Finding New Language

Part of what has been so challenging in therapy lately is that I have not been able to find words to really describe what I’m experiencing. It all feels so emotionally familiar, but also foreign and new at the same time.

My therapist always says that sometimes when we’re experiencing something new, it is hard to put words to it because we’ve never spoken about it before. This is particularly true when you are trying to speak the unspeakable.

In response to a recent blog post, a reader left a comment suggesting the book “Trauma and the Avoidant Client: Attachment-Based Strategies for Healing” by Robert T. Muller. I did a quick Google search and came upon the book, as well as an article titled “Trauma and Dismissing (Avoidant) Attachment: Intervention Strategies in Individual Psychotherapy” by the same author.

I had to read it a few times before my brain could settle down enough to make sense of everything I was reading. I have often been told I have an anxious-preoccupied attachment style or, more recently, a disorganized attachment style. I’ve done a lot of reading about those two styles to try and understand both myself and the work I should be doing.

So I was very surprised by how much I could relate to this article about individuals with a dismissive attachment style. It turns out this is fairly common in patients with intrafamilial trauma. Since these clients are by definition avoidant, it is a challenge to do research and develop treatment strategies for them. But Muller was able to tackle this important issue and what he came up with resonated with me in a very powerful way.

Plateau

Today in session, I was telling my therapist that I feel like I’m at some sort of therapeutic plateau. I have come so far in terms of stability. I am in a good place – my life is overall quite wonderful. Of course there’s a lot I still struggle with, but that is entirely internal at this point. I have eliminated all sources of truly toxic or harmful external stresses. There is no one left in my life who can, or would, hurt me.

So, naturally, I feel a compulsion to continue to hurt myself.

During last night’s session, I nearly had a flashback. I think the only thing that stopped it was that I felt it coming on and mentioned that fact to my therapist. She told me that she knew it would annoy me, but that she was going to do what she needed to do in order to keep me “in the room” with her. For us, that means she asks a lot of grounding questions and makes a lot of grounding statements.

Why is this annoying? Because it feels like an abandonment. Not necessarily from me, but from the parts that are stuck in trauma time. I want to pull away from the memories and sensations, but unfortunately that means that I leave those traumatized parts stranded in their present-day torture.

Which sucks. But I just can’t do it. I can’t go there.

Scheduling Changes

It’s probably fairly clear from all the time I spend blogging about scheduling issues that my therapist and I often struggle to keep our three weekly sessions. We’ve somehow always managed to figure it out thus far, but it’s tough. We both end up doing a lot of rearranging and making small sacrifices here and there to make it work. Overall, I think it’s worth it, but that doesn’t necessarily make it less challenging.

I’ve been seeing her on Mondays for a very long time. That has probably been the most consistent day in which we’ve had sessions together. Due to my latest clinic schedule, however, she’s had to do a lot of shifting her schedule in order to offer me three “primetime” (i.e. after standard work hours) slots.

Which means no more Mondays. For the next month I will see her on Tuesday, Wednesday, and Friday. Except for a couple of weeks where I either have class or she has a conflict and we have to switch Friday to Thursday. As I mentioned recently, we changed my session to Thursday last week. And then I didn’t have session today because my Mondays were switched to Tuesdays.

I really don’t like that. I’ve gotten into a nice little routine of starting my week with a session after school/clinic. It was bizarre and unsettling to realize that wouldn’t be happening today. One positive is that it opens up my schedule to attend my favorite yoga class again, but I still felt sad and upset about the missing my normal session time.

Not My Favorite

The first thing my therapist and I discussed during Friday’s session was the upcoming schedule changes. As I wrote previously, my school and clinic schedule will be shifting (yet again), causing me to change all three of my weekly sessions.

My therapist had originally discussed the option of having sessions on Mondays and Wednesdays, with the choice to do a double session on Wednesdays or two 90 minute sessions. I respected her efforts to maintain our three hours of session per week, but knew that the length of time from Wednesday to Monday would be very challenging for me.

My plan was to bring this up with her and explain my feelings. I didn’t have solution, but I wanted her to understand how this could potentially impact me.

But in a rare act of initiating the conversation, she asked if she could start out session by talking about scheduling. She said she’d gotten a little mixed up when giving me possible times and wanted to clarify. She said the Monday time would work, but that she couldn’t see me until 7pm on Wednesday (no big deal since that actually would work a little better on the days I have my seminar class). She also said there’s a chance she could see me for a third session. She said, “I could see you on Fridays, maybe, but that’s not my favorite.”

Um, what?

Scheduling Changes (Again)

My schedule is shifting. Again.

My third (and final!) clinical affiliation starts on the 21st and will last for 8 weeks total, Monday to Friday, 9-5pm at a local hospital.

The whole hospital setting is activating and I have plenty of fears and anxiety about that, but I can’t even go there yet. I just need to feel relatively calm for a week or so before I actively tackle those emotions.

But this also means I will have to shift sessions around again. I told my therapist my schedule as soon as I heard from my clinical director. She was okay with it and said she would start moving things around in her schedule to make room for me.

