What is a therapeutic relationship?

The last couple of days have been very difficult for me and it seems that soon after things get difficult for me then I will experience a major rupture with M. To try to give some background before my daughter told me about her friend admitting she was being molested I spent my session on Monday afternoon talking to M about the difficulty I have trusting anybody to not abuse my children (including my husband but mostly coaches, teachers, activity leaders). In an unrelated conversation last week I asked M about his birthday (which I knew was coming up). I bought him a copy of The Trauma of Everyday Life by Mark Epstein, wrapped it, wrote a birthday card, and then purchased a couple of gourmet cupcakes and took them all in to my session last night. It was a big step because in the last few years I’ve only given him disposable gifts like candy so he wouldn’t have anything permanent that reminds him of me.

So I sit down in my session putting the bag beside me on the couch and instead of starting with the cupcakes and gift instead we start discussing my daughter and her friend and what I can do to support my daughter and get help for her friend. The conversation is overwhelming and it doesn’t take long until I am completely flooded with overwhelming memories and feelings. I know from personal experience how things might get more difficult for this girl. Her mother might not believe her. Maybe nothing changes except her abuser her knows she told. M asks me how much resonance I am experiencing in this situation and how it reminds me of my own life. I collapse into a sobbing, crying mess unable to answer questions lost in my own thoughts of how bad this is. At some point I look over at the bag and realize how ridiculously stupid I was to bring cupcakes and a present to my session. It is meaningless in the face of what we are discussing, worse than meaningless actually offensive. I start to feel like therapy is just endless pain because I know that the session is almost over and I am not going to have to leave feeling alone with all this (feelings, memories, powerlessness, fear). M tries to say something about how difficult this is for me and my daughter but he is glad that we have the opportunity and strength to try to help. I hear “blah, blah, meaningless blah”

As I stand up I realize I have to cancel my session on Monday and I go to shake hands when M gestures to the bag on his couch that I’ve forgotten. I say “it was for your birthday” and as I start to choke out “have a good one” I burst into tears and run from his office. I am angry because I think he must have known that I brought something for him and not wanted to receive or discuss it. I write him an email telling him how stupid I feel for bringing cupcakes and acting like this is an actual relationship, like there might ever be a moment in a therapy session where we could eat cake. Then today for most of the day he doesn’t respond to that email. After lunch on my way to a work function I call his office planning to leave a message asking if he received the email and could he respond to it and he answers his phone. I am so surprised I hang up and then realize he has read my email, he knows how hard the session was for me, and he still couldn’t find time to respond to me today. I am so angry and hurt by this it almost takes my breath away and I have to hide myself to survive the afternoon with my work colleagues. When I got home tonight I checked my email and M and sent me a short response after I had hung up the phone. Part of it says the following “Yes this is an actual relationship but it is a very special kind of relationship that develops in therapy. That doesn’t make it a non-relationship that only a very specific type.” I don’t what that means to M but I think it means something like “it isn’t the relationship you want and you can’t count on it but it can help” and I doubt it but I’m trying to remember that this has been a very difficult week.

Triggered

Tonight my teenage daughter told me that one of her friends admitted that her father has been molesting her but not really badly. I won’t got into any more detail but it was an incredibly difficult conversation for me. I asked if she thought the friend could be persuaded/supported/encouraged to tell her mother or counselor at the school. She said no because the girl didn’t want to mess up her family. I told my daughter that the family was already messed up and that the girl wasn’t to blame but she probably did blame herself whether she could admit it or not. I also told her I thought her friend was talking about it because she wanted help. My daughter wants me to promise not to tell anyone. I had to tell her I couldn’t promise that because I couldn’t ignore what she told me. My daughter got very angry and my husband seemed to disagree with me. He said that I didn’t actually know that there was a crime. I told them both that I would never know that this had happened but I couldn’t wait until I had proof because I think it is serious enough that I should give my information to the authorities so they can investigate. So my daughter is angry at me. I don’t know the name of the girl and I worried that my daughter had made up the “friend story” because she didn’t want to admit it happened to her but she assures me she hasn’t and she was okay with discussing it with my husband. I stayed calm while I was talking to my daughter but afterwards I was extremely upset, crying and shaking. I wrote M an email entitled “F*ck, f*ck, f*ck” and then curled up in my bed staring at the wall.

What does “It’s okay” mean to you?

