In Session Today: Part IV

Sigh. Session today was mostly useless. My brain is shut down and I have no topics or thoughts or emotions to talk about. My T says it is depression. I don't know.

She is trying really hard to get me to go do an intake for a local recovery center, sort of a in-between place between once a week outpatient to hospital.

I had an extra session with T this week, as I was having what I called an overshare hangover. It was really painful and I felt really vulnerable. The extra session really helped. He was so accepting and understanding that I started feeling more comfortable talking to him about what I am really feeling on a range of topics. I feel like I am starting to understand myself more, like the way my brain works. I have a really excellent T, and he consistently continues to help me with whatever I need to work through. It is such a relief to know that I can tell him anything and that he will help me work through it.

I fought with my fear about saying but I told my T that there is a part of me that can't let go of the hope we'll one day be friends, even though the rest of me knows it's not possible. And that this part thinks I'm ruining my chances by talking about it.

T said... "that's a little bit of what I was naming last week. I think if we had met in another context we could have been great mates [in the British sense of friends]. But we met in this context, so we can't be".

In that one statement I was simultaneously overjoyed and heartbroken. Even though I already knew it.

I feel bad. My bill hasn’t been correct for months. No one has gotten back to me. I ended up running into the billing guy On my way out. I went into his Office and I explained that he had told me in April that my therapist was billing my insurance wrong and my bill was way less. He seemed confused. He thought he had already talked to her. He checked his records and she forgot to code some sessions correctly. He said he would tell her to go back and code them correctly and if it didn’t work, like if she was locked out of those sessions, he would lower my bill.

Does this sound like I’m trying to get out of paying my bill? I mean, the bill is wrong. Plus he didn’t return my call for 4 months. He said not to worry about the bill right now. That it might be another couple months before the correct bill comes.

I just feel bad.

I had this same conversation with my therapist today. It was revisiting a years' old talk in which I'd brought up the hope of friendship after we ended and received the same response - that we could have been good friends/colleagues if we'd met under different circumstances.

In the meantime I've pretty much come to terms with the impossibility of friendship and so was thrown today when she reiterated that she thought we'd make good friends, but didn't explicitly add the part about that not actually being a possibility. I know it's not, but my heart can't help but wish otherwise.

I had my first session of therapy two days ago. Last time I was in any form of therapy has been more than three years. It was not easy finding a psychologist in my language. But I actually found one working in the same community as where I live and he even had time to start new therapy directly (many patients are on holiday apparently).

I was a bit sceptical at first, but I am very motivated to go so I didn't cancel the appointment. I used to do that a lot in the past.

The first impression was all right. I didn't really know what to say. But he asked a lot of questions and although at first I got the impression he went in the wrong direction, I was astonished that he analysed me correctly in just 45 minutes. So I'm not that complicated I guess.

I remember many people have tried to analyze me during hospitalization. Lots of questionnaires and stuff. But this psychologist just got it without the need of extra tools. So it's worth paying a bit more to go to private practice.

I'm very glad I went. I hope he'll be able to help me improve. I have a new appointment next week.

The therapist started threatening hospitalization. She doesn't like my behavior. I didn't want to go to the hospital. I felt cornered. I meekly told her I would cease the behavior she dislikes. She wanted to know why I decided to do that. I told her I didn't want to go to the hospital. She said fine, but she would do that if she had to, to keep C safe . I sat in sullen silence.

I think the therapist hypnotized me or something, because somehow, we wound up talking about abuse yet again.

Session with T this week was earlier than usual.

Talking about a previous romantic relationship which is largely where my PTSD comes from

T: The things he did to you. They were wrong

Me: I suppose. I mean, maybe he wasn’t thinking clearly. Or maybe he was doing what was natural to him, but I just took it the wrong way.

T: Why are you letting him off the hook?

Me: I’m just trying to look at it from his perspective

T: Yes. We seem to be establishing everyone else’s perspective but yours. Out of all the voices in this narrative, yours is the quietest.

Me: I just want to make sure I am being fair to everybody and I want to make sure that what I say here is as accurate as possible. I’m not the only person in the world, you know.

T: No, you’re not the only person in the world. But in here, during this specific hour, you are. So how do you really feel?

Me: I don’t think that’s important

T: You didn’t answer my question. I asked you what you felt.

Me: I FEEL like that’s not important

T: *smiles and starts talking gently* Come on Em, you can do this. Try.

*very lengthy pause*

T: Say what you need to say.

