Category Archives: Therapy

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.

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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.

It’s Time to Stop Running

runningI’ve sat through group and individual therapy each week for the last eighteen months, and during that time, we touched on every aspect of my life. My presence is no stranger to the therapy room, but this is the first time I was ever able to untangle childhood trauma. I thought we were making excellent progress, but I was aware of bouncing from one topic to another, which eventually led to disorientation and feeling very lost.

It felt as if something fundamental was missing from the therapeutic journey and it took me all this time to understand what that might be. I may well have dutifully conjured up challenging memories in therapy and identified all the right feelings, but I didn’t sit with them long enough to form any kind of conclusion or attain healing

It’s devastating to reach this stage in therapy and I even wondered if the entire experience has been one big avoidance trip. The thought of having to go back to the beginning and trawl through the feelings all over again is a daunting prospect and there’s something very shameful in admitting that this is where I’m stuck…. at my age… a prisoner within the same past trauma.

When I first started this blog, the tagline read, “A tale too tragic to tell.” I was trying to convey how it almost sounds tragic to recount so many traumatic experiences in one short life. I find it difficult to hear pity and the last thing I ever want to do is sit around licking old wounds until they’re raw. What I do need to do during my final months of therapy is to stop bouncing around and learn to sit with certain emotions long enough to hopefully generate a solid state of recovery.

Shame. Humiliation. Fear. Anger. Those may well be some of the hardest emotions to admit but they are much more painful to sit with. They are the fuel to my avoidance and the catalyst to a lifetime of mental health problems.

Something happened in group therapy on Friday that seemed a benign interaction at first, but it inadvertently made me aware of something I’ve not quite grasped before now. The only other male member of the group asked if I have a problem with him. “You always seem to look straight through me,” he said.

I don’t have any particular issue with him, but our small interaction did feel slightly uncomfortable. I thought about his comment for some time afterwards and I reckon that he probably does detect subtle hints of something uncomfortable. I realised last weekend that the issue is not with him, but rather what his gender came to represent in my own life.

When I was a little boy, people would easily mistake me for a girl. Everything about me felt feminine and this played out in how I walked, talked, and the toys I liked to play with. I was only ever comfortable playing around girls and the boys found my lack of interest in football distasteful.

Maybe the gender confusion infuriated dad or he may just be carrying baggage from his own childhood. Those reasons bare little importance to the healing today, but he was always an angry bully who terrified me from an early age. His loyal-family-man principles worked hard to put food on the table and clothes on our back, but I was still unable to trust his apparent goodness. I’ve never hated anyone as much as I did my own father and his obsessively strict parenting instilled an incredible – sometimes inappropriate – fear of aggression and violence.

Unfortunately, a fear of violence mixed with feminine characteristics didn’t go down well in a deprived housing estate where violence was an everyday part of life. Fortunately, I wasn’t often a victim of physical attacks, but the verbal abuse felt every bit as bad. “Sticks and stones will break your bones, but names will never hurt you,” is a load of old baloney.

It was the older boys on the estate who would spout a tirade of derogatory names while threatening all manners of violence. My close group of friends – made up of both boys and girls – would say, “Take no notice,” but the shame and humiliation was devastating to live with. The gauntlet of abuse contributed to my refusal to attend school and all because I was not your “average” boy.

I’m not blaming myself, but those characteristics became an easy target by two separate paedophiles. The first lasted from the age of about five to eight, and the second from nine until I turned thirteen. At the time, I seem to have been a willing participant in our “games,” but of course, it was still abuse and the experiences had a significant influence in my overall trust of adults, especially men.

When I shared my gender confusion with the group months ago, everyone looked genuinely surprised, as there are no traces of femininity today. It took many years to rid myself of those very natural characteristics, although I do still harness a female part deep within.

I watched a programme on female to male transgender. One person said that one of the hardest things was to change some of her feminine characteristics into more masculine ones. He had to learn how to walk, talk, and sit like a man and be constantly aware of his demeanour in public.

I identify with that experience and even remember having to lower my voice to a tone that sounded more masculine. The world was very different back in the 70’s and if I wanted to avoid further persecution, there didn’t seem to be any other option. Through the years, all of these experiences came with a painful price of shame and humiliation, which harnessed the intense fear and anger.

I often wonder where the inner strength came from back then, but the desire to bounce back was always much stronger than the destruction. There was an element of self-blame and my narcissistic mother’s critical voice would ring out in my ears, “You brought it all on yourself.” The guilt soon became the mortar for shame and humiliation.

The ultimate betrayal came as a young adult when I became the victim of an attempted murder and my assailant was another male that I liked and trusted. It was never just about my attack, but the experience opened the door to a world of extreme violence and psychotic killers. I had never even spoken to a police officer in my life and now I was interacting with the judicial system and High courts. The reality became more traumatic than I ever imagined possible and it destroyed the last bit of faith I had in my fellow man.

