Musings on dependency

I have spent a lot of the last 12 months in therapy terrified of becoming overly dependant on (D)'s support and the therapeutic process. The psychodynamic therapy we are undertaking is somehow a lot more confrontational in this aspect than my previous therapy ever was. Whether this is indicative of a different type of therapeutic alliance or the difference in therapeutic orientation, I'm not sure. Perhaps a little form column a and a little from column b?

Trust and attachment are intrinsically intwined with dependency in my mind. If I allow myself to be open enough with a person, to share parts of myself and allow myself to accept and derive comfort from the relationship between us, if I allow myself to believe, that maybe, just maybe... I can trust that this person is going to stick around and not turn from the 'darker' aspects of me and my life... if I can believe that any of this is possible, than certainly I would want it, need it even and I wouldn't want to let it go. Always that belief that I would overwhelm people with my needs if ever I was to allow them to show.

Dependency, of course has developed a bit of a bad rap. Even amongst some of the MH professionals who really should be able to look at the issue a little less simplistically. Dependency is for infants and children, as adults we should apparently be able to look out for ourselves. At least this is the message we are given. In the public health system, "service users" may find themselves fighting and (sometimes losing) to access the services that they feel they need. The MH system creates an atmosphere of fear, fear of dependency on hospitalisation, fear of too much dependency on individual professionals, fear of dependency on medication, fear of dependency on benefits... the list goes on and on. And some of them are valid fears in certain situations. But the blanket, knee jerk reaction to these, and the suggestion that any form of dependency is regressive and not mentally healthy is unhelpful.

Yes, for some people and it some situation hospital can foster an unhealthy dependence on an 'unreal' world.  I think that's a possibility for anyone who is hospitalised. The world outside can feel scary and unsafe and full of decisions, that to suspend those responsabilities and know that you are at least physically safe for a while is certainly tempting. And it can be hard to know when you are actually 'able' to handle these things in the real world on your own. And of course, we have all heard the blanket dictate that anyone with a personality disorder will not benefit from hospitalisations (never mind if they have co-morbid depressions, suicidal ideations, psychosis etc) It's such a simplistic approach.Each situation should be looked at individually, rather than unbendable policies being enforced because of the bad rap of dependency. I myself have never had any issue really with accessing hospital care, but I read all the time about blogger friends who do, because of their labels, and it just seems so stupid to me.

Whilst I have not had much trouble accessing hospital care, my fears around dependency spring up in other areas. Dependency on medication. Now this is a funny one. Because whilst the MH professionals seem to make such a huge deal (rightly so) about the addictiveness of the benzos, it doesn't prevent them from dosing me up with them, and everytime that I have started to try and reduce my dosages, it has been at my suggestion rather than theirs. So on the one hand they help to create this fear of dependency, but on the other hand they continue to hand me medication, at times (not so much lately) it feels like hand over fist.

Within Case Management in the Public Mental Health system, I did undergo a little bit of stress at the end of last year in regards to being discharged from the service. The accepted thinking of the service is that they want to a) develop the individual's ability to soothe, contain and problem solve themselves and b) create a system of support that is community based rather than based on the mental health system. Fantastic in theory. But what I have found is that even while focusing on my ability to soothe, contain and problem solve myself, there are times when I am able to do this and times when it is a bit harder. In relation to developing community support, its great in theory, but the reality is that the average 'everyday' person is just not equipped with the skills, experience or ability to distance themselves as MH professionals are. So, some dependency on the service is necessary, and unless my MH issues disappear, potentially this dependency will exist for quite a while. But it waxes and wanes. I don't feel the need to pick up the phone and ring my case manager for every little issue (or even some of the big issues), we have cut contact back to once a fortnight, unless something comes up and that will probably reduce even further as things continue to go well. So, I think I am dependent on their being their as a safety net, but I don't feel its an unhealthy dependency.

Then we get to therapy, ah....therapy. The dependency that can be fostered in therapy is probably the scariest, because (D) has so much information I have trusted her with, so much insight into my thought processes and feelings, that she really has the potential to hurt me big time. She is a person who consistantly supports, holds (emotionally) and cares about me. Encourages me and helps me to learn. Sound familiar? Yup, as much as I hate to admit it, she has taken on a somewhat motherly role in my life.  And what happened with the last mother in my life? Let's see... I was a dependent infant, and she was emotionally and physically absent due to her PND. She entered into a realationship with a violent alcoholic and allowed him to physically and emotionally hurt her babies, once again failing those who were dependent on her for protection She then (as a way of coping) withdrew entirely from those dependents abandoning them into an environment where secrets and darker, traumatic abuses could take place. So.... yeah.... feeling dependent + a person who acts in a motherly fashion = big fears of reenactments of past traumas and let downs for me. I do a dance with (D) of throwing up my cast iron shell, and letting in tumble and letting her in. Is the dependency I'm experiencing with her a bad thing? From a psychotherapeutic aspect of course all the transference issues that are brought up allow for great opportunities to explore, reexperience positively and grow. But she is not my mother, and I am no child. What kind of dependence is reasonable and sustainable? I guess this is where the boundaries come in. And (D) is pretty good at making those clear and keeping to them I guess. Sessions are consistently within the same frame. Time, structure, she's never late, always dependable. Contact outside of session is thoughtful and purposeful, whilst still flexible enough around times of crisis. The other big hurdle was me. Accepting that I need this woman, that I rely on her and thats ok. But I still keep my eyes open, still put all information and suggestions through my own validity tests and don't rely on her for *all* of my emotional needs, because a) she is only human and b) as important a part of my life as she is at the moment, by very defination she will not/should not be around for ever, and will never be a solid presence in my real day to day life. And that ,I am beginning to realise, is a healthy dependency