Dysmorphia

Today’s session was a hot mess.

It didn’t start out that way. I had my first shift of clinical affiliation today, so I went to session right afterwards in my scrubs. The therapist opened the hour by saying, “Nice scrubs!” and I told her I had a funny story about that:

When I found out I needed scrubs for clinic, I asked my classmate where to get them. She said to just order online, so I found a company I liked and ordered them from Amazon. My wife suggested a certain size, but once she left the room, I decided to get the larger size instead.

When the scrubs arrived the next day, I pulled them out of the box and held them up to myself. Wife said, “Do you think those will fit you?” and I said, “Yeah, probably.”

“Okay. Try them on.”

I did. They were admittedly way too big on me. My wife asked me if I’d genuinely believed those scrubs would have fit me and I said that yes, I really did believe that.

At this point she took a photo of me in said scrubs and we jokingly posted it on Instagram.

I relayed this story to my therapist and showed her the picture. I explained that in the photo I am wearing size large scrubs and the scrubs I was currently wearing were a size small. I also added that Wife and I felt that taking a photo of me in these huge clothes would be a good way to demonstrate the severity of my body dysmorphia.

She agreed.

90 Minutes

Friday’s (extra) session ended up being 90 minutes long.

I walked in and sat down, immediately curling into myself and pulling my hoodie up over my head. I asked her if she was mad at me.

“No. But…are you okay?”

I just started firing off random and incoherent thoughts, explaining that I was most certainly not okay. I explained that a series of upsetting things had happened that were building up and I needed to just talk.

She told me to go for it and she’d just listen for a while.

I talked about how my sister (cousin) contacted me about my niece. Apparently my niece’s behavior has become very regressive since school restarted earlier this month. She’s been displaying very emotional and labile behavior and has stated that she hates school and hates riding the bus.

Upon further investigation, my sister learned that a boy on the bus has been harassing my niece – insisting that she kiss him, hold his hand, etc. She believes he has touched her as well, but can’t quite determine the nature of physical contact.

Ready to Run Away

Therapy has reached a point where I just want to run away.

I can’t really explain it. Nothing happened, at least in terms of the work. We’ve been trying to work through all of the post-MRI triggery nonsense to figure out this hidden memory or alter or whatever.

Lately, I’ve been getting so mad at my therapist. Or something similar to mad. I’m so irritated – with her, with myself, with the commute to her office, with the office itself. Everything grates on me.

Everything feels wrong.

I’m not really mad or irritated with her personally. There’s just something about the essence of her and her role in my life that makes me feel super out of control.

There’s so much internal chaos right now and I feel awful.

I don’t know how to describe it, but I feel like I am dying. Or frozen. Or dying a slow, freezing death. I often journal, either in an actual journal or on my iPad. Lately, I’ve just been writing the word DEAD over and over again, with no idea why.

Paper Clip

Some of the work I’m doing in therapy right now is around an uncovered memory that seems ready to reveal itself.

As I’ve mentioned previously, my memories generally come in pieces that gradually begin to make more sense over time. I’ve learned that it tends to go a little better for me if I actively work to put those pieces together. It seems to help me be more prepared for when the pieces collide and I get the more complete memory. Sort of.

In an effort to get ahead of this particular memory, I’ve been doing just that: I’ve created a diagram that has a big question mark in the center. The question mark represents what is missing – in this case, I believe it is either a specific memory, an alter I’m not familiar with (either new or previously dormant), or a combination of both.

I showed this diagram to my therapist at the end of Monday’s session and she immediately said that she wanted a copy. So I scanned and printed the page from my journal and brought it with me yesterday, along with a photograph that I felt very drawn to of myself at about age 3 or 4 with my grandmother’s dog.

She asked if I wanted to talk about the diagram and I nodded my head yes. She said that was okay and that she also wanted to talk about it, but then added that she’d like us to also talk about how to create a safe space for me while we work on this type of stuff. I’d mentioned before how terrifying and painful this can be for me; I often go into extreme flashbacks, body memories, or lose time. It’s very hard to recover from such moments.

Self-Care and Trusting my Instincts

Thursday’s session was tough for me. I’m still missing a lot of what happened after my therapist asked me what my feelings were trying to tell me (about how the MRI triggered me). I suspect we may end up discussing that more in session this week, but for now I’m at a loss.

Thursday night wasn’t too rough because I had a “required social activity” to attend nearby right after session. I was in both “social mode” and “academic/career mode” within fifteen minutes of walking out of the office.

So I pushed most of session stuff aside until the next morning. Then I had physical therapy in the early afternoon on Friday, so I was still in a similar mode, since I want to build a nice networking relationship with my own PT (it’s a small world, after all).

The moment I walked out of PT, I hopped on the train downtown. I got to the area a little early, so I grabbed a coffee and started furiously writing notes in my journal. There was a lot I wanted to talk about, most of which was unrelated to what did (or did not) happen in the previous session.

So when I walked into my therapist’s office, I was calm, relaxed, and cordial.

Epiphany

As I mentioned on Saturday, I told my therapist about the whole MRI ordeal.

