Introducing Myself

I am taking a huge leap of faith here. I hope you don't think it's too corny. I had to hold my voice back quite a bit, because my webcam's microphone starts reverberating if I sing to loudly, or powerfully. Also, sounds much better with a piano, but I can't play, so here is me singing "Nevertheless" all by my lonesome...Hope you enjoy.

Long Term or Short Term Therapy

I woke up today embarrassed and stressed that I opened up so much in therapy yesterday. Still I stand by my decision to do so. It was important for me to share my feelings for many reasons. One of the big reasons is I have a sort of "magical thinking" that if I tell someone I care for them they will disappear, or the relationship will end. For this reason I avoid telling many people I care about how much I care for them. Yesterday was my brave attempt to believe that speaking my truth will not affect my relationship with Dr. X. Today I feel the fallout and fear of that decision, but I think sometimes I need to challenge these beliefs, despite feeling the terror of impending loss...

On another note:
In my post yesterday, cbtish said...
"Yes, good therapists recognize the feelings on both sides in a therapeutic relationship.But it has to be said that few good therapists now believe therapy lasting many years, or involving the kind of feelings you describe, is likely to have a positive outcome.So it frightens me, too, that you feel you depend on him so much.The thing is, support, kindness and compassion do not actually promote change — instead, they maintain the status quo. Therapy is meant to be about healing. Things actually happen. Tomorrow is different from yesterday."

I would like to discuss my feelings about the benefits for me, of long term, versus short term therapy.

First thank you cbtish for taking the time to comment. I always enjoy hearing other people's opinions. On some level I agree with cbtish. I think for some people, some of the time, short term Cognitive Behavioural Therapy (CBT) may be the most effective treatment. However, I think we need to be careful that our dogmatic beliefs about a particular therapy do not mean we blanket all people with the same kind of therapy, especially if there are times when it is clear that a particular type of treatment may not be what the patient needs in that moment.

I think for me, during the early years of my illness (17-25) when I had had only a few Major Depressive Episodes CBT worked well for me. By the time I was 25 I had been depressed several times at 25 I saw a Counsellor for 6 sessions of CBT and I remained well for approximately two years. It really helped me. The difference is that at that point my illness was less severe and I was able to do the activities I needed to do to help myself become well again.

However, there were a few things every therapist, counsellor, psychologist and the pdoc I saw before Dr. X missed, or misinformed me about, or neglected to inform me about:

1. That there are medications that can help people. Not a single counsellor/therapist discussed this with me. I discovered this on my own after reading a book about depression. Personally, I think it is negligent to encounter a patient like me, who has had numerous MDE's, and understand that for the most part each seems to last longer and become more severe, yet not inform the patient that medications help some people.


2. Until Dr. X every Counsellor/Therapist I saw was very rigid in the type of therapy they practiced. One believed in CBT, one believed in Eye Movement Desensitization and Reprocessing. (EMDR), another was Jungian, another Psychodynamic etc. I do not believe for me that a particular therapy is necessarily the best approach. My mood disorder is such that my mood cycles between complete inability to even get out bed sometimes, to highly agitated and anxious, to feeling disconnected from everything, to how I feel right now: extremely motivated, content and relaxed. When I am fatigued and extremely depressed short term CBT, or even the ideas of challenging negative thinking does not help me. I do not have the ability to do the actions I need to do to challenge my negative thinking or to change my behaviour. During these times I need supportive therapy. Therapy that helps me understand it is not my fault I am unable to change, or get better. I need help understanding that guilt about how I am is unproductive. I need to know I am cared for no matter how I feel.


3. I need different approaches in therapy depending on how my mood is, and what kind of cycle I am in. When anxious I need someone to help me relax, and learn relaxation techniques. I often also need medications to calm me down. When I am high I need someone who is familiar with CBT and can help me set goals and activate my life, because during these times I have the energy and power to change, when I am agitated and depressed I need to have a therapist who is not rattled by my intense suicidal thoughts, someone I know will listen and not judge me, someone who allows me to speak my truth, When I am severely depressed I need someone who understands and helps me learn to participate in activities outside my house; someone who knows I am struggling, but believes I can do things anyways. Sometimes, I just need someone I feel connected to; someone who I believe accepts and cares for me no matter what.


4. My depression has been treatment resistant believe it is unconscionable to treat a patient for 12-16 sessions, see they were not well still, and end therapy despite the patient remaoning ill. Basically this is what would have happened to me, and happened to me, numerous times. The therapists would treat me, I seemed a bit better, or even much better, but I continuously slipped back into depression. I did not need short term therapy. I needed (and need) long term support to change huge areas of my life, to learn how to make healthier decisions and choices, to learn what kinds of activities drive me forward and which hold me back. My lifestyle has had to change dramatically for me to survive and thrive with and in spite of having this illness. Dramatically changing ones life cannot be done in short term therapy. Personally, for me, I often see that small changes take a very long time. In long term therapy I am able to practice my changes and polish them. I am able to find who I truly am, who I want to be, and how I want to live my life. Before seeing Dr. X I was lead to almost every decision by fear; fear of ending up homeless, jobless, loveless. I am not certain I made any decisions based on what I wanted and enjoyed doing. Long term therapy has allowed me to work through my fear and work towards what stimulates me. I feel I am working towards having a life based on Joy.

