Ouch… Depression

I am not sure what is happening to me this week. I was feeling good on Sunday, probably the best in years, but I woke on Monday morning to that familiar gut wrenching depression. I’ve been here many times before, but experience does little to cushion the blow, or ease the fear of the unknown. No matter how acquainted we are with our own personal monster, there is always an element of uncertainty whenever ‘it’ comes to visit. How long will it stay… how grumpy will it be… will it rip my throat out… can I do anything to improve it. I’ve barely enough energy to function… barely the enthusiasm to get through the day.

I’ve asked myself many times if there’s an element of loss running through this. Paul made a sudden departure and group therapy ended. Even though I feel relieved for escaping the uncertainty, the disappointment is bound to cast a shadow over the closure. But, there’s not a lot I can do about Paul’s sickness and maybe this is a valuable lesson in acceptance.

The group Therapist emailed today. Even though I officially finished last Friday, she’s encouraging me to attend the last group before the Christmas holiday, which is this Friday. I don’t want to. I’m not sure what I can achieve by attending one last group, but I’ll certainly consider it.

There’s not a lot more I can say. Writing is extraordinary difficult, but I thought it’s important to try to connect.

The end of Therapy

I often contemplated the end of therapy, anticipating a time of fear and doubt. Now that I’m here, the experience isn’t the Armageddon I imagined. This might be due to exhaustion, or it could be the wobbly relationship with my Therapist, Paul.

I would say that our therapeutic relationship has been a comfortable one. His calm, laid-back character oozed an impartiality and empathy that only encouraged conversation to flow effortlessly. The initial months of therapy were testament to a life that had wadded through its fair share of trauma. I don’t know whether to cringe or laugh at some of the dysfunctional beliefs and statements from those earlier days, but it’s comforting to realise that I’ve come a long way.

It will take some time to appreciate the finer details of the therapeutic journey, but one important element missing, is my Therapist Paul. His absences have littered our therapy space since the beginning of the programme. The first few didn’t mean too much, but the strain intensified slowly, as we climbed through six, eight, and then twelve cancellations.

I wrote about most of this in my last post, so I won’t go over old ground. By the time he returned to work last week, I had managed to plough through most of the transference and the anger dissolved into a minor irritation. His absences haven’t ruin therapy, but the constant dripping of disappointment, could corrode the trust within any therapeutic alliance.

When Paul and I met two weeks ago, it was obvious that he had been talking to the Psychiatrist of the therapy team. He knew already that I had seen him on his knees. Perhaps she asked him to justify praying during work time… on my therapy time. I pretended not to notice how our accounts seem to have different timescales. I’m not stupid and know exactly what happened that day.

He would’ve looked for me in the reception area at 2pm. I’m typically a couple of minutes early, but seldom do I run late. On this particular day, I imagine how he seized the opportunity for a quickie – a prayer that is – before returning to fetch me from the waiting room five minutes later.

I wasn’t expecting him to sit in a chair and wait indefinitely, but I arrived at the therapy room approximately three to four minutes late… this is hardly enough time to apparently form a conclusion that I wasn’t coming.

We had a frank conversation two weeks ago, but it can’t be easy for a Therapist to get an earful of transference, especially if they’re not okay within themselves. It would be so easy to assume that his unreliable history demonstrates a lack of investment in my therapy. I don’t believe he’s irresponsible. Some of his clients from the distant past, are as surprised as I am.

Paul said the therapy service is offering to extend my time, but my indecisiveness changed the subject quickly. Rather than leave on the 9th December, I can stay until the end of January. I was probably being flippant and bitchy when I doubted his ability to fulfil the commitment.

Two days later, Paul phoned to change the time of our next session. He called back five minutes later to say, “Thank you.” When our appointment day arrived, I received an email from his boss.

“Dear Cat,

Apologies, but your appointment today with Paul is cancelled. Please contact re any concerns

I should’ve been annoyed, but my time with Paul is over and that feels strangely satisfying. It’s not all negative. The value of our time together far outweighs his absences.

I replied to his manager’s email. My leaving dates are Wednesday 9th Dec with Paul and Friday 11th for the group. Paul’s still off sick and won’t be available for my last session tomorrow, but it makes little difference. The end is disappointing, but it has been a wonderful experience.