M and I have spent more time talking about the pit of despair I fell into during that session. He told me that if he was writing the “I fell in a pit” metaphor it would go like this. He and I are walking in pitch darkness. All of a sudden I’m not there and he doesn’t even know I’ve fallen or when I fell or where I am. Sometimes he can hear me yell as a I fall but sometimes it is like a slow awareness that I’m no longer with him. He says the first thing he needs to do is locate me in time and space and so he asks me questions to try and discover where I am and when I fell and maybe why. He doesn’t want to presume knows what has happened. He can tell I am deeply upset, crying, silent, maybe hiding my face. While he is talking I get more and more frustrated and start crying. I understand what he is saying and it makes sense to me know but when I in the pit the questions feel wrong. When he sits across from me and asks me questions I can’t answer I feel worse, stupid, slow, and even more wrong. It doesn’t take long before I think he is tired of me because I won’t do therapy right or angry at my silence and the pit gets deeper. Often when I leave the session I might feel angry but during the session all I feel is despair. So I think we are just going to keep repeating the same pattern. I will promise myself that I won’t let myself fall into the pit during therapy anymore. I’ll stay rational and be able to talk about things not just get lost in feelings because he can’t help me when I am like that. Of course I can’t control that and I fall into the pit, things get worse, then I consider quitting therapy or finding a new therapist, then I promise myself I won’t let myself fall into the pit… and so on and so on.

M surprised me by asking if I thought touch would be able to reach me at a time like that and I said maybe or perhaps sitting closer to me. M and I have talked about touch in therapy many other times. For the first few years we had no physical contact but now we shake hands at the end of every session. I know he does not think it would be helpful for him to get up in the middle of a session and touch me even in a very comforting, non-sexual way like putting his hand on my shoulder because of my background of child sexual abuse. Once I told him he was punishing me for something that was done to me as a child and therefore he must blame me for it. He disagreed with a lot of therapisty explanations. Because I knew that I suggested just sitting closer to me, on the couch beside me or on the floor together. I also told him I didn’t expect him to make a sudden move and decide to change seats without warning. I said that I thought that if I knew it was possible and okay with him that he sits beside me then maybe I could I ask him to sit beside me or if he could see me struggling he could ask me if it would help if he moved closer to me. I said we should practice at some time when I wasn’t stuck in the pit to see what it was like. M continued on to “wonder” how I might react or interpret him moving to sit closer to me and if that would feel helpful or not. All I could think was I just said I thought it would be helpful, what are you so worried about? Eventually I admitted that it is incredibly difficult for me to know how I would feel or react when I was stuck in that pit of despair and badness when I discussing it now because I don’t even feel like the same person in some ways. I think the main reason I would like him to try moving closer to me is that I would like to know that he wants to help me. I believe that when I am rational me but when I am stuck in the pit I don’t. Then I think he hates or knows how bad I am.

Eventually I managed to tell him that whenever I got to the place of just crying and hiding from him I did so because I felt wrong and bad so completely that I was ashamed to be seen by him. I said there were lots of different ways to get to that point but by the time I was there if he just assumed I felt bad and wrong to the core he would be right and there wouldn’t be any need to ask questions. Finally I burst out with “I just want you to tell me that ‘It’s okay’ even though you think that is just a hollow platitude that is meaningless because you don’t get decide what is okay for me. I promise I won’t hold you to it like a guarantee.” Then I rambled on describing the times I feel like I am contaminated and if he gets close to me he will be hurt or the ways I try to avoid asking for reassurance so he doesn’t have to lie to me. Sometimes once I start talking so many things come up that I sound like a jumbled mess and M just sits and takes in a deep breath. I waited and he breathed. I waited while he concentrated. Finally I said “it is just too much isn’t it, it doesn’t make sense, all my thoughts and feelings come out all mixed up”. He said “no. I was just thinking that if you feel bad and wrong and irredeemable then maybe ‘it’s okay’ isn’t a hollow platitude. Maybe it is what you need to hear so that you know that how you feel and your silence is okay with me. Maybe I big part of ‘it’s okay’ is actually ‘We’re okay”, I’m here and I’m sitting with you and your feelings. You don’t have to explain them for us to be okay. I want to understand and share your feelings when you are ready.”

I don’t know whether he will be able to say “it’s okay” without feeling like it is meaningless phrase but I feel like he understands why I want to hear it and what it means to me. What does “it’s okay” mean to you?

The aftermath

I’m out of the pit of despair that I was in last week. I don’t feel quite so hopeless and alone as I did then. M and I have spent two sessions discussing what happened during the session I felt so BAD and WRONG and the next session. We have had these conversations many times before. I spend a lot of time feeling like I’m doing the wrong thing and worrying about what I am doing but the “bad and wrong” feeling I had during the session was overwhelming and intense. The feelings seem to come out of nowhere to drown me. I don’t even feel like myself. The closest I can come to describing the experience which doesn’t have any pictures or rational thoughts is an “emotional flashback”. I hate it because experiencing intense emotions that seem to be out of proportion to anything happening in the present makes me feel crazy. I think that I am overreacting or making a big deal of things and that just adds to how BAD and WRONG I am. M just asks me questions which are impossible to answer with anything but I’m WRONG or just crying and I feel like he is backing away from me. His description is that I am barricading myself and preventing any connection from occurring when I feel BAD and WRONG. He thinks I feel like he is judging me as harshly as I judge myself and so I am trying to protect myself. It always makes sense when I am less emotional and more rational. The problem is I can’t stay rational.