On Monday, she mentioned it and said we should try to talk about it soon. So for Wednesday’s session, I went in with the intent to talk about two things:

Truth and Transitions

Since I had to go to therapy right after the rather disastrous appointment with my shrink on Monday, I was in a difficult emotional space. I felt intense rejection and a sense that the world was caving in. I think I also felt like I had very little left to lose, since I was now in conflict with both my therapist and psychiatrist, which emboldened me in a much needed way.

So when I got to session, I opened with about as much truth as I could handle. I said,

“I feel like we should just end this: therapy, sessions. Because I feel like you are dangerously close to bailing on me and I can’t tolerate that thought. I can’t be in that space, dealing with all of this fear. I can’t be waiting for that. I can’t be imagining it. I don’t want to think or feel or do anything that has to do with you abandoning me. So I just want to walk away now, before you can really hurt me.”

She first assured me that she has (still) not had any thoughts about bailing on me or ending our treatment, but then she asked if perhaps her comment from last week had left me feeling afraid and concerned that she was at a limit with me?

“Yes, absolutely.”

Birthday Grief

Last week was my birthday.

I told my therapist in the session leading up to it that I’d need her support. I wasn’t able to articulate exactly how or what she could do to help, but I knew it would be a difficult week. My birthday is always hard for me, for us, as a system. There are difficult memories and emotions that come up in a seemingly unavoidable way each year.

But things have also been very difficult for River lately. She’s been showing up in session more, talking in a really open and honest way that makes me, my wife, and my therapist very happy. It has made it kinda worse in terms of having an eating disorder, but my therapist is convinced this is all part of the recovery process.

So on Wednesday, River went to session. I’m not entirely sure what was discussed, but I know she ended the session by asking my therapist if we could call her the next day to check in. Apparently my therapist hesitated just long enough for River to feel something that was upsetting. My therapist told me she said, “Ugh, never mind” before more or less storming out of the office.

And then she didn’t call our therapist. No one did. Which sucks because I know I could have certainly used the added support.

Anyway.

Honesty

You told me to be honest. Well, you asked. I don’t know, you said something about honesty.

So I told you the truth. I said I WANT to be anorexic. I WANT to prove I am someone special, someone strong, someone worthy. I am not a “dieter” – nothing so common, so mediocre, so temporary.

You said I already AM anorexic. You brought down the DSM-V from the top shelf and read out the words that I know you don’t even believe in. You said numbers are stupid and categories are dangerous.

Still, you said that my diagnosis is anorexia. That’s what you would call me: anorexic.

But it doesn’t matter.

I am not anorexic ENOUGH. Not yet.

But then you got upset. And, yes, there IS room for both my truth and yours. You pointed out that maybe your truth got a little bigger than mine and I agree. You’re allowed to be angry that I hurt myself, but I’m allowed to feel upset about your emotions.

Because this is what’s real. This is what’s me. And if you cannot sit with that…if you cannot see me in the difficult moments that upset you…

you cannot see me at all.

-River

Making Space for Anger

One of the key things my therapist and I spoke about during our phone conversation Wednesday night was emotions. I told her I felt like I had trapped a bunch of difficult emotion within myself, specifically in my chest, because there didn’t seem to be a safe place to discharge them.

I was admittedly upset with her for leaving me in the waiting room for fifteen minutes. I wasn’t able to identify exactly what I was experiencing emotionally, but I knew there was a lot of energy built up. It felt hard to even breathe.

I didn’t want to go to Friday’s session. I considered bailing, but I’d had a difficult day at clinic (unrelated to the actual internship, more about food stuff) and I needed a place to process it. I decided while walking over to my therapist’s office that I would use my hour in session to talk about all of that nonsense.

Which I did. I opened the session by telling her I’d had a difficult day and then started to explain what had been happening. I was telling a story about my colleague who’d lost some weight and was passing around her before/after success story photos that were featured on a prominent website recently.

While everyone was reacting with the obligatory, “Wow you look so great!” comments, my classmate encouraged me to share about my own weight loss. She met me last year, about two months after my relapse so she’s watched my lose a pretty good amount of weight. She doesn’t know it’s due to restricting and disordered behavior, so I know she was just trying to be kind.

I told my therapist that I shared my weight loss with my colleagues. She asked me what number I gave them. I said I didn’t want to tell her that. She asked if I told the truth and I said yes. Then she asked me why I wouldn’t tell her what I’d told them.

“Because I don’t want to.”

Inconsistent

My therapist has always made a big deal out of scheduling and consistency. Each time we’ve transitioned to a higher number of sessions per week, she’s reinforced that we need to stay with that number, even if our schedules shift.

That is why we’ve done so much rescheduling throughout the last nine months. (NINE!)

And I loved it. I felt really cared about and taken care of by her. I knew it was all part of the way she conducts herself as a professional, but that’s not to be underestimated. Many of my previous therapists could not bring themselves to maintain even essential professional standards. So it always meant a lot to me that even when something came up during a normal session time, she’d push for us to find a time to reschedule.

And then I recently canceled a session to meet a new shrink during the same week some other part of me canceled our second session (which I then un-canceled). That event, as I’ve talked about extensively, prompted her to let me know that the shifting of session time was “less than ideal” and that she was not very impressed with my decision to cancel, even though it was to meet with a doctor. Which sent me reeling into a shame spiral that I’ve (clearly) yet to recover from.

And then it got worse.