Resisting Trust

In my last post, "What a Difference a Day Makes", rather than feeling better, (I am not), I think despite feeling unwell I was able to have some insight into how my perception of other's motives might be skewed by my own beliefs about how I want and need to be supported when I am unwell.
I feel like I had an epiphany about other people. It seems obvious now that I have embraced the idea, but I am NOT the centre of the universe. Ha, ha...sort of:>( I often worry that I am narcissistic...can you be narcissistic if you think you might be? Hmmm).

Given that others deal with their depression in many different ways, it is probable, and even likely, that if they try to support me or you, or help us, they will do so in the way they understand to be helpful to them. This may or may not be the way in which you want to be supported or helped.

I know I try hard to approach friends difficulties the way I think they might need supporting, but I bet I get it completely wrong much of the time, because of my reference point. I need love and affection, nothing that indicates dismissiveness, or anger, and honest feedback.

I realize now that I block people from providing me with honest feedback because I so often feel hurt and criticized by what others perceive as honesty and even support. Difficulty trusting others is a key component to my reacting negatively i.e. fearfully, or hurt) to honest feedback.

I have great deal of difficulty trusting others, even those who consistently prove themselves trustworthy, (eg. Dr X, my boyfriend, friends etc.). I think I have made progress in this area, especially with Dr. X, but I falter all the time.

I remember just last week how intensely hurt I felt by a letter he had written to my Family Doctor (in Canada specialists need re-referrals from the referring physician every 6 mos...seems ridiculous when a psychiatrist has been seeing me this long). In the letter to request a re-refferal he said something like (paraphrase), "Aqua's mood cycles. She sees this component of her mood and is afraid to commit to regular activities". Honestly, I feel okay about what he wrote now because he and I talked about how I felt hurt by his comment.

At the time, after I left his office and read the letter, I was so hurt and angered by his comment. I felt so bad about myself and the way I was, that when I wrote my post, "Concrete and Practical Help" I could not even write about the situation that lead to my needing this help.

I felt like he was saying that I "could" commit to work etc., if only I would; that it was ME stopping myself from committing and not the fact that my mood disorder, my depression, was so intensely unpredictable and severe. It felt completely contrary to what I thought he had been telling me for years; that my mood disorder and its cycling affect my ability to maintain the momentum, motivation, mood, and energy to commit to regular scheduled activities. As I read the letter, all the trust and honesty Dr. X had worked so hard to maintain dissipated in front of me.

Obviously, not ALL the trust disappeared, because I was able to discuss my anger and hurt with him in my next appointment. The discussion helped me understand what his intentions had been. I understood more clearly. What really strikes me today, as I write this, is how, after years and years of building a trustful relationship, I can so suddenly feel hurt and distrustful.

As I read the letter to my physician I tried so hard to tell myself I was mistaken in my interpretation of the words. I tried so hard to believe and understand that Dr. X was so good to me, was so compassionate, honourable and trustworthy. I tried to remember how consistently supportive he has been all these years...but the worm of distrust, suspicion and paranoia kept digging itself into my brain.

...and I wonder why Dr. X and others might be apprehensive and not completely forthcoming about providing me with open and honest feedback. Given my pathological difficulties with trust, given my fear of being punished and plotted against, how can he be sure I will accept his feedback is thoughtful, caring and therapeutic?

Why do I resist trusting people so much?

Hidden

I know there are people who are depressed who are depressed around everyone; people who are melancholic, or outwardly irritable. I am generally not one of those people. When around others I usually can either fake it and be sociable and pleasant, or my mood actually does lift for the time
I am interacting.

I suppose many would see this as a gift...the ability to pretend, or actually become "normal", i.e. my pleasant self, when I need to. It may seem something like a superhero's ability to become an ordinary human when walking amongst the general public.

There are costs to this way of being. When I am severely depressed the energy it takes to be what I think others need me to be is exhausting. I often leave a social function feeling so much fatigue I want to throw up. The second I walk out the door intense depression sets back in, and I feel exhausted; even more so than my general day to day exhaustion.

The other difficulty I encounter, and this one I find so frustrating I want to scream, is that people don't believe I am sick, or depressed. If I reach out, or open up and bring up how depressed I am, I often (more often than not, hear so many stories about how friends, relatives, family members of the person I am talking with suffer from a depression much worse than mine.

Sometimes I just let the comments go, because it is not a contest...if they think that is the case who am I to argue. So often though I feel like my pain is being dismissed as mild, or not worth worrying about, or even worse, that I am being told I am not depressed at all.

This happened last night. I managed to open up to someone about my mood disorder and they immediately told me their sister had a depression "...much worse than {mine}". The sister had had a breakdown, ended up in care and during one episode became catatonic and had to be hospitalized.

