In Session Today : Part III

Hi I'm actually commenting on this thread but kind of replying to your post at the same time as it seems closest to what I'm kind of feeling but struggling to put into words as I in no way want to come across as being negative about LT,s feelings expressed so well above
Having read a lot of the OP.s posts this one brings a feeling of concern for both LT and 't' - I've only had/have one therapist and decided early on that whether it worked out or not that it was going to be a one time only as repeating and starting over with someone else would be too painful and would stop me moving forward -I have had several deep ruptures with my 't'and we have decided together the best way forward with honesty on both sides however brutal that can be-I wouldn't stick with him if I wasn't attached in some way -I actually
Find his mind a delight to spend time with and I miss him deeply when I leave and for about 24 hrs after-in the UK we don't do a lot of outside contact so the option of immediate email contact at length is not there -this period is always the time is when s h rears its head so I do understand the strength of emotions around a 't' and I often feel that the pain of it all outweighs the gain and that is a choice I have to make as an adult
but the constant and permitted paid dialogue about attachment and/or

transference that seems to occur here makes me feel very nervous for LT and her 't'
Am I alone in feeling this

None of us really know LT's T. But he strikes me as the sort that would err on the side of caution.

I dont see anything he has done to suggest that he would put LT at real risk. I mean nothing is guaranteed but his boundaries are pretty solid and clear and he would have to do some major changes to make things otherwise. Thats all just my opinion from what I see.

I think that sometimes being on the forum helps clients bring up things like attachment, transference, or other difficult topics (e.g., in my case, invading my T's privacy through internet snooping). My T once commented that I am very brave in the subjects I bring up and I thought, well yeah, because I know from the forum that people do talk about these things and nobody spontaneously combusts, and it's often useful, and I'm not the only one in the world talking about these things. But it may be that most clients don't reveal as much. They feel it, they just are less likely to say it because without a forum like this, it may feel taboo.

Secondly though, anyone who's -- say -- an Irvin Yalom fan, would spend lots of time talking about the relationship. How much of the healing occurs within the relationship is up for debate, but for some of us it really feels central. This is not cause for concern unless the T doesn't know how to handle it, I think. Hoping for a good outcome, LT!

Quick update--session went well! Posting full writeup in a bit (there was just a lot there...).

In response to Nelly, this T seems to have really good boundaries. I had some issues with my marriage counselor (MC), for whom I had strong attachment and transference, because his boundaries were fuzzy and often shifting. So I'm pretty well-versed in attachment and transference--maybe too well! And T knows all about my issues with MC--it was one of the main things that led me to start seeing him (because ex-T, who I'd been seeing for 6 years, wasn't really helping with it).

Extra session with T today to address my e-mail about attachment. T was 5 minutes late to get me, which is rare. I was super nervous going in. I joked about how lovely it was outside (it was pouring rain and just above freezing). T said maybe if you were a fish. Then he said he was late to get me because he was rereading my e-mail so that it was fresh in his mind.

T said I seemed bothered that he thought I'd only been seeing him 3 months and also by his asking how long it took me to get attached to ex-T and MC. How it seemed I'd tied those things together. I said, "Yeah, it felt like you thought I was attaching to you too quickly." He said it wasn't about that, how he was just curious as to how the process had gone with ex-T and MC. I said, "Oh...I just assumed you were bothered by timing," and he said no.

He wanted to address how I was bothered by his comparing me to other clients (his comment last session about how I probably think about him more than any other client). He said he didn't mean it in a critical way. That sometimes it can be hard to know who we are in comparison to others because we're only in our own heads. So he wanted to give a comparison. And that he was sorry it bothered me. I said was OK.

He said how with that and something else in e-mail, how I'd said I thought he felt like something was wrong with me. Which implied I was broken. But he didn't think that. He said how everyone can use some improvements, to handle things better, to live life better. And that's what this was about.

T said he wanted talk about who he is as therapist, how he gives feedback. That some people want more of a “soft” approach, where the T doesn't really say much, and have left him for that reason. So he’d understand if I did that. I said I tended to find his approach helpful. How maybe 6 years ago, would have been different. He also reiterated that he’d be straight with me if anything I do bothers him—he wouldn’t wait 3 months for it to build up. I said I appreciated that.

About 20 minutes in, I said, tearing up, "I was actually afraid you were going to terminate me today." T looked really surprised and said, "Really? How did you handle that anxiety?" I said, "I figured I'd wait to see how the first part of session went." He said, "You've done nothing to warrant termination. Plus, I'd never spring it on you like that." I said I was worried about the e-mails. He said I'd been very respectful of his boundaries. I said, "Really? I was worried because I'd sent e-mails the past couple weeks." He said it wasn't like I had pushed for an e-mail response when he said he couldn't respond. Or done anything else crossing the boundaries. I said, "Yeah, like I haven't insisted you talk to me at 11 at night" (he's said he doesn't respond to anything between 10 p.m. and 7 a.m.). He agreed. I said, "Also, with the texting just for scheduling." He agreed with that, too. I said I just worried about e-mails a couple weeks in a row. He said if I was e-mailing after every session, then he'd probably suggest adding extra sessions. But not terminate me.

