Tuesday, August 19, 2008

Honesty in Therapy

Recently quite a few people have found my blog by googling "Honesty in therapy", or "How can I be honest with my therapist?", or variations of that theme. Today I will share some of my experiences with Dr. X and hopefully they will show you that being honest in therapy takes a huge amount of courage on the part of the patient, but also that the therapist or psychiatrist has to show they are worthy of that honesty in order to facilitate your being truly open with them.

I cannot think of a single instance where Dr. X. was judgemental about things I told him. I can think of many instances where I felt he ", "should be" or "would be" judging me. I can also think of many times where I can see now that I was "paranoid" he would judge me. In retrospect though, his refusal to label or judge my behaviour has allowed me to be honest in therapy.

Sometimes it has taken me a great deal of time to get to the point where I am able to share information. I weigh the odds of the information hurting me, or affecting Dr. X's relationship with me, or my relationship with him. I often spend weeks, sometimes much longer, worrying about opening up about something. Everytime I finally have opened up and been honest it has taken a huge weight off my shoulders.

Those who read my blog on a regular basis might notice that I use my blog to prepare myself to open up, to tell the truth, to Dr. X. A few times I have been intensely suicidal, lethal medications in my hand, and instead of choosing to take the medications I have written about how hard it is to express that kind of suicidality to Dr. X. Often it is because I am afraid of how he will react, or that he will take away my freedom. He never has, and the talking about it always de-escalates my suicidal feelings and reassures me I can trust him. (Note: I now trust that if Dr. X. did place me in the hospital against my will, he would be doing it for my own well being. I recognize that there may be times where I, or others, are not able to make those decisions for ourselves)

Sometimes if I absolutely cannot get the words out, if I simply cannot open up or tell Dr. X. the truth, I will print off what I wrote in my blog, or I type out the feelings and print them out. In my appointment I then hand the written version to him to read. As he reads the note I sometimes feel so ashamed of who I am and how I act, but I also recognize that he cannot help me if I do not let him know exactly what is going on.

At these times he usually reads the note and then is very silent, waiting for me to speak. Always these moments have been catalysts for more open conversation, and every single time they have promoted and reinforced a deeper sense of trust between myself and Dr. X.

I remember one time I waited 2 or 3 years to tell him about something I had done years prior. In retrospect, especially after telling him, I held so much guilt and fear inside me for such an unextrordinary piece of behaviour.

When I was in second year university I had a fairly short, but extremely severe Major Depressive Episodes(MDE). I would sit in my classes and all I could do is cry. I could not get the energy to shower for days at a time. Everyday I would go sit by the beach trying to get myself to kill myself by getting in the water and just swimming out to sea until I could swim no more.

In a couple of my classes nothing made any sense to me. It was as though I was sitting there, but the professors were talking some other language. I was having a particularily difficult time understanding lessons in one of my philosophy classes.

So, in desperation, believing there was a magical solution to my problem, I decided to look up the professor. I found out he lived near me. Believing it to be the magical answer to my not understanding his class, once or twice a day I would walk past his house. I believed that each time I walked past his house, all his knowledge would somehow magically transfer to me.

When I became well again, when my MDE ended, I felt so much shame about what I saw as a kind of "stalking" behaviour. I could not believe I would have done something so bizarre. I was afraid I was dangerous, and that if I told Dr. X. what I had done he would think I was too weird to be trusted. I was afraid he would be afraid of me. So I never told him or anyone I had done that.

A couple years into therapy I began to feel safer with Dr. X. and I forced that story out of my mouth and into one of our sessions. After listening carefully Dr. X. said (paraphrase), "What a beautiful story you have told me. It is wonderful that you were able to have such a magical belief in the way the world worked; beautiful that you were able to suspend reality and have such faith in a mystical type of transference of knowledge".

I was overwhelmed with relief and finally was able to talk to him about my fears that I had been stalking the professor, or that I might be capable of stalking another human being. I never wanted to SEE the professor, it was the act of passing his house that was so important. We talked about how I have OCD symptoms and and vivid imagination. He told me I was not stalking the professor, rather I was suspending reality and looking for a unique way to help myself in the class.