That sounds like a very severe depression to me. It is very sad. How though is it worse than mine...years and years of cycling, no medications that consistently help, or if medications help side effects that impact my life, isolation from most of the people I know, loss of my job, paranoia, fear suicidal ideation loss of pleasure, fatigue, inability to motivate myself...and an increasing sense that I want to die all the time?

Last night every time I would express what my struggle was like this person would interrupt half way through to explain how I wasn't that depressed. Eventually I just became quiet and listened. I felt really dismissed and vulnerable for opening up myself only to be told others are far more depressed, and that I really had not experienced a "real" depression, not like other people have.

I am sure some others are far more depressed, though I do not understand how a person would manage to stay on this earth much more depressed than I feel sometimes. It is a brutally difficult battle at this severity.

I am sitting here right now, just trying to hang on. I feel so isolated and scared. I cancelled a volunteer luncheon I was supposed to go to because I am so depressed I feel physically ill. I know I will be in trouble for cancelling, because I have missed so many meetings recently, but I just don't have it in me to be fake, or for my mood to increase to please others, only to make me more intensely depressed and tired later.

I know it is weird that I care that others see how depressed I am. It is not that I want others to see how depressed I am, or to say yes you are severely depressed, or even to empathize or sympathize. I just want others to know I am not slacking, or lazy, or using the system, or getting disability for something that isn't that difficult to manage. I want others to know I am struggling against an illness just as severe and real as any physical illness. I want others to know I am trying as hard as I can, but my enemy is vengeful and strong. Maybe too, I am reaching out for help.

Pain and Tears

I seem to have a never ending supply of tears. Why is that? It becomes especially apparent in my therapy sessions with Dr. K (or any other "therapy" sessions, formal, or informal),even if someone asks me how I am and actually wants me to tell the truth; and not say some lie like "fine.

Some people have told me they cannot go to therapy because it is too painful, or because all they ever do is cry. In some ways I look forward to therapy for these reasons.

If I don't go to therapy all my pain stays inside me and eats away at me and makes my symptoms worse. There is something comforting about knowing you can share your otherwise carefully hidden pain with someone else. It feels intensely powerful to be able to get all that pain out into the open, to toss the words that represent so much sorrow and anger and anxiety, out into the open room. To be able to share your feelings of strangeness, loneliness; "otherness" with another human being. To take a leap of trust and share anything you need to with another human being is cathartic and soul enhancing.

I sometimes think I should stop therapy. I often sit down in the chair across from Dr. X and think I have nothing to say, nothing to contribute. I sometimes feel I repeat my stories, my pain, my sadness, my struggles...over and over and over. Sometimes I sit in painful silence not knowing what to0 say, or not having the energy to say anything. Dr. X says that's okay. It is okay to sit silently in the room with him.

It seems counter intuitive. Therapy is for talking isn't it? For me there is also some kind of magical nature embedded in therapy with Dr. X. It never happened to me in therapy with anyone else. I sit across from my pdoc and often the anger, rage, anxiety and sadness quiets, dissipates, disappears. His demeanor, his patience, his attention, his acceptance and compassion seem to melt away some of my symptoms. I feel a sense of relief I rarely feel in the outside world.

I think my tears flow so freely in therapy, because I feel it is okay to let go, to cry, to not hide how I feel. I believe they also flow from feelings of inadequacy, guilt and shame that I need to address in therapy. I feel small and unworthy in front of people in authority. I cannot cry and let out those feelings in front of most authority figures. I can in front of Dr. X. He has worked hard to help me see us as equals, to help me learn not all men, not all authority figures, not all people in positions of power want to take me down, punish me, or hurt me.

I cannot believe how ingrained and generalized to almost the entire population (on some level I can see "authoritativeness" in everyone I know...everyone is better than me because I feel like such a loser for being how I am). So I cry because in situation when I am in front of other authority figures I feel scared, unworthy and afraid of punishment...I think I still unconsciously feel this way in front of Dr. X. I am so scared he will leave me, get sick of me, or think there is no point in continuing, or he will become unwell and leave.

I am so scared I will be abandoned because I am not a worthy person. This dynamic reflects my fears about others leaving me. The tears flow and flow and flow because I constantly feel afraid of rejection. My tears are defensive.

When I was little and growing up, I think I subconsciously learned that tears made my Dad stop belittling me. It stopped his teasing and torment of me. It stopped him hitting me. It decreased the pain in my life. I think my brain still makes me cry to protect me. I believe also I cry to release all the pain I experience or have experienced. Crying is a physical release for my mental pain. It feels so good to cry. It calms me.

