Thursday, February 18, 2010

I'm not very good at psychotherapy

I am a thinker. By no means the most intelligent person in the room, but I appproach the world analytically. I have an innate need to find reasons and explainations. I thrive on finding the rational and logical reasons behind other people's and my own actions. In some ways, it has been my greatest defense throughout my life. As a child my intelligence protected me on two levels. First, as a precocious child, who learnt the rudiments of reading and writing at around age 3 (according to family history) I used these skills to escape from the turmolt of my early life. I wrote stories, and later discovered the catharsis of poetry and journal writing. I read ferociously (easily plowing through the 15 books we were allowed to borrow from the library each fortnight) to escape into worlds that were anywhere but mine. Second, I used my ability to analyse situations in order to predict what was going to happen, in a very unpredictable home. I was highly in tune with my surroundings, people's emotional states and motivations. And thirdly, I used this understanding to allow myself to retain relationships, I could find a reasonable and rational explanation to excuse any behaviour on others behalf, so that I could accept and live with those behaviours over which I had not influence. This pattern continued well into adulthood. I am doing it right now! :)

This defense was, like most defenses, bothe protective and destructive. The need for rationality and logic got in the way of my ability to just experience life as it was. To feel and accept emotions, without considering whether they were valid or not.

I'm not very good at psychotherapy. I was very good at CBT, in some ways. I was able to dissect my thoughts like a scientist dissects a frog, to identify and label each thought and its purpose. I was even able to integrate some of the ideas at times. It helped, somewhat. It was exhausting though. I felt dragged under by the past, and what I managed to control in my day to day consciousness, through extreme hypervigilance, always having to be ready to pounce on that next cognitive distortion, I was unable to keep at bay when my unconscious took over during sleep or horrific flashbacks. I felt like I was barely managing the symptoms, but underneath there was an untreated infection of 'feelings' just waiting to go septic and kill me.

So, I started psychotherapy. And I suck at it.

Feelings throw me through a loop. They are neither logical, nor rational a lot of the time. They don't stand up to close examination. They are maurauding rebels without a cause, determined to occupy my brain and do whatever the hell they want. In psychotherapy, I am to accept these feelings, to embrace them, to try and understand those parts of me, not analytically, but empathically. I am finding this incredibly difficult.

I went into therapy today, nervous, but reasonably sure that I had managed to find a logical reason for my behaviour in the past couple of sessions, and why I thought therapy was stalling. I was validated by discussing this earlier in the day with my Case Manager (who seems to use more CBT/DBT orientated interventions) that I was showing good insight, and showing signs of things starting to click into place. Therapist (D) was somewhat less affirming. She did congratulate me on my ability to step away and think about the way my mind was processing things, and acknowledged I made some very valid points. She has two major issues with it. First, she felt that I had found away to analyse away any responsability on her behalf. That she had made mistakes within the conflict too, but that I was too scared of the emotions that came with that (fear, dissapointment, anger) to allow them in. So I bludgeoned them to near death with logic and over analysis, so I wouldn't have to deal with them. Second, as much as she was interested in what I thought intellectually about what was going on, she was more interested in how I felt about it. I found that incredibly difficult to answer. Emotions are just not a strong part of my personal vocabulary. I don't know how to speak of them. Sigh. I've got a long way to go. I'm not very good at psychotherapy.

We also had a brief but horrifying talk about the therapeutic relationship. At one point I was focussed on breathing shallowly to prevent myself from throwing up. She explained that due to the nature of the relationship I was going to have feelings for her "the therapist". I was going to feel hatred and dissapointment. I was going to feel love and sometimes just like. Arggggggggggggggh! I just kept quiet hoping she would get this little talk out of her head and move on. Thinking about it now, I have to acknowledge (stomach churning again) I do have feelings that reside somewhat closer to love (platonic) than like. And it horrifies me. She is somebody who knows more about me than most people, who has shown herself to be consistent and trustworthy, who appears to care about me, who I can share a laugh with, she is nuturing and protective.... it is much like the relationship between best friends, or even approaching a maternal type relationship.... but its not. I remain aware of the limitations and reality of what it is. But still, there remains this strong attachment, that the very thought of her leaving sickens me. I hate it. And yes, there are times, when my feelings move beyond annoyance with her, to a deep, visceral rage that I have yet to fully understand.

We spoke at some length (rather she spoke) about how it was not my job to protect her from any of this. Link back to her (forced) admission that I could be exhausting. She stated firmly, that if she was beginning to experience feelings of exhaustion or burn out, it was her job to be mindful of this and remedy it...not mine. My only comment was, that it scared me to not be aware of this, because if I didn't know where she was 'at', I couldn't be prepared. She reflected that this is how I must of felt growing up in an environment where one had to constantly, be in tuned, to be prepared. How difficult a responsability for a little girl, how heavy a burden. She reported counter-transference feelings of immense sadness. I wasn't ready to go there today.

On the way out the door, she told me she would call on the weekend and she had put aside a third session for me on Tuesday. I paused. "Haven't you had enough yet?". She replied gently, "No, Ophelia, I haven't.


  1. Wow. Apart from the last paragraph (D setting aside extra time for you and phoning you), we are almost coming from exactly the same position. I'm good at analyses, bad at feeling and emotion. I feel something approaching platonic love, but am also aware that it can never be 'real'. Nearly every word of this could have been written by me.

    The dynamic between therapist and client is such a weird one. I wish we could find some way to turn the attachment off, because it's so difficult for us to deal with as clients. And yet, in the psychodynamic school at least, those levels of transference are necessary for effective work to be done. An unpleasant dichotomy.

    Well, you do analyse very well - another interesting and well-expressed post :)

    Take care x

  2. Thx SI. Its a discomforting business, this therapy lark, eh? I get very frustrated when I read about yours, and others experiences within the NHS. It seems ludicrous to assume that there is some magic formula that can predict how long it will take a client to get better. And very stigmatizing, in that if said client doesn't get better, the implication is it is all their fault! I guess, Australia isn't a lot better. We get 18 psychotherapy sessions paid for a year, but you get to choose your therapist and can generally get in very quickly. The therapists are privately run, so there isn't a heck of a lot of beauracratic interference.
    Nonetheless, even with medicare paid ones, and the 8 (wtf) sessions my private health pays for, I have to pay for the rest. Near 100 sessions worth if I continue 3 x per week. (D) does give me a sliding scale fee. The point I'm trying to make, I guess, is that it is worth struggling for those out of pocket expenses to have a therapist that I chose, who is willing to go beyond the sacred 5o minutes if necessary. I wish you could have the same...

  3. Emotions are hard for me, too. I wish the functioning of my mind were orderly and rational, but the truth is it's all a big mess.