In which I get an extra session and it's total crap

My peeps. I'm having a moment of being pissed off at my usually lovely T.

After a long period of stability, I've been kind of depressed. One morning last week I was in this awful space after not sleeping and emailed my therapist asking if I could see her a second time that week.

She had an opening that day. When I went in, one of the first things she said was “let's talk about what you would have done if I hadn't been available today.”
It was not a great session. I was flat and felt unable to convey what I was feeling. Or maybe she was unable to get it. She seemed impatient. Like I should know better than this.

At one point I pulled up a tissue and it was the last one in the box. She took the empty box, got up, went to get a new box from her cupboard, opened the old box so she could flatten, fold and dispose of it, opened the new box and pulled up the first tissue, brought me the box and finally sat back down. It was like she needed me to get over myself and stop crying. I don't think I cry that often?

She’d had a full box on her table the whole time anyway. She could've just given me a few tissues or passed me her full box without getting up.

It seemed she was telling me I shouldn't be there and reprimanding me for my poor skills. I was so empty and tired and didn't get in the moment why I was feeling so bad and so disconnected.

The thing is, I would have managed fine if she hadn't been able to see me that day. Nothing terrible would've happened to me. She is really helpful (usually, I swear) but she is not my only coping strategy. I wanted to see her because I thought that it would make me feel better to talk to her. I thought I'd feel less lonely and more supported.

I kind of wish that she'd realized that she'd had her fill of me for the week. I wish she'd said nope, sorry, don't have a spot for you. As it was, I left feeling dumb, because nothing dire had “happened” to justify an extra session, just, you know, a dark night of the soul. I should apparently handle those with grace and aplomb all on my own. It's not okay to merely want extra comfort and support, I have to “need” an extra session. But if I truly need one, it's evidence that I'm kind of incompetent at regulating myself. Can't win for losing!

Do I bring it up next week?

Wish I knew the magic answer.

I had a similar sort of session with my t last week. After, I started feeling like I was no longer welcome there. That night, I had a dream where I'd somehow got hundreds of little nails in my back and I had to pull them out one at a time and they hurt so bad. I woke up from that dream thinking about my session, that "the tin soldier rode away". Like that old song. I don't know. Just, I relate. I'm sorry you're feeling this way.

One thing that comes up here on PC that I wouldn't have thought of on my own, is how extra sessions feel like a privilege , but we pay for them. I have to give up things that are important me to afford therapy, and I am really faithful about going bc I realize that is T's income. It is weird how this special effect happens in which we feel so so apologetic for extra time, and the T's seem to feel put-upon. You're not alone in this experience, for sure. That probably doesnt make it hurt your feelings any less, especially as it was a positive good choice and response to depression, not your only choice. I dont understand your T, in this case but I commiserate .

Yes, of course.

I will go ahead and point out the glaringly obvious that --
a. She could've had other crap going on with her (in my experience, surprisingly more common than we're led to believe) and / or,

b. She could've been pissed about her not figuring out that things were off with you / being caught off-kilter in how to 'be there' for you and that came across as anger / impatience towards you (again, in my experience, way more common than is generally thought and has usually resulted in my being told I'm avoiding things / making my therapist have anxious / concerned / out-of-whack-from-a-nice-calm-therapisty-demeanor type feelings etc).

I think when they have patients that they feel connected to and feel good about, it shakes their confidence when they don’t catch that something is going on. I agree that they can feel off kilter. But it isn’t your job to take care of them. Idk I find it hard not to reciprocate even a token of care back towards my t.

Definitely bring up your concerns. You have had a solid relationship that will likely get right back on track.

Feeling less welcome is a good description. Like in one fell swoop the unconditional positive regard is gone daddy gone. Though we have a fairly long history together and I'm pretty sure this bump won't end my therapy, these moments bring the transactional nature of the relationship into very sharp relief. There isn't the kind of affection or just access that allows me sort out these glitches in my other relationships. She also has access to such a young, vulnerable part of me that it doesn't take much to make me feel ashamed or rejected.