Me: What happened was heartbreaking. And right now it feels unfair that I have to deal with this before I can really move on with my life.

——-

Feels like my sessions are getting tougher.

T yesterday. He opened door to waiting room, I walked back, and he said "hi" quietly to me as I walked by him. I said "hi" quietly back. We sat down. T said it had been a while since we'd seen each other. I said "well, not really that long." T: "Longer than it it usually is." Me: "True." I said I felt maybe a little silly about the whole e-mail thing (that I'd sent the night before he went out of town) because I think I did mostly OK while he was away. T: "You said 'mostly,' so I'm guessing there was something difficult?" I said there was some stuff with my daughter (which is in TMI territory, so won't go into it here).

I proceeded to talk about that for a bit, with T listening, seeming understanding, and giving me a bit of advice on a particular issue (I have to wonder if his son had issues with it as well but wasn't going to ask). After about 15 minutes, T was like, "Are you feeling OK talking to me after the break?" Me: "Well, I'm kinda nervous, which is why I've been rambling on about this for 15 minutes." T: "It's normal to need some time to adjust." Me: "Yeah, but really it was only 6 days, so..." T: "Still."

Me: "I was kind of concerned that since I did OK...you'd think I was overreacting with the e-mail, with worrying about you being away." T: "I understood why you were concerned." Me: "OK, thanks, but I guess because I did OK, that I didn't reach out to you again, I worry that you think I was making a big deal out of nothing. That I could manage OK on my own." T: "I think it's good you did OK." Me: "Thanks, yeah, it's just more that...will you not believe me in the future if I'm worried about something like that?" T: "I don't think so. I think this was just one particular time." Me: "True, I guess if the week had gone very differently, maybe I wouldn't have been OK and would have felt need to reach out." T: "yes."

T: "Can I ask you something?" Me: "OK." T: "You keep bringing up the fact that you worry you shouldn't be seeing me twice a week. It feels like you don't think you deserve that. Why do you think that might be?" Me: "Well, I see people on PC who go twice a week, and they're dealing with really serious things. I guess I just feel like my stuff in comparison is just not as big. I worry you think I'm malingering or something." T: "I don't think that."

Me: "Or maybe it's really what I'm thinking. Like, I'll think, 'Oh I'm managing pretty well, why am I coming so often?' But then I think about things that show I'm not really OK. Like...I didn't tell you about this at the time. But a few weeks ago, when I'd sent you that e-mail saying all the negative things about myself,

Shifted back to the my not deserving care thing, that I thought I hadn't struggled enough. T: "Sort of like the 'Big T' thing?" Me: "Oh, like the big-T vs. little-T trauma? Kind of that. Or like we'd discussed before, how some people had really awful childhoods but mine wasn't really that bad." T gave an example of neglect, that there could be a really acute case of it, a particular incident, or it could be something that happens over time, where it may not seem that severe at a glance, but it's more the chronicity. Me: "The what?" T: "The fact that it's chronic." Me: "Oh, 'chronicity.' I don't know what I thought you said. Are you saying neglect from my parents?" T: "Not necessarily, I just chose neglect as the example. I was more thinking of the chronicity of your anxiety and OCD from when you were a kid." Me: "OK, though there was also the fact that my parents didn't give me the support I needed for that." T: "Right, that, too. But just the fact that you've been dealing with it for so long, it can have a cumulative effect." Me: "That makes sense."

T: "I also wonder: Do you maybe feel like you shouldn't be experiencing anxiety at all?" Me: "Well, in a way, I feel like, I have a husband who loves me, a great daughter, we're doing OK financially--so in a way it feels like a 'count your blessings,' thing, like I shouldn't be struggling so much emotionally." T: "You can appreciate those things and still be anxious." Me: "True, I guess. Though maybe this partly is from my mom saying, when I was in high school and went to her saying I was depressed, 'what do you have to be depressed about?' Like I didn't have the right to be depressed because I had parents who loved me, I was doing well in school, I had friends. So I feel kind of like I shouldn't be depressed, now, too. Can I be both depressed and thankful for what I have?" T: "I don't see why not." Me: "OK."

I mentioned my fear of insurance deciding to no longer cover two sessions and said I'd figured out a plan to deal with that if it happened (like 2 sessions every other week, 1 session the other week). T: "Do you think you could have come up with the same plan if that did happen, instead of before it happens?" Me: "Probably." T: "You need to learn to have faith in your ability to handle things as they happen. Instead of trying to prepare everything beforehand." Me: "Yeah, I know."

