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.

 

One of the Gateways to a Suicidal State of Mind

As World Suicide Prevention Day was on the 10th, I would like to write a couple of posts this coming week about one of the gateways to that suicidal state of mind, depression.

One of the worst things about depression is the uncertainty of just how low the mood will go or the duration of each episode. That sense of losing control of our own mind can quickly become a terrifying prospect.

When I first became clinically depressed in 2000, it felt as though a bus had just hit me from behind. I was completely drained of emotion, exhausted, and hung out to dry.  My entire body was suffering from chronic pain, eventually earning a Fibromyalgia misdiagnosis. Days rolled into weeks, months became years, and I steadily lost track of time.

The only routine I could muster was a simple structure based around a minimum of 16hrs sleep, an inadequate junk food diet, and lots of time caring for my two adorable cats, who sadly passed away last year. The quality of sleep was poor due to endless night terrors and I would start each day feeling as if I had just lived through every minute of those nightmares.

What I didn’t realise was that the SSRI antidepressants I had been using for a decade were renowned for vivid dreams and perhaps not the best choice for nightmares associated with PTSD. The Doctors held little interest in my recovery and seemed more concerned if I was suicidal. Their questions were more to do with covering their own ass than any genuine interest in my wellbeing.

I haven’t met one person that suffers from depression who has never experienced a certain degree of suicide ideation, but I was petrified of psychiatric wards and it was shameful to admit those morbid fantasies of killing myself. I will say a little more about this in my next post.

If I had been more honest, or possessed enough strength to find new Doctors, maybe there would’ve been more opportunity to manage the depression and recovery might have transpired sooner. When our mood is this low, we’re definitely not thinking straight and paranoia over losing more control can lock us tightly within that revolving door of depression and ineffective medication.

Of course, everyone’s experience of depression is different and we need to find own slow route to recovery. If you’ve ever been depressed for years, it’s easy to forget what life feels like without a degree of despair looming overhead. A perfect example of this happened to me on Friday.

I returned home from group therapy feeling unusually hyperactive with racing thoughts, rapid speech, and a general feeling of wellbeing. At one point, I wondered if someone had spiked my water with speed and even considered taking a benzodiazepine to help bring me down. While it wasn’t a bad feeling, I didn’t know what was happening or how I should respond.

After a few hours of buzzing around, doing additional spring-cleaning and bribing the dog to go for yet another walk, I realised that for the first time in fifteen years, I was actually feeling free of depression.

I was desperate to share the experience with my neighbour and friend, Sarah, but every time I attempted to say the words, “I feel happy,” I burst into tears. Sarah must have thought I had already lost it, but the tears were an expression of my relief to have come so far. This might be difficult to understand if you’ve never lived in the dark world of depressive illness.

It doesn’t seem to matter what stage of recovery we’re at, one of the biggest fears and major obstacles to reclaiming our lives is relapse. We’ve all been there, feeling relieved at that faint glimmer of improvement, only to open our eyes the next morning to find the black dog of depression is growling at the door once more.

It doesn’t seem to matter how often I’ve experienced this, each episode is fraught with grave disappointment and that familiar fear of the unknown. According to some internet figures, in a small minority of people who suffer depression, the symptoms seldom go away entirely. Those who experience two episodes of depression are more likely to have a third.

When we’re depressed or only just recovering, the last thing we want to consider is the prospect of relapse. However, a recurring bout of depression or a temporary worsening of symptoms is a very real probability and I find this knowledge has helped me to deal with the life-sucking disappointment whenever it happens. Even though I feel relatively good today, that awareness is always on standby.

Unfortunately, I’m not a lover of self-affirmation techniques at the best of times. The trouble is, I become so consumed by the depression, I just can’t be bothered telling that sad face in the mirror how wonderful and capable he really is. It just doesn’t cut it for me.

My technique has always been to accept the mood as it is for today, although I appreciate this may sound a little too much like giving up to some people. Stressing over the process was never helpful, but by accepting those backwards steps as inevitable and even an integral part of our healing, did remove a proportion of the sting.

One of the most important tactics for my own stability is to maintain a simple routine. This may only be within four walls or a short distance from the front door, but having a basic purpose in our day is enough to plant the small seeds of recovery.

Seeing Beyond the Void

As we go through life, each of us develops defence mechanisms that help deal 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.

The 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 others 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.