Yes - that's what happened for me - I have a fairly long history with my t too (6.5 years) and that session, even though it wasn't bad by any stretch, left me acutely aware of the fact that I'm "just her job". And like you said - she has access to that young, very vulnerable part of me that just felt horrible and yes, rejected.

I cant even. Her behavior just seems so hostile to me.

OMG. A huge part of what stopped me from saying "WTF! Sit your [behind] back on your chair and be my freaking therapist!" was this feeling that I should be grateful and not complain, that she was being nice by letting me come. But of course she's paid for that time and while I can be appreciative, I don't have to be obsequious. Also their jobs do entail a certain amount of accommodating clients who are having an especially hard time.

I wonder if she was concerned that you have some kind of back up in case she is unavailable and just got focused on that issue instead of letting go of her concern and really listening?

I also know that for me, when a session gets off to a bad start it can be difficult to regroup; maybe if she had been more focused on learning what was going on at the beginning the kleenex thing would not have seemed so dismissive.

Sorry you had a bad session, though. It is so, so disappointing when I do an extra session and it doesn't help. I get mad at myself and at T1 when that happens.

I would definitely let them know how you feel. A T should never make you feel that way. I'm so sorry they acted that way.

Of course you bring it up. I have felt when I've asked for extra sessions (and he's been able to fit me in, which is not all the times I've asked) something in the neighborhood of your reaction, that T is eager, excited even, to get to the point and expects me to jump in more quickly and articulate what I need more directly than other sessions. When I brought up feeling this way (next session), he said his intent was to make sure there was enough time to talk about the real issue, so he probably was more "hurried," but he was also having trouble understanding what I needed. For me there's a real pull to perceive things in him and react to those, when I'm not feeling at my best.

It seems to me (in this part of your post I quote) that you're making assumptions about what she thinks and feels, when you can't possibly know it. Feeling how other people are feeling isn't a thing. Nobody's gifted enough to read people well enough to get into their internal world when that person isn't telling you what it's like for them. But it isn't about how they feel, it's about what's going on in your internal world.

But totally fair game to tell her everything you said here.

Oh. Yeah. I think you and Growly Cat are right on the money here about the therapist feeling distressed. My therapist has a hard time with my depression. It hasn't come up for a long time so I forgot about that problem she has. She's good with moods but she's not so great with the "illness" part of mental health.

I was saying that I just didn't feel like living anymore. Not that I want to end my life but just that I have little enthusiasm for it right now.

She startled me a bit saying "was that the last one?" And it took me a minute to realize she was talking about the tissue.

I looked and it was, so I nodded. Then she said, "Well! That's a problem I can easily solve!" And proceeded to make the biggest deal ever of replacing them. Sounds a lot like she was feeling uncomfortable and handling it badly.

I am really trying to deal with her response here.

Like. Really. Trying.

I would have felt really bad about that too, because it's hard to ask for help when you need it, and then to have her be kind of mean about it, would make it way worse. I don't get the feeling that you ask for extra sessions all the time either. I guess if you did I could understand her wanting to make sure you had other coping skills, but what's a therapist for if you can't count on them during the rough times?

And I would definitely bring it up next time, otherwise it's likely to fester...or at least it would with me.

I know. It makes her sound like a total nightmare. She's not. I swear. It's like every once in a great while she's wearing an extremely uncomfortable thong and cannot be still. I can think of only one other occasion when this happened to that extreme, that time she got up mid-session to look for a couple therapist's business card because I told her my partner wanted a divorce.

I was not depressed or feeling especially vulnerable with her that day and I got totally annoyed with her and said "your anxiety is getting the better of you and you're not being here with me!" She sat down, re-centered and apologized.

She often gets up to fiddle with the vents or windows but I attribute that to the whimsy of her menopausal body temperature and don't take it to heart at all—it never seems related to me.

So you're basically saying I'm not a mind reader? Man oh man! Come on! My insecurity JUST KNOWS when other people don't like me and are annoyed with me. I'm an emotional clairvoyant. Madame FJ. I can read your cards and everything.

