Tuesday, February 9, 2010

The therapeutic relationship.

Ok. I know that there are a lot of much more informed and better blog posts out there in regards to this subject, and this will probably be a very boring post to read. You don't have to. But I just had a very 'wiggy' session and I need to process, and this blog is my place to do it.

So, today I had my make up session for the one we missed yesterday, because of (D's) conference. I was in a much better place for discussion this week, than I was last week, as some of the 'other people's drama' has calmed down, and also, I would hazard a guess, because of the increase in my Serepax dose. So, (D) began the session by asking how the last few days had gone. I rambled on about lil sis's ex finally moving out etc, and she let me ramble for a bit before saying, what she really wanted to hear about was me. How had those five days been for me? I kind of giggled at that point, because she had a point, I was not paying her to sit and listen to my sister's relationship issues for an hour. Ok, so moving onto me. I told her that I had handled it ok. I also told her about my little meltdown on Friday at lil sis, and the residual anger/agitation/irritableness that I had not been able to shake since.  I told her about the incredibly uncomfortable physical reaction that I had to it on Friday (shaking uncontrollably) and aboutt my frustration with myself for not being able to get control over myself in regards to this irritation over the weekend. We spoke about why I was so uncomfortable with anger. She zeroed in on my use of the phrase 'cracked up'. Enter various interpretations...the cracks that allow bits of me to be visible and allow bits of other people access in, the cracked egg etc. Cue my response that the cracked egg in the carton is the one that goes bad, if we are going to indulge in this over-analysis of a throw away phrase. Cue her, if some what predicatable comeback, that the cracked egg allows the chicken to be born. Well played (D), well played. I really don't know why I let myself be drawn into these debates over the deeper meaning of words and phrases, that I am pretty sure really don't much have a deeper meaning. I said cracked up, were I from a different locality I may have said "Had a barney" "Chucked a tanty" "Did my block" or any one of many other meaningless and trite phrases. I guess maybe it's that, if I can engage her in these trivial debates, it is more time deflected away from uncomfortable subject matter.

Finally, she just out and out asked me what it was about anger that made me so uncomfortable. Which of course, made me extremely uncomfortable. To the point where I did what  swore to myself previously I wouldn't do, and let a little too much of my crazy show, by jumping up and straightening her mat. I recentered myself, and answered that anger made me uncomfortable a)because it is unproductive b) because I feel like once I allow myself to get angry I can't contain it and stop it (not like the Incredible Hulk, or anything, I just feel like once I give myself permission to be angry at one thing, a whole plethora of things come pouring out that I am angry about and c) I was uncomfortable talking about it with her, because I knew we held diametrically opposed ideas about anger and it felt too much like a confrontation. (D) considered all this and replied to b) that "it would eventually stop, that is the nature of it" or something along those lines. Then she considered "diametrically opposed. I clarified. I have a firm position in my head that anger is completely unproductive, particularly with my family, as it makes no impact on them, nor does it get them to change their behaviour (see lil sis's lack of help or understanding on the weekend), so all that it does is make me feel horrible and hateful. And she of course, holds firmly to the idea that anger (when contained and appropriately directed) can be a productive thing. I hate situations like this, because I really feel like there is nothing she can say to change my mind... and it just feels confrontational and makes me feel like a recalcitrant child, who won't listen to reason.

So, we moved onto a) anger isn't productive. I tried explaining to her that in my family, my anger is not heard. It wouldn't matter how loud I screamed they would not hear it or accept it. I could get angry at my family's inability to allow me to break out of the role of passive peacemaker who will always give in, or I can just accept that I can't change them, and if I choose to have them in my life (which I do) then I just have to accept that. I came to this conclusion after being told by them repeatedly post-od in 2006 that I had to be more honest about how I was feeling, only to be shut down completely everytime I tried. She asked me how my family had reacted to my 'pitching a fit' on friday night, and my general crankiness and agitatedness over the weekend. I told her that big sis had tried to have a word with lil sis about it, but I just don't think it sunk in. Other than that, I said, they mainly just made a joke of it. She asked me what they said, and I cringed inside knowing how bad it would sound to her. She said that it was not about blaming anyone, just trying to figure out the communication dynamics within the family. So, I gave her the example "Be good, because your Auntie Ophelia is on the edge, and she might crack it, then we'll have to take her back to the nuthouse". I felt so ashamed saying that out loud, becuase I know how it sounds. I think (D) was a little speechless for a moment. I tried to explain that that was just the way they all talked, and that I just had a thinner skin than the rest of them, but she told me not to 'minimise' it. I know, some of the things that my family says could be considered inappropriate, but that's how we've been brought up, to make a joke of things so we don't have to discuss anything unpleasant or requiring emotion. And, yes, at times it feels incredibly invalidating, but I also tend to make a joke of everything, to make other people more comfortable with things. Sigh.

