Clarification

After reading Zooey’s email response, it seemed like she was trying to set a boundary, but was simultaneously refusing to be explicitly clear with me about it. I felt like her email was a cop-out and that she was STILL not taking responsibility for her own actions and decisions. I also knew that if I didn’t ask for clarification, I’d agonize over what, exactly, she meant.

So, true to form, I wrote her back and simply asked for clarification:

Thank you for responding, Zooey.

This may be redundant for you, but I do want to be perfectly clear on this: are you telling me to not ever communicate with you again in any way?

I understand the restrictions on personal relationships post-termination. In person and in a previous email, you said that you welcomed updates about my life. It would seem you are perhaps backtracking on that, so now I am admittedly confused.
I think it would be best if we were both explicitly clear on the boundary you are setting. Otherwise, it will probably drive me crazy to try and guess what is or is not okay.
Thank you,
Andi
This was her response, which made me both laugh very loudly and cry a bit:

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NOW You Care About Ethics?

Zooey responded to my voicemail by emailing me. Here is what she said:

Andi,
I received the voicemail you left on Friday. In response to your questions regarding contact between us now that we have terminated, I want you to know that my profession’s code of ethics prohibits personal relationships with current or former patients. Please be respectful of this. I encourage you to explore and work through your feelings with your current therapist.
Sincerely,
Zooey

I am admittedly emotional about this. She initially said that she “welcomed updates about my life”. She emailed me back last month. She didnt give me any parameters to follow. And as I’ve already pointed out here and here, she was certainly unethical in her termination process.

But I think I am actually relieved. Now I can really begin to let her go. It will continue to be painful and awful and messy. But at least she has given me the gift of FINALLY setting a boundary on this. And although it’s irritating that she just now figured out that her profession has an ethics code, at least this wil give me a chance at closure. 

Better letter than never?

Stranger

Screen Shot 2015-03-05 at 9.16.39 PM

I recently saw the above quote while browsing tumblr. It’s short and vague and was probably written by an angsty teenager who just broke up with their bf/gf, but as soon as I saw it I felt like someone had punched me in the chest.

That quote essentially sums up who Zooey is to me now: a stranger who knows more intimate details about the most horrible aspects of our story than any other human being on the planet.

And that is excruciating.

I cannot accept this. I desperately need her to NOT be just a stranger with all my secrets. I need her to be something more. Someone more. Something bigger than that. I need to feel like our relationship goes beyond just me sharing secrets followed by estrangement. I need to know that I meant more. I need to feel like we’re somehow still connected.

I dreamed of her last night. It was a weird dream about living underwater, but I woke up missing her terribly. That feeling just sat right in the center of my chest all damn day, making it hard to breathe. When my wife got home this afternoon, I just started crying. I explained how much I miss Zooey today and how I don’t really understand how I’m supposed to be dealing with all of this. And that I wish so much that I could just talk to her.

So my wife suggested I just ask for what I want. And I did. I called Zooey and left a voicemail somewhat along the lines of this:

Hi Zooey, this is Andie. I actually have no reason for calling you, except that I just really miss you today. There’s nothing even significant about today (I don’t think) but you’ve just really been on my mind. I’ve spent a lot of time in session processing all of this with someone new. And that helps…a lot. But there’s no guidelines or handbook for navigating this situation, so I think I’m just trying to figure it out as I go.

I don’t really know what to say, exactly. I don’t need your professional help and I’m okay. But…you’re someone who means a lot to me and I would really love to hear your voice.

So this is probably super weird, but I’m going to ask if, when you have a some moments free, you could call me back and we could just talk for a few minutes. I don’t know if that’s allowed or whatever, but I thought I’d ask anyway.

My number is [number].

Thanks. I hope you’re well. Bye.

I don’t know that she’ll call me back. I hope she does though, even if only to let me know that it actually is not appropriate for us to be speaking on the phone now that I’m not her client or whatever. I really have no idea what I would even say to her if she did call back, but I’m not sure that it matters. All I know is that it felt very important to me that I be heard – that she know how I’m feeling and that I be able to send some of that energy out into the world.

