The Therapeutic Relationship

Most of last weeks session with my psychologist was spent discussing our relationship. I had started the session by telling her that I didn’t want to be there. She wanted to talk more about that. I got angry at her after a while, and felt a lot of agitation and impatience. I wanted to tell her to just stop. I felt there were other things I wanted to talk about instead. Things I thought were more important.

She told me that this relationship is important, so if I feel a disconnection with her, it’s really important for us to discuss it. That if I ever feel that something she did or said hurt me, I must tell her. She doesn’t want things to be left unsaid. I told her I would, but told her that I want her to do the same thing. Because one of my biggest fears is that she feels negatively about our relationship, but keeps it to herself.

I care about what she thinks of me and how the connection feels to her. I really do. Perhaps a little too much.

Since that session I’ve spent a lot of time thinking about all of this. I came to the conclusion that she’s right. It is important to discuss the relationship. A month ago, I would have loved to have spent an entire session talking about our connection. But I’ve become uncomfortable discussing it lately. Uncomfortable feeling this attachment. More and more I’m feeling this need to pull away from her. To keep her at a distance. To withdraw.

Because now it feels very real. Before, I loved the connection we shared. But lately, while I still love it, and need it, it’s become more solid. More real to me. And that scares me. I’ve never had this level of connection with anyone before. I’m terrified. The potential for getting hurt is huge. I know she’ll still unintentionally hurt me. She’s only human after all. But it’s not just that. It also comes down to my own shame. I feel embarrassed for wanting her, for needing her. At feeling this bond. There’s a lot of shame attached to it, and I don’t fully understand it yet. I long to reach out sometimes, but it also stirs up those feelings of shame. Reaching out feels wrong. A pattern from my childhood, where reaching out was met with negativity. Now it feels like a boundary violation, not just a boundary crossing. I feel like I don’t deserve the attention. That I’m not deserving of her time. That I’m not worthy.

I always thought I allowed certain people relatively close to me. But looking back this past week, I was sad to discover that that wasn’t the case. I kept everyone at some distance. Never allowing them too close. And now it’s coming out in my therapeutic relationship. Even the most important relationship in my life, that with my grandmother, reveals that pattern. I just wanted to spend time with her, be with her. But never talking about my deeper feelings or fears. Never connecting on a deeper level.

On Tuesday I sent my therapist an email with a one of the rare pictures I have of me when I was a little girl, the only one I have of me and my mom together. I also attached a ‘personality’ profile I have taken when I was 19 and in college. Feeling the need to push her away, I decided to use a DBT skill instead, that of opposite action. So I sent her that email to pull her close again. It was important for me to reach out.

I’m grateful now that she pushed me to talk about it. There are a few things I want to discuss with her in our session on Monday. And I don’t care if we spend the entire session working through these things. It has to be done. It is important.

But I’m scared.

Being My Own Friend

During my therapy session yesterday, I was highly annoyed with myself. I told my therapist that I feel I should be better by now. That I should just get over everything and move on. She told me that I’m very harsh on myself, and set very high expectations. That’s very true. I’m my own worst enemy. My harshest critic.

Then I got to thinking. I’ve read articles before on treating yourself as you would treat a friend. Back then it didn’t make much of an impact on me. But now I get it.

If a friend tells me that she’s a terrible person because of something she’s done, what would I tell her? I’ll tell her something along these lines:

“I can understand that you feel like a terrible person. But you’re human. We all make mistakes. The good thing is that we can fix these things. And those things we can’t mend, we learn from them. Simply by you admitting to what you did and how terrible you feel about it, you’re actually showing me the opposite. If you were truly terrible, you wouldn’t have been feeling this bad about it. That tells me that you have a good heart.”

Now what does it sound like when it’s me that’s done something I’m not proud of? It goes like this:

“You stupid idiot. Once again you fucked up like you always do. You’re the worst person in the world. Can’t you ever do anything right? You deserve to feel terrible about yourself. You shouldn’t even be allowed to live.” Yes, that’s really how I talk to myself. Black and White thinking in full swing. I would never talk to a friend like that, so why shouldn’t I show myself the same courtesy?