I recognize now that I may have been having some kind of psychotic delusion during that depression, but Dr. X never used those words. He gently helped me see the magical nature of my thoughts without judging me, or making my experience a bad one. It was simply a different experience than most people might have. He assured me he knew I was not dangerous, or a stalker, that I was a human being trying to understand her world.

Being honest with him then, and his positive reaction to what I saw as a frightening and terrible flaw in myself, set the stage for my feeling more and more free to express myself and be honest in therapy. Honesty in therapy takes guts and determination on the part of the patient. It also takes consistent compassion and kindness on the part of the therapist or psychiatrist with whom patients entrust their information. The therapeutic alliance that is created between an open, willing and brave patient and a welcoming, compassionate and consistent therapist is what facilitates honesty to take place in both directions. I feel blessed I have such a therapist.


Polar Bear said...

I'm glad you were able to share that story with Dr X and that his response was such a positive one - one that made you feel good even.

He is a very very intelligent man. And I'd have to agree that the relationship or alliance between a client and a therapist is soo important. I know that there are things I've done (for my own good usually, but hard to do) because of V.

Aqua said...

I'm glad you commented...I was worried and a bit afraid others might think I'm a stalker:>0 when I posted this (I'm not). I just have weird beliefs sometimes.

Making me feel better in spite of some of my strangest behaviour is a Dr. X. specialty. He is really good at seperating the behaviour from any kind of judgement.

Thanks Polar Bear. I am really glad you have V to help you. Change is hard, but you and I can help each other too.

Annie said...

Aqua, This is a significant post and I relate to the underlying fear and self doubt that is present in the depth of depression. I agree with Dr.X that it was a creative way to gain understanding and knowledge.
I also relate to the difficultly in understanding a teacher, it does indeed sound like another language.Thanks for such a profound post. Peace, Annie

Anonymous said...

aahhh, the good ol' stalker feeling! i say that with a tad bit of humor because i know the feeling. this summer in the midst of my depression and ECT treatments, i would call my therapist randomly for support. she gave me her cell phone number and told me i could call anytime, but i hate doing that b/c i believe i am violating her time and she'll think i'm stalking her. i even confessed my thoughts of her considering me a stalker and she graciously reassured me that i was not one! whew.

you know, being open and honest with your therapist is the catalyst for growth, but that has to be returned for the growth to bloom. i am blessed to have a great therapist as you are, but i am still working on sharing those thoughts that i think will turn her away from helping me!

aqua, i am so glad you have a great therapist.

Aqua said...

Thanks Annie and Kara and Polar Bear,
I really am glad I have such understanding and caring readers. It makes me want to open up more and the more I open up and feel accepted no matter how I'm feeling, the better I feel.

sara said...

As Polar Bear said, more than an intelligent man, he's a good man.

And reading you gives me so much to think about about how bad my doctor really is. Anything I have written, which to me, like you, is the most honest and most unspeakable things, he hardly looks at after I get up the courage to show him.

But maybe being able to realise that despite liking a person, I can be in a bad relationship, and finding a normal way to end it, and so on, might be therapeutic too. Anyway, thanks for helping show people what it can and should be like.

Aqua said...

Hi Sara,
I love how you write so openly and honestly. It is what I love about your blog. A big part of why I write this blog is to show others that a great theraputic alliance, based on YOUR needs, not the psychiatric community's, or not the insurance company's, or not your employer's needs, but your needs...is imperitive to help anyone with a chronic mental illness not only survive their illness, but hopefully thrive in spite of it.

I know I get really negative sometimes, but I write exactly how I feel. I think that shows others who are as depressed as me that those moods may stick around, but a good pdoc can help you learn, and be supportive of valuable coping techniques. I really feel I am here because of the immense, unjudgemental and unflagging support I receive from Dr. X. I hope you are able to find that in a pdoc. You deserve it.