We shifted onto the topic of some marriage stuff that I don't feel like going into here, because some of it's been ground that we've tread before. I'm not sure what got me off on that tangent, but I wish I'd stuck more with the main topic we'd been discussing, since I don't think the marriage topic got me anywhere (it was really only like 10 minutes though, if that even).

We were basically out of time, but I said, "I know we're out of time, but since I'm seeing p-doc tomorrow, I just wanted to know if you talked about anything with her besides saying you think I should see her more often to figure out the OCD stuff." T: "Not really, just that you're only seeing me now, that you're no longer seeing ex-T and that you've either terminated or are at least taking a long break from ex-MC." Me: "Oh, OK."

He confirmed me for Friday, and we scheduled for both Monday and Thursday. I went over and paid. Shook hands as he said, "Have a good weekend." Me: "You too." T: "Wait, today's Wednesday. I'll see you Friday." Me: "Right, I was thinking today was Monday!" T: "See you soon." Me: "See you then."

Seems like a jittery session- nerves? I get like that sometimes. Is this before you saw PDoc and heard what they talked about, or did you decide not to bring it up?

That's very perceptive! Yes, definitely nerves. I think mostly because he'd been out of town, so it had been longer in between than usual. And I wasn't sure if he'd want to discuss more about why I was struggling with his being away, since I'd e-mailed him about it the night before he was leaving (he did send a kind, understanding reply). It was before I saw p-doc--the session with T was Wednesday, and I saw p-doc yesterday. But I also was nervous about seeing p-doc, so that may have played into the session with T. I see T again today, so will bring it up with him then, but just in an "I'm curious" way not an accusatory way.

i feel weird seeing t again after a break

Two main things:

1. Separating religion and sex since due to trauma they've become intertwined in my mind. T says I have to retrain my brain but seems to want me to do it on my own time. I don't understand why she won't help me.
2. She told me she had an LGBT (lesbian, gay, bisexual, transgender) training session and provided some resources. She says I need support elsewhere for this since this is a trauma center. She thinks this is causing me significant distress, which it is, I actually left session with a big knot in my stomach.

T today. As we got back to his office, he went, "You're wearing sleeves today!" (I'd been wearing sleeveless lately, but a sort of ruffly short sleeve top today). Me: "Uh, yes? They're pretty short though."

My car came up, and he said he was glad it was fixed. I said how I felt better that it wasn't all in my head that something was off with the tires. And apparently the reason they're loud is that they're "performance tires." I said I'd gotten used to it though. T: "Oh, did you just turn up the volume on the stereo?" Me: "Yep, basically!" T: "What's that clanking in the car? Just turn up the volume!" We both laughed. That helped break the ice.

I mentioned seeing p-doc the day before and that I'd been anxious about it. T: "Were you anxious about it because I'd talked to her?" Me: "Maybe partly. And actually...she brought up something you guys had apparently talked about that you hadn't mentioned." T: "What was that?" Me: "About my drinking." T: "Oh, I don't even remember that we'd talked about that." Me: "It's OK, she just brought it up at the end of session and said how you'd mentioned it to her." T: "So it was kind of unexpected. I'm sorry." Me: "It's OK. I mean, it's a topic I'd brought up with her before."

He later said that if he were to talk to her in the future, he'd definitely let me know first and talk to me first about anything he would have shared with her. I said I appreciated that, and it made me feel better.

Talked about the drinking thing, how I was possibly going to try a med to reduce cravings, then read up on it later, got kinda freaked out by it, and changed my mind. But that I was going to try different SSRI. T was surprised that she'd suggested a med for the drinking. I talked more about that and my conversation with her. T: "Wow, sounds like a really intensive session." Me: "Yeah, kinda."

Discussed non-medication ways to deal with drinking, like trying other coping techniques such as meditation/mindfulness, exercise, reaching out to other people first, then if that doesn't help, go ahead and have a drink. How drinking can be an easy fix for anxiety (I could tell he didn't mean that in a critical way), such that one can forget other methods of dealing with it. We talked about stuff related to that till about the half hour mark.