I said I worried he didn't want to work with attachment. How he kept saying that he wasn't psychodynamically trained. So I worried that meant he didn't want to deal with attachment stuff. He said he's fine working with attachment. And that he believes all therapy, except stuff like very strict 8-session CBT, is built on the relationship. How the relationship is the most important part, that it might not even matter what modality of therapy you do--if it's a good relationship, it can be effective.

I also talked about how in the past couple months I went from basically two therapy sessions a week (MC and either ex-T or T) to basically just T. That seemed to be a lightbulb moment for him. He said “so basically you’ve cut your therapy sessions in half” I said yeah...plus having outside contact with them. He said he hadn't really thought of that. He asked if I might want to come more often for a bit, like twice a week or sort of an every 4-5 days thing. I said I’d think about it. Or maybe could do twice a week every other week, just for a set period of time.

I also asked if he’d ever been in therapy—he looked puzzled and said yes, for his degree—did I want to know if he understood it from the other side? I said yes, how pouring out all this stuff for an hour, then bye, see you next week can be difficult. He asked if I left some sessions feeling kind of raw, and I said yeah, at times. He said he didn't realize that, and that’s something we can work on, to make sure I’m in an OK place leaving session

I was going to bring up how it bothered me that he mentioned his wife being sick the previous session, as a reason he had to check his phone when he got a text (because of the stuff with MC's wife). But then self-disclosure in general came up, mostly regarding MC. T said how he realizes it can be an issue with me. That it seemed like I was trying to take care of him, saying, in response to the e-mail last night scheduling a session: “I know your wife is sick, so if schools end up being closed, don’t know if you can come in tomorrow.” He said I didn’t need to worry about/take care of him. That he wouldn’t offer me the time if it wasn’t available and he couldn’t be there.

I think I asked if he could have done phone call if he couldn't come in. He said how he preferred to meet in person, how he uses the phone for some sport psychology clients, like if they went off to college. But he thinks in person is better. I said, "Because you can see body language and things?" He said yes. Then added, "Maybe that session where I had my arms folded the whole time would have been better over the phone." I said, "Yeah, maybe!" And we both laughed.

I forget how this came up, but I said I had a certain impression of him the first few sessions that changed. He seemed curious, and finally I said, "Well, you seemed kind of detached and also arrogant." I said that was reinforced with his e-mail response where he wanted to be referred to as "Dr. T." He asked, "So what made you come back?" I replied, "Actually, I don't know! But you seemed different after the first few weeks. So I'm glad I did. Maybe it's just how you come off at first?"

T said he wanted to comment on something. I said OK. He said he felt like I see him as a puzzle without any pieces in it. So little things I’m learning, I’m putting in the pieces. Though they may not all be accurate. I started kinda laughing when he was describing that, saying I'd explain in a second. Then I said I’d used the exact same explanation about figuring out what was going on with MC’s wife. T was surprised at the parallel (asking if I'd told him that before, and I said I didn't think so). I said how that’s just how I am in general--not just with T's, but other people in my life.

He said how that it must be an exhausting way to be, to always be trying to figure that stuff out. But he seemed to understand that it’s related to anxiety, that it gives me better sense of control. He also said how it seems like it would be hard to be there in the present if I’m thinking about all that. I said yeah...

I said how I think a lot of it came from my mom, how she wouldn't give out much information, that I just had to piece things together. He said that made sense and would be something to discuss more in future sessions. I feel like all of that was really giving him insight into how my brain works. Like I might make more sense to him now.

I knew we were out of time. I said how last session, I'd made mistake of bringing up attachment right at end, like I'd kind of wanted him to say a particular thing, like reassurance, but he didn't. And I should have just asked. So today, I said, "So working with the attachment with me is OK, right?" And T said that it was. I could see in his eyes that he meant it.

Confirmed time for next week, then I went over to his desk to pay. We shook hands as he said, "Have a good week." I said, "You, too." He said, "Stay dry." I said, "Not sure I'll be able to achieve that one," and he laughed. Then he said, "Take care," and I said, "You too" and walked out.

LT--Wow that sounded so similar to me with my attachment talk and fears. Also my T's reaction about it

Also I recently went from 2x a week to once a week and then last week had a random second session cuz of an email LOL... anyway it's been so much harder on me with weekly. Even with all the stuff that happened to me lately. I feel more attached than I did going 2x a week, not sure why, is that similar for you?

I am glad it went well....

(((LT))) good writeup! You know i had a fear of getting kicked out when i started with this t, but it was more because i thought if i was even slightly cheerful, then my therapy would be over. I think that was because my parents pushed me to grow up so quickly. I couldnt believe him when he would tell me i could stay like indefinitely. I may be wearing out my welcome now, but for the first few years at least, i was always jumpy - insecure - about my place. In the family, i guess. Now THAT makes sense to me.

just be prepared that going more often can intensify the attachment. Like putting more fuel on the fire... In the begining my t suggested coming twice a week just while things settled down with the intense transference.... six to seven months later... still going twice a week and things are getting harder. So while for some, going extra helps, it can also intensify attachment struggles. The T relationship can take a lot of head space going more often.

I can't even describe how traumatic the session was.
Abuser contacted us right before the session. With the understanding we would see him after the session.
During the session could not speak. Just terror.
People were moving around inside the building. Walking past the room. Clanging. Banging. Footsteps. We were trapped in terror thinking he was outside the room, thinking he was coming in to get us.
We could not speak. T could not help. T could not get through the terror. I could not get out of it.
Then time was up.