I checked the clock. She smiled and asked me whether time was going a bit too slowly for me, or whether I had something I was wanting to say before the session ended. But it was less about that, and more about the growing feeling of agitation, that I was coming into therapy, and getting these thoughts all messed around in my head, I got to 'feel' these feelings that I apparently have a right to feel and then go home to my very real, very imperfect, invalidation world, and try to manage. I didn't think it was fair to bring up this giant mess of emotions when I had to walk out the door after 50 minutes and deal. Which is stupid, because essentially what therapy is all about. Sigh. Anyway, I told her my thoughts. (D) replied that we did need to work towards getting more containment as we approach some of the more difficult stuff. She said that therapeutically, she actually thought I would benefit from more contact (I currently see her twice a week!) but she realised financially this would be difficult for me (she already charges me a sliding scale rate, which creates bif issues around money and power balances for me) She mentioned looking into some organisations that may subsidise the cost of therapy. But I vigorously shook my head. Seeing her,even for one more session a week just brings to head the ugly issue of dependence for me. Ugh! She talked about the possability of daily phone check-ins, which I also rejected. She asked whether this was because of the dependence issues or because I was worried about being a burden to her. Both really, but mostly the former. She told me that a certain level of dependence is expected and somewhat necessary for the therapeutic relationship. But that it is something that we both keep in mind and moniter. She asked me to think about it and asked if she could call me tomorrow to check in. I shook my head. She asked if this was because I was worried about the being a burden issue. I shrugged. She told me she would call tomorrow. Sigh.

It is a weird, weird, weird relationship the one between therapist and client, particularly in pyschodynamic therapy The reality is, the last few weeks have shown I am dependent on her. And I hate it! And I am fighting desperately against it, whilst at the same time needing the support to anchor me. Arrrrrrrrrrrrrrrgh! How do i know when it crosses the line from healthy (in the therapeutic context) and unhealthy? I guess I trust her judgement. And I do. Some of my family seem to think she is trying to rort me, suck me into staying in therapy, keeping me unwell. Not only is this laughable, as I don't think they fully understand what mental illness really is.  But is also, this is laughable because I am not exactly a cash cow. She sees me twice a week, say 50 weeks a year, so 100 sessions. Of these, medicare pays for 18. Private health pays for 7, but only $65, so (D) cuts the price to $80, so I pay a $15 gap for those. Once those 26 sessions are used up, the next 74 sessions are all down to me. (D) has cut these sessions down by $130 to $30. Do I feel guilty, do I hate this ? Yes. Am I under any illusion that she is trying to keep me in therapy to milk me dry? No. If that was her intention there are plenty of people who could fill my slot and pay her a lot more.

I hate this
I hate this
I hate this


  1. *hugs*

    Just want to say that I get every word of this, and understand your frustrations with the way sessions can develop. It winds me right up at times; every word, every nuance, becomes important to the psychologist. Grr. And dependence and attachment in psychodynamic therapy is endlessly frustrating, regardless of its apparent necessity. I understand why it should be there, but it feels like we're in an intolerable position at times :(

    Take care xxx

  2. Certainly not boring!

    It's wrong to assume that money is the only thing that motivates people. If you went elsewhere for help, D could take on another patient who would pay the full price, so in effect D is actually paying to keep you. That alone makes your relationship look very unhealthy.

    She mostly seems to make you feel uncomfortable and dependent. It's hard to know which of those gives her the reward she thinks is worth paying for. Making you uncomfortable puts her in a position of power, which some people find rewarding. Making you dependent puts her in a position of responsibility, which some people find rewarding. It could be a bit of both for her.

    Of course, it's not wrong for her to get such a buzz out of her job that she's willing to take a pay cut if she's doing you some good at the same time. But it doesn't sound like she is.

    In order to help you work on anger and frustration, she started by making you angry and frustrated at her, which is good psychodynamic technique, but then she didn't seem to know where to go with it and the session ran out of time. If she doesn't have the skill to do the work in short sessions, I don't think more frequent sessions are going to be the answer.

  3. Thanks SI. I often read about your sessions with C and think, yes! That is exactly it! But I don't have the whole "Bond and attach to me, but only for the next 20 weeks, because the NHS says so thing hanging over my head. That is really unfair for you. (D) has told me she intends to be there for as long as it takes and I want her there. Which is somewhat reassuring.

    Hmmm CBT, you made some interesting points. But it just doesn't really ring true for me. I understand that most therapists will put aside a portion of their business for reduced fee patients, and a certain portion for full fee ones. The money issues and discomfort around it, come down to people who have been abusive to the power that money gave them over me in the past. (D) acknowledges that and approaches the subject with tact and compassion.

    Maybe sometimes we do run out of time during sessions, whether it be because of poor planning or me dropping an LBT in the last 10 minutes or so, as I occasionally do. But for the most part I feel like the rhythm of the session is pretty good. Its only when I step out of the door, that things generally turn to shite.

    As for the power/dependence thing... well I haven't figured that out yet. My gut feeling is she isn't doing it to satisfy some machevallian need for power or dependece. I think she just genuinely takes her responsability as a therapist seriously. And I don't know, maybe I'm an interesting case? Yes, it feels uncomfortable, and yes a lot of the time I hate it, but that's transference right? Take emotions or feelings I have most of the time in the real world, induce them or bring them out in therapy and then work through them slowly.

  4. But thanks for your insght CBT, is good to get a different point of view, I can use to inform my own opinion. :)