I learned a valuable skill from my therapist yesterday, which works great in the context of this post as well. I was going through one of my insecure phases and wondering whether I really can trust her completely. “I don’t want to be here today”. “What if you don’t really want to work with me and you’re only staying because it would be unethical for you to drop me?” Those kinds of things. After 6 months with her, I had hoped those insecurities would be non-existent, but that’s not the case. Just when I feel closer to her than ever before, and am enjoying that wonderful connection, it’s not long until I find myself pulling away and falling into the insecure, negative place again.

Yesterday, instead of reassuring me the way she sometimes does, she made me work this time. I suppose there has to be a balance. She can’t just always reassure me without showing me how to change my own thought patterns and reach conclusions for myself. That being said, she still managed to sneak in reassurances, and didn’t leave me completely alone trying to work through this.

She asked me these kinds of questions for each of the negative thoughts I was having (she encouraged me to look at the facts):

What is the evidence that she’s trustworthy?
What evidence is there that she’s not trustworthy?

What evidence is there that she doesn’t like working with me?
What evidence is there that she does like  working with me?

This ‘little’ exercise took a while. She really makes me work hard, and sometimes it feels like my brain just wants to explode. Not to mention my rage at having to spend so much time on something that seems so trivial at the time. Afterward though, I see just how valuable it really is, and I’m grateful for it. I have so many cognitive distortions, and negative patterns and habits that I’ve developed over the years, so of course it’s going to be hard to train my mind to think differently. I need to be kinder to myself. I need to be my own friend.

I can use this skill to be a better friend to myself. When I start feeling like a failure, a waste of space, or whatever my mind comes up with, I can practice this technique.

“I’m a failure.”

What evidence is there to suggest that I’m a failure?
What’s the evidence that I’m not a failure.

This stuff can be used for anything. Thank you psychology. Thank you therapist.

I’m going to practice being kinder and more gentle with myself, and talk to myself the same way I would to my friends, and other people in my life. If I find myself being harsh, I will re-frame it and ask myself what would I tell someone else if they feeling the same way.

We deserve to be our own best friend.

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The Dangers Of Self Diagnosis

Result: 66/80
Probable diagnosis of PTSD

That’s the result from an online test that I took last night.

It started when a blogger friend wanted some advice on a post she had written. So I gave my thoughts on the situation. She was worried that maybe it was post traumatic stress (which, until this afternoon, I thought was the same thing as PTSD), so I suggested that she search for the DSM criteria on it. She came back to me and it turns out that she didn’t ‘qualify’ for the diagnosis.

By now I was curious too, and decided to also take the test. “Just for fun”. As I was reading the questions and working my way through them, I felt this chill run down my spine. Those questions struck a major chord with what I have been experiencing lately. And the high score I got at the end worried me.

But then I started laughing. I actually laughed out loud at myself. Why? This whole thing reminded me of the time that I was convinced I had ADHD. I had also taken the tests for that, and had most of the symptoms. So I started reading articles and books on the subject. But then a year or two later, I got diagnosed with BPD instead. On the positive side, at least I know pretty much everything there is to know about ADHD, including the medications. That can’t be a bad thing.

It’s so easy for us to assume we have a physical or mental illness by what we read on the internet. Just like a sore throat can have many different causes and signal anything from a cold to cancer. To say “I’m going to die, I have cancer!” because Google or a medical site listed that as one cause, is dangerous. It’s the same regarding mental health. It can cause unnecessary stress and paranoia, and some people even take it a step further and change their entire lives. Thinking we know what’s wrong with us can sometimes cause serious harm, because we think we don’t need to get it checked out. After all, we know what’s wrong, right? The medical website said so, how can it be wrong? No, it’s not necessarily wrong, but there’s lots of factors involved in order to get an accurate diagnosis. So we might miss what’s actually really going on.