He is the only way to relieve the terror.

Hi LT
I'm glad it went well
I in no way meant to imply that your 't's boundaries were not secure or that your knowledge of attachment and transference issues was not extensive:-)
My feeling of concern likely stems from a cultural difference in the way and frequency of outside contact which allows these issues to take front stage on an almost daily basis-that's not to say that I don't spend a lot of thinking time on my relationship with my therapist and the impact it has on my therapy and we do discuss it in session-it is sometimes very scary and painful and has been the cause of me "dumping" him on many occasions as I can't keep putting myself through it(I am a victim of narcissistic parents and a 28 yr marriage to a lying cheating emotionally abuse man-the level of disrespect humiliation and control exerted would seem unbelievable to many but not here on PC )
So my concern is genuine-I just hope these as yet unprocessed feelings don't undermine or overwhelm your still fairly new therapeutic alliance

This is so well expressed :-)
Kind of what I've been saying in a slightly different way that the more the fire is allowed to be fuelled( emails extra appointments etc)the more potential for some of us(I would probably put myself in that category)to become increasingly consumed by it-I have had extra appointments occ asionally (in my part of U.K. Once every 2 weeks is pretty much the norm)and although I was able to discuss a seemingly overwhelming situation more frequently which helped to process it I also am very aware that my "need" to talk to 't' also increase exponentially and I find myself thinking of more and more stuff I need to tell him and even manufacturing conversations between us in my head-to the point of worsening my already very bad insomnia and counting the days until next appointment

The pain this causes me and the time consuming nature of it makes me want to do everything I can to avoid it but then it means I have too much I want to say next time and have to spend so much time sorting the priorities as only have an hour-frequency of contact it's a catch 22 for me
I had an enforced 5 week therapy break over xmas /new year as 't' was ill and he works alone so no alternate available unless I just stabbed a finger on a very small list-the first 3 weeks were hell (s h bonanza) but by the 5th I was getting stronger and even angry with him(transference I guess) and first session was a bit uncomfortable for first 10 minutes -if I keep going over old ground with our relationship he will eventually say "we've been here before you're not too much for me I never feel that I don't want to see you but if you keep pushing me away I will eventually listen !! That breaks the thread and we both laugh and move on
Seeking reassurance is human nature and I really really get it

Monday Feb 5, 2008 session notes:
I was not in a good headspace most the day. I was talking with a friend before session. I was watching the clock. I kept saying I needed to go but not leaving. I was very early last week so I knew I had more time to stay at work than last week. Eventually, I had pushed it to 12 mins after 3pm. I still had to gather up a few things then I headed out. I got to the car with 15 mins to go.

On the drive to session I kept switching radio stations as nothing seemed to sound good. I was agitated. This sucks... therapy sucks… I don't want to do it anymore. I don't see the point of it. That's where my head was when I came to session today. Which made talking about increasing sessions very unusual. I had to keep balancing my impulsive desires to just say screw it all with the longer-term goals of being better and not losing you.

Finally, I stumbled upon "Small Town" by John Cougar Mellencamp on the radio. I let that play. It has a good beat that let me thump my hand down on my steering wheel as I drove while singing it. This let out a little amount of the energy. I had been driving more aggressive than I usually drive. I got to your office, parked, around the building, and in the first door with 4 mins to spare. I went through the 2nd door and caught it so it did not bang. I went down the stairs and went to push your button. I hit Dr. F's button at the same time and had to figure out how to turn off the light. Once I had the lights correct, I went into the waiting room.

There was a coat in the chair I normally sit in and someone else sitting further down along that wall. I ended up sitting at the end of the waiting room. I pulled out my purple ball and left everything else in my bag. After a bit a guy came in and sat down along the 3rd wall in the waiting room. As it got closer to 3:30, someone came out of Dr. F's office; the person whose office opens directly to the waiting room came out and retrieved the person that was first in the waiting room. Then the person from your office left.

A few moments later, you came out to get me and said hi. You were wearing your glasses, brown/tan capri/hiking like pants, long sleeve shirt (I don't remember sweater or not). I think I said hi back, I might not have. I was angry. We headed back.

We got in your office, I moved the pillows, sat my back on the coach, then sat down. You commented it being busy and I said yes 3:30 is a busy time, you said at least today. I said last week too. You sat down. You said something about not having a chance to check your email to see what I wanted to do about the corner. I glanced over and yes, it was the same as usual. You asked me if I wanted you to move the furniture now. I said no. You asked more about the corner. I again declined it. I said I didn't want to talk about it. You said ok.

I told you that I had wanted to talk about the more sessions a week, insurance, and stuff. You clarified the had part of my statement, wondering if I still wanted to talk about that. I said that I did still want to talk about it, that was why I didn't want to talk about the corner stuff. I was playing with the purple ball, spinning it in my hand.

I told you that I called wife’s insurance and that yes, I have unlimited number of MH visits. I said that was what the customer service person told me and then I asked to speak with someone in behavioral health. You said something about that being a good idea. I told you that they said that they do not check every claim, they do random audits and frequency flagged accounts - so sudden jumps in frequency. You made a comment about computer algorithm. I agreed.

