Thursday, October 16, 2008

I Fear I Will Be Scrutinized

It is difficult to recreate the intricacies of a therapeutic moment, or moments when I come home, and sit down to write a post. Often, even within the therapeutic moment, it is difficult to describe, explain and sometimes, even bring up, what is going on inside my head. That is how I am feeling right now.

Dr. X. is so patient and understanding when I am trying to get things out. We have a long therapeutic history together, and on a huge level I trust him more than anyone on earth. Intellectually I know he is trustworthy. When it comes to an emotional level though, I have a difficult time trusting that anyone is who they appear to be.

His behaviour has always been consistently kind and compassionate. He has always appeared to care for me and not judge me in any way. In fact, I cannot think of a single time when, (factually vs. my paranoia) he was anything but supportive. I do not know why I cannot always believe he will not reject me, or does not secretly dislike me, or does not privately disrespect me, or think I'm a complete waste of space.

Most often I feel like my even thinking he would be like the person I worry he might be is disrespectful towards him on my part. He has never given me any indication he thinks anything but good thoughts about me. It is me who has difficulty believing; especially when I am really depressed.

I am using "belief "in the philosophical sense, where it is an unquestionable belief that leads to knowledge. An example might be believing the world to be round, allows you to take that next step and try to sail to the other side, whereupon a successful sailing, where you did not fall off the edge of the world leads to clear knowledge that, at the very least the world is not flat, and your belief it is round is closer to becoming knowledge.

This might be part of the problem. A patient can believe anything they want about their psychiatrist, but there is never any opportunity to have those beliefs turned into knowledge. You can never "know" your pdoc, you can only believe what you experience. To feel safe I need my beliefs backed up by knowledge.

The therapeutic alliance is such that the patient knows very little about the psychiatrist. In many ways this is a beautiful thing. For me it means Dr. X. can be anyone I need him to be at any given time. On another level it can be a frightening thing, especially if paranoia, or fear of rejection, or an intense need to be cared for, or valued, or not rejected are symptoms that flair up and become intense when I am depressed. Unfortunately, when I am really depressed, it makes sense that Dr. X. becomes the subject of my fears.

Today we reviewed my schedule. I did not do very well. In fact the things I really feel NEED changing did not get done at all. This led to the following paraphrased and (very) abridged recap of our discussion:

Me: I hardly did anything this week.
Dr X: You made up the schedule and came prepared with another schedule for this week
Me: Well, I haven't even filled the new schedule in yet and I didn't dust, or drop off the laundry, or cook dinners...yadda, yadda, yadda...I am so disgusting. If you saw how messy and dirty my house was you would be disgusted.
Dr. X. I challenge you to take pictures of your messy house and bring them to show me in our next session.
Me: (inside feeling absolutely mortified by the thought of doing that.) There is absolutely no way I could do that.
Dr. X: Why do you say that?
Me: (inside thinking a hugely complex set of ideas...I'm disgusting, it would destroy any semblance of "normality" I have tried to maintain with Dr. X, I would completely destroy any image of "togetherness", or likability I have left with him, etc.) I am afraid you would not like me, or would disrespect me.
Dr. X: Maybe this is an important behavioural exercise. You keep thinking I will not like you for your messy home. Showing me your home and seeing your worst fears be mistaken would be a good exercise.

This is when I began to fear my whole good relationship with Dr. X. was just imagined. I knew nothing about the man except what I see in our sessions. I imagined him having a beautiful and immaculate home. I imagined how disgusting my home would appear to him. I believed if I showed him my home he would be disgusted with me. I believed that I had worked so hard to be "likeable" and pictures of my house would destroy all I had worked so hard for.

It became obvious to me that showing Dr X. my house would lead to him disrespecting me, seeing how truly lazy and unorganized I really was, and that inevitably it would lead to his rejection of me as a person he valued.

I understand that taking the pictures and "joyfully" sharing my messy house with Dr X. could be good behavioural therapy, but what if it backfires and he really is disgusted in me?

Please note: I understand this trust issue is my problem, and that Dr. X. has never indicated in any way that what I fear would take place, but the fear is so powerful I feel sickened that I even tell him this stuff.

I just saw(seconds ago) this very fitting video...


Anonymous said...