That incident actually happened on Tuesday, but I didn’t have session until Thursday afternoon. I spent most of that time stumbling through each hour, just holding onto all of that crap until I could unload it in session. I literally kept repeating to myself, “Just get to Thursday. Just get to Thursday…”

We spent a good portion of session talking about her comment from Monday’s session. Then I put my head down and quietly said, “So I got that MRI on Tuesday.”

“Oh? How did it go?”

I immediately started to tear up as I told her how horrible it was. Then I walked her through the whole thing in as much detail as I could remember at the time. She was equally horrified and seemed completely repulsed by the lack of sensitivity from the hospital staff. She also asked me a lot of questions about my injury and my thoughts on why they needed to do the scans a specific way, etc.

Then she asked me how I got through the entire 70 minutes. I told her that I did some serious mental gymnastics: I explained the meditative breathing and the clicks-as-words thing and then I outlined how I started creating stories about people who’d been there before me.

When I finished giving her a character outline of the “Sassy Black Woman”, she laughed (which was appropriate because I was being animated and funny) and said, “You could have used a little of that Sassy Black Woman during that process, huh?”

Talking About Her Comment

Going into Thursday’s session, I knew I wanted to talk about the comment my therapist made on Monday in response to my fears around our growing attachment (“Well that’s kind of hard when you’re coming three times a week!”). I re-capped that part of the conversation and I explained that it felt like she was making fun of me or mocking me somehow.

“How so?”

“It’s like you were saying: ‘Well what did you think was going to happen if you came here so often?!’…as if I am stupid or something.”

“I don’t think that. In fact, I have no expectation that you should know what to feel or expect about coming here three times a week. I’m sure you feel a lot of complicated things about it.”

She continued…

“And I can see how my comment might not have sat well with you…”

She paused a bit to reflect on the conversation and her own intentions.

“I think what I was doing was responding to the double-bind you were in: that you want so much to have support and to feel safe and secure in this space, but at the same time, that intimacy scares you and pulls you out of the safety. So as I was listening to you speak on Monday, I realized how difficult this situation is for you and I wanted to speak to that.”

Shock

It’s been hard to write for the past few days. I had this experience on Tuesday that has been difficult to process or understand. There was a lot to hold onto, so it felt impossible to even begin writing. But I’ve been able to talk though it a bit in therapy, so I want to try to write it out here.

*Mild trigger warning for content (medical trauma)*

Earlier this week I had to get an MRI. Which, for those who don’t know, is a type of image taken of the body using magnets. The scans vary in length and type, but the entire procedure is generally around 45 minutes or so.

I was prescribed an MRI due to a previous injury to my hamstrings and hip muscles. Since my bone x-ray was normal, the orthopedist wanted a scan to see what might be going on with the soft tissues in that area to cause me pain, or that may be attributed to slow healing.

I wasn’t given very much information about what to expect. Some friends in the radiology program at my school informed me that the machine would be very loud (and to ask for ear plugs if they didn’t offer), the room would be cold, and I’d probably only have to go halfway in the machine.

When I got to the hospital, the security guard sent me to the wrong location (to be fair, he directed me to inpatient MRI, which sounds pretty similar to outpatient MRI) so I had to walk across the entire hospital to the correct location. Luckily this appears to happen often because there were blue arrows stuck to the floor that followed directly to the outpatient radiology clinic.

Working Through Some Attachment Fears

I eased into yesterday’s session before reading the “special” email to the therapist. I knew I wanted to read it to her. Well, I didn’t want to, but I had a sense it would be important to share and discuss.

Before bringing it up, I mentioned feeling as though I’d been triggered by a lot of different things lately. I said, “It just feels like I’m trying to work through this thing and right when I think I’m at a better place with it, something else triggers me and I start to spiral again…”

She let me carry on with being vague for a while before asking me what that thing might be. I told her it was somehow related to our relationship, but that I was struggling to verbalize my thoughts and emotions. She reminded me that I didn’t need to have it all figured out in order to talk about it.

I reiterated the feelings I’d first mentioned on Friday when I said that the relationship felt both threatening to me and as though it was somehow in danger itself. I told her it feels like I’m in a place I didn’t want to be and I’m both angry and ashamed that I’ve arrived here. I also feel guilt over having put myself into this place again and I feel both stupid and irresponsible for doing so.

Naturally, she asked what I meant by the “place” I’m in.

Special

When I went into session today, I knew I wanted to discuss the threatening feelings around the relationship I have with my therapist, but I also knew it would be challenging to feel that extraordinarily vulnerable.

As with most difficult topics, I thought using the Zooey situation as a medium to communicate about our relationship would suffice for now. So I chose to share an email I’d written to Zooey last July; an email that I’d describe as one of the most shameful things I’ve ever written.

As a preface, Zooey and I had been having a conversation in session about boundaries and the nature of our relationship. I told her I was concerned that the relationship had become “unhealthy” and that I was struggling with the inconsistencies in regards to out-of-session contact. I wasn’t sure what I felt or thought, but I wanted to talk with her about it.

