Why is therapy so painful?

Why does every session with M either have to be painful and confusing or repairing and reconnecting after painful and confusing sessions? Is there some way to do therapy without having to feel so stupid and worthless while discussing things? Does M feel like we aren’t working hard enough unless I leave the session feeling terrible about myself and what we are discussing? M was the first person who was willing and able to see my pain and not blame me for it. He challenged me when I tried to minimize it or take responsibility for it or ignore it. It was and still is incredibly powerful and transforming for me. Unfortunately, I’m starting to think that all M can see about me is my pain so it is all we can talk about is pain.

Today was my first session of the new year. Just before the break we were starting to talk about some difficult things about our relationship and how I felt about him (a dream etc) but it seemed difficult to just jump back in to that conversation. I’ve felt okay during the break but there are a lot of things looming in my life. I find out if I am losing my job in the next 2-3 weeks (funding decision about the entire project not just me) and a pretty big medical test (not difficult just potentially life-altering results). I was glad I could enjoy the break and not obsess about things that I couldn’t control.

I tell M I feel okay, neither good or bad for most of the break. I am not worrying about things because I’m trying not to think about them yet but I’m not really happy. I’m not looking forward to things, life is just a series of things I have to get done. M asks if I realize how said it is not to be able to look forward to anything. He asks me if that feels different than usual and I’m not sure. I’ve never been one of those people who look forward to things. I usually worry things will go wrong. M asks me if I can look forward to spending time reading a good book (I read a lot). I say I don’t look forward to it but I do it. I make time to read everyday and during the holiday break I spent a lot of time reading. I say I don’t mean that kind of day-to-day thing when I talk about not looking forward to things. I can enjoy reading a good book or seeing a movie or spending time with my children it is the longer term things that I can’t look forward to.

M says sometimes when you (meaning you like all people not specifically me) have very busy schedules, you can start to feel like everything is something on a “to do” list. He says that you forget to feel grateful for doing things you enjoy. He also said something about feeling like you are stealing time from other things to do the things you like to do. He said he things part of it is not recognizing your time is your own. I start crying and he asks me why. I say because he makes it sound hopeless. He makes it sound like I just have a negative perspective and I’m unhappy because of how I think about things. He says perspective is not fixed, it can change. I say not really or not much. He agrees you can’t change your perspective much. So I spend the rest of the session bawling and getting more and more upset. I mean what is the point if I can’t change my perspective much. If I’m unhappy because of how I see things doesn’t that mean my unhappiness is my fault and won’t change much. Isn’t that totally ignoring all the actual painful things that exist in my life? I mean I don’t know about my job or my health, I am miserably, painfully overweight and I can’t stop eating. My weight stops me from doing lots of things I would enjoy as well as making me feel terrible about myself. Is a small change of perspective really going to help much? Why work so hard for a small change in perspective? By the time I leave I’m in pieces and this was a session I was trying to stay calm and reconnect with him.

Sex **Triggers**

I’m struggling in a new way right now. I’ve been spending time online looking for casual sex partners who would be willing to “force” me to have sex. I know it is a bad idea and I won’t actually do it. I don’t want to cheat on my husband but I keep looking. I tried to tell M about it in my session today but I couldn’t. I told him I wanted to hurt myself but I wouldn’t describe what kind of hurt I meant. I had hoped talking about sex last week in therapy with M (and with my husband and H) would decrease the desire to have someone force me. I have always been excited by the BD activities of BDSM role-playing. I’m not into actual physical pain or injury but I like being tied up and forced to have sex. I am excited by being used for someone else’s sexual pleasure. I used to think BDSM games were no different from liking a particular sexual position or type of sexual activity and I am sure they are that way for many people. When I first started dating my husband I told him about my desires but he wasn’t interested and after trying a couple of times I realized that he wasn’t capable of acting that differently than himself and I resolved myself to only fantasizing about those activities.

