It's hard

In processing what went wrong with my internship clients (who all fired me the same week), my supervisor said that I am supposed to leave my clients feeling better at the end of a session. That sounds nice, but it left me wondering because therapy almost never makes me feel better. Usually I have a bad headache by the time I get out to my car, which just gets worse through the rest of the day. I usually feel a little less depressed while I'm there, but anxiety goes through the roof, and I dissociate to the extent that I'm not really safe driving home. I pretty much always leave feeling frustrated. But still, I can't wait for time to go back again, and it's so hard to wait two weeks for the next visit. Just writing this gave me a headache.

I've been reading and found something that sheds some light on why my experience is this way. I think it may have to do with my personality disorders. According to the book I'm reading, experiencing depression is necessary in the process of activating the real self. It doesn't feel good though, and I wonder if I even have a real self in here somewhere. But I guess that's the part that hurts. The part that has felt dead for so many years. I hope this works.

As for my clients, I hope that not many of them have to go through the same that I am right now. I don't know if I would be able to put them through it. I like the idea of making them feel better, and hope that I can do that. I hope that I will know how to help them feel better. And I want to feel better too. I hope that comes sooner rather than later. T says that what is happening to me now is actually everything starting to come together, even thoguh to me it feels liek everything is falling apart. I'm supposed to stop being helpless and start coping. Sounds good in theory, but it's hard.

Rap

((((((Rapunzel)))))))) I hope it gets easier for you. It is so hard.

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Rap said:
my supervisor said that I am supposed to leave my clients feeling better at the end of a session.

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My T misses that objective most of the time! LOL

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According to the book I'm reading, experiencing depression is necessary in the process of activating the real self.

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I may have whatever this personality trait is too then. 2 of the last 3 sessions left me feeling worse, not better. Yet both ultimately yield valuable behavior changes. Unfortunately for me sometimes I am a slow learner and I need to reach the end of my pain tolerance before before I realize how much something sucks and take a different action. Its like I try to get out of a room by running to the wall repeatedly. Its only after I am exhausted and batter to the point that I can't stand anymore that I start looking for a door.

I think by "better" it's meant end-of-session "hopefulness". Kind of a "we'll figure it out together" sort of ending that just reminds the client that the therapist is there and helping, that the two are a team, and the client is able to do the work. That we take whatever happened in the session and get down and dirty with it and get all twisted up after the session is a bit different, LOL. T's can't predict or help with that.

yeah - i've read countless times "the client may not feel better at the end of each session, so do not judge your progress by that factor". Maybe just ending on a positive note like Perna said, instilling hope, or just knowing you're there for them. If therapy was supposed to make us feel better it would be called "comedy hour"....

(((((((((((( Rap ))))))))))))

Have you shared this with T yet? I think she might be able to help you evaluate what's going on both in your own T and with your clients.

Best of luck to you

It gets really confusing who to talk to about what. I've talked to my supervisor about what happened with my clients, but I severely limit what I tell my supervisor about my own issues. I really want to tell her about reacting this way to what she said though. Unfortunately, I have such delayed reactions to things that I don't realize how I feel until at least an hour or two later, and then it's too late to talk about it. The next week I tend to forget. I'm thinking about switching internships entirely since there is very little left for me to do now at this site, but I'm attached to this supervisor now and I don't want to give her up. I have told her that I have Seasonal Affective Disorder and that I was going through relationship problems the last several weeks, but have not dared to tell her that I have personality disorders and lifetime chronic depression and anxiety. I don't know if I should tell her more about that or not.

I don't think that T even believes in SAD, btw. She's not into anything that might make a convenient excuse. I have told T about my clients not wanting to see me, and she knows that I am in trouble on all fronts right now. In fact, I broke down and cried at work because my annual evaluation was going to go very poorly - I keep missing work and not getting things done because I can't focus and I am in slow motion all the time and tired and not coping. I took a day off from work a while back to go to a retreat. It was the first time I ever asked for or used personal time off from work. I've never had it available before, and it feels like I need a really good excuse to ask for it. I feel guilty about taking time off. But something happened that triggered me, and that day that I took off, I was plunged into depression that still hasn't gone away. Okay, it's not exactly a new issue, but it was a crisis that I haven't found my way out of yet. I couldn't even go to the retreat because I was not functional enough to get ready and leave the house.

T knows about that. I have told her about my car crash and the tooth I broke (grinding my teeth on my way home after therapy the day after the missed retreat). I told her about losing my clients. BTW, when I have missed work, I have had these things as cover stories - needing to shop for a car, go to the dentist, etc., but haven't really come out and told anyone that I wouldn't have been able to function on those days anyway. I might not have lost my internship clients if I hadn't tried to push myself to keep going when I wasn't up to it. I thought I could handle it, and thought that being reliable for them and maintaining continuity was better than not seeing them at that point, but I was so wrong about that.