I went on to explain how she said that if audited and denied, it would not apply to past sessions but would for future. I told you that they could even authorize only 1x wk. She didn't come out and say that directly. She said that the standard of care is 1 x wk; so, when you asked me about this, I said standard of care. You had a response to these words/this concept. I relayed that she said that she knows of a few cases that have been approved for psychoanalytical therapy but very few; that most are denied. I said that I did not tell them that I was already see you 2x week.

We talked briefly about the concept of me losing sessions. I said that I thought it would be very bad for me to start down this path and then have sessions taken away. You agreed. I said that it was funny in light of last sessions topic on how I perceive the risks of asking for things. You asked about my usage of the word funny. I said funny in that not funny way. You understood/agreed.

I made the comment about asking her the paranoid question of if just calling her would trigger an audit and that she said no. I said that I figured at that point someone calling about increasing their number of sessions to 4 x wk and talking to a LCSW in a behavioral health division shouldn't be too surprised at the paranoid question. You kind of laughed at this, in support/agreement.

You asked me how it felt to make the call. I said that it had to be done, that I needed to have information to make a decision. It was very matter of fact. I was a bit nervous of triggering an audit or having someone look to closely at things. I think we talked a bit more about this, I'm not sure. Towards the end of this topic, I said something about it not really being all that useful information. Pretty much right where I was before. I'm unsure about the order of the next few things.

Somewhere in here I told you about talking on the forums about it and how some people have this number of sessions covered a week and have them being billed as medical. You took note of that. I said I didn't know what that meant. You asked if that was here in America. I said yes. You said that you were glad to hear someone in America was covering/seeing the value of this type of therapy.

I think we returned to the topic of sessions being taken away here and the need to justify the therapy. I again stated that I thought it would be bad for me to have sessions taken away from me once started. I clarified that I meant specifically for me, who I am, and what my issues are. You agreed and stated that we will need to be thoughtful in how we proceed because of this (and I got the impression, for other reasons too). I asked you why you thought it was a good idea for me to increase my number of sessions. I continued, saying that it seemed you thought it would be a good idea; however, you could have just been open to letting me/us explore it and why I was bringing it up rather than actually thinking it was a good idea. I again got the impression that you thought it was a good idea, either through something you said or non-verbal.

You made some comment about me wanting to know the details of your thoughts/opinions, that I took as you not being sure how to answer my question, being aware that it was a tricky question. I clarified that I didn't need to know the details but more along the lines that did you think you could frame things really meet that medical needs. You said that you'd have to ask around and try to find some people that had been successful at getting it covered to see how they wrote it up and what their situation was. I understood where you were coming from on this. I wondered if you would even find someone that was successful. It does seem to be a needle in haystack situation. So, yeah, I think you think it would be a good idea or could have benefits, that might be a better way of saying it. [typing this up, made me realize that at my work they have separated out behavioral health from mental health and maybe that's part of the key there. I'm not sure how they define the differences beyond substance abuse.]

I was clear that I was wondering if you really saw reasons why this modality would be good for me in terms of issues and not just because you believe in it, that you know I am interested in exploring myself at this level - willing to explore myself at this level. It is a double edge sword... am I mentally/psychologically bad enough that I need this level of therapy and what does that mean verse no I'm not bad enough to need it, but it would be good because it would help you understand yourself better... then why do I feel so bad, I really do just need to get over myself - thoughts. It is a no-win situation. Like I wrote about, I'm not sure I really want to know "how defective you really see me". And yeah, I can't seem to frame this in any other way - I'm either highly defective or just attention seeking, neither of them are really all that positive ways of looking at this whole thing. By the way, when I brought this up to a friend, she said that if I am attention seeking at this level, then that in and of itself is a sign of how messed up I am. I’m not so sure you’d agree with that statement.

I told you about having found some links on their website about this stuff and that they define long term psychotherapy as being anything more than 12 sessions. You said something like 'what does that say about how they view mental health'. I said maybe it was 10 sessions. I said that I put the links on the website for you. I think it was here that I went on my soap box about mental health care. You just kind of let me rant here a bit. We've talked about this stuff off and on so nothing new and I've been left with the feeling that we agree on many of these topics. I said something about treating the symptoms or the causes. You responded, I don't remember if you said something or just nodded. I went on to say how my work is doing this big push for mental health right now and I don't know who to talk to about my experience.

I brought up the fact that regardless of modality, almost universally across the board, the one thing almost everyone can agree upon is that it is the relationship that is key to the success of psychotherapy. You agree and said the alliance or therapeutic alliance. More was said here, I don't remember.

You brought up the concept of having them cover 2 of the visits as out of network. I said that I had thought about that. I said that as an employee, the insurance I get does not allow for any out of network providers not even in mental health. So, if I've been working with someone and established a good relationship then to become a new employee and be told that it won't be covered at all is harsh. You question the no out of network. I said that as long as my insurance has someone that provides the service, no out of network coverage is allowed. It is only if my insurance does not provide the service will they refer out. You wondered then that maybe my insurance doesn’t offer psychoanalysis/psychoanalytical modality, then maybe we could use that as a way to get it covered. I said something about thinking that they would take the concept that they offer psychotherapy and that is good enough. It is something to ask about, I just don’t know who. I thought about you looking to get into my insurance’s network; I did not bring it up. I remembered you stating that it was something you were not interested in pursuing.