Now I feel a lot more conflicted about that type of sex. It is probably obvious how conflicted by how many different words and initials I have used in this post to describe it. z I hate that I’m excited by fantasies of rape or forcible, painful sex. It bothers me that my sexual fantasies are very similar to my PTSD-like nightmares that sometimes wake me up feeling like I am physically in pain, terrified with my heart pounding, sweating, breathing heavy, and feeling sexually aroused. I did manage to tell M that last week. That the fantasies that I have while having sex with my husband are like my nightmares which terrorize me. It doesn’t sound like a good thing. Also those nightmares (or fantasies) are much worse than anything that happened to me when I was abused as a child which makes me wonder think there is something perverse about me. After I left my session last week I was very sad and I was flooded with a lot of memories of my sexual history and how much shame and confusion I felt. Today M asked me what memories I thought of and I couldn’t tell him even the easiest one. The one where I didn’t do anything wrong and it is only looking back I can see that my feelings probably related to my abuse. Thirty years ago I had my first boyfriend and once we managed to find a place to be alone and started making out. Mainly kissing and necking and slowly we moved onto second base. When I felt his warm mouth on my nipple it was incredibly exciting. I still can remember how shocked I was and how I felt it throughout my entire body. I was completely overwhelmed and caught up in the moment until he moved his hand down to my ass and it was like I was thrown completely out of my body. I felt like I was watching from six feet away and I couldn’t feel anything anymore. I stopped his hand and he agreed that was as far as we would go but I couldn’t get back into my body at all. We kept making out and I tried to feel something and then I pretended that it felt great and faked my way through heavy breathing and moaning so he didn’t know I just wanted him to stop.

Another memory I had been the first time I was sexually excited by a book I was reading. I was a teenager and I don’t remember the name of the book but I haven’t forgotten the scene. The story was set in some fantasy world which resembled viking times. A woman is walking down the street when three soldiers pull her into an alley and start to rape her. They hold her down and cut off her clothes. One of the soldiers rubs the knife along the insides of her thighs and then gets ready to rape her. The hero walks by interrupts the rape, beats off three soldiers, and rescues the girl. It takes the rest of the book before she finally admits she loves him and gives himself to her. The culmination of their love in a consensual and mutually satisfying scene wasn’t nearly as exciting to me as the aborted rape scene.

I told M today that if I couldn’t even tell him the easy story about my first boyfriend and what happened when we made out I didn’t think I’d ever be able to talk about what sex is like for me today. I can’t tell him about the first man I had sex with and the games we played or my entertaining the idea of acting out a fantasy now. I think what I’m most ashamed of is my sexual desire. I am so ashamed of my sexuality I can’t talk about it. I can’t reason with myself that all humans are sexual because what if the intensity of my desire is out of proportion or out of control. I could if I had describe what happened without describing the emotions or at least I did earlier in therapy when I first discussed the abuse. It is my emotions that seem so wrong or to but it another way I am ashamed of my sexual desire.

Depression – what is it to you?

I am feeling very bad lately. I feel trapped and hopeless because I can’t seem to do anything differently in certain areas of my life even though I know what I should do. I hate myself for it but I rarely say that because I have found that people are uncomfortable if you say negative things about yourself so I don’t express how I feel except in therapy and in this blog. In a comment to my last post Ellen said that it sounded like bad depression. There are a lot of parts of my personality that my doctor (or Ellen yesterday) called depression. It bothers me because I have always felt that way about myself if I sat down and actually thought about how I felt about myself. My doctor likes to use the Beck Depression Inventory (BDI) to assess my depression symptoms and I have often argued with him about the usefulness of the tool. You can easily google the entire inventory if you are interested (or you have probably taken at some point) but I am going to discuss just one question from it.

8.
0 I don’t feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.

It is pretty clear that the higher numbered answer to the question is supposed to be indicative of depression. I don’t agree in part because to me the statements don’t seem to be talking about the same thing. For example I answer pretty consistently with 3. I don’t blame myself for everything bad that happens in the world. I am not responsible for diseases or natural disasters for example. I do blame myself for things that happen to me or people around me.

This afternoon, I missed the last step on the way out of my kid’s school and twisted my right ankle and fell in a very undignified and probably visually disgusting way in front of a large group of parents and children gathered around the school. I didn’t cry out and I refused any help from a few parents who offered it because I was immediately ashamed of myself. I fell and fractured a bone in my left ankle last October and I still haven’t completely recovered so initially I was grateful it was the other ankle until I tried to drive or walk down the stairs because neither of my ankles had the range of motion required to walk down a stair properly. As I went around the rest of my afternoon icing my ankle and hobbling around I thought about what had happened. I knew I fell because I felt so bad that I had been fighting off tears and the urge to give up on my life and lie in my bed all day. I was thinking about my misery and trying to get through the things I had to do today (work, my kids, their activities, etc) so I wasn’t thinking about walking down the steps and I certainly wasn’t looking at them. It is also my fault because I am morbidly obese and ny weight is putting a terrible strain on my joints making them prone to sprains and breaks. I am in terrible physical shape and I don’t exercise because I am always in pain it seems. I also wondered why I am so uncoordinated and clumsy and I’m always falling. When I was a child my family regularly talked about how clumsy and accident-prone I was. My mother used to complain that she spent all that money on ballet classes so I would learn some grace and while I learned to be graceful while I was dancing I still walked around the house like an uncoordinated elephant and she didn’t understand it.