Work offered me partial FMLA to give me time to recover and catch up with things. It would have just let me reduce my hours for a while and have some breathing room. But I had to have documentation from T, and T refused to sign the paperwork for me. Apparently, if I have personal leave available I should just schedule a day off without making excuses for it, and if I run out of leave then I will need to go to part-time status. For some reason those options seem impossible to me and I'm most likely to keep on running myself right into the ground.

So, I guess I haven't exactly shared this particular question with T. I was reading that book yesterday, and I won't see T for almost two weeks now. She is taking a week off because she said that she needed to, and I said that I wished that I could do that, because I really need a break, but I don't get one. In the coming month, I will not have one single day that isn't scheduled. There is no time that will be just mine. So, I'm trying not to bother T while she is taking time off. She said she wouldn't answer me if I emailed her anyway.

Somehow this is supposed to make me start to cope more effectively. She keeps telling me to start coping. I'm also supposed to start being competent and figure out how to do that and how to solve my own problems. Most of the solutions that come to mind are pretty certainly not what she would consider good coping.

I rambled a lot. Sorry. I'm not sure I even answered the question.

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Rapunzel said:
In processing what went wrong with my internship clients (who all fired me the same week), my supervisor said that I am supposed to leave my clients feeling better at the end of a session,,,

Rap

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Rap. I don't know, but I had the best T in the world, years of experience, well-known, and if the session was good, I still felt like crap after therapy.

I am surprised your supervisor said that. I once read that in order for therapy to work, you must feel discomfort along the way.

I usually purposely schedule my T appointments late in the afternoon or on days off so that I can "recover."

I am sorry for you and hope that you can work things out. It's hard to work when feeling like crap, and harder to deal with others when feeling like crap.

I have plenty that I could say about this but I won't. Sending my support

Rap, what did your clients say when they quit?

I would pick one thing and work on that. Do you have a light for your SAD or are you getting outside some; I would start taking a 15 minute walk on break at work. A woman I worked with did that, walked around the buildings in the morning and then in the afternoon. Go to your regular doctor and get the SAD diagnosis, that's not something one "believes" in but something that just is and can be worked with and made better. SAD responds to enough sun/light, that's what it is.

But pick one of the problems you have mentioned and work on it. You say you are scheduled for work the entire coming month. Pick one day at random and tell them you're taking a personal day. Then plan that day so you're doing something "fun" as well as getting a chore or two done. Sleep late deliberately, get your hair done, something for you.

My clients didn't talk to me about quitting. With each of them, the last time I saw them I told them when I would be coming back (they are all nursing home residents, and I visited them there). They all agreed about the next visit, and none told me that they weren't interested in continuing. My supervisor had been their therapist before I started, but they had run out of funding and she has to do billable work. But she stopped by to check in with them and they told her they would rather just have her drop in as she could, and not have me. It is very possible that they all have attachment to her, and didn't want a replacement, and when I was stressed enough that everyone could see it, I probably didn't seem like much in comparison. I wonder if, since I had told my supervisor about my SAD and current impairment, that she went around and asked them if they would rather have her try to visit them as possible here and there.

I do use a light for SAD. I also take St. John's Wort (currently in massive amounts - I need to be more consistent with that on a regular basis and stop playing catch up there). Since I'm already doing what I can about the physiological stuff, and I don't want prescription meds, I don't see the point in going to a medical doctor. I have once before, and then I didn't want a prescription so it was like why was I there. The doctor agreed that I have recurrent depression, and also that St. John's Wort has evidence to support that it works. My previous therapist also agreed that I have SAD, but the current one is more interested in stopping the excuses and labeling, and focusing on being competent and functional. I like that, but sometimes I would like for her to validate that there are reasons for these symptoms and that it is really hard.

I do need to get out and take a walk or something regularly. I get out of that habit every winter when it gets cold, right when I need it the most.

I don't necessarily have work every day, but between work, internship, therapy appointments, and other obligations, there is not one single day this month that I don't have to be somewhere for something for a significant amount of time. I probably could find one day somewhere and take it off. That's scary for a whole new set of reasons that I don't have time to get into right now. I'm not good at taking time off.

Rap

Yeah... me too.... Sorry rap things are going this way. I can't imagine why your t won't help you out... seems terribly cruel. THis isn't boot camp.
=( Hugs, Kiya

(interesting that your T "needs" time off but apparently you don't! )