I don’t believe these tests should be used by individuals to diagnose themselves, and go about their lives living according to this ‘diagnosis’ that they assume they have. These tests are just a tool to help guide you to seek professional help if needed.

There are a few questions on the PTSD list that overlap with the symptoms of BPD, anxiety and depression. So how can I know whether it’s a result of these diagnoses or whether it’s PTSD? That’s one example of why this isn’t just black and white. It’s not a simple thing. I believe that only a professional will be able to distinguish the difference.

When I was working at the bookstore, a customer came in one day (clearly drunk), and asked whether we had any books on Borderline Personality Disorder. I knew the Psychology section really well, so I told my colleague that I’d help this customer. I showed him the few books we had, and he told me that he’ll take all of them. While I was ringing them up, he proceeded to tell me (very loudly) that his wife is crazy, and that she’s always shouting at him, that he can’t do anything right in her eyes. He said that she has BPD so he was buying the books for her. I asked him whether she was seeing anyone for it, and he told me that she doesn’t need to because he knows she has it and doesn’t want to waste money. That the books were cheaper. At that point I wanted to say something (a few things actually), but I kept my mouth shut and tried to get him out out of there as soon as possible, because he just wouldn’t stop complaining. Everyone around us were staring and shaking their heads. Even the manager was on the verge of throwing him out. I breathed a sigh of relief when he eventually left. But I was pissed off.

And the sad part is that this kind of thing happens all the time. I’m guilty of it myself. Case in point; I’m sure my dad has NPD. But I’ll never know whether he actually does, because he’s always made it clear that he thinks psychology and therapy is a load of bullshit. So it’s not my place to try to label him, or anyone else for that matter.

Another thing. People tend to throw diagnosis around like it’s a new fashion statement. Those people who think it’s ‘cool’ to be able to say “I think I have Bipolar Disorder”, are precisely those who don’t, because if they had to live with it, they’d be wishing they didn’t.

My previous doctor had a note on her door:

“If you come in here having diagnosed yourself using Google, you’ll be charged double.”

I can’t remember the exact wording, but it’s pretty close. Every doctor should have that sign up.

So Google… You’re helpful and all, but I don’t trust you. So I think I’ll stick to my psychologist’s assessments.

Oh, and in case anyone is interested, this is the test I took.

Insecurity, Hot On The Heels Of Vulnerability

Therapy is hard sometimes.

And yesterdays session was one of those.

I’m always open during my sessions, and trust my therapist with things I can’t ever speak to anyone else about. She holds my secrets.

But this one was particularly difficult for me. For some reason it felt like I was more exposed than ever before. I’ve told her lots of things, some worse than what I revealed to her yesterday, I think. Yet, this just felt different. It was the hardest thing I’ve told her so far, and I don’t know why that was the case. But she was amazing, and made me feel safe and comforted in those moments.

I can’t even remember what brought it on, but at some point during the session I had a damn panic attack. It was horrible. She was with me every step of the way though, something I’ve never had anyone do for me before. So I’m glad she was there, and not somebody else. She knew how to handle it, and she was gentle and kind, and I got through it.

It was a hard session, but I felt cared for during most of it. But then at one point it went horribly wrong. I took everything as an attack, a judgement. And all I wanted to do was shut down. Disappear.

I felt so fragile. I just wanted her to understand where I was coming from. But it felt like we were on opposite ends of a mountain. I was (metaphorically) yelling things at her, wanting her to really see and understand where I was coming from. And she was yelling things at me from the other side of the mountain, and I felt like she couldn’t really hear me. I felt invisible.

She was pushing me. She told me I need to be pushed sometimes. That she was trying to motivate and encourage me. Whenever she’d tell me that in the past, I would agree. But I realized yesterday that the truth is… I actually don’t need to be pushed. How could I expect her to know that, when even I didn’t realize it until yesterday? I can’t. I need a gentle touch. I’ve had enough “tough love” in my life, and it’s never worked. While it may work for others, for me it has the opposite effect. It makes me feel really low, invisible and even worse about myself. When someone is gentle with me, that encourages me. That motivates me. That pushes me.

