Where do I go wrong? or why do I get stuck?

I am feeling frustrated in therapy again. I feel like therapy helps when I am able to talk about things with M, particularly the first time I discuss something. I’m not sure what is supposed to happen next but what usually happens is I stop talking, feel like M isn’t understanding how difficult it is for me, I get angry at M and at therapy, and then the rupture. So if I try to describe it I am hoping someone will tell me where I go wrong. Is is that I give up talking about it too soon? Is it that I have unrealistic expectations about what therapy can do so I’m always disappointed by it? or something else.

The trigger:

I have an infected tooth that is going to required a root canal and crown. I have had several of these before and I always go to the same specialist for the root canal. During my appointment he asks me why I haven’t had a different tooth extracted (which was his recommendation). I tell him that the oral surgeon wouldn’t extract the tooth unless I was willing to start the long and expensive process of getting an implant (9 months and between $5000 and $6000). I say I can’t afford that. He asks about my insurance and I explain that it has an annual limit of $1500). He says he understands and tells me he will write the surgeon saying I need the tooth extracted even if I do not get an implant. He then examines the current tooth and tells me it needs a root canal. He walks me to his business officer so I can book an appointment and says something to her I don’t hear. The business officer tells me that the root canal costs $1535 total but the dentist is waiving his exam fee today of $150. I get very upset and start crying. I find it very upsetting when someone gives me money or a discount on a fee like this. I feel like I owe them and that is really bad. I don’t mind borrowing money or negotiating a lower fee or when someone says if you buy two of those I will give you 10% off the price. It is being given things that upsets me. I’ve stopped seeing professionals after they have done that for me because I find it so difficult to face them again. I know I have a problem with this.

Last week – session 1:
I tell M about what happened at the dentist and how I started crying in front of the business officer. I tell him how awful I feel. M asks me if I can discuss my feelings with my dentist and tell him I would like to pay the full fee (which I am not sure is what I want, … really I want to stop feeling bad about it.) M suggests I don’t feel worthy and I would have been uncomfortable about any gesture the dentist made that was more than I expected. I said no, it is about the money. In the past, this same dentist has called me at home in the evening after a difficult appointment, left his cell phone number, answered my call while he was out to dinner, and another time gave me his number so I could contact him over a holiday weekend if I needed him. At the time I appreciated his concern.

After the session:
I thought more about the issue and started to feel really bad that I was okay with the dentist giving me his personal numbers or that I called him when he was at dinner. I feel guilty. I think about other times I’ve been uncomfortable with people buying me something or giving me a gift even with friends. I also start thinking about a couple of awkward situations that involve money and M that I’ve never discussed with him but have bothered me.

Session 2:
I tell M about my realizations about feeling uncomfortable with a lot of things but how money is especially triggering. We discuss how it relates to my childhood. When I was a child my brother paid me in quarters and candy for sex acts (at least I remember him promising me them I don’t remember him paying me). I express frustration because I understand that makes the issue of payment complicated for me but I also understand that I professional giving me a discount is not expecting sex or a friend paying for my coffee is not going to say “now you have to do something for me.” I still feel really bad though. M says that understanding doesn’t make the feelings disappear. I want to know what will and he says continuing to talk about it. I tell him about one of the awkward situations involving him and money. Several years ago (about 5), I showed M some pictures of me on my iPad. M came and sat beside me on the couch while I did and then went back to his chair. At the end of the session, I found some change on the couch and said this probably fell out of my purse. I scooped it up and put it in my wallet without really looking at it or counting it. All of a sudden I remembered he had been sitting on the couch and it was more likely change that fell out of his pockets and I said so. He reached into his pocket and said probably. I start to take out my wallet saying I’m not sure how much it was and he says forget it. M says he remembers the pictures but not the change. I say “of course not you aren’t crazy” M tells me I’m not crazy I have reasons to be hyper-vigilant.

When it first happened I couldn’t forget about it. I obsessed about it. How much money was it? (a handful of change but we have dollar and two dollar coins so $3) Does he think I took his money on purpose? How could I return it? Should I leave it in his outer office? what if someone else takes it? what if he doesn’t realize it is from me and that I’ve returned his change? should I try to do it to his face? After my first session last week I was right back to obsessing over it. After the session I send M and email telling him about my obsessive thoughts.