I guess what I am saying is there is a time and a place for short term therapy, but to be dogmatic about either short term, or long term therapy is to miss an opportunity to really help a patient change the outline, or structure of their life to one that supports ongoing wellness and resiliency. Patients like me may need ongoing support indefinitely. If I discontinue therapy, it will not be with an eye towards never going back. If I need help again I will return. For me long term therapy, and different types of therapy within my sessions has been extraordinarily effective and helpful . I really believe it is the relationship between the patient and therapist that leads to lasting positive change.

Relationships, trust, and the ability to be truthful and open about all aspects of my life in order that I have the opportunity to address those aspects, can take a long time. The relationship between myself and Dr. X. is strong and I feel safe to make the changes I need to make. I am grateful I have a therapist who understands the psyche may take time to adapt, change, and grow. For me, long term therapy has led to a great deal of positive change; not just surface change, but change that is becoming embedded in my character. This is a great thing.

Soaring

I am really "over the top". I can see I'm going to fast, but I cannot slow down. It is strange, but in many ways I feel like myself again. I am ebullient, chatty, charismatic, and "on". I have tons of energy and feel really good. However, I can see I might be a little annoying too.

I am catching myself talking to loud, too fast, over speaking people, talkling on and on to people I don't even know (people on the ferry, at the store, etc.) ,interrupting, and too enthusiastic (yes, that is possible). I can see I need to back off a bit, but I try and then I do it again. I both hate and love this side of me...the bursting with stories is good, until I find myself dominating the conversation. My energetic self is good, until I find that energy turning into anxiety, irritability, or worse yet, agitation. My effervescent self is good until I overwhelm people with my thoughts and ideas. My energy to do things is good, until I plan a trillion things and manage to do none.

All in all, while I wish I were a bit calmer and quieter, but I certainly would rather be this way than my depressed self. Right now I want to LIVE. It has been a long time since I have felt up for more than a few days here and there.

I slept last night...I think because I took 1000mgs Tegretol and 100 mgs Trazadone, but now...at 12:14am I am wide awake and can't get to sleep. I have to get up early tomorrow too. Yikes. Here's hoping my energy will subside ASAP (for the night) and will return with the sunshine. (Well the fog actually...it is thick and solid right now...scary to drive in)

The Value of a Powerful Therapeutic Alliance

I am falling deeper and deeper into depression; again. I feel so helpless as I feel myself falling farther and farther down. I went to my appointment with Dr. X yesterday, and all the way there I kept thinking: "I have had enough, I cannot take this anymore. I am quiting everything: medication, therapy, and if that doesn't work, life.

I sit down in my chair, across from Dr. X. and I feel an intense shame come across me. It is as though I feel not worthy to be in his company, to take up so much of his time, to have him see me for so long. I feel that same shame right now. How can I get so much help, and such good help, and still remain unwell?

I sit facing Dr. X. and I feel certain I must be exhausting to him. I must frustrate him so much. I cannot imagine how he manages to meet with me week after week, after week. How, after seeing me crash, seeing me unable to manage simple tasks, seeing me fail over and over again, how can he not be intensely frustrated, or in my mind even worse; how can he not have given up hope for my ever becoming well?

I manage to ask him if I frustrate him. He explains frustration is not the right word; sadness, a sadness that you would feel for a friend, or family member who remains chronically sick, that is closer to how he feels.

I feel touched by his saying that. No one except my Mom, when she was alive, has ever said that to me before. No one says they are saddened by my struggle to become well. My family mostly tries to make me believe that everyone has depressed days, shifting moods, anxiety, etc. That depression is normal. This makes me feel completely misunderstood. I am certain this state of mind is not "normal". They assure me I am strong and need to step out of this hole I am stuck in. Either that or they say "get a job", as thought that will fix me.

Even my Mom used to say I needed to accept my illness, get a job and I would become better. My husband says I am sick because I focus too much on my depression, am in therapy, and take antidepressants.

People without this illness have no concept of what it is like to struggle, and then often to even lose the ability to struggle. Life is hellish, empty, frightening, worthless, hopeless. I wake up everyday hoping today is the day, but most often I realize and know it will never end. It has been part of me for too long.

Sometimes I wake and think: " Today is the day this MDE will end". I have glimpses of joy, moments of laughter throughout the day, but after the moment ends it feels as thought the moment is mocking me; laughing at me, not with me, showing me a moment in time that will only ever be that: a moment, a split second of freedom, an infinitesimally small break in the darkness.

I sat in my appointment yesterday, ashamed of who I have become, wanting so badly for Dr. X. to know who I have the potential to be. In the moments we talk I believe he may know my real self. He may understand I am a better person than the one I have become. Actually he sounds like he accepts both of me: the sad one and the bright and joyful one. In fact, it appears he sees us as neither one or the other. It seems he sees the real me through the sadness. During the time I sit in that chair, across from Dr. X, I feel that the sad and joyful me are seen as one and the same.

I am not two people. It is not fake for me to be joyful for a few hours and barely able to move the rest of the day. Dr. X even says it is not a facade when I laugh gleefully at my puppy running and jumping for a Frisbee, and moments later feel sad. My sadness, and fatigue, and amotivation, my wanting to sleep all day are all symptoms. We will continue to work to address these. He seems confident that wellness is a possibility, that I will not be stuck in this hell forever, that we can, at the very least, help me lengthen and intensify the good moments.