It’s too much to carry all alone.

Traumatic Disconnection

I recently came across a glossary of key terms related to Relational-Cultural theory put out by the Jean Baker Miller Training Institute (JBMTI). One of them, “Traumatic Disconnection”, really stood out to me. Here is their definition:

TRAUMATIC DISCONNECTION:
Disconnections that occur when what might be an acute disconnection triggers someone (often suffering from posttraumatic stress disorder) into a place of reactivity (the amygdala hijack) where she or he becomes unavailable to relational repair. The person cannot come back into connection because of a heightened sense of danger. Until safety can be reestablished, the therapist must honor the client’s dramatic return to strategies of disconnection. Ironically, these traumatic disconnections sometimes follow an increase in closeness, a relinquishing of strategies of disconnection. In those moments the client feels increased vulnerability and may have to resort to old ways of self-protection.

What struck me the most about this is how salient this particular experience has been for myself and other members of our system as we’ve gone through therapy. Looking back, I can very clearly see this pattern in our behaviors. In fact, when I re-examine the very last session I had with Zooey before she terminated treatment, I can see how it was essentially dominated by this feeling of traumatic disconnection. Here is how I described that experience to her in my termination letter:

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Math

Screen Shot 2015-02-24 at 7.32.16 PMI kept a running list of all the sessions I had with Zooey. I recorded the dates of each session, whether they happened in her office or on the phone, and whether or not an office session was extended due to some sort of “crisis” or if a phone session was due to an urgent or emergency issue. Today, I went over that list and did a little math to determine the ratio of each type. Here are my results:

82 sessions total (100%)
69 regular office sessions (84.1%)
2 sessions with Wife included (2.4%)
13 extended office sessions (15.8%)
13 phone sessions total (15.8%)
1 phone session with Wife only (1.2%)
9 planned phone sessions (10.9%)
4 “emergency” phone sessions (4.8%)
17 “irregular sessions” (20.7%)

That means we literally spent 1/5th of our time on unscheduled crisis management. Maybe 1 out of 5 interactions seems like a lot, but it’s also important to note that not every unplanned session had the same duration as a full 45 minute session. There were also a few shorter phone calls (5-15 minutes, some planned, some not), both scheduled and unplanned text interactions, and several e-mails that we sent her (non-emergent and always with her explicit permission).

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Too Tired

I am too tired to write a post today. But I promised myself I would get something written down every day for the sake of helping to contain the tremendous emotion I attempt to carry around all day every day.

Finals are done. Thankfully. I felt good about both tests, but my professors are sneaky tricksters. So…we shall see. Really hoping to maintain my 4.0.

Session was okay today. Emotional. I feel profoundly sad for a myriad of reasons, not excluding severely missing Zooey. I don’t miss her as my therapist. But I do still miss her. A lot. I’ll write more about how session went when I have more energy.

For now, I shall attempt sleep.

Better

Luckily, today went much better than yesterday. I think just writing about how awful and worthless I felt was enough to propel me out of that funk and into some semblance of productivity. I managed to eat three (somewhat) decent meals today, study for several hours, and do an impressive amount of live-tweeting during the Oscars.

I have another therapy session tomorrow. Since I only got through the death of a family friend and contacting my brother on Friday, I am probably going to try to talk about my Wife not getting the job and one other thing (that I haven’t yet talked about on this blog). I don’t know if I’ll get through it all, but it’s a good starting point.

I should also probably talk about last session, yeah? I mean, I totally just started crying when she merely mentioned increasing the frequency of sessions to twice-weekly. She’s probably wondering what the hell was going on – what was I thinking/feeling in that moment? I was thinking a lot of things.

Mostly, however, I was thinking,

“No…please don’t do this. Please don’t get invested. Please don’t start caring about me. Please don’t get me to trust you.”

The fear of connection was incredibly overwhelming. She did, of course, mention Zooey in that moment and said something about how I was probably reacting to the experience of losing her and the awful termination we had. Yes. Of course. I think I cried for that, too – for the fact that this beautiful relationship that I valued so much somehow turned into a source of such tremendous pain and self-doubt. I ended up reaching an unprecedented level of trust with Zooey that I didn’t believe was possible with a clinician. In one fell swoop, it all came tumbling down on me and now I’m just buried in the remnants of that disastrous ending.

