]

I would be interested to hear what the 'rules' are. I have a sinilarb problem letting go and trusting and I don't seem to have any 'rules' as such. She says everything can be managed, and everything I have asked for or suggested has been met. This makes me nervous, it is not something I have been used to. Do you think you would still have problems trusting even without rules?

It sounds like you're blaming yourself a lot for this. I must admit I have an uneasy reaction to your use of the words 'discipline' and 'consequences'.
I understand you may need structure right now, but if it feels punitive to you, I wonder if that is a cause of resistance for you? Therapy really is a collaborative endeavour, and if you are struggling with these rules you have a right to discuss this with the therapist and work out a structure which you are more comfortable with.

[fullsassahead]

Alright...so some of the rules look like this...

1. I have to have a supplement in session. If I refuse it, she will not let me come to my next session. I know that may sound harsh, but I am significantly malnourished and dehydrated due to my eating disorder. Recent rules in addition to having the supplement are allowing her to open it (so she can break the seal and know I didn't replace the supplement with something else) and allowing her to check to ensure that it is done.

2. Bed rest. I'm allowed to work, but I am supposed to restrict activity. I know what the parameters are for me to be off of bed rest, but they seem ridiculous and it isn't fair that I'm supposed to be seated or laying down all the time. I asked if my doctor could remove me from bed rest and my T said no. In the end, my doctor agreed with bed rest, but still.

There are other rules that come up. I'll say or do something and, suddenly, there will be a rule or consequence. She is definitely firm and has been consistent to this point, but I am scared. And, there is something else, too, but that may be appropriate for another thread. I am just really having a hard time with structure. And, I've certainly done my fair share of acting out. But, all that has done is show her that I really do need the rules - in her words, I am demonstrating that I cannot take care of myself without them...

[fullsassahead]

I didn't expect so many responses!

I will do my best to answer some of the questions that have been asked. I do not feel as though I am being punished at any time by my T. Words like discipline and consequences are not negative to me - they express the reality of a situation. Punishment would be punitive. I don't feel as though anything she asks of me or sets boundaries on are inappropriate. And, I don't doubt that she has my best interest in mind. I do not always like the rules, but I know that I need the rules...and, they help me feel safe and more secure. But, at the same time, they scare me and cause me to behave in a way I am not proud of.

I don't have rules, discipline, or consequences in any other relationship. I have experienced such structure within a residential or inpatient setting, but never as an outpatient and never outside of a therapeutic relationship. I have significant trauma and neglect in my background and healthy structure is a foreign concept to me. And, truth me told, I act out, but typically wind up following the rules set forth because, at my core, I appreciate them and so need them. By nature, I tend to be a rule follower. On my own, I'm barely hanging on, though, as I am unable to build structure for myself. However, knowing that doesn't help me not rebel, act out, and test my T. It makes no sense and all the sense in the world. And, that just makes it all the more frustrating...

[atisketatasket]

Originally Posted by fullsassahead

Alright...so some of the rules look like this...

1. I have to have a supplement in session. If I refuse it, she will not let me come to my next session. I know that may sound harsh, but I am significantly malnourished and dehydrated due to my eating disorder. Recent rules in addition to having the supplement are allowing her to open it (so she can break the seal and know I didn't replace the supplement with something else) and allowing her to check to ensure that it is done.

2. Bed rest. I'm allowed to work, but I am supposed to restrict activity. I know what the parameters are for me to be off of bed rest, but they seem ridiculous and it isn't fair that I'm supposed to be seated or laying down all the time. I asked if my doctor could remove me from bed rest and my T said no. In the end, my doctor agreed with bed rest, but still.

There are other rules that come up. I'll say or do something and, suddenly, there will be a rule or consequence. She is definitely firm and has been consistent to this point, but I am scared. And, there is something else, too, but that may be appropriate for another thread. I am just really having a hard time with structure. And, I've certainly done my fair share of acting out. But, all that has done is show her that I really do need the rules - in her words, I am demonstrating that I cannot take care of myself without them...

The two rules you mention I would describe as controlling without knowing more. Does this woman have a medical degree? And you're outpatient and seeing her voluntarily?

I'd be just as resistant as you if I had to follow those rules.

I dunno. The bed rest may be a safety issue. I had a friend who had a mild heart attack at 20 as a result of having so little fat around her heart and trying to exercise.

[Ididitmyway]

If your eating disorder puts your life in danger and if your therapist co-ordinates her rules with your medical doctor, then I don't have a problem with her rules. But I don't know enough about the case to be certain.

[atisketatasket]

Originally Posted by My kids are cool

I dunno. The bed rest may be a safety issue. I had a friend who had a mild heart attack at 20 as a result of having so little fat around her heart and trying to exercise.

I would agree, except OP's doctor doesn't appear to be the originator of the bed rest plan, the therapist does. Given that most therapists are all Exercise! Exercise! Exercise! like they are the second coming of Jane Fonda, I find that a therapist gets to set the rule odd.

Unless, again, she has a medical degree or this is inpatient, which it doesn't seem to be.

[fullsassahead]

I'm torn and feeling kind of panicky after starting this thread. I feel like I've done something wrong.

I don't feel as though her rules are inappropriate or controlling. We have discussed my need for a higher level of care due to the severity of my eating disorder. And, I have had significant health consequences this year as a result of how sick I am. My dietitian, doctor, and T all work with one another and the rules regarding the supplement and bed rest were born out of their communication. I guess my wanting to share this and ask for support and advice is less about the rules themselves and more about my reaction to them.

Does that make sense at all? I'm sorry.