I’m not blaming her at all. I’m not attacking or criticizing her. She’s still a hero in my eyes. She’s still up on the pedestal, and in my opinion the best damn therapist there is. I just think we’re both still learning how to work with one another. Every relationship is like that. Figuring out how best to deal with each other.

Seeing that the time was running out, as usual made me feel horrible. I hate it when the session is over. I always wish it could go on a little bit longer. I hate goodbyes. I felt angry, and expressed it in a crappy way. My therapist rightly pointed out that ending sessions makes me anxious, and that I was trying to push her away. I don’t want to push her away, so I don’t know why I still do.

As the session was drawing to a close, we discussed how we felt about it. I realized that I can’t really express my feelings when she asks me my thoughts on the session, and I stumble over my words, because I usually only truly know how it felt to me a little while afterward. My mind seems to work that way… Slow. I need to analyze for a while first. I was happy to hear that she thought it had been a good session. That was reassuring and comforting.

I was going to carry that with me until our next session. Knowing that I have nothing to worry about. Then, this morning, I sent her a text, setting up our next session. And that’s when it went downhill for me. Reading things into every omission. Most of the time she ends a message the same way, by telling me to have a good morning or afternoon. But something was different today. Something so simple. Like also not asking how I was. Ending the next text with something that just felt so impersonal. Small little things that shouldn’t affect me. But those small things brought the insecurity out in full force and I felt so incredibly hurt and confused. And that intensified with the email she sent a little while ago. Most of the time our communication feels warm and soothing. This time it felt so impersonal and distant. Clinical. As if we were strangers. I keep telling myself that she’s just really busy or tired, which is the most likely scenario. I think this insecurity was caused by the after effects of being so revealing yesterday. I always tell her about things that she said that upset me, and most of the time I had just read the situation wrong. She handles it so well. So I’m hoping that once again this is the case.

But still, I can’t shake the feeling that she’s disappointed in me. I hate being so damn sensitive.

I still feel vulnerable and ashamed from yesterday. The remnants of the shame I’ve always felt about that specific event but that I would quickly push down? Because it’s one of those things that I barely ever wanted to admit to myself, and pushed away whenever it would surface. But I feel like maybe I shouldn’t have told her that after all. I’m feeling very insecure about it. Insecure in myself. And most of all… Embarrassed. Exposed. Vulnerable.

And then the thought came: What if she didn’t believe me? What if she doesn’t like me anymore?” Where is all this insecurity coming from? And why do I still feel so fragile? Like the tiniest thing will just rip me into pieces.

It seems that for me, being vulnerable opens the door for insecurity to enter. Sharing something very personal and difficult is a major risk. Even when it’s sharing it with someone you trust very much, it’s still daunting.

I so desperately want her to believe in me, but how can I expect her to when I don’t even believe in myself? As she pointed out, I have a habit of giving up too soon, of quitting. Which is the truth. I’m surprised I’ve managed to keep this blog up for so long. I’ve only had one person in my life who believed in me, and would tell me that often. And knowing that, I always did my best. One positive voice drowned out all the negative voices that kept telling me that I’ll never amount to anything. That I couldn’t do something. But her belief in me, pushed me to do and be my best and not give up no matter how hard something was. That person was my grandmother. My best friend in the whole world. The world that crashed down around me when she went away. After that, something changed. No longer did I have her encouraging voice, and the negative voices gained a powerful foothold. And I let it.

Scared. Insecure. Did I share too much? And why does it feel like my heart is breaking?

I feel this incredible need to beg her to stay. Like a child holding onto her parents legs, begging them not to leave.

Maybe she should walk away. She’ll have to do it though, because I won’t be able to.

I just don’t feel worth it anymore.

Am I still worth it to her?