This week – session 1:
M asks me more about my obsessive thoughts about the change incident but I have difficulty telling him more. He doesn’t seem to understand why I am so bothered by it. I wonder if he thinks I should give him some money for the change (like he suggested I pay the dentist). I don’t know what I am expecting but I feel like I am not really getting a response from him about this issue. I also have no idea how embarrassing myself by telling him about this is going to help me resolve my feelings around the issue of money and gifts. I start to get frustrated with M. He seems to be saying that this is how I feel and I can’t change how I feel. He says I need to have some compassion for myself. I feel like I do but that doesn’t help. Nothing helps, I told him something that has bothered me in the past and it didn’t make a difference except I feel stupid and that he knows how stupid I am again. I feel like therapy isn’t working because M isn’t doing anything. By the end of the session I am saying very little and feelings upset.

After the session
I realize that once again, I wanted M to do something to make me feel better but he didn’t because that isn’t what therapy is about. He doesn’t try to make me feel better. He doesn’t say anything about the change because it isn’t an issue to him. He won’t say I am not worried about the money or you aren’t worthless or anything I can interpret as him caring because he never does. I’m just angry because I want him to but I know he won’t so it is just wasted anger. I leave him a message telling him I feel sad that I feel this way and that I do have some compassion for myself that this is so difficult and painful for me but nothing changes and I still feel sad.

Session 2 (tonight):
M asks me if he understood my message and if his email response made sense to me. I don’t say much. He asks me how I feel. I don’t feel much. I tell him I don’t want to talk and I think it is because I don’t want to get upset. He asks me if I think I get upset because I talk to him about things or if I get upset anyway. I am frustrated because I understand I get upset by things other than therapy, the triggering event had nothing to do with therapy. Eventually I tell him talking about upsetting things leads to me being upset at him, that I get angry that all he can do is tell me that I feel the way I feel and I can’t change it so I must have compassion for myself. I think he should do something but even while I’m angry I know it isn’t his fault so why talk about the anger. So I feel stuck and I don’t want to talk about this anymore, which leads to me not wanting to talk about any of the other potentially stuck issues in my life, which means we are sitting in silence again and I’m crying. M says I keep hearing that my feelings can’t change but that isn’t what he says. He says if I keep talking about my feelings and my experience that will make a difference. I say I can’t do that . He says I did do it before. I leave and now I’m wondering what am I supposed to do.

Anxiety

I am feeling very anxious. I’m avoiding calling my parents house because I’m afraid of calling when my mother is out. I am also regretting canceling call display on my home phone because I’m afraid he will call me again. My father won’t talk to me if my mother is there. I’m not sure I want to talk to him at all but I haven’t decided what to do.

I’m also in a lot of pain because I have a tooth abscess. I’m taking antibiotics for the infection but I’m going to have to have a root canal followed by a crown. This kind of dental work isn’t new to me. I’ve had a lot of root canals and crowns over the last 15 years. They’ve all been done by a specialist and most of them have been successful but I had an infection in one of them about 18 months ago. He performed a very painful gum surgery which wasn’t successful. I was supposed to have the tooth extracted but the oral surgeon I was referred to didn’t want to extract it if I wasn’t going to have an implant put in its place. An implant costs between five and six thousand and my insurance will only cover a small part of the cost. I decided I couldn’t afford it so I asked the oral surgeon to just extract the tooth and he suggested waiting.

During the examination of latest infected tooth, my specialist asked me why I hadn’t had my other tooth extracted. I explained why I hadn’t. He said he understood that the oral surgeon wanted to give me the best possible care but if it wasn’t possible for me to pay for the implant then I should still have the tooth extracted because of the danger of future infections. He said he would write the oral surgeon asking him to do the extraction. Then he walked me to his business officer to arrange my next appointment. The business officer told me that my root canal would cost just over $1500 and the dentist had waived 10% of his fee. I burst into tears surprising the business officer. I was so ashamed but I couldn’t stop crying. It was awful.

I tried to talk to M about it today. I’ve had this reaction before. Six months ago I saw a chiropodist a couple of times and the last time the chiropodist didn’t charge me for the appointment because he said he didn’t do anything for me. I argued that he gave me his appointment time but he didn’t change his mind. I didn’t start crying until I left his office but I haven’t gone back to him. I know rationally that in both cases the professionals involved chose to give me a discount but it feels so wrong to me. I didn’t tell my dentist I couldn’t afford the implant because I couldn’t pay his fee. M tried to ask me if I felt like I was beholden to him because of his discount and I said not rationally.