I think M is a good therapist for me, the adult me who is rational and intellectual. However, I don’t think M reaches the child-like emotional part of me. She thinks he doesn’t care at all when she is so upset and alone and he just sits back and waits for the adult me to talk to him again. I wrote my own version of the Portia Nelson’s I Walk Down the Street and sent it to M before our session.

You and I are walking along and suddenly I fall into a pit. You don’t get angry at me or call me stupid for falling in the pit. You don’t say I’m too sensitive and it wasn’t even a very big drop or a painful fall. You don’t insist I get out of the pit right this minute because I am embarrassing or difficult. You don’t tell me that it is my own fault and then remind me over and over what I did to cause me to fall into the pit. Instead you sit and wait for me to get out of the pit. You listen to me cry and tell me how sorry you are that I fell and got hurt. Occasionally you ask a question like “Can you move your left hand?”. Then you wait for me to figure out that means I probably haven’t broken my arm. Then after some time the pit seems to fill in and I can get out and we can start walking again, until the next pit. I am grateful for your patience and presence but I’m also angry because I want you to do more. I want you to climb into the pit and help me. I want you to look for broken bones and help treat my injuries. I want you to comfort me and sit with me until I feel strong enough to move. Then I want you to help me out of the pit and help me find out what causes the ground to dissolve beneath my feet.

The Pit

Sometime during my session on Friday I fell into a pit. The pit where the loudest voice in my head is screaming how bad and wrong I am and any new input just makes me feeling badder and wronger. M started by telling me that he was processing his feelings with his family and friends and his personal tragedy wasn’t stopping him from the work we were doing together in therapy and in my life. I felt guilty because I am not sure what I am working on right now and fairly quickly after that I felt excluded from M’s real life with his “family and friends” who were able to help him and I just took from him. I realize that is how therapy is supposed to work and M was keeping his boundaries but rarely does he seem to emphasize it with references to “his family and friends”. Then I realized that I had gone from feeling sorry about his loss to feeling sad about being left out and I had made it all about me in some obnoxiously narcissistic way. I started crying and I was so upset I couldn’t speak and I had to think about how to breath with all the tears running down my face and my nose getting plugged up and leaking. I hid my face in my hands and a handful of tissues because I am sure I looked hideous.

Then M started his inquisitive routine. He sits back and waits to see if I am going to say anything. Then he might ask me a question like “can you tell me anything about what you are feeling right now?” or “why do you feel the need to hide yourself at this moment?”. He sits back and waits for the answer and then moves to the next questions. When I do say something, he doesn’t have that much response. Of course that could be because I am not speaking in sentences instead it is phrases or ideas that start and then don’t get finished. I spent an agonizing weekend feeling terrible and writing a lot trying to figure out why. I must have sent M four different emails explaining some of the things I had almost said. I also told him that I didn’t understand why the ground dropped out from under me and left me in the pit of self-hatred. I knew I was afraid I wasn’t working on goals in therapy and I was ashamed that I depend so much on M that I was still going to sessions even when I wasn’t working on specific goals. I feel guilty that he might not realize that I am depending on him and so I am ashamed of my feelings. M knows that I depend on him because we’ve discussed it many times before but I couldn’t apply any rational thoughts to the overwhelming feelings of the pit. M and I have been in this place many times before. I get angry because when I get overwhelmed by emotions I think M sits back and becomes more analytic and I feel alone and overwhelmed. I feel connected to M when I am thinking rationally but when I am overwhelmed emotionally I don’t and that is a terribly lonely feeling.

For me it is like M and I are walking along and suddenly I fall into a pit. M doesn’t respond as my parents would when I was a child. He doesn’t get angry at me, call me stupid for falling in the pit. He doesn’t tell me I’m too sensitive and it wasn’t even a very big drop or a painful fall. He doesn’t insist I get out of the pit right this minute because I am ruining his life or embarrassing him. He doesn’t tell me that it is my own fault and then remind me over and over what I did to cause me to fall into the pit. Instead he sits and waits for me to get out of the pit. He listens to me cry and he’ll tell me how sorry he is that I fell and got hurt. Occasionally he will ask me a question like “Can you move your left hand?”. Then he waits for me to figure out that means I probably haven’t broken my arm. Then after sometime the pit seems to fill in so I can walk out we can start walking again, until the next pit. I am grateful for M’s patience and presence but I’m also angry because I want M to do more. I want him to climb into the pit and help me. I want him to look for broken bones and help treat my injuries. I want him to comfort me and sit with me until I feel strong enough to move. Then I want him to help me out of the pit and help me figure out what causes the ground to dissolve beneath my feet hurling me into a pit. I don’t think he can do that.

