My Therapy Session - Part 4

(This is a continuation from Part 3, where I write about what my t said)

PART 4

My t said that when she says or does something that makes me feel very hurt or unsupportive, I usually have an immediate cascade of thoughts and emotions. The cascade can last for hours or days. If it continues long enough, it leads to the point where I am ready to say "SCREW THIS, I QUIT!" By that time, I am so upset or angry that I have built a huge wall around me, feel distant, and am convinced that everything is hopeless and no solution exists. By then, I feel desolated by the experience, drained by my emotions, and exhausted by the whole situation.

My t said that when I reach that point, I am numb. I am not really "present" in the room. I am disconnected from her. My t said it is "that" part of me that she feels has been showing up in her office the past few weeks since our rupture.

My h agreed. He said he could tell this past month that I have not been myself. He said I have seemed different this past month, kind of distant. He said when I get upset, I go somewhere inside myself and won't let anybody in. (Those are the time when I start misplacing and forgetting things - which are indicators that I am dissociating.)

Then my t asked me, "Would it be possible for you to let me know RIGHT WHEN you first notice that I've said or done something that upset you? If you pay attention to how you feel in your body, could you let me know what's wrong BEFORE the whole cascade of thoughts and feelings begins and you spiral down to the point of no return, where you are ready to say, I QUIT!" She asked, "When you first notice you're feeling bad about something I've said or done, can you say, 'Your reply didn't feel supportive to me. I wish you had done such and such.' "

At this point in the session, I started feeling fuzzy in my mind and couldn't think. I kept forgetting what she was asking me. I had to ask her to repeat it twice. It took a few minutes to figure out what she was asking.

To be honest, I am not sure I am aware enough to tell my t I'm upset before the cascade of thoughts and emotions starts. I DO know when something has upset me. I have the awareness at that time. But the cascade starts almost immediately. Once it does, I feel like I am already caught up in it.

During the cascade, several different explanations come to mind about what has happened between my t and I. With each different explanation, there are different feelings that go with it. It is like there are several people presenting different arguments in my head. Each argument feels true and the feeling that goes with it seems justified...until the next one begins. I'm not sure I am making sense, as this is very hard to describe.

So that's what happens during the cascade that leads to the point of no return. My t wants me to tell her I am upset BEFORE the cascade starts. Can I do that? It sounds so easy, but it is not easy to do. Once something triggers and upsets me, it seems to happen automatically.

So my answer to my t was, "I don't know if I can do that or not, but I can try."

(more to come in Part 5)

I can try is a perfect answer, and yes you make perfect sense to me.

My T considers this a form of disassociation. When you can't track what the other person is saying because your head is fuzzy and for me it's like the words bounce off me, I don't know what they mean. It has taken some time, but I think my T has started to catch my body language around this place for me and has been able to ground me back the last few times. One thing that I think helped was after the fact letting her know when things went fuzzy for me, when I lost connection.

T3 has suggested that I raise my hand when I start feeling fuzzy. I find that easier that saying something.

I like that, I will try to remember to tell my t about it.

Peaches, as part of learning to do that (tell your t as soon as you are aware of it) you can just do the best you can as see where it takes you. It doesn't matter if the cascade has already started before you become aware and present enough to say something. By letting t know at that first awareness of it it will still be sooner than you have let her know before. It's okay to not be perfect at it yet.
Each of those different arguments probably are true and justified. Every one of them is real even if they are opposite and different. Every one of them needs and wants to be heard.

Agreed to all these points, and also for someone who has issues with dissociation, your recall of your session(s) is amazing!

I told my T I was having difficulty hearing her, it's the first time I could say anything and about all I could manage. She at first thought I meant she was speaking too softly but then got what I was saying. I agree with having a code or something you can do as it may be too hard to be specific

Thanks, Velcro. When I leave a session, I remember portions of it. Then, other pieces of the session come back to me the next day, or the day after. Some bits that felt fuzzy in her office will suddenly make sense. My mind will start working to put the events in chronological order. Eventually, I can form a pretty good summary of what happened at my session, which allows me to write it down, either in my journal, or here.

It's a "putting together" process. Like taking puzzle pieces and fitting them together until you can see the picture...or like being a reporter, and taking notes jotted down from an interview, and rearranging them until there is an understandable story. The more time that goes by following a therapy session, the more I understand what happened.

I seem to remember my session in stages. At first, I go over and over it in my mind until I can remember "the facts."...what my t said, what I said, what happened after that, how she reacted, etc.

After I have a pretty good idea of what happened in the therapy session, I will start getting feelings about it... why did my t say that?...why did it make me anxious when she did such and such?...why did I want to avoid that topic?