M told me many people are uncomfortable with people giving them things or doing favours for them. He asked if it made the relationship seem personal instead of professional. I said no, it is really about the money. This same dentist has called me at home on the evening after a previous root canal to check up on me and when he didn’t get to talk to me he left a number for me to call him when I got home. I called him and he was in a restaurant having dinner. Another time he gave me a card with his cell phone number and told me to call him if I needed to talk to him. Neither of these things made me feel uncomfortable. I appreciated his concern. This discount makes me so uncomfortable I want to cancel my appointment and never go back. I hate how irrational I am.

My T does not have a plan for therapy

Recently M responded to a message I left him by saying he was surprised by my feelings of hopelessness and despair because at the end of the session he thought I was in a more positive place. When I heard his message (I hadn’t answered the phone) I felt instant panic, followed by a desperate need to apologize for surprising (and disappointing) him, and then fear. I tried contacting him but we weren’t able to talk to each other until my next session a few days later.

During the session, M asked me why I felt so panicked by his message. I had been thinking about it and I told him I thought something about his message made me feel like he was as lost as I was when it came to therapy, that he didn’t have a plan, because why else would he have been surprised by my feelings. I don’t think M has ever expressed surprise about anything in the 6.5 years I’ve been seeing him. I said I knew he didn’t have a step-by-step, how each session should go plan but I thought he had some kind of loose plan, like I thought he knew that I didn’t like being left in silence, or I wanted him to say something supportive after I expressed difficult things.

He told me that he didn’t have a plan, he had guidelines, or information but he didn’t have a plan. He also said that he didn’t know what I wanted him to say. He continued by saying he worked at avoiding getting caught up in trying to figure out what I wanted him to say because to do so would feel inauthentic and weird and not how he operates. I wasn’t too happy him agreeing he had no plan. I told him that I felt like we were just both wandering around hoping to run into something important or helpful which explained a lot about how I have felt about therapy over the years. M took the opportunity to point out the many ways that my belief that he had a plan for therapy was probably contributing to my unhappiness with therapy, my feelings that it wasn’t working, and my fears about it being successful.

Since that session I have been more and more bothered by that conversation. If he doesn’t want to spend anytime thinking about what I want him to say or do, why have we wasted so much time with me explaining how I felt like he didn’t care or didn’t like me? Why did he ask me what kind of things could we do differently so I felt his care? Why try sitting of the floor, or handshakes, or doing a puzzle? What is the point in telling him how I feel or think in reaction to him and our relationship? Is therapy just some random event where you talk about things until you find something that is sensitive or difficult and then you try to figure out why? Is therapy like a Roomba(), a robot vacuum cleaner that cleans a room by a random walk method which involves heading in one direction until it hits an object and then heads off in a different direction. The room gets clean but not in the most efficient (with respect to time and energy) way possible.

So let me know, does your therapist have a therapy plan?

Lack of safety in therapy

I had a session with M today and I was about 7 minutes late because I sat in my care and fought my fear of the session. I thought of just talking to him on my phone which would be less scary but considering the fact that I was outside his office I decided eventually to go in. It was a hard session and I never felt comfortable. I had listened to my sessions from last week and I was surprised at how similar the recording of the last 20 minutes of Wednesday’s session was with my last post, surprised and saddened. It felt when I listened to it as frustrating and hopeless as it felt in his office.

I felt like M was tired of me today, that he was frustrated, and that he was giving up. He told me that he wouldn’t change the way therapy worked but he realized that part of my wanting to be closer to him was that I wanted him to want me to be close to him. I said he was probably right because if he wanted me to be close to him then that would mean that he cared about me and he wasn’t going to quit therapy. However, he told me that he wouldn’t change anything about therapy to have me feel safer in therapy. I asked him what the solution was to my dilemma and he told me to talk about my feelings and why I doubted that he cared. Problem is that when I do try talking about things that made me feel like he didn’t care or didn’t believe me he doesn’t really respond. For example, last week I sent him an email telling him that I felt like he was laughing at me during the last session and I wondered what he meant by that laugh and that when he used the word perspective in a conversation with me it sounded to me like he didn’t believe what I was telling him and that it was *just* my perspective. Today he mentioned that I was hyper vigilant and analyzing every word he used but he didn’t say “I do believe you” or I wasn’t laughing at you.