I haven't had too many extra last-minute sessions but I agree that there is often an expectation that if you ask for an extra session, you have "content" of some kind, an agenda. So "nothing new has happened, I just feel overwhelmingly miserable and I want you to be with me" seems insufficient. Also, I guess I didn't articulate that crucial second part: "I don't want you to troubleshoot or skill build or crisis plan or whatever, please just sit with me for one more hour. This week I need more."

OK. You are my hero now. That's totally awesome.

"Well! That's a problem I can easily solve!" kind of says it all. I would definitely bring up that comment specifically. It's not right for her to take it out on you if she doesn't feel competent when you take a downturn. She may have had other things going on that made her feel that way before you showed up, but that's no excuse to dump it on you.

I don't understand or subscribe to the idea that a second session is a privilege. Either they have an opening and want to fill it or they don't. I am sorry you were put into a position of having to feel worthy of it, and I hope you work this out next time you see her.

I agree with your assesment that she seems uncomfortable with the "illness" part of depression...except, uh, itsn't that what being a T is about? In 2.5 years of therapy with my T, I'd say 85% of my therapy has been me talking about how I don't want to live/what's the point/etc....and she has never once been uncomfortable about it or tried to steer me off the topic. That would make me nuts.

Yeah. You'd think, wouldn't you? Probably a few things going on here:

1) I have rarely said stuff like that to her. I think it's a bit of a departure from how she knows me to be. So while she should be upping her game and being more present (which she was trying to do by the end), I can see why internally she'd be thrown off.

2) She isn't a psychologist and doesn't do heavy-duty mental illness stuff. Mostly this has been great. I have had lots and lots of people to diagnose and medicate me and almost none who know shite from shinola when it comes to shame, self-esteem, feelings, family, relationships and other interpersonal stuff. She is an absolute rockstar in those areas and my life is much better for it. But she does not have first hand experience of how it is when your brain biochemistry plays evil tricks on you nor does she have particular professional expertise in this area. So we've had to navigate this together when my crazy is active. Interestingly, her non-medical model of patience and curiosity has taught me how to breathe through some stuff for which I previously would have absolutely needed meds (or more meds).

3) I have been with her for a long time and she's seen me through some truly brutal times in my life but she hasn't seen me really mentally ill. I suspect that this isn't just a lucky coincidence, I think that staying in therapy is a big part of what's kept me well. Also by the time I started seeing her, I'd committed to staying on my meds. (Okay, now that I think of it there was one time I was pretty ill after having my daughter and going off meds for pregnancy, it sucked and T didn't get it and that's when I first understood that she was pretty limited in this area.)

Why is this insufficient? It seems like a perfectly reasonable thing. I told my therapist last week that I was feeling needy. He said that there's nothing wrong with feeling needy. Personally, I hate feeling that way, but maybe he's right, there's nothing wrong with that.

I didn’t read all the responses so apologies if I am repeating anything anyone else said.
I liked and agreed with somebody who said we pay for the privilege of extra sessions. It’s true, we pay the t, so why the attitude.
I would bring it up with your t, are we not allowed to struggle between sessions? I wonder if your t had felt tired and stressed and perhaps bitter about having to give up some of her time off.
That was her choice to work or not and she should have said no rather than shaming you.
We all have dark nights of the souls, there is nothing wrong with asking for help. It didn’t sound like your t was much help.
What did you really need from her?

Given that you have a long positive history with this T, it sounds like she may have had a bad day or was distracted and probably did not mean to be rejecting or shaming. She should have done better though either to control herself or not accept the extra session instead of that passive aggressive behavior.

Thanks for all your support and validation. I will definitely talk about it with her at my next session. She said she had a last-minute cancellation, so I mean, the time she gave me was time that she'd already blocked off for for work. I don't think she resented me for using her time, I don't think she meant to shame me, I think she just didn't get what kind of "emergency" I was having and she didn't handle her uncertainty or her reaction to me very well.

It would have been really helpful if either one of us had clarified what was needed from the session. I think if I'd said "just sit with me while I talk about how desperate I'm feeling right now," she'd have done so swimmingly. But I suspect she was thrown off her game by the notion of an emergency. I'm going to assure her that in the future I will be very clear about the distinction between "your extra support/time/perspective would be greatly appreciated" and "I'm in a crisis so major that my very life hangs in the balance."