I talked about how sure one can connect to more than one therapist, but for some people based on issues/needs that might be easier said than done. Also, seeing the wrong therapist could actually cause harm. I don't think you agreed with that statement. I do. I've heard enough stories on the forum of how bad interactions with therapists can set back a person's progress or add another layer to the issues/experiences. I again state something that means if my work is going to be tackle Mental Health in a serious way then they need to change their whole mindset on what Mental Health means.

This lead to the concept of maybe me paying out of pocket for some of the sessions. You asked me if I'd want 3 or 4 visits a week. I paused and looked down. I had been spinning the ball and moving it about in my hand throughout this discussion. I focused on the ball. I didn't have an answer for you because in the moment, I wasn't even sure any therapy was being helpful. I spun the ball. I think it was here that I said I was mad. You said you could tell. You looked at the ball. Yes, the ball. I had grabbed it as a last minute thought. I talked about the th-m swing. I said that I'd start with 3 and see. Either M-Th-F or M-W-F. I asked about what your thoughts were about extending your availability, in general. I commented about maybe your thoughts were just to open up W for a while, which wouldn't help me on that Th-M swing. I said that that I wouldn’t be able to afford it in the long term if I was paying out of pocket but maybe I could afford it long enough to do a taper back down. You asked me how much I thought I could afford. I said I’d have to look at my budget and decide which items would have be adjusted and such.

We talked a little about time of day of appointments. I asked you if you knew if people coming this often had an easier time outside of session; would it be easier to leave session and go to work. You said that some people find that it is easier because of knowing they’d see their therapist the next day. We acknowledged that it probably also depending on what they were working on at any given time. We’d talked about doing a M-T-Th-F roll of thing. You made the comment that I could actually do a M-T-W-F or any combination.

Somewhere around talking about me paying out of pocket for the sessions, I said that if I was to pay out of pocket I would want to discuss more those details as to why you think the increase in sessions would be helpful. Mostly, I think what I am looking for is what you think I would gain from the increased sessions. I keep waffling on wanting to know and not wanting to know what your thoughts are about me from a clinical perspective. We've talked about this off and on in the past, or I should say that I've told you what my thoughts are around this and you've listened. With the exception of acknowledging that I was depressed when I first came to see you and at the time we had that discussion, you felt I was no longer "clinically" depressed.

This topic seemed to be winding down and I brought up how I didn’t feel like Elio this weekend. That I knew my likes and history, I just didn’t feel like I was Elio. That I wondered what were Elio likes. I said that I talked to a friend about this on how common it is and how we agreed we are not a good control group. You asked me what if it was common, I said something like then ok, it’s fine. You asked me how I’d feel if it was uncommon. I said that it would be ok, it is where I am. I was distant here, emotionally apathetic. I was playing with the ball more just moving it in my hands rather than spinning.

You asked me something like who was Elio. At first, I said I didn’t know, not me. Then I said focused, dedicated… I don’t remember what else. You said something about having an equation of Elioness. Then you asked who I was or something like that. I didn’t like your question. I was me, of course. It felt like you were looking for me to give you another name or something. I think something was said here, I don’t remember.

Then I asked if you watched the Super Bowl. (Yes, I was done with that topic.) I didn’t like how it was going and didn’t want to talk about it anymore. You asked if you should answer it. I said something, I don’t remember. You said, that you didn’t watch the game.

I looked at my watch and saw that it was close to time. I pulled out my phone and shared with you the video of the ballad to a therapist. You asked me what I thought about it. I said that I thought it was funny. I said that it’s stuff that comes up on the forum and sounds like someone who has been in therapy before. I then brought up the part at the beginning when the therapists says that they are going on vacation and how Kristen responds in that slightly shut down way. I said, it’s the “we can handle this” look/feeling. You said separations can be hard. I asked you if you knew of Kristen Bell. You said you didn’t. I said that she’s been a strong proponent of Mental Health awareness and that she’s been diagnosed with major depression (I looked it up, depression and anxiety, not major depression – per articles on web).

At some point, I brought up the topic of wanting/needing to know something is in place if something bad happened to you. I told you that it seemed you were surprised or amused that I even questioned if you had a plan. You asked me something about how that was for me. I said at the moment it was fine. You asked about later. I said it was still fine. I told you that I was thinking earlier in the day, ‘Why wouldn’t I question if you had something, my parents didn’t take care of me’. You agreed, given my history, why wouldn’t I question if you had something or not. I said that I understood that you were trying to give me space to explore and figure this out. You said that you were trying to. I think I might have said thank you to that. I’m not sure I’m grateful for it. It’s really hard to sit with it, to balance all the elements of it, and to try to figure out what it is I need so that it is not an issue. There are moments, many moments, that I wish you’d just tell me, yes you have something worked out, I’ve got you covered OR just say, nope, not going to put anything so formal in place. Though I think that later one would be very hard for me to swallow.

Time was up. I gave you, your journal. You waited for the I love you. I didn’t want to tell you I love you. I wasn’t as mad. Finally, after several breaths, I act like I’m going to get up. You say ok, and something else about seeing me on Thursday or having a good weekend or something along those lines. I stayed seated, breath, and tears start. I repeat to myself, I’m not sure if I say it loud enough for you to hear or if it was just in my head, ‘you have to go’. I am trying to get myself to move. Finally, I say that I don’t want to go. You said, “I know”. I said that I didn’t want to tell you that I love you because that means I have to leave. You started to say something, “even if you…” I interrupted you and said even if I don’t say it, I have to leave. You started again and said, “even if you don’t say it, I know.” I said that even if I don’t say it, it doesn’t mean I don’t feel it (I’m thinking I might as well say it, I feel it). I think you said I know to this, things were kind of swirly at this point. I said I love you. You said, “I know”. I said that sometimes I wish I didn’t. You asked if I thought it might be easier if I didn’t. I said yes.