He wasn’t even understanding about how scared I felt about coming to the session or how afraid I was that he was going to quit therapy. When I told him that I was afraid he was going to quit, he said “interestingly you are the one who keeps talking about quitting”. I said because that is how therapy works I tell you what I am thinking about and you don’t so you might be thinking about quitting and discussing it with colleagues but you wouldn’t tell me until you had made the decision. He said so you think I am on the same trajectory as you so you want to quit first. I said how would I know if you were thinking about quitting you don’t tell me that you aren’t and I know you wouldn’t tell me if you were. Then at the end of the session while I was standing up and packing up my stuff he said I’m not thinking about quitting. I wish I felt more relieved about it.

Another session, same old feelings

Today during my session, M and I started with an easy discussion about what I did this weekend and how my children were, blah, blah, blah. When M switched to the topic of therapy, he started by discussing some of the reasons I have given him in the past for why I don’t think he is interested in talking about topics important to me. Things like, he doesn’t ask me about certain topics, or his response when I bring up the topic. Then he asked me if there were any other things that gave me the impression that he didn’t want to talk about things. I said probably the feeling I had that certain subjects were wrong. That it wasn’t okay to talk about how I feel about him or how I wished he would touch me to comfort me. I told him that when I was talking to my marriage therapist and the session started to focus on the difficulty I have been having with my own therapist I said it felt wrong to me to talk about my own issues instead of couple issues. He challenged my belief that it was wrong because he said that things that were difficult for me were also affecting my relationship with my husband. He said it was no different from us spending 20 minutes discussing my husbands work stress (which we do regularly) because his work stress affects our relationship. I don’t remember what exactly M said next but it certainly wasn’t anything to challenge my feeling that it is wrong to talk about how I feel about him.

The session continued with some discussion of triggers and how I can identify if I have been triggered. He asked if I would tell him or my husband if I felt triggered and I said “yes, if I could understand it” but if not I was more likely to keep it to myself and try to figure it out. The session was very low-key. I didn’t get upset about anything and we didn’t delve too deeply into any subject. When I left he shook my hand and I noticed, again, that he didn’t try touching my arm or shoulder. I understand why he doesn’t do things that I think would comfort me or help me feel safer with him but that hasn’t stopped me from wishing he would. I wrote him an email when I got home saying I didn’t really understand what more we could do. I could come in and tell him I wish he had said something about my feelings about him, something like he thought it was important to discuss, or I could come in and say I wish you would sit beside me and let me lean on you but I’ve done that before and after I say something like that he explains why he doesn’t respond that way. I understand his reasons but I don’t know what happens next. He isn’t going to change how he does therapy. I don’t think that I am going to change what I want. And once again, I’m back to talking about quitting therapy because it is hopeless. I didn’t tell him I was quitting. I’m not actually thinking about it. Instead I was explaining to him how every session leads me back to that being the solution to our impasse. Trying to quit is so painful so for now I’m not quitting. I’m just trying to be with the hopelessness.

I feel like a little girl

Last Monday I had a session with M that was so upsetting. Near the end I begged M to get to make his point. He said he didn’t have a point. Then I accused him of trying to drive me crazy and I meant it. I felt like I was on the edge of an abyss and he kept pushing me closer and closer to the edge. I think he was frustrated because I wasn’t able to hear what he was trying to say. He apologized for how difficult the session was at the end and I said it didn’t do me any good that he was sorry. It was incredibly painful and since that session I have felt exhausted. I’ve seen him three times since then and each time the session starts okay and at some point I become so sad. I’ve been trying to tell M why I am so sad but I don’t think he understands.

The session after the terrible session I told him some of the things I’ve been trying to tell him about how I felt about him touching my arm and me telling him that I love him. I felt like I said a lot of the things that I’ve been struggling with lately and that was a good thing. Then a few days later I listened to my recording of the terrible session and it felt like I was listening to somebody else. Usually when I listen to a session a few days after it, hearing it brings all the feelings and thoughts I had during the session back to mind. It gives me a chance to journal about things that I didn’t talk about. This session wasn’t like that at all. I knew it was my voice but I couldn’t remember what I was feeling and I couldn’t understand why I was so upset. I could hear in my voice the absolute desperation I felt. I could hear how angry I was at M when I was accusing him of driving me crazy but I couldn’t figure out why I felt like that. I don’t feel like the me that listened to the session 5 days later or who has been trying to talk to M about it is the same me who was in that session.