I feel myself laugh when I think of my dog. He is bringing so much joy, and at least some fresh air and exercise into my life. He drags me out of bed, deserves a walk and play time. I am fully responsible for his care. Which at times seems overwhelming, but also is a responsibility that protects me and gives me energy.

Dr. X and I begin to talk about how we, as Dr. and patient, interact. He begins asking me questions I do not know how to answer. He asks me how my interaction with him differs from my interaction with a friend. I try to express how a friendship is a two way relationship and we have a one way relationship. I feel distanced from him by that separation; the him and me.. The game we play has rules and strict boundaries. The playing field looks different to each of us. We are playing entirely different games and I do not completely understand the rules. I only know there are strict boundaries that I need to guard.

I feel intensely uncomfortable asking him questions. I feel like it is not my place to question. That is how I was brought up. Call people Dr. Sir, or Cst.,Cpl, Sgt, Staff, or Inspector. They ask the questions. You answer them. I try to ask him questions like he seems to want, but I feel awkward and nosy. He insists I keep asking. I'm thinking it is a type of behavioural therapy. He wants me to see and believe he is a person like any other, that he cares about me, that I can ask him anything.

All I keep thinking is he must think I am a complete loser. I bet doctors make fun of people like me. Sit in their offices and laugh about how bizarre people like me are. Over coffee, having conversations that begin with: "You would not believe the patient I had today...". I feel scared people do not like me, make fun of me, are secretly talking about me behind my back.

At the same time I feel so disrespectful of Dr. X. for even thinking he might be like this. How rude. How unthoughtful am I to think this man, a man who has always been there for me, who is consistently caring and goes out of his way to help me, how can I even think he would be like that? I feel like I have hurt his feelings for even suggesting this might be possible.

I cannot, however stop worrying that he will give up on me, or that he is exhausted by me, or simply cannot take it anymore. It is always what happens. I wear people out. They leave me. I even used to ask my Mom, every time I spoke with her, if she loved me. As though her actions never screamed those words loud and clear. They always did, but something inside me felt I was unlovable.

My husband and I have been together 16 years and everyday I think he wants to leave. Everyday I ask him: 'Do you love me"? and everyday he answers yes, but I cannot believe anyone would love me, or care deeply and honestly for me. Not really.

This is what I need to work on in therapy. I need to learn to believe I am likable and worthy of people caring about me, and for me. This is where a powerful therapeutic alliance is intensely important. If I can work through my conflicting feelings about Dr. X., maybe I can reflect the behaviours and beliefs I learn onto the rest of the relationships in my life. Even if I am scared, what I do know, is that Dr. X is the safest person with whom I can to practice and relearn better personal and social skills.

Puppies and Behavioural Therapy

Dr. X said something interesting to me in my session yesterday when I was telling him about how my new cute little puppy and I are doing. I was explaining that I was taking a bit of an authoritarian approach with the him (the dog...not Dr.X ;>)

From my perspective it is better, and more manageable, to begin to set clear boundaries and expectations with a puppy who is 22.5 lbs, than to try to get an 80lb dog to change it's behaviour, or do what you want it to do

When I say "authoritarian"...I don't mean my Dad style, scare the crap out of you so you never make a mistake type treatment. That kept me in line while my Dad was watching, or if there was a possibility I would get caught, but left with difficult to control wild streak the second I left home.

With my puppy I am setting clear boundaries and using praise, not punishment, and a few other techniques that really work. I believe in the idea that dogs are pack animals and still maintain many of the behaviours of pack animals. In keeping with that I believe every pack has a leader, its Alpha dog. The job of the Alpha is to protect the pack and ensure it continues to exist and flourish. That's my job

It is up to me to establish my being the Alpha while little puppy is still a little puppy vs. a big dog . I do not want an 80lb boxer trying to become the head of our pack. My husband really should be second in line...but he is not being as consistent as I think he needs to be

Anyways, I have had the puppy a week and he is smart with a streak of stubbornness in him, but here are some tricks I've learned...and it really works. (I got some of these out of the "Puppies for Dummies" book...you know those yellow and black books that teach you all kinds of things. Some of these books are very good (the drawing one is great) and they are easy to read if you have difficulty reading, or with concentration, because you can just read snippets of sections to get really clear ideas. Other things I learned from my Dad when he trained and worked with police dogs

First thing that is going well. I have established a "potty" place and am teaching him to pee/poo on command. He pretty much has it down. I just repeat, go pee, or go poo...and the important thing...do not look at them, ignore them while you say it...as soon as I stopped looking at him ...he began to go. The idea is that an Alpha would not keep looking back on the pack. They LEAD the pack. This idea is great because it is easy to cleanup after the dog

Second thing I have taught him...and he's REALLY good at it, is to heel. I immediately insisted the puppy either walk behind me or directly to the left of me. if he tries to move ahead I just give him a bit of a quick tug, reposition him and walk a bit faster. Within two days he was walking slack leashed beside or behind me MOST of the time...a few little hierarchy takeover attempts, but a polite correction by me and a hug and "good boy" when he gets back into formation and we are off again

The other thing I learned about this behaviour is that if you walk ahead with confidence, even continuing walking if they sit down, they catch up quickly, because they want to be near you...so just keep walking if they stop and they will follow

The coolest thing is that today, because he was so good at heeling I took out my bike and taught him how to run beside me on my bike through the blueberry field. We did a few slowish, short runs, because young puppies shouldn't be exercised to much, but he was awesome at it. We had great fun.

