Saturday, October 04, 2008

It's Not Always Perfect: Sometimes That's Why it Helps

I recognize that there are many many people in therapy who are really struggling, either with their therapist and/or with their continuing, and maybe worsening mental illness, in spite of therapy and medication. I was looking back at my recent posts and I can see that my therapeutic alliance with Dr. X. might seem perfect, or completely seamless to people who have only fairly recently been reading my posts. I want my readers to understand that I have struggled with difficulties in therapy too. It has take a long time for me to feel as safe as I do with Dr. X

It is true, I am, and have been since I began seeing Dr. X, extremely confident that he is the right Pdoc/therapist for me. This is not to say I have never had difficulties with him in therapy. There have been many times in the past where I have entered, departed from, or have been in sessions, where I feel incredibly scared, or abandoned, hurt and once, even punished. Therapy is often an extraordinarily difficult process to participate in.

I entered therapy because I was extremely and increasingly depressed. That depression; its causes, it continuation, and its increasingly worsening hold on my life, brought tons of baggage into the therapy room. That room had two people in it: myself and Dr. X. Any room full of that many difficult behavioural and thought patterns carries the potential for lots of conflict. For me, I do not believe that good therapy is free of conflict.

What I do believe is that in good therapy, when conflict happens, both the patient and therapist feel safe addressing the issues that cause or contribute to feelings of conflict. I am not suggesting it is easy, or that I always feel safe addressing issues as they happen.

Often, within the session, I am feeling angry, or hurt, or rejected, or simply feel I made an idiot of myself. At the time I am simply unable to garner the courage to speak up, or address how I am feeling about something I feel is happening within the session.

Sometimes, I am able to address my fears during the session. I remember one time I was late for my appointment. I am never late. I waited in the waiting room, and 5 , 6, 7, 8, 9 and 10 minutes went by and Dr. X never came to get me. At about the 5 minute mark I began thinking he was punishing me, by the time 10 minutes had gone by I was sure he was teaching me a lesson.

Finally I got the courage to go up to the receptionist and ask if she could get him. He came out, and immediately I knew my mind had been getting the worst of me. However, it was important for me to say something, both because I was angry and hurt for 10 minutes, and also so we could make a plan if I am late again. Addressing the anger and hurt in a calm and safe environment, with a therapist who listened and understood became a learning opportunity and a therapeutic alliance building exercise.

Some of my readers may not have been reading my blog for very long. To ensure everyone that I have conflicts with my therapist too, and that the relationship blips happen within even the strongest of therapeutic alliances; I thought I would share some links to previous posts that express some of the difficulties I have had within my patient/therapist relationship.

The key when reading each of them is that every single time there was a conflict I forced myself to talk with Dr. X. about it. Sometimes it took a few sessions before I felt safe to bring it up. Sometimes I could not even say the words, so I printed up my blog post and let him read it, and sometimes I addressed my feelings in the moment.

The important thing is I never let conflicts go unaddressed. Why would I? The conflicts I have with Dr. X. are always reflections of feelings and conflicts I have outside the therapeutic hour. Addressing fear, shame, anger, depression and anxiety about something that happened between myself and Dr. X helps me work out those feelings when I later have them with someone else.

The following are links to posts, and short excerpts from those posts, to give you an idea of what the post is about. I am hoping others in therapy might see that conflict in therapy can sometimes be used to gather great insight into yourself, others and your behavioural patterns in other relationships.

That said, I do not believe all conflict within therapy is good. My experience has been that trust and mutual respect between therapist and patient needs to be strong, and in place, in order for the conflicts to be healthy learning experiences.

I learned more from the following therapeutic moments than any other moments I have had:

1) "Opening Up Too Much"

"I just got back from my therapy session. I have mixed feelings about how it went and how much I opened myself up to Dr. X..."

2) "Do I Tell My Pdoc the Truth?"

"...The truth I am afraid to tell is how deceptive I have been in regards to my dog's prescriptions. I have been amassing very large amounts of two types of heart medications and a very large, and definitely lethal dosage, of Phenobarbital My dog does need these meds, but I have been getting the pharmacist to give me all his refills at once under the guise that I do not want to pay the dispensing fee for monthly doses.That is not the truth. I want to use the medicine to commit suicide..."