So I hurt and I cry in therapy, but for me those are two huge reasons to keep going. I need to release all that sadness and pain. I need to share these with someone I trust and believe in. I need to know I am not alone in my struggles. I need to know that there is at least one person in this world who will support me and help me and care for me no matter what I am feeling. Maybe I will never be completely "well", but the support helps me continue to try.

Graciously Accepting Compliments

Yesterday near the end of my session Dr. X looked at me and explained he wanted to say something to me, but he wanted me to accept the compliment, and not reject it, or become self effacing about it. He really wanted me to try hard to accept and embrace what he was about to say. At this point I became extremely self-conscious and worried about what he was about to say.

At this moment, as I write, I am going to practice accepting praise at face value AND being proud of myself:

He began to express how much he like my blog. Not just that he went on in detail about what he like about it. I don't even remember what it was he said about it, because I was listening and it all seemed surreal. It seemed unlikely that someone like him, someone so important to me, someone so intelligent and well read would see so much value in what I write. I wish I could remember what he said, because after he said it I was flabbergasted. Yet, at the same time could not help but doubt the sincerity of such profoundly kind and elaborate praise.

I tried REALLY hard to just ACCEPT what he was saying, but I couldn't help let slip, "Are you serious? Do you really mean that?". He looked at me with a slight look of consternation that told me I had slipped up and done exactly what I had promised not to do. I was supposed to accept what he said, be proud of myself, and if I wanted to, say thank you.

I still find it hard to believe that he meant what he said, despite deep in my heart recognizing that he is not one to lie, or make things up. I wanted so badly for him to enjoy my writing, and it feels so important to me that he be interested in what I have to say, that it feels impossible that he would actually feel that way.

I was thinking yesterday why I would have such a reaction to praise about something I do, and something that means so much to me. I love writing in my blog. I find it intensely cathartic and challenging to write about the issues I do.

All I can think is that maybe I was projecting my Dad onto him. I try to please my father, to make him proud of me, yet no matter what I do I feel I never please him, or live up to what he wants, or expects, me to be. I am always a disappointment. My being depressed, and off work makes me disappoint him even more. I am trying hard to let that go, but I find the dynamic clings to me.

I think, because my blog is so important to me, I believe it became a contender for incurring disappointment in someone who matters to me. That is why I took in the compliment with a huge amount of doubt about its sincerity. My immediate thought was that the compliment was a gesture to placate me, to retrain me, to make me feel better during a therapy session where I was feeling so badly about myself.

My Dad called last night and asked me how my dog training was going. I told him about our first trip to the off-leash dog park, and how the despite all my hard work training my puppy to learn the words, "Come", "Sit", Heel" etc., the second my puppy saw another dog he was off like a flash and I may as well been a stranger. He tugged madly on the leash when I did manage to leash him, even though on the farm he happily walks with a loose leash at my side.

My Dad sounded so indignant. What the hell are you doing letting him off the leash? What did I tell you? That is when you need to use the long lead. He needs to be on a leash." Those words don't look too bad as I write them, but it was the tone in which they were delivered that said..."You are a fucking idiot, you never get anything right, I don't know why I even bother"

It is no wonder I get so angry with myself. I have internalized my father's dismay in who I have become, and who I was my whole life. I swear at myself; internally scream at myself, to, " just fucking get it together. Fucking change you idiot. You are such a loser. You don't get anything right. You just aren't doing the right things. You aren't trying hard enough. If you were you be better and back at work. You are disgusting."

Dr. X. explained that it is very difficult to get rid of those negative voices in my head, but I can bring more positive voices in to counter the negativity.

During the phone call I should have been thinking:

...Dad is just trying to help me. He does not realize that criticism from him cuts me to the bone. As a policeman, he spent his whole life barking commands and ordering people around. He does not understand how deliver a message softly. That's not his fault. He is a product of his life, just like me.

I need to not take his help as rejection. I need to accept what he is saying at face value. He is only trying to help me be a better dog owner, and he has the knowledge to do that.

Wow, I have worked really hard to teach my puppy manners and commands. He is however, still a puppy, and he has just recently been off the farm and into other environments. He becomes over stimulated and distracted by all the new things. I made a mistake. I have never had my own puppy before so I did not know better. I should have had him on a long lead. I know that now and will be better prepared the next time we go out. Dad was only trying to help me.

I feel like I will never learn these lessons. It is so painful to make the same mistakes over and over again. I would like to graciously accept Dr. X's compliments and believe he meant what he said. I feel flattered and very pleased with myself for all the effort I put into writing the things I do in my blog. Dr. X. you helped me feel even better about something I love to do. Thank you.

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.

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 week...as 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 things...so 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 pdoc...so 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.

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.

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.