I am very comfortable and happy with my sexuality and gender today, but I don’t understand why I’m unable to heal from the shame and humiliation, and the fear and anger. I do get along with men in my day-to-day life, but there’s always an underlying discomfort and this particular interaction in the therapy room has connected me with something I spent years avoiding.

It’s time to stop running

stop running

A Daunting Prospect

guiltyI was only just writing in my last post about the significant improvement in mood and then I woke two days later, with a severe dose of the blues.

While I’m struggling to understand the therapeutic process – or fully believe in the healing – positive changes are undoubtedly underway. The sudden turnaround in mood wasn’t immediately obvious until I reread my therapy journal from the night before. The words were bold and clear, adorned with question marks, “My attempted murder.”

When Wednesday came along, I really didn’t want to go to my session with Paul. I wasn’t consciously avoiding any connection with the memories of my attack, but I did feel suffocating apathy. I know from experience that something very powerful takes place whenever we choose to a sit with the feelings in therapy, even if they are only resentments for being there.

Paul sensed my unease, “It looks as though you’re finding it difficult to be here today.”

This took me by surprise. He’s one of the most passive Therapists I’ve ever met and not usually forthright with his own observations. We talked for a while about trivialities and then I eventually told him about my journal entry and the change of mood.

“It’s the only issue I haven’t yet focussed on in therapy, but I don’t know how to even begin talking about such a traumatic event. I can easily run through the details, but they always feel more like describing a movie, completely absent of any personal connection. I’ve never even thought about the impact it had on my life, never mind the feelings.”

“This reminds me of the issue you had during the initial months of therapy when you were experiencing dissociation from feeling anything in the moment.”

“I know this is a form of dissociation but awareness does not seem to help, it only adds to the frustration. Whenever I go in search of the feelings, there is only an empty space… nothing. If there are no emotions, what is there to talk about?”

“Do you feel anything right now?”

With great relief, I noticed the clock was approaching the end of our time, “The only thing I feel right now is intense fear, as though a black hole is opening at my feet… and I am slowly backtracking.”

Two days later, it was time for the weekly group therapy and once again, I desperately didn’t want to go. I can see how this was purely avoidance, but my mind was playing tricks at the time. I scrambled to find every possible reason not to go, even sabotaging the journey to keep me late.

I shared with the group how confusing it felt not to be able to talk about the feelings. One of the other members said something so simple that I wondered why I hadn’t thought of it myself.

“Sometimes it’s easier to identify the feelings, but quite another to feel them.”

That statement’s so true. I can identify the terror and helplessness, the fear and anger, the violation and intense hurt, or I can tell you about how it was the final straw to a lifetime of violence and injustice. The missing ingredient, crucial to healing, is the ability to feel any one of those emotions.

At the start of therapy, I had this general plan of the things I needed to talk about and, morebottling importantly, the emotions I should feel. I couldn’t bear to think about certain childhood memories and the thought of willingly analysing them in therapy was a daunting prospect, but I knew exactly what to expect.

The experience of almost losing my life to a psychotic murderer feels entirely different. Even though I lived with the aftermath all these years, the depth of emotion is completely new territory and any thought of digging up the trauma is terrifying. But, I will be disappointed if I reach the end of this therapy programme in January without a reasonable attempt to connect with the feelings.

Seeing Beyond the Void

As we go through life, each of us develops defence mechanisms that help dealth1W15UEW3 with a wide spectrum of stressful situations and to protect us from painful memories. Two clever tactics that I know very well are suppression and repression.

Suppression is something everyone does. It’s when we think about something, but then consciously squeeze it to the back of our mind. This doesn’t need to be in a negative way and can act as an aid to filter out one thought while we deal with something else.

Suppression and repression are very similar, although repression is a little trickier to identify because much of the avoidance takes place on a subconscious level as we deny the memory or emotion even exists. I’ve only just become aware of my own repression, which unravelled during a poignant moment in therapy last week.

When I became a victim of an attempted murder, which I wrote about here, I was extremely lucky to survive, but what I hadn’t realise until now, was a fundamental part of me died inside. While the experience was particularly traumatic, the history of my assailants past crimes, including murder, would only add to the horror and hinder any path to recovery.

I’ve always abhorred any kind of violence because abusiveness has been a prominent pattern in my life since early childhood. Each incident of physical, verbal, emotional, and even sexual abuse would slowly hamper a willingness to recover, while placing significant strain on my ability to bounce back. My traumatised brain soon interpreted life as dangerous territory and wise to be devoid of trust.