T: "Was that the main topic you wanted to address today? We have time left if you wanted to talk about something else, too." Me: "I did want to talk about that some, but I think we're good on that. As for other topics, maybe returning to what we discussed last time, about my not feeling like I deserved care? I did have a thought about that, how maybe it's sort of like a spectrum, where one end involves feeling like maybe I don't deserve care, like seeing you twice a week, then moving to not deserving care at all. Then further down, on the other side (I gestured)

T: "I was thinking more of how you seemed like you didn't feel you deserved to feel anxiety, like how you have a job and a husband and a daughter." Me: "And friends. Yeah there's that, too." T: "But I think with you, it's like anxiety has been there pretty much all your life. It's just a part of who you are." Me: "Yeah, I guess you're right. And OCD, which I was reading doesn't usually manifest until early 20s, I've had that since I was a kid, too. And I continue to struggle with it, like I can function, but there's all this stuff in the background I deal with."

T: "And that's something most people can't imagine unless they've experienced it themselves. Or they might think, 'If that happened to me, I'd just make the thoughts go away.' But what they don't realize is that it's not that simple. That people with anxiety don't choose to feel that way--why would they?" Me: "Yes, exactly. And I've seen cartoons comparing how people react to mental illness vs. physical illness, like you wouldn't tell someone with diabetes 'why can't you just make your blood sugar be regular'?" T: "Yes, there's a huge difference." Me: "Like, everyone has probably hurt their leg or arm at some point, so they understand how that would feel." T: "Exactly, they can understand someone with, say, arthritis. And some people just aren't as physically healthy, so they struggle more with that. It's the same with mental health." Me: "So it's like I have a weak psychological immune system?"

T: "But stuff that goes on with the mind is scary. People don't want to think about it. If they do, they think, 'Oh if I felt depressed, I'd just push it away.' But if they stop to really consider it, it's scary." Me: "Yeah, like why Alzheimer's is so scary." T: "Yes. It's also part of why it's more difficult to change public policy in mental health, people don't want to really think about it."


I said how I worried how that plus attachment/abandonment issues would add up to a therapist thinking I had borderline personality disorder. But that I'd looked it up before and didn't think I really met criteria, that maybe I had a few traits but not the full thing. T: "Are you asking me a question?" Me (sort of, but not sure I wanted to know the answer): "Uh, no." I said with ex-MC, it had come up at one point, and I was sort of asking, but not really, and he said how his grad school roommate and good friend had BPD. T: "So like he was normalizing it?" Me: "Yeah, but it's not like he ever said what he thought of me." I said how ex-T had suggested at one point that I try a DBT group, but that it kind of bothered me, like she said I needed help with emotional regulation. That I'd read more about DBT but didn't think it was for me.

Me: "Guess we kind of went on a tangent there." T: "How did we get here again? Oh, I guess the (topic in the trigger warning)." Me: "Yes that was it. So going back to the previous topic, I guess I also think that people probably think I'm doing better than I am because I'm functional, like I get my work done, I'm social...But really there's all this stuff going on in my head, all these things I have to push against to get my work done. Hm, it might be interesting if I were to type some of that out." T: "It would make a good essay." Me: "True. But it's like from the outside, everything probably seems fine."

T: "It's like a duck in the water. From the outside, it's gliding easily across the water. But if you look underneath the surface, its feet are kicking furiously." Me: "I like that analogy."

Time was up. T got his phone out, confirmed next week. I went over to pay and said again how I liked duck analogy. T: "I'm surprised you hadn't heard that one before. It's one of ex-MC's favorites." Me (internally: "Ack!"): "Really? I don't recall him sharing that one before. I thought his favorites were about him playing basketball." T: "Well, he tends to use it more with teens who have ADHD. At least you don't have to deal with that." Me: "What?" T: "ADHD." Me: "Well, H and D have it, so..." T: "Well, at least just from the outside then!" He stood up (usually stays sitting) and shook my hand, saying, "Have a good weekend! It's Friday, right?" Me: "Yes," T: "OK, got it right this time!" Me: "Yep! Thanks, you too." As I was turning to leave, he said, "Take care." I replied, "You too."

These are the times I love your T. This kind of straight-shooter, reality -with-tenderness makes it clear he is on your team, an advocate for you. That seemed like a deep, connected session- I could feel the caring through the words.

Yes, that's part of what I like about him as well. I did feel really connected to him and supported throughout the session, and the feeling has kind of stayed with me, too.

I just wanted to share something that's been on my mind that happened this week with my T. I wasn't sure if I had to start a new topic, or bring the one I made earlier this year on her tardiness. I decided to post it here, since I don't wanna overflow this forum

So, anyway, to what happened. It's a question on ethics, that made me really uncomfortable.