Have you ever felt like this before? With him? I reckon in 7 odd years you probably have.
I bet that sometimes you've had to talk about other things which have made you worried that he'd judge you, or stuff which you were ashamed of.
Maybe things you maybe used to worry about a lot, and don't seem so bad now? Or things which you can talk with him about freely now, which once seemed impossible to even THINK about, let alone discuss with him?
If there are, I wonder if THEY felt as bad then, as this does now.
I think you should take that gamble Aqua, take him a photo of your puppy too, then you can always blame the dog for the mess!
xx Lola xx
(Yes, you can do it!)

Dr Shock said...

Impressive description of therapeutic alliance and a nice video or better a nice song and music.
Do you like Neil Young? (just kidding, I know you do)
Take care Dr Shock

mini uk said...


I don't often comment but like reading. Oh please take pics & show us! I supect I am rathe rlike you, I was feeling mortified at the idea if my own Dr T asked me to do such a thing I'd think it was aplan to get rid of me.

Do you have the tv prog, How clean is your house? I suspect you have nothing to worry about, it would be a good exercise but I feel for you deeply, take care of you.

Oh just a thought, could you do before and after pics after clearing up, I bet the difference you saw on anothr day would be so much less, you could do that for you initially, see what you think.

Take care of you

mini uk

Aqua said...

Lola: I love the name rolls off the tongue...I digress. Yes I have felt this way many, many times, and it probably isn't about him, it's about feeling scrutiny from everyone around me when I am symptomatic.

I had to laugh because your suggestion to take him a picture of the puppy and blame the mess on Skookum is brilliant. Not only the suggestion, but also because I found the yellow paper I had originally written last week's goals on mostly eaten and torn to shreds by my today I could have used the excuse "my puppy ate my homework" except for the fact that I had rewritten it and saved it to my computer.

Dr. Shock: Thanks for stopping by. I thought the video fortuitous because it spoke about doing things without worry or fears of judgement. I know you like Neil Young to (some of his stuff you said...what other kinds of music do you enjoy?

Mini UK,
I am glad you took the time to stop in, visit and write a comment. Your begging, "...Oh please take pics & show us!..." both cracked me up, and got me thinking that if Ido manage to take pictures for Dr. X, the next step in a behavioural type exercise might be just what you suggest. Honestly, I don't evenm think I can show Dr. X, but if I do...I will post online too...I will try to at least. Thanks for the supportive comments.

Handsome B. Wonderful said...

Hmm, I wonder if a messy house is something many folks like us with mental illnesses deal. I suspect so. I say this because I too have a messy house and never want people over because of it. I just can't be bothered with house work when I'm struggling to stay alive everyday.

And when people do come over I apologize up and down for it but they are always cool about it. Though I never believe them. Trust like you said is hard to come by when paranoia is a strong aspect to ones illness like it is for you and I.

Maybe one day I'll take some pix to put on the blog. I'd be more willing to do that then for my therapist because I don't know most of my blogger friends in person. There's a level of anonymity there.

mini uk said...

hi again,

I was thinking about you this morning in relation to me, my own mum was abusive & twisted is probably a good word, in my head I see myself as a very messy creature, my mum would insist on 'tidying' up even when the house was clean & tidy. I like going to peoples houses where you see a bit of dust etc, dishes piled up, it makes it looked lived in. I do know someone who hid her calendar because it was written on therefore too messy for her kitchen, I wouldn't want to be that tidy. I go for not a health hazard reassurance and ok, please don't feel obliged to post pics _ I don't think I could!


Aqua said...

HBW: People who come by my house also seem "cool" about it, but I still feel ashamed. The only person with whom I finally and I truly felt it was okay to have the messy house with when they were here was my Mom She always said my house was warm, homey and welcoming. She also said life is too short to spend all your time cleaning your house. Given how young she died, she was so right. My Mom was the only person I really loved having as a visitor.

Mini UK: When I was a child and teenager every Saturday my Dad would have "inspection". He was a policeman and to him having things perfectly cleaned, in exact positions and set up perfectly were part of his job (perfectly pressed uniforms, shiny brass, shoes shined to perfection were all part of "inspectin" each day on his job". Inspection at our house included looking under the beds to ensure I han't stashed my stuff under the bed, perfectly made bed, hospital corners and all, impeccabley(sp?) neat drawers and closets and everything in my room perfectly in place. If it was out of order he would make me start again. I think I have a bit of resistance left over from being a child in these conditions.