She responded by saying. “I don’t normally text or email with clients. It’s not that you’re special, I just think that works well for you.”

Seems innocuous enough, right? But it devastated me.

Here is that email, written and sent within 40 minutes after session had ended. In fact, I was so upset that I called my wife right afterwards, then hung up and drafted this email from my iPhone while sitting on a stoop at a realty office on Broadway. That is how strong my reaction was.

I was terrified out of my mind to share this, but I did. And now I’ll share it here:

Zooey,

The first thing I did when I left your office today was pull out my journal and write this quote down:

“Well I don’t normally text and e-mail with people. It’s not that you’re special or I like you better, but…”

Thanks, Zooey. Thank you so very much for the reminder that I am in fact not special. The decades of various forms of neglect, abuse, and torture we’ve endured had not made that quite apparent enough.

And here’s the thing: I know that as a therapist, you’re not supposed to play favorites or become over-invested in us or our treatment. I know that it’s important to have boundaries in order to keep the relationship therapeutic. So if you did feel that perhaps I am a special client that you particularly enjoy working with, it would be inappropriate for you to share that with me. Fine.

But to go out of your way to preface a statement by emphasizing that you do NOT think I am special, nor do you like me better was just…..I mean, what the actual fuck? That was so hurtful.

The fascinating part of all of this is that you made that statement on the final day of a month where we had fourteen sessions. We’d been in contact nearly every day (or at least someone had). You sought out a new supervisor to help with my case. You’ve called us at night and texted back when we were upset. You’ve been coordinating with Wife to help us. You stayed late at the hospital and were late to your personal plans to make sure we were safe. You got this workbook to help move forward with therapy with various alters. You’ve gone out of your way to make sure we get attentive and effective treatment. That feels special to me.

As clients, I think we all want to feel and believe we’re special….that our therapist loves and cares about us and secretly prefers us to other more boring or difficult clients. That’s our fantasy to do what we will with. For me, I struggle so much with accepting even basic compassion and care from you (or anyone, really). It has been a challenge to not counter every good interaction we have with an internal follow-up to remind myself that I’m just another client and you’re just doing your job and that you don’t actually care. Sometimes I tell myself that you really do care and maybe even do feel a little more invested in my treatment because I’m intelligent and interesting and generally cooperative and articulate. Whether that’s true or not is irrelevant – it helps me feel more worthy of treatment and it makes it a little more okay that sometimes we need a lot of extra treatment.

But now you’ve taken that from me. And that really fucking sucks.

Especially because earlier today I tried, but couldn’t find any words, to express how much I love you. Perhaps I could have just said the words themselves, but that felt both too raw and potentially inappropriate.

But I do love you. I love you so much it overwhelms me. The time in between talking or seeing you can feel excruciating. It’s hard to remember if you’re even real when I’m not directly communicating with you. Weekends are especially challenging because the time between Thursday and Monday feels eternal and I’m always convinced that by Monday afternoon, you’ll have forgotten about us or stopped caring altogether. If we (well, some of us) could text you every single day just to reassure ourselves that you’re alive and that you remember us, we would.

And THAT is what I meant today by “unhealthy.” I feel as though I shouldn’t feel as attached and invested in you as I do. It feels like I’m doing something wrong…like there is something perverse or damaging about the bond we share. I haven’t exactly had a model for what it means to have a healthy relationship with someone in a position of authority and responsibility. Most of my relationships have ended up perverted and damaged.

I know this isn’t the case. You didn’t neglect or abuse me. But you did hurt me. Us. I can’t believe you would say such a thing. I just can’t figure it out or make sense out of it. I mean, honestly: why?? What was the point?! People don’t just randomly say shit like that!

I can’t read your mind, so obviously I’d eventually like to hear your reasoning behind whatever the hell that even was. But I don’t want to come in next week. I think I just need a break. This week has been so traumatic and now you’ve hurt me in a way that feels unbearable. I know that’s dramatic and you’re probably going to pin this all on my own transference, but whatever. You play a part in this relationship, too. No matter what you say, I know it’s not all just about me and my needs and what I get out of it. Relationships don’t work like that, even therapeutic ones.

So I think after I get back from vacation might be a good time to resume sessions. I don’t know. I need to think about this a lot more. Maybe it’s time for us to just move on altogether.

Either way, one of us will let you know.

Until then, we’ll be replaying your quote over and over on a loop in our head….Thanks so much for that.
Andi

Her response, 90 minutes later:

Andi,
I am sorry for my poor choice of words, and I am sorry that I hurt you. I hope to see you on Monday so we can talk about this more.
Zooey

You can probably guess that I went to that Monday session, but nothing was resolved. We didn’t really address the comment she made. She did say, “Andi, you must know you’re special. Your willingness to be vulnerable, your self-awareness and ability to articulate yourself is unparalleled. You must know that about yourself.” (I mean, yes and no?). We also never made it back around to have a conversation about the potentially unhealthy nature of our relationship or my endless confusion over boundaries.

Because, like most things in my time with her, we never really talked about anything.