 

Transference with my Therapist

Wow, this feels weird to be back in the comfort of my own blog. I’ve been on the missing list while I battled with technical issues for a few weeks. Luckily the PC is insured, but why are insurers ultra-efficient at collecting the cash and then so slow to deliver the goods.

Taking a break from writing about my therapeutic journey wasn’t such a bad thing. I didn’t have much choice because my therapist, Paul, went off sick… again. He must have cancelled between 10 & 12 sessions, which make up a significant chunk of time within an eighteen-month programme.

I last saw Paul about four or five weeks ago, but he didn’t see me. I had arrived a minute late for therapy and was dreading the wait at reception, which is a long, narrow corridor situated between three busy mental health units. Paul’s already aware of how my PTSD and agoraphobia struggle to deal with this area, but I didn’t feel confident in his attentiveness.

On this particular day, the reception was crowded with an impending drama unfolding. My first reaction was to hide in the toilet where I stood in the silence, listening to voices escalate on the other side of the door. It was four minutes into my therapy time and I had two options; leave the building or go straight to the therapy room. I chose the latter, which transpired as one of my biggest mistakes.

I approached the closed therapy room door with caution and peered through the small window. To my relief, Paul was alone, fixing something on the floor. I gently tapped on the door. His head half-turned in my direction before turning back to face the wall. I didn’t twig that he was in the middle of some kind of ritual, so I tapped on the window again.

It felt like something had just smacked me hard between the eyes. I stumbled backwards, dumfounded. Paul was bopping up and down on his knees. I returned to the reception corridor feeling humiliated, like a naughty pupil who had just witnessed his teacher in a very private moment. I couldn’t understand why Paul was doing his own thing in our therapy space, while I was on meltdown in an environment that we both know is unsafe.

I sat staring at the reception wall for eternity, but in reality, it was probably only for a minute or two. In those moments, all the previous cancellations came crashing down, one disappointment after another. I thought about Paul on his knees, while I questioned his commitment and his investment in my therapy. I walked slowly towards the exit, looking back one more time.

Over the next couple of days, I couldn’t understand why memories of childhood abuse were streaming through my mind. It became one of the most challenging times of my therapy, but it was about to get a whole lot worse. Two days later, I arrived for group therapy, hoping I might see Paul in the building. Instead, someone handed me a letter to say he was off sick for the next week, which turned into three.

Even though I am vaguely aware of transference in therapy, it took a while to realise this is what was playing out between Paul and I. At first, I was just flat_out_furious and with a raging war imploding deep within, I stomped around ruminating for days.

Transference isn’t isolated to therapy, but it can happen to each of us in different situations. It’s when a person reminds us of someone or something from the past. This might be in a positive way, or it can develop into a very distressing experience.

I blamed myself for his unreliable schedule and felt guilty for sharing my anger in group therapy, as though I had somehow deceived him. It was my fault for going to the therapy room and I was completely responsible for reacting so badly to a catalogue of events that was rocking our otherwise good relationship.

When we experience abuse in childhood, it’s difficult to understand why our caregivers would cause us so much harm. The only way a child makes sense of abuse and trauma is to shift the focus of blame from the abusers onto themselves. We internalise the belief that we are fundamentally bad and the words of our abusers become the sand and cement of our self-blame, “You deserved it… You had it coming… You brought it all on yourself…” Unfortunately, the self-blame doesn’t stay behind in childhood, but progresses into our adult lives.

In my rational mind, I know this is not my fault, but it’s difficult to unravel and dissolve a lifetime of believing I am solely to blame for just about everything. Not so long ago, I would’ve dumped Paul. Why would I want to stick with a Therapist who conjures memories of an abusive past?

Paul certainly didn’t let me down intentionally and his behaviour is not of an abusive nature. I’m quite sure he’s already aware of the impact these absences have on clients, but there are obviously some medical issues. This part of the therapeutic journey has been the hardest, but I realise that it’s also an opportunity to work with the transference. I guess self-blame doesn’t go away overnight, but one of the first steps is awareness.