So my sprained ankle is my own fault because I was so busy obsessing about myself I wasn’t paying attention, I am morbidly obese and out of shape so I deserve it, and I’ve always been clumsy and uncoordinated. The statement that represents no depression in the question above doesn’t seem to fit at all. I have no idea how other people feel about themselves. I think I am worse than a lot of people I know but I imagine that there are people in the world I am not worse than. Doesn’t everybody blame themselves for their failures and negative traits? If you don’t what do you do when you fail? or have an accident? See blaming myself doesn’t seem like a symptom of depression to me. It seems like a part of my personality and I assumed a part of everyone’s personality. This is getting long but tomorrow I’ll discuss another set of statements from the BDI that makes me wonder what is depression.

In limbo

I’ve started writing a post a dozen times and can never finish. There is nothing to say that I haven’t said before and it feels so stupid to keep saying the same things. I feel hopeless. I am very sad at times but mostly I just feel apathetic and numb, like nothing matters really. There is no way I can change. I hate myself. I hate how I look and how I feel. I am so fat that I’m uncomfortable almost all the time. I think about my weight constantly and how I need to do something about it and then I start eating and eat and eat and eat. I don’t care about therapy anymore. During the last two weeks I haven’t listened to my sessions. I’ve hardly written in my journal at all and I’ve barely kept up with blogs. If I didn’t have children I think I wouldn’t even get out of bed anymore. I want to give up.

I don’t have any idea what to talk about in sessions with M. I”m tired of trying to talk about how miserable I am or how much I hate myself. Today I cried a lot during my session but that isn’t new and it doesn’t mean much other than I hurt. I’ve spent so much time trying to figure out how therapy is supposed to work and what I am supposed to do. I’ve agonized about whether I should quit therapy or find a new therapist or whether M hates me or isn’t a good therapist for me. Right now I’ve giving up thinking about quitting therapy with M because I know that I don’t want to and the conflict between the different parts of me was “killing me” (or at least using up so much emotional energy I wanted to be dead). I told M after our session that I felt like I was “in limbo” but not the Catholic limbo of my childhood which is basically the waiting room outside of hell. Instead I was “in a state of being neglected and immobile, with no prospect of moving to a better place”.

I’m anxious and I feel guilty about it

My mood has been a lot better lately. I rarely find myself overwhelmed by sadness and unable to stop crying. I still cry ever session I have with M but I used to cry everyday at work, whenever I drove somewhere, before I fell asleep. I haven’t thought of ending my life in months even when I”m angry or sad. Generally I feel better but I have so much anxiety about therapy. It seems stupid that I spend so much of my time agonizing about therapy and my relationship with M while I am practically ignoring important things in my real life.

I feel better but I haven’t changed my actions. I am still overeating obsessively. I have no trouble eating healthily during the day and every night I start eating junk food. I don’t even think about food a lot, I just get up and start eating. Sometimes I feel physically sick from being overfull and I”m still eating. I am scratching arms and legs until they bleed over and over again. My kids keep asking me to stop because it looks disgusting. They remind when I scratch without thinking but it doesn’t make a difference. My feelings are all mixed up. I feel good except for the tight feeling in my chest. I hate having no idea why I feel the way I feel.

I’m off for a session with M that is going to be difficult because I don’t know what is going on with me.

I hurt

On Sunday night I missed the bottom step of a very small staircase. My heel stayed on the step and my toes hit the floor. Unfortunately my body weight was moving forward and fell twisting my ankle and hurting my wrist by trying to stop my fall with my hand (which is ridiculous because I weigh too much to stop my fall). Monday morning I had an appointment with my weight-loss doctor and when he saw me hobble into his office he insisted that I have my ankle X-rayed. I told him that it couldn’t be broken because I was walking on it. He asked me to show him my medical degree so I knew I was beat. Last night he called me to tell me that I had an avulsion fracture in which a small part of my bone was torn away from the main part of the bone by the tendon. The only treatment is ice, rest, wrapping the ankle which I was doing anyway but he wants me to start physiotherapy in a few weeks.