I am teaching him to sit when a car comes in the driveway, and when someone approaches us. Both for the safety of the dog, but also for the people. There is nothing I hate more than an adult dog who jumps up on you when they greet you. 20lb puppy...sort of cute jumping up to say hello...80lb dog doing the same thing a disaster waiting to happen

All the stuff I am teaching him are like games to him. He's sucking it all up like a sponge and loves the attention he gets when he "gets" a command.

Lastly, one of the first things I read was to introduce your puppy to as many sounds: loud, shrill, sharp, annoying etc, as you can before they are 16 weeks. So I have been doing that in the house with the vacuum cleaner, the hairdryer, mixer, etc.

I learned yesterday that if your puppy is scared of a noise, or scared of something the last thing you are supposed to do is bend down, pet the dog, make eye contact and reassure him. (Which is definitely what you have the urge to do...i.e."Oh poor puppy, its okay" ) This places you (in the dogs eyes) in a subordinate position, where now it's his job to protect you. It can lead to a over protective dog, which can lead to aggressive behaviour.

Instead, you are supposed to pull the dog on the lead closer to you. Place the puppy between your legs, hold them slightly tight between your legs (this reassures them that you will protect them...like an Alpha would), stand tall, remain calm and say good boy/girl in a calm, firm voice, while the noise or thing scaring him goes on.

I was skeptical of this one, but today when I took my bike out it needed to be washed (I haven't ridden it in years years..argh! The noise of the power hose spray freaked the puppy out, so I left the hose on, went over to him and put him between my legs, stood tall, no eye contact, acting like the noise was not significant. He immediately sat down. I returned to hosing of my bike and he sat there super calm, no longer afraid of the noise.

It happened again when I took out the air compressor to pump up my tires. I did the same thing and "voila" he could have cared less about the sound after that.

This whole post does actually have something to do with my mood disorder, or at least some of the symptoms and behaviours I have that feed my depression. One of them is difficulty being an authority figure. I am always afraid I will be rejected, or not cared for, or thought as mean, or uncaring. Afraid I will be unloved. This has greatly affected me in the jobs I have had, because each promotion brought on more 'authority" which to be became synonymous with stress and isolation.

The interesting thing Dr. X. pointed out was that this puppy training is great behavioural therapy for me to practice being the authority figure in a way that is loving and respectful, but also ensures I get what I am requesting and still remain cared for.

He's right. In one week I have taught the puppy a lot, but he has taught me that he loves me even more when he knows what is expected of him.

Oh yeah...note to self: the bike ride and running made for a much calmer dog this evening. Keep this up. We both need the exercise.

Anger

Warning: Violent suicidal imagery: may trigger (Please read this first)

I saw Dr. X this morning. I really needed someone to talk to. Until a few days ago I was feeling really good. I felt on track, I was feeling confident I could accept the chronicity and cycling of my mood disorder. I was feeling like I was on the right path, and then something happened.

Something happened that at first made me really irritated and annoyed, and then as I thought more about it I became enraged at how I felt I was treated, and am periodically treated by someone I care deeply for.

Anyways, it doesn't matter what the thing that happened was. What happened was how I later reacted to it. My rage grew so big that I began having suicidal thoughts; violent rage-filled suicidal thoughts. I began thinking of stabbing myself in the chest over and over again so the anger would end, of beating my head until it stopped, of hanging myself, of shooting myself in the head to stop the rage.

Dr. X. and I talked about why I was having such violent thoughts.

1. First, they were just thoughts. I had no plans to do any of those things. I just couldn't get the thoughts out of my head. So they were obsessive thoughts, thoughts invading my mind.


2. Second, they all seemed to be about my finding the fastest way to get rid of my anger. All of the "ways" of committing suicide that invaded my head would result in fairly instant death...and a complete end to the anger.


3. Third, I think they were akin to "cutting"...the more the thoughts came the more calm I became. It was like the thoughts themselves were like my cutting myself to get rid of the pain.

Dr. X was pretty straight forward (well sort of) today about how much anger I have inside me. He seemed to be trying to say it in a roundabout way, so I am not 100% sure what he was saying, but I think he was saying anger is a big part of my depression. We have talked a lot about the anger inside me throughout the years, but I don't think he's ever really said that to me before.

Other therapists have told me my depression is anger turned inwards. I agree I do have some of that happening...but that is too simplistic. I think Dr. X's approach is less dogmatic than that. He recognises there are definitely some biological and genetic components to my depression and that the environmental/psychosocial components are more complex than that. Plus, I am not always angry...but I am usually depressed.

I wish Dr. X would say exactly what he is thinking sometimes, instead of "couching" information in mysterious ways. I think he was saying I need to address my anger. I agree I do feel angry about some things. I told him I am angry my Mom died, I am angry my Dad is an ass, I am angry I lost my job to depression, I am angry I have been anxious and depressed for so long. Who wouldn't be?

I don't think I am usually angry though. In fact, I rarely express anger towards other people. (Maybe my husband...poor guy he gets the brunt of it...but not for no reason most of the time). I am not a confrontational person, generally I am diplomatic and I always am respectful to others even if I am mad at them. For example, I have never ever been disrespectful towards my father, no matter how much he irritates me. He is still my father and I respect that.

I think when I feel well I am not angry. Dr. X says I am a bit wild, suggesting maybe I am feel pent up and that is causing me to be angry.