Trying to talk to M about the different “me’s” and how awful it sounded to hear the me who was so desperate and frightened. I don’t feel like M knows what to do next in therapy. He wants to understand what was so upsetting in that session and so he is asking me lots of questions but I don’t know why I was so upset. I can’t explain something to him that I can’t understand myself. I think that is why I am so sad. I’m afraid that I’m going to be stuck in the me that is in so much pain and makes no sense. I’m afraid that M doesn’t know how to help that me because he can only talk to the me that answers questions and can talk to him. I told M that at the start of the terrible session I had things I wanted to talk about (the touch and the I love you) and he kept talking about something I didn’t understand and so I wanted him to get to the point. He wondered if that was what triggered me, feeling like he was monopolizing my time and preventing me from talking about things that were vital and important. When he said that I just went silent again because my instantaneous, gut reaction was I don’t know what is vital and important. Eventually I told him that I could own that there were things I wanted to talk about but I couldn’t say that they were vital and important. He told me that they were vital and important because I wanted to talk about them. To him it was that simple. I wish the child in me could believe it.

Breathing

Breathing or respiration is controlled by the autonomic nervous system. According the Wikipedia the Autonomic Nervous System currently states:

The autonomic nervous system (ANS or visceral nervous system or involuntary nervous system) is the part of the peripheral nervous system that acts as a control system, functioning largely below the level of consciousness, and controls visceral functions.[1] The ANS affects heart rate, digestion, respiratory rate, salivation, perspiration, pupillary dilation, micturition (urination), and sexual arousal. Most autonomous functions are involuntary but a number of ANS actions can work alongside some degree of conscious control. Everyday examples include breathing, swallowing, and sexual arousal, and in some cases functions such as heart rate.

Your body breathes without you thinking about breathing or telling it when to breathe. For a short time you can tell you body not to breathe but not for long. It isn’t the kind of thing that normally produces a lot of anxiety for people but it always has for me. I have always been afraid that I wouldn’t be able to breathe. When I read a story about someone being tied up and gagged I thought about whether I would die if that happened to me because I breathe through my mouth most of the time. I don’t like anything close to my face or around my neck no matter how cold it gets. I don’t have any reason for my fear of not being able to breathe that I can remember. I didn’t have asthma attacks as a child or being suffocated in fights with my peers.

In my mid-thirties I was diagnosed with asthma. I was surprised because I had never had a typical asthma attack where I struggled to breathe. I was tested because I had a history of environmental allergies, repeated episodes of bronchitis in the previous 10 years, and a fairly chronic dry cough since my third child was born (about six months earlier). The cough went completely away after a couple of weeks on Symbicort (a combined maintenance and short acting inhaler). For the last 8 years I haven’t thought about my asthma at all. It was well-controlled on half the dose prescribed by the doctor and I went in once a year to have my lung function tested. This summer during my regular check up my doctor told me that my lung capacity was slightly reduced but I felt fine and my chest sounded clear so I didn’t worry about it. About six weeks after the appointment I felt like the Symbicort just didn’t work as well anymore. I felt like there was something heavy resting on my chest, like I was getting an infection and I started coughing more. A few weeks later a different doctor was so concerned when he listened to my chest while I was breathing that he sent me for a chest X-ray to check for pneumonia (which I didn’t have) and got me an emergency appointment with my asthma specialist. At that visit, my lung capacity was lower and I had signs of inflammation. He told me that my asthma was getting worse. He prescribed a week of Prednisone and a follow-up visit in two months.

I had the follow-up last week. The Prednisone was amazing and in three days I felt much better. My breathing was easier and all the aches and pains in my joints went away. About a week ago my chest started to feel tighter even though I was taking my medicine at the full prescribed dose. It corresponded with a drop in temperature where I lived and I wondered if I was getting sick but I never got any worse. At my appointment my doctor told me that I didn’t have the signs of inflammation I had two months ago and my chest sounded clearer when he listened to it but my lung capacity was even lower. My normal lung capacity had been 2.5 litres for years and now it had dropped to 1.86 litres. I asked him if he thought I had something other than asthma because I have been worried that I had COPD and he told me I couldn’t have COPD because I have never smoked. He said he didn’t want to talk about any other possibilities until after I had a more sophisticated breathing test which I couldn’t schedule until the middle of January.

Since then I’ve spent a lot of time reading about asthma and COPD. Asthma is a completely reversible obstructive lung disease usually diagnosed in children and young adults. COPD is a chronic, deteriorating obstructive lung disease usually diagnosed in smokers or ex-smokers in middle-aged or older adults. People with COPD die because they can’t get enough oxygen from their breathing. It sounds like my worst nightmare. It isn’t rational but I keep thinking that I have developed COPD and that is why my medications don’t work as well as they did initially. I am thinking about my breathing.