A Conversation Between Me and My Dad

Me: Hi Dad, guess what? I bought a new car. (I've been driving and old 1986 minivan for years...love it, but it's time has come...well, did come years ago)

Dad: Hell, you never listened to your father's advice. Why in the hell would you buy a new car? (sort of joking I think)

Me: The same vehicles, but 3 years older, are only $3000.000 less and have no warranty, it made way more sense to buy new, plus I have never owned a new car. I just wanted a new car.

Dad: What else are you up to?

Me: (really excited)..oh, I applied for and got the volunteer position to teach 3 half day printmaking workshops to teens in the summer.

Dad: What kind of teens are they.

Me: Teens coming to the Art Clubhouse. Teen with mental illnesses.

Dad: Oh, you mean not real teens?

Me: (in my head...WTF?) (Out loud)They are REAL teens, what is that supposed to mean? They just have illnesses too.

Dad: Why the hell aren't you getting a real job, one that pays? Why the hell would you volunteer when you could be working for money.

Me: Well, I'm only volunteering to teach 3 hours a week and it's in a rehabilitative and supportive environment. I am trying to get better.

Dad: Well if you can volunteer to work you can get a real job.

Me: (wishing I'd never called, and wondering WHY I always contact him with the delusion that someday he will actually be proud of how hard I try, and wondering where I could get a job that allowed me to work just 3 hours a week and where I could feed myself and pay the rent) Dad, I am still not well. I cannot work right now. I am slowly trying to get better so I can work.

Dad: What you need is a real job. You have been doing that volunteer stuff for a long time now.

Me: (thinking yes...I've been managing a few hours a week for the last 1.5 years, but just recently began to feel safe doing that or even well enough to do that....and besides that, what I do in my volunteer work now is far more "real", much more meaningful and important than anything I have done work wise in my past). I am not ready to work yet Dad. I'm trying to get well and volunteering in this supportive environment is a safe way for me to work towards that.

Dad: Hrmfft. (Translation: you are so lame)

Me: (Hanging up from a call I initiated and entered feeling excited and proud of myself; and hanging up from the call feeling dejected, rejected, diminished, ashamed)

...bye Dad. I love you.

Dad: yup, bye. (click)

Delusions of Being Unloveable or Rejection Sensitivity?

I am not sure if what I experience are delusions, but today I received an e-mail from my sister. She had forwarded a letter from a friend we had in grades 8 and 9. This friend had been trying to contact me for the last two years via e-mail. I simply never returned her e-mails because I feel so ashamed of what I have become.

I felt she would be repulsed by me, like I was completely unlovable and such a loser for being so depressed for so long. I felt she would reject me, or even worse, make fun of me and who I have become. I feel embarrassed for not being able to work. I feel like a loser for never having kids, which I chose because I knew I could barely take care of myself, let alone a beautiful child. I feel like I am a bad person and no one will like me when they find out who I am.

In the letter my sister forwarded to me from our old friend the friend was so kind and empathetic. She said so many kind things about me and our times together. She sounded genuinely sorry that I was struggling so much. I don't really know what to believe about how people will react to me now. Maybe people understand more than I believe they do?

Independence

I think lack of independence has, in many ways, led to my depression and kept it from going away. My husband is away and I am noticing that I am free in a way I have not allowed myself to be in a long time.

I am free to turn on the heat when I want to without being afraid he will criticize me (I pay the bill...so not sure why he cares either way). I am free to go anywhere, with anyone, without being afraid he will get mad at me. I am free to do the things I like to do without feeling guilty about doing them. These things are informing me that I allow my husband to control me in so many ways. I give up independence to keep our relationship comfortable, to avoid conflict. I don't like that I do this.

I feel like I give away bits of myself by giving up my independence. I notice that whenever he has gone away I feel a sense of freedom that I do not feel when he is home. Alternately, my strong sense of needing my independence can be a big problem. I push people away because I feel suffocated, or feel like I need my space. I think this is a defense mechanism. I push them away before they get the chance to push me away.

I struggle so much with my fear of being rejected by others. I believe this stems from two things in my life: As a child and teenager I had to move with my family to different parts of the country every 2-3 years. Each time I moved I had to make new friends. I think I gave up some of my independence and became who people needed me to be in order to make and meet new friends.

Also, I had a father who dismissed my ideas all the time. He was the most important male role model in my life. His dismissiveness was heartbreaking as all I wanted to do was please him. I am 42 and he still dismisses me and I still try to please him. It still hurts me every time he rejects me. I do not know how to become independent in this relationship, other than avoid him, which is what I end up doing.

I have replaced my father with a husband who does the same thing. It is strange, but the more I feel dismissed, the more I struggle to be close to the person dismissing me. This affects my independence. I do not feel safe being independent because I fear I will be rejected.