That’s not really true because when I lose that loving feeling, I feel so much worse. After session, I wonder why I even said it. Was I mad at you, was I trying to take out any of my anger out on you? Did I hurt your feelings? It was such a mean thing to say.

I get up and slowly work my way to the door. You are wishing me well and see me in short order. I don't think I really respond. Out the door, up the stairs, and out to my car.

Yesterdays session was so intense & completely drained me, this is the major point that stood out for me:

"That I was hostile and attempted to drive him away by saying and doing mean things. That I became my father. "

"Good because I want to hurt you ... because I love you"

I developed an intense attachment to my T and was going once a week. The time between sessions started to become unbearable and I found myself wishing the week away and feeling anxious. We changed to twice a week and it has helped me greatly. I don't think I am anymore attached than I was before as it's still just as intense but now less painful. I also feel twice a week for me has allowed me to move at a better pace and delve more into things. Before it I found I was spending 20 minutes of each session just recapping on my week before I could get any real 'work' done. The one negative I would say is that going twice a week does mean a lot of my headspace is taken up with thinking of T and therapy in general. This was happening when I was going once a week though. The difference is when I was going once a week a lot of that headspace was taken up longing for T and for my therapy day to come along but now it's is filled with more productive things like thoughts and insight on what we've talked about etc. Often stuff comes up in one session and I don't get the chance to process it fully until after the session. This comes up afterwards and thankfully I don't have to wait a whole week until I can revisit it.

For me, as someone who had developed an intense attachment to my T going twice a week has helped me.

I had a session with my parents. T wanted to see and hear them. She thinks its important. It was hard. I didn't had the energy for it.

Session yesterday... (just as a background my panic disorder has not been great lately) so when t finally came and got me I was on the edge of a panic attack. I told him that as soon as I sat down in his office. And the cbt in him came out a bit. He reassured me that it’s ok if I do have a panic attack, and then helped me get grounded by doing a quick guided relaxation exercise. It helped really well and I was able to not have a panic attack and even calm down enough to have a productive session.

He did challenge my logic about being in control and even said I had some twisted logic, when it comes to my need for control and it trumps my need to survive. It doesn’t make a whole lot of sense, and the comment stung a lot, but it has challenged me thinking a bit and that is what I need to do when I get stock in this cycle of irrational thinking with the panic disorder.

At the end I asked if he had any openings next week because I had been spacing my appointments out a bit lately. He didn’t have his computer up and running it so he asked for me to schedule at the front desk. I was surprised to find out I wasn’t scheduled for a good month(which is a mistake) and he was pretty much book solid. Thankfully we got it all worked out and I will see him next week.

In session today, I felt behind museum glass or separated from my T. This has been going on since the holidays, whereas before that we felt like a tight team with a very solid rapport. I'm not sure if I had previously romanticized therapy and my T, and now have a more realistic view of the relationship or if there is an unrepaired rupture.

We talked about being grounded in the present as a sign of mental health, and how trauma gives a sense of a never-ending story in which time never really passes from taboo or terrifying events. He gave me a really touching metaphor from the lion/witch/ wardrobe. I lost a baby and he dotes on his two young kids; there is a constant tension or awareness of that discrepancy in our talks. He often gives me a Harry Potter or a children's book image, and then searches if there is pain that stems from his reading these things to kids. I find it very human- and it's like one planet signaling to another - it is poignant. I am good with it in metaphor, but I do get out of attunment when he talks about the challenges of co parenting well etc- I find it insensitive I guess.

Part of the problem is this is the first time I have committed myself to talking about what my T calls "extreme" childhood trauma. He finds it fascinating the dissociative devices I used( unconsciously) to be high functioning and just to "overlook" the facts of my own early life story. Truthfully, I did kind of regard it as if it happened to someone else, and couldn't affect me so long as I worked hard and performed well, and I also did well in relationships of all kinds- a strength.

However, now that we have stripped away defenses, faced difficult truths, did prolonged exposure to some specific memories etc, it is like wounds that had been bandaged for decades suddenly reopened.

There are times I feel so angry he sends me back to city streets in tears, and there are times I feel pushed too hard to also fulfill my responsibilities in real life. What is new though, is the holidays really highlighted how much this is a job for him, and while I am a challenging case and kind of street cred for my T, he doesn't have real skin in the game person to person. That IS appropriate, it just doesn't feel very good.

I have this feeling like before breaking up with someone in real life- like a failure of feeling or a central apathy in which my capacity for caring about the relationship is dwindling, but I don't want that to happen. It's weird.

Have you talked to him about how Christmas affected you and it highlighting the whole, just a job thing?

I did try to talk to him about it, but it really got out of control and was an anomaly. He said he felt shut down by my sudden sadness, that he did care, that he did think about his work outside the fifty minutes, that it is completely my choice if I tell him the reason I cancel and that he wouldn't get sad with me if I miss here and there, that there's not much difference between 5 sessions and 8 sessions if it is all ongoing.