BPD & Attachment

Those of us with BPD have unstable patterns in relationships. Until I started therapy, this fact didn’t even appear on my radar. I was living it, but not consciously aware of these patterns. It was only when I started therapy that it was brought to my awareness. I see it play out in my relationship with my psychologist as well.

One of the criteria for BPD in the DSM IV is:

(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

This is also known as “splitting”, and is a common defense mechanism for those with BPD. In one article I read, the author referred to us as being emotionally 2 or 3 years old, with a lack of object constancy. Object constancy usually develops between the ages of 2 and 3, and is a normal developmental stage in early childhood that those of us with BPD haven’t quite mastered. What is object constancy? Out of the Fog puts it this way:

An inability to remember that people or objects are consistent, trustworthy and reliable, especially when they are out of your immediate field of vision.

You can read more about this on their website.
http://outofthefog.website/top-100-trait-blog/2015/11/4/lack-of-object-constancy

This is how this looks for me:

I become so attached (obsessively so) to anyone who shows me an ounce of care. They become my whole world. Then, it starts. One little word, one small action, and I feel it all crumble down around me. The feeling that I’m being abandoned or rejected is all consuming. If I don’t hear from someone for a while, I start believing the worst. No longer are they this perfect hero, but now just another person who has rejected me, or is going to abandon me. So I withdraw and push them away. After all, it’s better to pull away myself than have them walk away.

I adore my therapist, and after almost 5 months she still has that place on the pedestal of my mind. But there have been occasions where I’ve found myself withdrawing. Wanting to push her away. She refers to it as “push-pull”. If I don’t hear from her for a time, I get extremely distressed, and I find myself trying to erase any trace of her from my mind. Anger. Pain. But never hate. A few minutes or hours later though, she pops back into my mind, and I long for that connection to her again. It’s extremely frustrating.

I wrote this letter to my therapist last night. I wasn’t going to even send it to her, but I feel it perfectly represents all I’ve written about in this post. So I’m publishing it here.

Dear (therapist),

I don’t mean to be a burden. I don’t mean to doubt you, your words, or your reassurances.

For the past two days I haven’t been able to get the idea out of my head that maybe you’re angry with me. That maybe I did something wrong. Knowing that I can’t ask you that question. Thinking that if I contact you and ask you that question that I so desperately want the answer to, that you’ll get angry and put up more boundaries. Thinking that I’ll have to wait to see whether I hear from you, or if you show up, to know whether my fear is just another projection.

I don’t want to be like this. It’s hard for me. Excruciating would be a more accurate description of the anguish I feel. It’s like having a knife twisted, pushed and pulled into my heart and stomach, over and over again. It stops for a little while, only to start up again when something triggers the abandonment fears. I don’t mean to constantly want and demand your attention. I hate it as much as I fear you do.

You’re not doing anything wrong. You’re doing everything right, and more. It’s me. My mind can’t quite grasp that when you send me an email, or text message one day, that it’s equally valid a few days later. That you haven’t changed your mind. That you still care. I’m trying hard to change that. You should know though that I hold onto those kind gestures, and look at them, reading them again whenever I’m missing you. They keep me going. They keep me strong.

I’m sorry for being too much. Even though in my own world and life, I never feel like I’m enough.

How do I tell you that you’re my life line, when I’m terrified that revealing that will make you pull away from me… Fearing that I’m too dependent? Would it be okay if I told you that if it wasn’t for you, I don’t think I’d be here writing this letter? I don’t think I ever told you this…That first day I came to see you…I had decided that if our meeting didn’t go well, and I thought you couldn’t help me, that I was going to end my life. That you were my last attempt at staying alive. The others made me feel hopeless, that I couldn’t be helped. That I couldn’t be saved. Perhaps that’s why I’m so attached to you. Why I feel this bond with you. You saved my life that day. You saved my life a few weeks ago. You save me when I’m unable to save myself.

Thank you for all you do. Thank you for caring for this woman who’s still a little girl inside, working on growing up and soaring. Becoming the woman I can be.


Rayne