Anyway, I’m sure I’ll figure out what I want to say at some point between now and tomorrow afternoon. It’s not like I am EVER at a shortage of conversation topics. I guess I’m just nervous to follow-up what ended up being such a weirdly emotional session.

But today was better. Maybe tomorrow will be better, too. Wish me luck on my finals!

Change of Plans

Despite all of my insistence that I not go to my scheduled therapy session today, I ended up going after all. I was late, since I forgot to set an alarm, but I was there.

Ultimately, I realized that even though my sessions will end up close together, it’s still only one per week. So, financially, it’s not any extra expense. Additionally, the more I pondered it, the more I realized that considering the recent drama that has unfolded, now is probably a good a time as any to have sessions relatively close together. I certainly have a lot to talk about.

And talk I did.

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Termination & Ethics, part 2

Last week I posted about the NASW’s ethical guidelines for Social Workers, particularly in regards to termination practices.

4113548Since then, I’ve been reading Treating Complex Traumatic Stress Disorders, by Christine A. Courtois and Julian D. Ford. Chapter 4, entitled “Best Practices in Psychotherapy for Adults”, outlines the best evidence-based practices for helping patients with C-PTSD and related disorders. They essentially highlight the same 3-phase model that Zooey’s DID “expert” supervisor advised her to use and that many trauma specialists accept as the best approach for trauma. I read the “expert”‘s book as well and I liked the model, so Zooey and I agreed to try that. It is also very similar to how they approach treatment in the residential trauma program I attended in the Fall. I’ll write more about that treatment and the phases in future posts, but here’s a basic rundown:

  • PHASE 1: Safety and Stabilization
  • PHASE 2: The Processing of Traumatic Memories
  • PHASE 3: Reintegration

My understanding is that the idea is to get the patient stable and in a safe place so that they are able to engage with their traumatic memories without resorting and/or regressing to unsafe/destructive coping skills. Then, once the memories have been processed, phase 3 is essentially a culmination of the previous two phases. The client is able to use their new skills and information to analyze themselves and move beyond the effects of abuse. Or something like that.

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Ethics

imagesMy bestie is getting her MSW (Master’s in Social Work) right now, so when she learned what happened with Zooey…let’s just say she was not impressed. In fact, one of her first reactions was to reassure me that this was most definitely NOT an acceptable way for Social Workers to behave. Zooey is an LCSW (Licensed Clinical Social Worker) and since I’ve been learning about medical ethics in my own studies, I was curious if Bestie had been learning something similar in her MSW program. I not-so-discretely asked her about the ethics surrounding social work practice. She sent me a link to the NASW (National Association for Social Workers) Code of Ethics. Here is what is listed under “Termination of Services”:

1.16 Termination of Services

(a) Social workers should terminate services to clients and professional relationships with them when such services and relationships are no longer required or no longer serve the clients’ needs or interests. 

(b) Social workers should take reasonable steps to avoid abandoning clients who are still in need of services. Social workers should withdraw services precipitously only under unusual circumstances, giving careful consideration to all factors in the situation and taking care to minimize possible adverse effects. Social workers should assist in making appropriate arrangements for continuation of services when necessary. 

(c) Social workers in fee-for-service settings may terminate services to clients who are not paying an overdue balance if the financial contractual arrangements have been made clear to the client, if the client does not pose an imminent danger to self or others, and if the clinical and other consequences of the current nonpayment have been addressed and discussed with the client.

(d) Social workers should not terminate services to pursue a social, financial, or sexual relationship with a client.

(e) Social workers who anticipate the termination or interruption of services to clients should notify clients promptly and seek the transfer, referral, or continuation of services in relation to the clients’ needs and preferences. 

(f) Social workers who are leaving an employment setting should inform clients of appropriate options for the continuation of services and of the benefits and risks of the options.

Okay, so here’s my response to various parts of this:

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