3) "Is it a Love Hurt Thing?"

"...Today I went and saw my pdoc again and he says he thinks I should go off all medication for a while and really work on my relationship with my husband and other non-medication things (like exercise, eating well etc.) ...

...I lost it...I feel so ashamed of how I reacted...

...I felt like my pdoc was taking my husband's side and my family's side..."

4) "You Won't Die From Not Sleeping!" (About being 'taken off' benzodiazepines when I did not feel ready...this post actually led to a really good discussion and a lot of support from my pdoc this past I try to come off them again. This time I feel safer and more confident I will get help if I need it)

"...All I want is to sleep, but I asked my pdoc what to do and he said he did not want to take all this energy away from me. I was hoping he would give me something to help me sleep...Why can't I ask more directly?

"...He said he did not want to sedate me when I finally was feeling more energetic. He wants me to look at it and use it in a positive way, because I have been so depressed for such a long time with no break in my mood. He said, he doesn't want me to feel like he is not supporting me, or dismissing how difficult not sleeping is, by saying that, but he wants me to really try to use this time to push forward..."

5) "Preparing For my Therapy Session Tomorrow"

"...I don't know why, but I feel it is not my place to ask Dr. X. to reveal some of these maybe I can do it on paper..."

(About things I was unable to talk about or open up about in therapy)

6) "A Fine Line"

"...I just need help and I'm not one to take myself to the hospital, or call my I cry, and I cry and all I want is a way out."

(About my inability to tell Dr. K how suicidal I feel, or to reach out)

7) "Prepare to be Cut Off"

"I went into my session today feeling really good, despite not having slept more than a couple hours last night and not much the past week or so.

...Then I do not know what happened, but all sorts of negative thoughts started to creep into my session..."

8) "Truthtelling in Therapy" (I sometimes print off things that are really difficult to say and hand them, or read them to Dr. X)

"I feel so ashamed and guilty about how I behave. While I believe absolute honesty in therapy is extremely important to, (and maybe the cornerstone of), successful therapy, I still hold back and find it hard to explain the bad things I do to myself..."

9 ) "Judge and Jury" (about my projecting my Dad onto Dr. X and its affect on the therapeutic relationship)

"... I felt so stressed out and scared in my therapy session today. I have been severely depressed (even more so than usual)and have been feeling really paranoid about being abandoned...both physically and emotionally, by Dr. X, by my family, by my friends, basically by everyone..."

10) And Then the Door Slams Shut"

"...Ahhhhhhhhhh! I want to scream. Four days ago I was going on and on about trust and how I am feeling safer and closer to my pdoc and now I am totally obsessing about how I think my pdoc is not being straight up with me..."
how I was able to talk to Dr. X about my feeling dumped

11) "Blind-Sided"

"...I do not think he is being honest with me. I think he saw an out and took it as quickly as he could. I feel totally let down...and angry that when I am so severely depressed, (but finally had the courage to ask for him to change his schedule to meet a need of mine), I got shot down in flames..."

12) "Freed Up" (about my addressing how I felt "Blind-Sided")

"...I am so proud of myself today. I was brave in my session today and brought up how I left the session in shock...wondering how, when I was brave enough to ask for a change to accommodate my needs, I left feeling like I had been dumped like a hot potato..."

You know that song by REM..."Everybody Hurts" It is really important to speak up and try to understand and work things out if you feel hurt happening in therapy. I swear speaking up with Dr X. has led to some of the biggest therapeutic epiphanies I have ever had.


s said...

Good review post. And it makes me realize how far I am from even discussing the conflicts without precipitating a major blow up.

Aqua said...

Hi S: Thanks for reading. I am hoping things begin to turn around for you. I'm thinking of you often. Keep trying.

Annie said...

Aqua, I am always impressed with your honesty and even more in this post. It was helpful to have a review of your experiences with Dr.X. Thank you for sharing your feelings! Annie

Aqua said...

Thanks for the comment Annie. I try really hard to be as open and honest as I can here, because I see it as an extension of my therapy. Dishonesty would be a waste of my time:) I'm glad the post was helpful.