Trust is the necessary ingredient for all human interactions, from casual acquaintances to personal relationships. Losing the ability to trust means everything about life feels unsafe. Meeting new people or visiting unfamiliar places eventually becomes something of the past.

th43ZJN5J0The more vulnerable and withdrawn I became, the more I developed an unhealthy need to protect myself from any kind of attachment. My need for love and affection or to trust and be trusted, had sunk beneath years of repression and there was no awareness of just how cold and distant I had become.

I painfully recall the pleas of significant people to consider their feelings and wishes, even if I had none of my own. It felt like they were on the attack, rather than trying to save me from an emotional black hole. As time progressed, the empty space became so vast, it was impossible to see beyond the void.

The dissociation from reality eventually made me inaccessible to those who had spent years trying to hold on to the person they once knew. The consistent pleas meant nothing and I slowly cut everyone meaningful from my life. The diagnosis of Depression, PTSD and Agoraphobia were my new companions in life, but the Disorders also became my shield against any expectations to change.

In the last fifteen years, venturing beyond a two-mile radius of home hasn’t been on the agenda and there are only six places I can visit, anxiety free. While I do believe in my ability to overcome these phobias, I’ve made little effort to push the boundaries. In all this time, I cannot recall boredom or loneliness ever featuring within my comfortable agoraphobic cocoon.

For reasons that may always remain a complete mystery, I once believed this dysfunction lifestyle was not only justified, but also acceptable. I had repressed my emotions to such a depth that I forgot they even existed.

When I learned of my friend, Anne’s, death recently, via the extraordinary coincidental telephone call, my mind became flooded with memories of a time when I viewed life very differently. Over the course of the last couple of weeks, these new realisations are like awakening from a fifteen-year coma to find that I’m living an unacceptable reclusive lifestyle.

There were a number of stark moments in therapy last week, as I recalled the pain caused to othersthAQ8EK2XX and the injustice I dealt to my own potential. Repressing the fundamental emotions necessary to human existence only blocked the flow of healing and tainted my perception of trust.

Fifteen years of extreme isolation is a very long time and I’m careful not to get ahead of myself. I’m excited, fearful, and fragile, all at the same time. It’s impossible to find a way back to something familiar, any previous point of existence no longer exists. The unknown feels a scary place to be and the challenges ahead won’t be easy, but somehow I need to find the courage to move forward.

Therapy and Healing

I’ve not been writing a lot about therapy lately. My last post about Paul’s absence was actually twoWP_20131116_001 weeks old. I’m not sure what’s going on for me right now. In the days leading up to this therapy programme, I often wondered what healing from trauma might actually feel like and what shape the process might take.

Each one of us have our own route to healing, but my own journey  feels as though I’ve been on a rollercoaster ride of reflection and rumination, writing and talking… anger… regret, and many stages of grief.

We learned early in our group how important it is to observe the feelings. There were months when I seemed to exist in a weird trance like state with a whirlwind of emotions circling inside my head. I thought acceptance, healing, and change might never come into focus, but this is beginning to feel much more likely.

The last group I attended was two-weeks ago. I had only just received the bizarre telephone call, which brought news about the death of my long lost friend, Anne.

I’m still trying to grasp how extraordinary that coincidence actually was and the news has been difficult to come to terms with. However, the experience came to mean so much more than synchronicity or grief.

In the days that followed the news, my mind was awash with long forgotten memories of the past. It took a few days to realise that beyond the nostalgia, was a clear view of how I once viewed my existence.

I recalled the enthusiasm and heaps of confidence that would eventually become lost beneath years of mental health problems. I have able to taste what life once meant to me and what I meant to life.

When I first approached a Psychiatrist five years ago, almost begging for help, the distress came from a realisation that I didn’t want to get any better, “not if it means interacting and trusting other people again…” My perception of life had been utterly dismal for so many years, it was easy to lose track of what existed before the days of mental illness.

th0UQOMD3LIt feels as though these long forgotten memories form part of the missing jigsaw and now I can see a lifestyle that is worthwhile aiming for. Of course, everyone changes with time and there is no return to a former self, but I finally envisage what life could look like.

We return to usual sessions next week, but already my time is running out in therapy. We finish group in December and from January until June, I will be on a rapid sliding scale with my Therapist, Paul.

It might sound strange, but my least problematic condition in recent years has been Agoraphobia because it kept me safe and comfortable within an isolated cocoon. At the heart of the debilitating phobia is a fear of venturing into strange places with the prospect of meeting unfamiliar people. This brings me full circle to the very place I started with my Psychiatrist five years ago, only this time, I do want to face those fears and I will ultimately find a new life, but the prospect of change is scary and therein is the next stage of my therapy.

Dr Gerald Stein writes a nice post on avoiding our fears, taking control, and making the best of life here