The last part of understanding my therapy session is getting a grip on what I learned in the session...what was the main point of it? What was my t trying to get me to think about? What did my t want me to work on this coming week? This is the most difficult part for me. I'd say it takes every bit of 1 week or more to get to this point.

On the other hand, if I am super busy after I leave my t's office and don't have time to sit quietly and think about my session, piece together the facts, or pay attention to how I feel, I'll forget a good majority of the session by the following week when I go back. I might only have a fuzzy general idea of what we discussed and a few blips of conversation I can recall.

The more I dissociate in the session itself, the less I will remember what happened. The more present I stay, the more I remember.

Even though I get confused by my dissociation, it is considered co-conscious. I never lose so much awareness that I have "woken up" somewhere I'm not familiar with.

If I dissociate at work, and it isn't very bad yet, I can usually know it enough to get to the bathroom stall so I can reground. If I am not able to recognize it and leave the office, and a coworker stops by, they may notice that I seem "not with it" or "upset," or that my eyes are red and teary. That is why it is so important for me to learn how to catch the dissociation right when it starts and get control of it.

If I dissociate at work, due to a trigger, and can't get myself calmed back down and regrounded, I have had to go home sick. Thankfully, this happens much less often than it used to.

Hi Elio,

It's interesting that your t can tell by your body language that you are dissociating. My t seems to know also when it happens, but I am not sure HOW she knows. I know I must either look or act or sound differently, but I've never actually asked her how she knows. She will just say something like, "Who just showed up to 'take you out'?" or "What other part just stepped in and took away your feelings?"

Hi Kecanoe,

That's a good idea! My t seems to notice it before I do. In your case, do you always notice that you are dissociating before your t realizes it?

This sounds like a very similar process I go through with my session notes and why they are important to me.

Hi Amyjay,
You're right. If I can't get enough awareness to let my t know when the cascade first starts, I will try to let her know whenever I DO realize that there's a cascade happening because something she did or said upset me.

What you said about all of the differing viewpoints and feelings being true and justified...that's where I get so confused. How can they ALL be true? The way I end up feeling about my t totally changes, depends on which part of myself I listen to and believe.

Hi JaneTennyson,

Do you have a code word you use with your t to let her know you are dissocating?

This discussion of dissociation is interesting to me because my T has said I dissociate a lot during my sessions. I'm not sure how she knows because it happens even when I'm looking at her. I'm not present, she says.

Does direct eye contact bring you back, or doesn't that help? My T put her feet on top of mine as a way to ground me. Peaches, has your T done anything like that?

T knows when my mind is elsewhere more than I know. I don't know if it's that I'm easy to read, or if she's very attuned to me. It must be because their job is to pay close attention to our body language.

Hi Rainbow,

No, my t has never put her feet on mine. Sometimes if our session is over, and she is afraid that I am still not fully present, she will have us stand up and throw a fuzzy pillow back and forth, or stretch and move around, feel my feet holding me up, notice things in the room, and stuff like that.

I'm not sure if looking in her eyes helps ground me. Hmm...I have to think about it...

I think it depends on which part of me is present. If it's the dissociated part of me feels like a child part, it is almost impossible to look in her eyes...and if I do, it seems to keep me in that dissociated state.

Trying to notice different things around the room helps ground me more, or things like throwing the pillow with her.

I think its just because they are unintegrated. Like in a non-dissociative person they may still experience all of those feelings (because I think its pretty normal to have many different feelings about upsetting things) but be able to "own" and accept all of them. Like they can say "I feel this and this and this as well!" Whereas with traumatic dissociation particular emotions might be attached to traumas from the past, so it isn't "safe" to feel them or own them because it brings up stuff that is disowned and repressed. So they are "disowned" as "not real".
I do this all the time! So much of my stuff is "not real". It makes it really hard to know what is valid and what is not but I am learning to see that all of it is valid and real. (Slowly!)

Getting upset by something T says, dissociating, getting fuzzy, becoming exhausted... sounds like a form of uncontrolled exposure therapy. And sounds very distressing and maybe traumatic. I can't help thinking about first-do-no-harm.

It's common to talk about the client needing to get grounded before end of the session, or having trouble coping later. But these are signs of emotional and nervous system dysregulation, and if the session is that overwhelming then what the hell is going on?