I think the reason this elicted such a negative reaction from me is that he is worries and reads into it if I am 3 minutes late, and analyzes why; if I cancel he thinks it is resistance etc. I guess I just didn't buy what he was saying. It felt like a matrix mind game. On the other hand, it is petty to hang on to the issue.

It definitely was memorable how poorly we communicated and how we didn't understand each other's viewpoints at all. I told him I felt like he was daring me to quit, and then he kind of said this is escalating on its own and we don't want this. I agreed, I said I was sorry, and that I probably did overreact.

It could be the problem is I apologized when I wasn't sorry to kind of appease the situation, and he was quick to see it as my issue .

It is very rare for me to get in any kind of conflict with anyone, especially people for whom I care- the conflict itself scared me, and it never resolved, but just got shelved.

It left me with an aversion of some kind, to the same level of conversation and confiding, and a sense of faking it.

At first I didn't know what to talk about today. I told T I missed him the whole week. Talking about that led to anxiety, which ended in hyperventilating for half a minute or minute or so. After that I was feeling a bit better. T mentioned how one of my friends usually calms me down during such episodes by hugging me, and since he's my T he couldn't really do that. From there we started talking about my issues around physical touch, especially hugs. He mentioned I might be suppressing something, which triggers lots of confusing emotions whenever I get too close to someone.

Feeling really exhausted after that session, but I guess sleeping will fix that. He mentioned he will be going on vacation for a week after my next session. I might ask him to hold my teddy bear I bring every time for a bit before that, but I'll probably be too scared to manage to do that.

Well, we had a breakthrough. A very very necessary breakthrough.

The session started off rocky. I arrived 30 min early, sat in the waiting room, and attempted to check in as to what parts were where, but I couldn't stay present enough to grasp any of it. I was very fragmented and shaking. I went up with C and, while there was no anger or upset, I struggled to string words together.

We did sort out things from yesterday (thank god I'd written things down that I wanted to say), but beyond that, I was eventually finally able to present parts in a visual concept that resulted in C finally understanding something he hadn't before -- the crucial point, actually.

I'd sketched out how it works for me by drawing a cross-section of my head from the top (ha) and dividing it into 3 parts like a 'car' kind of - to use my car analogy. I pointed out where eyes and ears were and put a little steering wheel on the 'drivers side' of the head. I X-ed out the back portion - the 'trunk' - to indicate any part back there was not aware of what was going on out here. There are, however, also parts that aren't even in the trunk - they just aren't on the diagram at times. I guess that would mean I'm unable to 'find' them at that time.

Then, using the colors some of the parts have 'picked' for journalling, I drew out where each part had been during yesterday's post-attempted-robbery session. (Actually, I did that yesterday). I'd also spent a few times today checking in and re-drawing where everyone was when I noticed big shifts.

At first, C said it wasn't news to him - it was all what he already thought. I said that was ok - if this was how he already understood it and I was confirming it, that was ok. But, then, finally while I was pointing out "this is why I got upset because you see this part isn't the same part as the 'me' part" and he said something like "the way I see it, you are the big circle - the head."

I immediately exclaimed "No! Oh no! Not at all! That's just the head, me and the body aren't the same thing!" And that, ladies and gentleman, seems to have been the ah-ha moment for C.

Does he understand everything? No way. But, neither do I. And, by that point, the part I call "GSD" (as in "get s*** done") had fully taken over, and I was but a passenger. GSD understands the system far more than I do, it seems - she has far more access to information than I or any other part, I think. She spilled so much to C. GSD, you see, has this awesome ability to totally wall off all other parts in such a way that there's no backlash after those walls come down. The other parts don't hear, see, and they don't seem aware that they've been kept out of something either.

We wound up talking about so much: about how some parts have their own clothing, about how the parts have different appearances, some with different genders even - about the struggle to keep some parts from drastically changing my body's appearance, etc. We talked about why I know my husband would be scared/worried if I told him all of this, about the part with the SH/ED behavior and how it has scared him in the past. About some parts' abilities to use these walls to take over in such a way that other parts that might stop them (from SH for instance) are unable to do so. About parts that I have horrible 'working relationships' with...on and on.

GSD seriously almost shook his hand at the end. I laugh. She ended with "thank you so much for taking the time to fit us in." and even made statements about "we have plenty of time to talk more about (can't remember what part-related topic) on Monday; it isn't far away." It's a bit eerie to me...being so much more aware of parts. I can't really decide if I like it or not... it is kind of one of those ignorance is bliss things, I think, sometimes.... I said to C that this is just always how I've worked... but this is the first time I've ever spoken to anyone about these details. And, it's true... despite having gained some awareness 10 years ago (and then having lost it), NONE of the stuff that came pouring out of GSD today was the same as what I understood 10 years ago. Honestly, most of it was stuff I didn't even know....that is a weird feeling. And it absolutely wakes up those 'this isn't real' parts. (Which, btw, we also talked about - that some parts' primary objectives are to keep the system a secret....and THAT is why this is ridiculously hard to talk about -- especially out loud.)

One thing C said that I'm not sure is accurate and we'll have to discuss later is that the "me" part I indicated on my papers is the "essential me" that has always been there. I do not think that is entirely accurate, but, I'm not ready to dissect that at the moment.