Last week I had a check up with my general practitioner as a follow-up to my emergency room visit with chest pain. My doctor told me that I need to lose weight because as I get older carrying so much weight will be hard on a lot of different systems in my body. I want to lose weight too but I can’t. She suggested bariatric surgery. A few years ago when my weight loss doctor suggested surgery I was so upset I nearly quit seeing him. I hate the idea of surgery. I think that if I can’t control my eating then no physical barrier to eating will work anyway. I’m afraid I would be one of those people who overeat and became physically ill after surgery.

I’m feeling quite depressed about my inability to control my eating and my physical health. I haven’t talked to M about it though. I’m not sure what is the point of therapy if I don’t talk about what I’m worried about.

Rage

I’m exhausted. My head and neck aches. So does my jaw because I’ve spent so much of today gritting my teeth and tensing my muscles. I’ve cried off and on. I’ve written in my journal. I called my friend, my sister and eventually M to talk about my feelings and still they are overwhelming. I’m angry at my mother. I’m angry that she came to my daughter`s graduation and insulted me in the middle of a church where I was surrounded by other parents. I’m angry because I didn’t get angry then. To be clear my mother is always like this. She has always told me what I was doing wrong. She comments on my weight, my clothes, my makeup (or lack). She talks about how I don’t clean my house or parent my children properly. She has told me that she loves me so she can’t keep quiet about what she sees me doing wrong. I told her that I wish she didn’t love me.

My sister isn’t happy that I”m so angry at my mother. She listened to my story and then told me that she thinks my mother is angry at me for a conversation I had with her a week ago and so was attacking me. She also told me that there was nothing I could do and I should stop being angry because “that is just how she is”. My sister likes to complain about my parents and the things they do to us but she doesn’t like it when I get angry. It is like there is the right amount of frustration I should feel about my parents and when I go past it then my sister is uncomfortable and tries to shut down the conversation. Usually after a conversation like today my sister avoids talking to me for several days and then avoids the topic completely because she wants me to calm down.

I spent the day having imaginary conversations with my parents: conversations where I told my mother the effect it has had on me to spend my entire life being told what I do wrong; conversations where I told her I wasn’t listening to her talk like that anymore and I was leaving anytime or place she started in on me; conversations where I didn’t explain anything and just told them to f**k off. My imaginary conversations ended with my mother stabbing me in the back with a kitchen knife. It is a ridiculous to consider my mother attacking me physically because she is a frail senior citizen. Also she isn’t a violent person although she used to hit us suddenly as punishment when we were children. Once she broke a plate by smashing it onto the top of my head when she was angry with me at the dinner table. I can’t believe that even in my imaginary conversations my mother wins. No wonder I feel so powerless around my parents.

Around the middle of today I left M a message telling him how angry I felt and asked him to call me. When he eventually did call I realized that I was trying to manage my anger and hoping that he could talk me out of it or through it or something. He couldn’t but he did understand why I was so angry. He suggested I try to write out my anger and that I reserve my anger for my mother and turn it on myself but it is too late for that. Last night after the graduation I couldn’t stop eating. I ate until I felt sick and then I ate some more. Then for most of today eating anything made me nauseous. I have scratched at my skin until I bled and cried until my head ached and I’m still so angry.

Sadness and grieving

Today I had to leave a fun event because I couldn’t stop crying. My daughter’s team had a family skate at a nearby rink. The season is almost over and it was an opportunity to spend time with the team members and their families without the pressure of a competition. I like the people who attended and I’m going to miss them when the season is over. The problem I had is that after only a few minutes skating I felt tired and my knee hurt. I decided to stop because I was afraid of falling and hurting myself. I sat down and watched the rest of the group on the ice. At first I was enjoying how much fun people were having but it didn’t take long for me to feel left out and alone. I guess I should explain that the reason I was having trouble skating is that I’m morbidly obese and I’ve been overeating and gaining weight slowly and steadily over the last 2-3 years.