I am confused, again

At the beginning of my session Wednesday M told me that one of his siblings died on the weekend. I don’t think he planned on telling but he told me he was going away to the same place as he went a few weeks ago and I asked if things were okay. I told him how sorry I was and we discussed how sudden it was which reminded me of my mother-in-law who thought she had a cold for two weeks before she was diagnosed with leukemia and she died less than three days later. When M tried to talk about how I was getting along with my husband I didn’t really want to talk about it. It felt wrong to talk about my life particularly when I already felt like I wasn’t working on anything in therapy anyway. Of course things snowballed aw the week progressed. When I left the session I sent him an email saying again how sorry I was and that my problems seemed insignificant. Then I went home and thought about the number of things that the death in his family had triggered in me including:
1) fears about my own health because I am not in very good shape physically and I often have nagging symptoms so stories about people feeling mildly sick and then finding out they are dying are so scary.
2) fear about M dying
3) feeling about my own siblings some of whom I am trying to develop healthier relationships with (for the most part with little success) and others that I am rarely in contact with. what will I feel if one of them dies suddenly and there are no more chances for us to work things out.

I wrote M an email telling him those things and then I tried to explain that I didn’t actually feel like my problems were insignificant. Instead I felt like I wasn’t “really” working on those problems which made therapy sessions less important. I have started to feel like I am not willing to change how I eat or talk about my feelings and how they relate to overeating and my body size. I think I want to work on them but I keep going to therapy and not addressing them and I think that is telling me something. I feel like I am going to therapy under false pretences because I am not willing to address those issues but I keep going anyway because I like feeling like M cares about me and is there to listen (even though I’m not talking). I feel like I’m stealing something from M because he doesn’t know I’m not there to change (my husband pointed out I am paying him so stealing is not an appropriate description) but it is how I felt. I decided not to send the email in advance to M and instead would take it into my session yesterday and discuss it. That didn’t work out very well but I will talk about that session in my next post.

What next?

I feel nothing. I am going to a session with M in an hour and I have nothing to talk about. I don’t think that M is angry at me or judging me. My husband and I are getting along fine but I don’t feel like things can change. I feel like I am waiting for the next eruption to occur. One of the biggest things that I would like to change is my weight but I don’t think it is possible anymore. I have a lot of pain in my knees and ankles and heels sometime. I avoid doing things I used to enjoy such as hiking because it is so difficult and I’m worried about falling and hurting myself further. When I was younger I wanted to lose weight so I would be more attractive and now I wish I felt better physically but neither reason has made a difference to my overeating. I also have spent over five years talking to M without discussing my overeating at all and only rarely discussed my body. It is odd considering I started therapy on a recommendation from a weight-loss doctor and that was the initial goal of therapy. Instead I have made improvements in a lot of other areas of my life but I avoid talking about weight.

It is odd for me to be thinking about stopping therapy without being angry at M or afraid he wanted me to quit. Since this conversation I have continued to believe that M isn’t frustrated or angry with me. I can’t imagine us being friends but I can believe that he cares about me and my life. I can’t remember a time when I have gone three weeks without having a crisis about my relationship with M. I wish I could feel better about the fact that I seem to have worked through some/a lot of my insecurity about M and my fears of abandonment.   Unfortunately even though I trust M more I still don’t know what comes next.

Alone

I stayed home this weekend while my husband took our kids to the cottage. I said that I wanted to get things organized before the kids went back to school next week. That was only one reason. I have been incredibly hurt and frustrated and angry with my husband and early last week we had a big fight. I tried to talk to my husband about my worries about finding new jobs (we both have received notice from our employers). He became incredibly defensive and it didn’t matter how I tried to talk our fight escalated. My husband lashed out at me verbally and really hurt my feelings. After he calmed down he apologized for what he said and told I was right and he hadn’t been looking for a job seriously (which is something I hadn’t even said). I had almost no reaction to his apology. An apology doesn’t mean much anymore because it keeps happening. I don’t understand how he can lose his temper so completely that he can be so cruel. It feels like he hates me and I’m the b***h who is ruining his life. The next day I realized that I feel hopeless. I don’t thing he can change and I don’t want to spend the rest of my life waiting for the next time he loses it. We ended up talking every night last week until early in the morning. We also had a two-hour sessions with our marriage T. I know my husband loves me and I love him. I don’t know how to get over how hurt I am by him losing his temper. Being alone has given me a lot of time to think but no answers.