I was anxious walking into the session. As I was telling a friend before I went in, the second session is always the worst. There's a formula that all clinicians tend to follow in the first session. "Tell me about you and your history, but at a safe distance. I'll tell you a little bit about me, and I'll see you next week?" That's safe. That's known. In the second session, you still don't know who the clinician is, and they don't know you either, so the dance is awkward and fills me with anxiety.

At the end of the last session, he had given me a scale about dissociation that we spent most of the session discussing. He asked me questions about the things that I ranked highly. For instance, I apparently dissociate a lot when I'm driving. I hate driving, so I don't want to actively think about it. It's just something I do. I also have a tendency to dissociate from pain. It's why I'm still largely functional whenever I have my migraines or whatever.

There were a couple of questions that he asked me that were uncomfortable, and he commented then on my anxiety. He also mentioned that he noticed it when I first walked in as well. I said that I was anxious, but that I was okay to continue talking about the screener. "Well," he said, "I want to go at your own pace. So if something becomes too much, just tell me and we can switch topics." I told him that I struggle with that sense of agency in change. I don't advocate well for myself at all.

"Okay," he replied. "What if we came up with some way for you to signal to me when what we're doing is too much. Then instead of you using your words, you can show me the sign, and instead of me acknowledging it, I'll just discreetly change the topic." I was confused. What kind of sign?

"Well, this is just an example, but that pillow to your right, the one that I can see. What if whenever you were feeling a high level of anxiety and we need to move on you can turn it over to the other side. It's a different color so it's very noticeable." I picked up the pillow and looked at it. He was right. One side was rainbow and the other side was teal (so basically my dream pillow.) I said I liked the idea, so let's go with it.

We continued on discussing the screener, and he mentioned something that we had discussed earlier that gave me a great deal of anxiety. I told him something very personal that I've never discussed with another human being before, and it just felt very intimate to discuss, because it's something that I do by myself only. So I flipped over the pillow.

"So I told you that I had a few things I wanted to try to do today. One of them was to explore some coping skills that might work. I thought maybe we would try one now. Would you like to blow some bubbles?"

I looked over at the little end table next to me and there was a small thing of bubbles sitting on it, like what you might get at a wedding. I opened it up and blew a few bubbles, and laughed when he started to pop a few of them with his finger. I did the same. "How do you feel now?" he asked.

I was okay, and we were able to make it through the rest of the screener without any other major incident. Then we talked about some of the other coping / grounding skills that he wanted to show me. We talked about the idea of visualization a little bit; I work with it a lot at work. He had some candle samples to see if smell was helpful. I kind of shrugged my shoulders at that. I don't have a great sense of smell to begin with, plus I'm still super congested from my bout with the flu, "Yeah," he said, "I probably should have realized."

We went back to the screener for a moment, and he said that he was impressed with my ability for insight and the way that I was able to articulate my feelings and experiences with things. That it sounds like I have a tendency to dissociate at times, which seems to be adaptive in my actual life, but might be a hindrance to therapy at times, because it's easy to dissociate if it's already a coping mechanism that you can activate when stressed out/triggered/whatever.

I kind of shrugged my shoulders and said yes, but at least we were having the conversation. I hadn't ever discussed dissociation before with another therapist, and I guess I assumed I didn't do it often. The reason is because I have had very severe dissociation before, where I did feel 100% out of my body, but in my everyday life I apparently have the predisposition to depersonalization and derealization.

He took the time to emphasize again that while it's important to recognize our coping mechanisms, he also doesn't want me to push myself too far too fast. This is when he attempted to reassure me. "We're in this together, I'm not going to abandon you, etc." This for me was very hard to hear. I like the idea that he seems invested in my success and wants to see this through to some type of conclusion, but I also don't believe it at all.

RoboT never said these things to me, that he wouldn't abandon me or that we were in it together. He looked at himself more as a guide versus an active collaborator. So we weren't in it together, and he was going to abandon me. Granted, I left him before it came to that, but had I stayed like I originally intended, he would have left me, and it would have been in a state worse than what I came to him in.

So when New T (nickname will be Bubbles) said that, my anxiety went through the roof. I said to him that I knew I was projecting onto him, and that it wasn't fair. He said something like, "on a human level I'm touched that you care about the fairness of this all, but as your therapist I don't care. My feelings aren't important here."

Which made it worse. Because RoboT interjected himself so much into the room that his feelings did become important.

I tried to deep breathe to soothe, it didn't work. I tried a couple of other things, and they didn't work either. "It's okay," he said. "I'm not going anywhere, not now or in the future." Which, of course, didn't help. I looked at the clock and we were 5 minutes over, which made me feel terrible. Somehow I pointed out the time.

"Are you thinking about hurting yourself?" I shook my head yes. "I meant it when I said last week that I'm not going to make you leave if you're activated like this. It was concerning last week when you said that you used to go home and hurt yourself after therapy."

So finally after trying a few things to calm me down, I ended up blowing more bubbles and popping them. He said that popping the bubbles was the best part, and I agreed. He asked me to scale where I was anxiety wise, and it had gone down enough for me to leave. I didn't think that my schedule would allow me to see him next week, but it worked out that I'm seeing him on Wednesday.

daisy: he sounds really great!

I don't think you overreacted.Could you bring it up again? As this is something that's still on your mind and tell him you apologized for appeasement, not because you meant it.