I spent a lot of my life feeling like I was different from everybody else and I didn’t fit. Some of that was an effect of being sexually abused and feeling guilty and bad and disgusting. I’m definitely the odd man out in my family and no one in my family is interested in understanding or accepting me. Now I’m different from other people because of size and weight and my inability to participate ‘normal’ things. I hate the fact that I’ve caused this difference. I’m the one who keeps eating. I’m the person who has struggled with eating and my weight my whole life and haven’t been able to stabilize either. I’m an emotional eater and when I feel like I did tonight at first I isolate myself (tonight I left the rink and walked home) then I start blaming myself and I get angry at myself. Before I know it I’m imagining me changing my life dramatically; I’m planning to eat only healthy foods, and exercise regularly. Then I realize I’ve made those plans hundreds no thousands of times in my life and it has never worked. That leads to more hating myself and then all I want to do is binge. I’m never going to be able to lose weight and I’m so miserable it seems like at least I deserve to eat something I like. Then I hate myself again and I’m so sad.

This week I cried all through my sessions with M. The first session I cried about my family. I cried about the way my sister has completely ignored what I said to her about my feelings. I cried about the way my mother is unwilling to talk to me unless I’m ‘happy’. I cried about the fact that I’m not able to have an honest conversation with any member of my family and have them respond to it with any kind of empathy. I cried because the people who have been the kindest to me aren’t related to me. The second session I cried about how I felt rejected by my meditation teacher but I didn’t tell M about it because it seemed like it would be worse if he knew exactly what happened (I had told him I was upset during my meditation class in an email last week). I also didn’t want to tell him about what happened because I know that M would tell me that there are other interpretations for what happened and I know that but I don’t find that as helpful as M appears to think I should. I have been walking around my life and randomly being overwhelmed by sadness and tears. It makes it hard to function and is so exhausting.

Things get busier

I’ve had a very busy week. I was away this weekend because two of my children were in a competition away from home. I always have fun at these competitions even though I’m very nervous during the competitions but I enjoy spending time with the other families on the team. I enjoy getting out of my house and all the chores I have to do even if my whole family is crammed into a small hotel room. The winter is the busiest time for my children and counting this weekend we have five competitions in six weeks. Most of them are home competitions that can be driven to for the day or two of the competition.

Earlier today I was laughing and not looking where I was going and I didn’t see a step and I fell and twisted my ankle. It was painful and embarrassing because some people I don’t know came running to help me as I lay on the floor trying to breathe through the pain. I’m very overweight and I probably looked ridiculous falling. Now I’ve spent the rest of the day icing my ankle and trying to keep it elevated. My mood has taken a turn for the worse. I’ve been struggling with my weight my entire life for a lot longer than I have been overweight actually. Recently I’ve started gaining weight and I have no control over how much I eat. I’m unhappy in my body and feel uncomfortable and awkward. I hate myself because I can’t stop eating even though I’m physically so unhappy. My weight and eating habits are a major problem in my life in so many ways, my physical capabilities, my self-esteem, a huge amount of my internal self-talk (always negative) and I never talk with M about any of it. I was referred to M by a weight-loss doctor and he sees me regularly so he can tell that I’ve gained weight and I still never talk about it. I think weight has got to be one of the most simple equations possible to lose weight I need to eat less and exercise more so what would there be to talk about. I know what I should do but I don’t do it. It doesn’t help that M is a naturally thin man.

Ouch !

I’ve been incredibly busy lately and sick and tired. In some ways I’m detached from a lot of feelings right now. While some things in my life are going well and I’ve made a lot of progress others are completely stalled. I’m overeating constantly like I’m afraid if I stop all the food might disappear or I might have to feel something. I haven’t had sex with my husband in over a month and I’m much less afraid and triggered about my childhood so things are going smoother but I’m afraid I’m never going to be able to have sex again. Now matter what I do I can’t hold onto any positive feelings about M at all. I have sessions like last week where we talk about what isn’t working and what we can try in the future and then follow them up like today where we end up in the same pattern neither of us trying anything we discussed. I didn’t feel like talking about anything because I’m detached. M suggested maybe I’m afraid there is no hope of change so that is why I don’t want to talk about things. I think he is right but he thinks I’m talking about eating or sex and I’m really afraid there is no hope of therapy working. I’ve spent over three years learning to trust M and talk about difficult things and I’m finding out I’m wasting my time. Tonight I sent him an email that said “I want you to tell me to fuck off because this isn’t helping” and to make things worse I sent it to his home account when I usually only write to his office account. He didn’t answer but that is not a surprise. I wish I could do something helpful.