I do often feel like I am held back, or hold myself back, or pent up; kind of like a Mustang used to running free, who suddenly becomes bridled, broken and locked up in a corral. My corral is my anxiety, that stops me from working towards my dreams (actually it stops me from even dreaming about what I could do) and what I really want to do. The other "corral" is my depression that makes me feel less than capable, or helpless, or that change and choice is hopeless in my situation.

I think I am working hard and making huge strides towards changing and working through and with my depression and anxiety. I am trying so hard to change. I am not sure how to address my anger in a constructive way. I don't want to be mad at people, or get angry when it is not reasonable.

Plus, in the initial situation I alluded to ANYONE would have become angry. I managed to stay calm during the incident. It was only afterwards that I became angry that I allowed myself to get caught in a situation like that. That was when I got angry. I got angry because I felt both taken advantage of, disrespected and treated like my caring about someone was a bad thing.

I think I will need to address anger again in my session next week, because other than me somehow getting my anger out of me, I'm not really sure what Dr. X was trying to tell me.

Raging

AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!

I feel like I am going to explode. I am so angry, hurt and RAGING MAD at the way I am treated by people I love!

Is Public Privacy Possible?

Last session I managed to tell Dr. X. most of the things about my obsessive thoughts. It was extremely difficult, because he was the source and the subject of my thoughts. I was looking at my stats and saw that he had visited my blog a few times and looked and numerous sections (labels) in my blog. I became scared he would feel I was disrespectful to towards him in some of my posts.

Despite my earlier offer this year to let him read my blog, when he did I became scared I had disregarded that there are two of us involved in my therapy, and that I was too open about who I see him as, and how he and I interact. I was fearful that my blog crossed some boundary; that I exposed him more than I it was right for me to do. I could not stop worrying that I had destroyed our relationship.

He assured me I was always respectful; that that was part of my personality. I still feel unsure about whether I cross Dr./Patient boundaries in my blog posts. I feel my blog is immensely helpful to my mental health, but I also want to ensure I respect other people's privacy. I worry that he was just saying that to make me feel better. That is a problem for me, not trusting that people are saying exactly what they mean, that they are not placating me, rather than having an honest conversation with me.

I use my blog to augment my therapy with Dr. X. I have mentioned before that often it acts as a preparation tool. A sort of 'practice run' for the next therapy session I am going to (or sometimes that preparation takes place over and over, until I am able to say what I need to say). I also use my blog to debrief myself after a session.

I often wonder how much of my session I remember "correctly". I remember reading Irvin Yalom's "Every Day Gets a Little Closer: A Twice Told Therapy. In the book he recounts how he and a client wrote about each therapy session and then exchanged notes. In particular he was astounded by how different he and the patient saw the session. Things he felt were really important, the patient either ignored, or glanced over. Much of what the patient found helpful was the relationship between herself and her pdoc.

In my sessions I am often so emotional I cannot think straight. Writing reinforces things Dr. X and I discussed. There can sometimes be problems for me though, when I misread something in my session, or if my symptoms are bad and I am feeling 'paranoid'.

I place the word paranoid in quotations, because I am never sure if I am paranoid, or if what I sense, see, hear really happens. I really feel I have a gift/curse for picking up on small vocal cues and sounds, details, messages and body language that others miss, or do not recognize they are showing. My theory is that because my father was so unpredictable in his rage I learned to sense infinitesimally small cues and changes in his behaviour to prepare myself for the flight/fight/freeze response before things happened.

Something that might support this theory is when, in first year university, I volunteered for a study that was measuring the relationship between hearing and depression. I was extremely depressed at the time. They put me through a flurry of hearing tests and seemed to be astounded at what I could hear. They told me I could hear sounds in ranges that people were not supposed to be able to hear.

Anyways...back to Dr. X's privacy. I again want to assure my readers that I respect your privacy. Dr. X seemed surprised I knew he had visited. The only way I knew it was Dr. X. (or was pretty sure) it was him, (a particular person) was because of his particular server. It had shown up before when he looked at some of my paintings in a session.

You will notice I have two statistics sites,"Sitemeter" and "Statcounter". on my blog. One gives me information about numbers of visitors, where they come from (cities and countries, and how long they visit my site(these are not accurate and usually show as 0) . Sitemeter also tells me how people got to my blog, (e.g. what they googled to get here).

Statcounter provides a bit more information about which pages people viewed and things like that. In Sitemeter it supposedly shows the latitude and longitude of visitors, but please know that it is not accurate in terms of where people live. I was very concerned when I first signed up for it as it appeared anyone with Sitemeter could track the address of my IP.

Rest assured, I checked it out and that is not the case. For instance anyone who posts from Vancouver shows as living at one particular address, on the same street. I have tested this out with a couple friends, and even people I do not know who show up have the same Lat/Long...so it is NOT GPS co-ordinates. In fact, my Lat/Long shows I live in the middle of the Fraser River miles from my house.

I have these stats counters on my site because I am an info junky. I find it interesting to see people from all over the world vi sting, to see how many people visit, because I want to know if I am keeping people's interest, or posting about things that people are interested in. My blog is about my therapy, but I also want to make it relevant to others.

If you have any questions about your privacy and these two statistics programs, please ask me, or add them to your own site and see for yourself what they provide. I believe if you click on their icon (at the bottom right of my blog) you can read more info about them.