Budfox, what is going on is standard trauma reactions. No, it isn't caused by therapy. It is caused by abuse and trauma. Yes, the trauma reactions are triggered in therapy and also by the therapeutic relationship. No, that doesn't make therapy the problem. The trauma reactions are triggered by every day life and every day relationships regardless of whether a trauma client is in therapy or not.

hi peaches,

i've been reading all your posts, parts 1-4, and can't help but to completely relate to much of it...at one time, this was exactly how many of my therapy sessions were going, becoming triggered, dissociating to other parts (alters), and the session being one big fuzzy blur. often i was leaving in a dissociated state as well, struggling between sessions, not able to get enough support from my ex-T. this caused a lot of ruptures with my ex-T because either he was misunderstanding me or more likely, i was misunderstanding him because i could not fully register what he was saying when i was in these dissociated states.

i know that this may not be a solution or option for everyone who struggles like this in session, but halfway through my years of therapy, i asked my husband if he could come to a few sessions to support me and help me from 'misunderstanding' my T as we worked through yet another rupture. it was so helpful to have him there, that he continued to go to most of my sessions until i was ready to terminate (2.5 years later, twice a week for much of that). he could help explain the things to me during sessions that T was trying to say, especially when i was stuck in one of my many child states, and he also helped to convey things i was trying to get across to T. after sessions, he could help me remember the session and the things that T and i discussed. this assisted me immensely with processing after my sessions and since my husband was involved in the sessions and knew the difficulties i was struggling with, he was able to offer the proper support between sessions that my ex-T could never fully do.

"Given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good."

If something triggers a traumatic reenactment, it's reasonable to ask whether that something ought to be stopped or at least reevaluated. Not doing so means abandoning common sense and concerns for client safety.

But her T DOES step back, often when Peaches is triggered.

I have struggled with my T to let him know when the cascade is happening as well. I would keep in mind that it's not like your T expects you to suddenly catch it before it happens--that's expecting too much, in my mind. But if you focus on letting her know as soon as you are able to, it may get easier in time to notice when it's happening and let her in on it.

It got easier for me but it took a lot of time and a LOT of practice and misses where I couldn't tell T what was going on. And in time the dissociation became less profound and distressing to me.

I wanted to update everybody regarding the situation with my t. She is on her vacation now (cruise to Croatia and Italy). This is the second week I haven't had my session. One more week to go before I see her.

I haven't consulted with a different t. I thought about it, but I didn't want to do it behind my t's back and she was already on her trip.

I mentioned again to my husband my idea about going to a different t. He still doesn't think I should switch t's. He has done it before and says it was difficult and stressful. He reminded me that my t has stuck with me over 15 years and has helped me a lot, despite this one repetitive issue we keep having.

He reminded me that I'm grieving over the death of my mother-in-law recently, and if I throw away my relationship with my t now, it would be self-destructive of me.

I'm pretty sure that both my t and my husband think that the reason I'm making such a huge deal over what happened with my t when she was in Portland is because my MIL's decline and death was already a huge trigger for my issues with loss. So any misstep by my t feels like a huge betrayal. I'm not sure what I think. I guess it's possible. I never have any issues with my t about anything other than her lack of responsiveness or bare bones support when I'm in a crisis. But that's my biggest trigger!

While my t is gone, I'm supposed to be thinking about what direction I want to go in my therapy. I've already told her no more working with dissociated child parts or talking about childhood traumas. I know she doesn't like me saying that because she thinks it's necessary to do that in order for me to heal. But I told her that doing that work makes me dissociate, regress, and feel helpless and scared...I can't contain it when I leave...so if she can't support me between sessions when I need it, I'm not going to do the work.
Period. My coping skills just aren't enough when Pandora's box is opened.

So...what should I suggest we work on when my t returns? Going back to the DBT book we didn't finish (we were about 2/3 of the way done). Doing the Journaling for Anxiety book (which we barely started)? Something else? My goal is to do something that will keep me in my adult mind and hopefully make me stronger so that I can take care of my own internal scared child parts when I get triggered or dissociated. I don't know if that will be possible for me down the road. It isn't now. But relying on my t to do it for me when I can't isn't working.

Does anybody who has been following my recent threads have any good ideas about what my t and I could work on when she returns from her trip that might help me move forward and out of this repetitive rut with my t of needing too much support and it not being available?

I don’t have any ideas but I think the ideas you mentioned, some of the undone work you’ve already started might be a good starting point.

For what it’s worth, I think you are wise to understand that you cannot do the kind of work you were doing without additional support. That sounds like a reasonable boundary to set.

I suggest you work on developing and strengthening coping skills in order to prepare you better for tackling the trauma work.
I hear you saying that you won't work with dissociated child parts unless t begins to help you between sessions when you need it most, but that sounds suspiciously like a child part driving that anyway so you might not have as much say about that as you would like, unfortunately.