[kecanoe]

To me, it sounds like t is trying to create something like an intensive outpatient program with you as the only client. If you were inpatient you would have a lot of rules to follow so I don't think there is a problem with the rules you have mentioned.
If you need structure and respond well to rules at your core (as you stated in your posts) then I think you have found a creative and helpful t.

[kecanoe]

Originally Posted by fullsassahead

I'm torn and feeling kind of panicky after starting this thread. I feel like I've done something wrong.

I don't feel as though her rules are inappropriate or controlling. We have discussed my need for a higher level of care due to the severity of my eating disorder. And, I have had significant health consequences this year as a result of how sick I am. My dietitian, doctor, and T all work with one another and the rules regarding the supplement and bed rest were born out of their communication. I guess my wanting to share this and ask for support and advice is less about the rules themselves and more about my reaction to them.

Does that make sense at all? I'm sorry.

Sure, it makes sense. I also have a dissociative disorder and there is part of me that would rebel like crazy over the rules even while part of me was glad for them.

[atisketatasket]

Originally Posted by fullsassahead

I'm torn and feeling kind of panicky after starting this thread. I feel like I've done something wrong.

I don't feel as though her rules are inappropriate or controlling. We have discussed my need for a higher level of care due to the severity of my eating disorder. And, I have had significant health consequences this year as a result of how sick I am. My dietitian, doctor, and T all work with one another and the rules regarding the supplement and bed rest were born out of their communication. I guess my wanting to share this and ask for support and advice is less about the rules themselves and more about my reaction to them.

Does that make sense at all? I'm sorry.

If you don't find them controlling, I accept that - you are in the best position to judge, after all. I am less troubled by the rules if they are being created by a team that includes medical personnel and not just being created by a therapist.

Is perhaps your reaction to the rules the reaction many patients have? Like I resist taking medications even though it is better for me (and absolutely necessary for a physical condition).

Also, if you decide you want to delete the thread, click on the report icon in the first post and tell the moderators so.

[junkDNA]

It sounds like she's attempting to create an inpatient type structure in an outpatient setting

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[Waterbear]

You have done nothing wrong by posting. It can be useful to gain other peoples perspectives sometimes to help with your own. Do not fear, but try to sense how you feel about everything having heard other people.

[fullsassahead]

I'm trying to sit with the discomfort and not immediately delete this thread. Though, it does make me feel better to know I can.

My therapist has said she's trying to recreate inpatient or residential on an outpatient basis. I know that I am a mess when left to my own devices. The ED is severe right now. It's commonplace to discuss hospitalization and my doctor has made it clear she will send me to the ER if my vitals are not stable. Thankfully, I've been holding steady for the last couple of weeks. But, I've had a bad year thus far - I've been hospitalized a fair amount, unfortunately. I'd be in residential in a heartbeat if it were feasible. So, my treatment team has been very strict on some things. I apologize for not making it clear that my T did not come up with those specific rules on her own. She is, however, the one to enforce them as I have the most contact with her. She will often tell me that my two hours with her are the only ones in which someone else can take over and set boundaries, rules, and healthy consequences. She also says it's the only time I have help fighting the thoughts in my head. Of course, I do have my dietitian as well. But, she's not quite as firm as my therapist is.

I think a lot of my resistance has to do with my dissociative disorder. I also think a lot is pushing boundaries and testing her to ensure that I can trust her and continue to feel safe with her. Since this is all new to me, I do find that I'm fearful that she will give up on me or find that I'm too much trouble and not worth the effort. I also think it's because the eating disorder is loud and the thought of having to drink a supplement or not be able to exercise is scary. I'm struggling with all of this, but I wonder if that's not to be expected. It can all just be overwhelming at times...

[Ididitmyway]

It sounds like deep down you feel the rules are right for you and that they are helping you to stay structured though other parts of you don't like them. I suggest to listen to this inner voice. If it tells you that you need those rules and that you need someone to impose them because you are unable to do it yourself, then you need them. Any feelings of anger or resentment or the desire to rebel are normal. Just let them be. They aren't wrong in any way, so don't judge yourself for feeling angry and acting out. You are getting used to something you've never had, a structure and a discipline, so the discomfort and the desire to rebel are understandable and to be expected. Hopefully, the discomfort will gradually wind down as you get used to the structure and eventually you'll be able to create structure in your life yourself. Meanwhile, just accept the struggle and trust that it will take you where you need to be.

[Nammu]

Could you be resisting the rules because subconsciously you are not ready to get well? Getting healthy takes a lot of commitment, maybe the prior hospitalizations and threat of residential has kept you from reaching the bottom. Although medically your bottom could be death. Could you maybe tell yourself over and over( write it out if you need to) that the rules are ment to keep you alive until you are ready to fly? Think about the rules as a security blanket?

[Rive.]

Depending on the severity of your eating disorder, and not knowing more re specifics of said disorder and/or your compliance etc. (and I am not asking). To me her 'rules' seem set up to help keep you safe and ensure you are doing what is healthy to keep you safe...or even alive. So, as this point I do not see her being controlling.

As for sharing here, it's up to you to share as much (though be aware it's best to stay anonymous i.e. no identifying details as posts are 'google-able' etc) or as little as you feel comfortable with.

[Monarch Butterfly]

It's good you posted, we're here to listen. If your T coordinated these rules with a physician that might be normal. I can understand rules are sometimes not easy to follow especially if you haven't experienced it from other T's. If you do feel uncomfortable could you tell her how you feel? They may have these rules in place for your own physical, mental health and safety.

[AncientMelody]

I wish you the best. I am sorry for the severity of your health issues. It sounds like there is a well coordinated program set up, but I understand how it could be difficult for you.

I admire and respect your struggle, and I hope you find a way through.