Disclosure

(**Note: I misunderstood Dr. Shock when I wrote this blog post. He agreed with Dr. X's type of disclosure. Misunderstood or not, his thoughts were the catalyst for my writing about this topic and it felt good to get it all out of my head. Thanks Dr. Shock).

You may have picked up from my blog that I am not only in therapy, but I am also intensely interested in the therapeutic process: The patient/therapist relationship, how that alliance affects therapy and how powerful a catalyst for change and growth a relationship with a trusted therapist can be.

This post is inspired by my curiousity about that process. Recently Dr. Shock has written a series of posts about the Dr./Patient Relationship. They are all very interesting. I find myself both agreeing and disagreeing with one aspect of the Dr/Patient relationship he believes in. He disagrees with a Dr's self-disclosure (in particular when speaking of a psychotherapeutic relationship).

I for the most part agree with him. I think it is important for me as a patient to be able to project my difficult relationship communication problems onto Dr. X. When Dr. X "becomes" my Dad, like in my recent post "Letting Go of the Past", I am able to reflect afterwards and learn from the experience. It is during those moments when I learn the most.

I have had therapists who spent much of my session comparing their problems to mine, telling me everything about themselves. These have never been helpful therapeutic relationships to me. They begin to feel like they turn into therapy for the therapist instead. Dr. X. is not like that. He is very good at limiting self disclosure to almost nothing. While I have an intense desire to know him better, I appreciate that he reveals little to me, he is whoever I need him to be at any given time.

Recently however, he did disclose to me that he has been unwell, and that it appears he has MS. Dr. Shock finds this disclosure uncalled for (**Here is where I misunderstood Dr. Shock' position about Dr. K's disclosure...he actually agreed with Dr. X disclosing his illness ...read his comments and the posts on his site).

Here is where I disagree with Dr. Shock and the following disclosure about my past will explain why. (If you happen to read this Dr. Shock I would be really interested to know how you would manage a situation like this after reading some of why I think this self disclosure was imperative for my well being.)

I have had numerous situations that have intensified my fears of abandonment. The following were probably a few of the things probably the straw that broke this camel's back:

My Dad left my Mom when I was almost 17 years old. I came home from school one day and my Mom as gone. I had no idea why, or where she went. she just disappeared. It was traumatic.

A week later she returned home and suddenly my Dad disappeared. Although I discovered he had moved into his own apartment, again, there was no explanation as to why he left. I was distraught, confused and felt intensely abandoned both times. As the weeks wore on I began to fall into my first depression, but I had no time to help myself, because my Mom was disappearing too, only in a different way.

She began to drink, stopped eating, wouldn't get out of bed all day, began leaving us at night to go drink, lost weight to the point she began to appear anorexic, became so angry she was hard to be around (she is was usually the most calm and compassionate, loving person I have ever encountered). In a word she became severely depressed as a result of my Dad leaving. She desperately needed a job as she had no money of her own.

My Dad had always taken care of us financially. She could not get work, or manage to renew her licensing requirements to become an RN again because she was too sick. When asked my parents if we could see a counsellor, they both responded "it was none of my business. It was between them"

All I knew for years was that my Dad left. I had absolutely no idea why, or why he never came home. He was just gone. I made up all kinds of things in my head..." I was a difficult child, he didn't like me, he couldn't handle my sisters and I, he had just decided one day that he did not want to be with his family, etc." I felt intensely abandoned, sad, lonely, let down, ashamed that I had been such a bad person that I made him leave us. I had destroyed our family.

I felt abandoned by my Dad, but even though my Mom was physically still around, she was gone. She was inconsolable. She was one of those women who married for life. Divorce and remarriage were not options. It was so sad to watch such a beautiful, strong, and loving Mom become nobody without her husband. Without Dad she disappeared into severe depression for at least 10 years and remained moderately to mildly depressed until the year she passed away.

Two years after my Dad left I could not handle the feelings I felt for losing both parents, for not understanding why it had all happened, so I left home to get away from those feelings. I ran.

Four and a half years and three cities later I phoned my Dad and a man answered the phone. Suddenly, it became absolutely clear why my Dad had left my Mom. He was gay. For the first time in years I felt an intense sense of relief and understanding. I finally understood why no one would talk about it. It was the typical shame issue too many people feel about being gay.

Unfortunately, that was not true. My Dad had remarried, and now had a whole new family, a new wife and two sons, without telling any of us. He had left my Mom for a woman he had been dating for a couple years while still living with us. I can't even express the shock, and feelings of betrayal I felt, and to this day feel. My father marries without telling us, allowed us to suffer feelings of abandonment and fear we were the cause of him leaving, when all he could easily have explained what was going on. Maybe not when he first left, but at the very least before he married.

The woman he married was an absolute bitch. I rarely say that abut anyone, but she was the equivalent, and perhaps worse than, the epitome of the evil stepmother. She would draw you in, get you to reveal your souls deepest feelings and then use those to bait my Dad, and to make him angry at us. My little sister used to have to go stay with my Dad very couple weekends. She could hear my Dad's wife yelling at him about how he had to get rid of her. How she did not want my sister there, ever.

She destroyed any hope that my sisters and I could ever have a relationship with my Dad. My Dad has never once mentioned why he left Mom, or even the fact that he did. He never once stood up for us in front of his wife, or any other time tha we know of. Any attempts over the years to talk with him about his leaving and how it affected us ended in our being immediately silenced. This (among other things) left all his children with no ability to have any kind of trusting relationship with him.