I got to her office 3 to 5 minutes before our regular scheduled appt, knowing it would take another 5 or more minutes until she would be able to let me in. She's never on time. I've ranted about this "flaw" of hers on this forum before. It was 10 minutes past our scheduled appt time, she comes out of her office with the client that goes in before me, client wishes her a happy break then leaves. T sees me and says 'hold on just a little longer, okay?' I said ok, but I was already a little pissed. 5 more minutes and she comes back, ready to take me in.

As we enter her office, she says, 'I'm sorry I'm a little late today. The thing is, I am never late, but there are clients that linger longer. That client that came before you, for example, is one of them.'

I was really surprised by her remark. I found it quite rude to talk about a client to other client, especially complaining about them. My immediate thought was 'Well, the problem is your inability to manage time, not hers.' but I didn't say that. I said something about not having anywhere to go after my session, so that was ok. I kept imagining whether she spoke ill of me to other clients. That was not okay.

I totally agree with you that it is her issue, not the clients’. I often go a couple of minutes overtime- and I often say sorry about it. My T always says that I have nothing to be sorry for, as it is her job to pay attention to the time. The way she makes it a non-issue is to schedule 15 min in between her sessions, so it never impacts any of her other clients.

I am astonished/ outraged by that . It would be upsetting to hear your T deny reality or be defensive; it hurts her credibility plus it is rude to you.

My T is never late- not once in two years. On the flip side he gently but with an iron-will gives me the boot when the session is over no matter WHAT.

Does she still charge you her whole session fee?

Does she go over with you too?

My t has gone over with the client before me, but it is rare. She sometimes goes over with me if we are engaged in discussion or I need some extra time to collect myself.

It doesn't bother me both because it is rare and I do appreciate her occasional flexibility in caring for her client needs (mine and others'), and because she is typically timely and good at setting time boundaries for sessions.

It would bother me a lot if she were to do so on a regular basis, or to blame anyone but herself for managing session time.

She usually doesn't go over with me. If so, it's by a minute or two. I definitely did not appreciate her not owning up to being late. It's not up to us, clients, to manage time. I understand if the client may need a little longer to recover from a painful session, but I don't believe this is the case. It's too frequent for it to be a coincidence, and it has happened almost every week for the past 18 months since I've been in therapy, with different clients coming before me.

Does she at least give you the full time? (45, 50, 60 minutes, whatever the standard is for you?) If not, then that's really unfair to you. My ex-marriage counselor always used to run late, like up to 20 minutes at times, which could be really frustrating. Especially because he stopped bothering to apologize... But then he'd often run over with us, if we were having a difficult session, or sometimes just randomly. Official session length was 45-50 minutes, but he usually gave us 50 at the bare minimum, often an hour or up to an hour and 10 minutes. So in my mind, partly because I had strong transference and attachment to him, I justified his being late as "He's giving extra time to other clients just as he gives extra time to us." So it seemed OK. Ex-T was generally on time, I guess.

But now with current T, he's generally right on time, to the point that if he's 3 minutes late to get me, I start wondering if I had the incorrect day/time. The couple times he's been maybe 5 minutes late, he's apologized profusely. He's said a couple times it was a difficult session and he was giving the client a bit more time. But to me, that's really different from what your T is doing, which is putting the blame on the client. That would bother me, especially as I'm likely to be a lingerer, still talking as I'm paying him, then for maybe up to a minute after. But I feel it's the T's responsibility to keep the time, and they shouldn't say it's the client's fault. It's one thing to say, "It was a really difficult session, and I wanted to make sure client was safe to leave" or something like that. But what your T said seemed to put it all on the client. And, like you, I'd wonder what the T was saying about me to other clients... I'd bring it up with her.

I personally wouldn’t be bothered by my T being late because of a client, but that’s mostly because my schedule is flexible and can always wait. I don’t really mind waiting if a client before me is having a tough time. It can be really difficult putting everything back in the box again and going back into the world.

But it would completely bother me if my T tried to blame that client for being late. It’s irresponsible and judgemental and I would address it with my T the next session.

My T does tend to go over the time with me a lot. So he makes sure that I’m his last client of the day, because of how frequent we tend to go over. We’ve talked about how it happens a lot with us and what that means.

this is an email I just sent my therapist. we had a pretty bad session yesterday.

Wow Junk, that was brave of you to share, sounds really tough for sure. Hope he responds well to that