What does this have to do with Dr. X's disclosure? Everything. Given I so often, so easily, and so strongly project my father onto him any sudden disappearance on his part, without my understanding why, would cause me to relive those feelings of abandonment, disingenuity, and deceitfulness all over again. Any trust I had in him would be gone, and I am not sure it could ever be regained, especially if I found out he knew, and had known for some time, that he might have to stop work for a while, or "disappear' for a while.

I am working so hard in therapy to learn that I can trust others, that people are genuine, that not everyone will leave me or outright lie to me, or lie to me by leaving out information. It has taken years for me to trust Dr. X. and to begin to feel safe.

On top of my Dad's deceit, and my intense sense of abandonment surrounding the way it all happened, I recently lost my Mom. She had been the only person in my life outside of therapy who really, really supported and understood me and my depression. She became ill with pancreatic cancer and died within 2.5 months of her diagnosis.

I am still having an intensely difficult time dealing with, not just her loss, but the swiftness of her death and the traumatic act of watching her die: watching her try to cling to her children, seeing her try so hard not to abandon us. The intensity of her will to survive, even after she fell into the final throes of death, gasping for air for hours, trying to communicate, when her ability to talk was gone, watching her not wanting to abandon this world and all she loved in it was so traumatic I don't think I will ever recover from the unwilling and unexpected abandonment of someone I loved so much.

Dr. X. needed to tell me he was ill to preserve the integrity and trust in our therapeutic relationship. He needed to show me he valued me enough to be honest and forthright about his potentially needing to cancel, or rearrange appointments. I needed to feel I was important enough for him to be open with me about WHY he was unable to see me; that it wasn't because he didn't want to see me, or because I was a difficult patient, or because he wanted to get rid of me. I needed to know I was not being abandoned and that I would be taken care of in his absence. Dr. X.'s decision to disclose his illness and the potential it had for him possibly needing to take time off work periodically was only decision he could have made given my background and the issues I have been dealing with.

Therapy and Boundaries

This is to address a couple comments on my last post. It also addresses things I have thought about, wondered about in therapy, things that made me stopped doing things I really enjoyed doing, because I beacame afraid I may be perceived as crossing boundaries.

In my previous post "Co-Blogging Re-visited and a Therapeutic Epiphany", both Dr. Shock and Jcat encouraged me to to continue towards trying a co-blog with my pdoc, in spite of some reservations about this being a means of avoiding the person to person communication issues I have, or a way of overstepping the therapeutic boundaries.

I agree with Dr. Shock when he says not to generalize another therapy's belief onto my relationship and therapy with my pdoc. That was a powerful comment and really made me think. I believe my pdoc and I have a really good and mutually respectful therapeutic alliance. I am not one to try to cross boundaries. In fact my crossing boundaries might signify a breakthrough in my therapy, because I am always so conscientious about doing the "right" thing, about not ever making a mistake, or taking a chance.

I, like Jcat, find it easier to express myself clearly in writing. Like her I have wondered about, and was careful to not cross anything I felt was a boundary.

I used periodically send cards to my pdoc , just to say thanks. I never saw this as stepping over a line, or "acting out". I saw it as, and meant it to be, a symbol of kindness, caring, and to let him know that even though my mood never seemed to get better, I valued his seeing me. Of course one could look for a subtext here: I was fearing abandonment because I felt I was an incredible burden on Dr X. because I was so unwell and not making any progress. I sent the cards to let him know I wanted to continue trying, that I found him helpful and that I really wanted to keep seeing him. That is all true, but the cards were more like a thank you for his consistently being there when I needed someone.

I live on a flower farm, and I used to sometimes bring flowers to my appts for Dr. K. I stopped doing it because I felt really self -conscious that maybe that was crossing a boundary. Flowers seemed too personal, even though there were thousands of them growing all around me, and I found joy in giving them away. It is a shame I felt wierd about bringing some to Dr. X, because the act of choosing the flowers, arranging the bouquet, and the joy of giving a beautiful gift heartfelt gift to him. actually inspired me, the giver.

When I was saying Ms. Fuller gave me food for thought, it was that she reminded me of some of the things I used to do, and stopped doing, because of my fear of crossing boundaries. There is obviously something there, because I rarely bring flowers in, or send cards anymore, because I feel uncomfortable for some reason, though I'm not sure why.

I was also thinking she has a point about how it is really important for me to learn to speak what I seem so easily to write. Despite that I feel I really have been able to speak up many times, because I write.

I think writing directly to my pdoc, about my experience in therapy, as long as we have an agreement that his portion takes place within the therapeutic hour, will only enhance my already great experience in therapy with Dr.X. I will remain conscientious of the boundaries between us; they are as important to me as they are to him. I am looking forward to trying a private co-blog with my pdoc.

Psychosis and Insight?

A few sessions ago I asked my pdoc if he thought that sometimes my depression might be psychotic? He said he has wondered that sometimes given some of the suspicions I have. I know what he means, sometimes when I am in the midst of these suspicions I don't seem to have insight that I am suspicious. It really seems like what I am suspicious about is going on. Other times I am suspicious that my suspicions are suspicious. Are you following?

Take today for example. About 4 months ago, out of the blue, a member of the Art Clubhouse for people with mental illnesses I belong to phoned me while I was teaching a class and asked me out to lunch. I thought it a bit odd at the time as I had only met him a couple times. I agreed to meet him in a public place, but he offered to pick me up at the studio after my class. I felt uncomfortable, but for some reason couldn't say no.

He picked me up and we went to a cafe. I made it clear I was married by talking about my husband a few times. During the initial meeting I found out he had worked for the same national police organization, in an HR capacity, that my my Dad, my Uncle and my Cousin all worked for, or were retired from. He said he knew my Uncle and Cousin.

I don't remember right now, but I believe he mentioned knowing my Cousin and Uncle, before I mentioned they worked for his employer. We talked a lot about this the police force and my Dad, my Uncle and my Cousin. It made me feel awkward, like he was fishing for information, either about me, or my family.

After the first visit I began to think he was undercover either for the police, or for my insurance company. Things he said didn't make sense...like his employer had no disability insurance...I doubt that is true given how huge this employer is.

He invited me out again a few weeks later. This time I felt more guarded, but despite my "suspicions", he seemed like a really nice person and we had a good visit. I let my guard down and was, I think now, too open about myself and my family.

Now, four months later, I have not seen this person once at the Studio. I am increasingly feeling like he is not a member at all, but a police plant trying to get information from me. A tiny part of me (maybe 2-3%) thinks maybe I am being crazy about this...but a huge part of me is really stressed out and worried about it.

This type of suspicion is a kind I often have. I get really suspiscious that my insurance company is spying on me. So suspicious at times that I close all my curtains so no one can see in. I was even on the ferry once when I thought two men were following and watching me. In fact I was certain one of them was taking pictures of me with his cell phone.

At the time it was happening I was 100% suspicious, but as I thought about it more and more, I started to wonder if it was my mind playing tricks on me.

About the last 6 months I was at work I became increasingly paranoid that all the people I worked with hated me and wanted to see me fail. It was brutal. I could barely get into work because I felt like everyone was out to get me. Any interaction with the people I was worried about was painful and filled with so much anxiety I could barely manage it. The pressure I felt to change their minds about me was overwhelming.

I look at it now and I can see that I may have been exhibiting strange behaviour, resulting in people thinking I was weird and therefore they may have thought I was not good at my job and then they reacted strangely towards me, which I picked up as their being against me.

Anyways, I guess what I am wondering is a few things:

• Am I paranoid about this Police person being a plant (I am really concerned about this given things I said about my family to this person...and give their sudden abcense from the disability arts clubhouse)? It was like they knew how to draw information out of me.
• Was I psychotic at work? On the ferry?
• Does that mean I do become psychotic?
• Can you be psychotic if a tiny part of you suspects you might be mistaken?

P.S. My blog spellcheck isn't working...is anyone else having the same problem? Please ignore my spelling mistakes.

Why Can't I set Boundries and Say No?

I am a member at an place that offers art classes, art supplies and studio space/time for people (members) with particular major mental illnesses. At this studio you can be a participant in classes, help teach classes, or be an instructor. Most of the classes are taught by members. I have been a member and taken a few classes over the past few years, but this year I pushed myself to do more.

My pdoc and I discussed creating a community for myself. I love this studio. The members are great. Also, there are occupational therapists who are, in my view, the best I've seen. I feel like members are treated completely as equals by the O.T.'s, something I haven't experienced before. I feel valued and cared for. It is a great community for me.

This year I applied to be an assistant instructor. I am near the end of my second class and I love it, I love the people, I think the instructor is great too. It also gives that day some structure; gets me out of bed, provides me with a reason to leave home, etc. On top of that it gives me a sense of accomplishment, and my life a small sense of purpose and meaning. So I decided to do more.

I now volunteer to help with another class as well. I also attend an array of planning and information meetings. I just finished taking another course there and now I have volunteered to help people move from structured classes to working at the studio on their own. On top of that I have committed to volunteering once a week at our city's Shakespeare festival.

The problem? I am completely overwhelmed and depressed right now. For the past maybe 9-10 weeks my depression has been worsening and I am as close to suicide as I have ever been, maybe closer. Every therapy session for at least the past 6-7 weeks Dr. X. has either asked, "Have you considered ECT again?", or "Have you considered a hospital stay?".

Dr. X. is not the type of pdoc to TELL me what to do. I can only surmise these queries are his way of "suggesting" these options. I have thought of both and I think I need both. I have, however, made commitments to Studio and to the Shakespeare festival. I am loathe to break commitments, even if I know they are getting in the way of my getting well. It is almost an obsessional urge to keep my word, but also because I fear the consequences.

I believe I can manage to back out of the Shakespeare festival after the required 7 shifts and feel okay about that. I have just completed week 4. The real problem is that I just cannot, and will not, break my commitments to the studio. I fear there will be repercussions if I do. I worry I will lose the O.T's faith in my reliability. I also am afraid I will lose the connection and respect that I have worked so hard to gain with other members in this community. I fear the loss of future opportunities at the studio, for instance other instructor opportunities. There are a million reasons why. I told my pdoc my commitments end August 19th. That is when I would consider a hospital stay.

Now the real reason I am writing this is because one of the other studio helpers called in sick last week and then this week called to say they will not be returning to help because of their symptoms. (They told the OT to explain that to us).

I am so proud of this person. I am also jealous that they understand their boundaries, that they are able to say no to take care of themselves, that they put themselves and their mental health first. When will I get there? Why do I not put me first? Or why do I have such a warped view of what putting me first looks like. (i.e. avoiding judgement and punishment). I hope my co-helper will be okay, and I hope I can learn from this person's strength.