Life in a Bind – BPD and me

Borderline Personality Disorder, Generalized Anxiety Disorder, and my therapy journey. Listed in Top Ten Resources for BPD in 2016 by goodtherapy.org. I write for welldoing.org and for Muse Magazine Australia, under the name Clara Bridges.


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Have you googled your therapist?

My husband was away today and I spent a lovely sunny day out with the kids, exploring fields and paths, playgrounds and pubs we weren’t familiar with; taking in the scenery and people watching. I drove nine miles from our house so that we could spend five hours doing all of this within a mile (or less) of my therapist’s house. On the way there I tried to navigate a slightly circuitous route, map on lap, that took me past Jane’s (my ex-therapist’s) house – both on the way there and on the way back.

I’m not proud of either action, though to be fair (and partly by way of an excuse), I love the part of the city near my therapist’s house – it’s one of the ‘gut-instinct’ reasons it ‘felt right’ when I had to choose a therapist when my sessions with Jane were ending. It’s the sort of area I would love to live in and so spending time there, with the added bonus of activities for the kids, would be a pleasure whether or not my therapist lived nearby. But I would be lying if I said that feeling physically closer to her wasn’t a factor.

As for driving past Jane’s house – it’s been a very long time since I last did that, and I’m somewhat surprised that I did it today. Particularly given the fact that as described in ‘Progress can be painful’, I have finally accepted that, important though she is to me, she is a part of my past, and though I certainly miss her, I don’t think I’m grieving her in the same way. But as I drove past her house and saw the same car in the driveway, I felt some reassurance and relief, and I realised that I am still worried about her health (which was one reason she decided to retire and could not take me on as a private patient). Although logically the presence of her car means absolutely nothing at all, it felt as though it was some sort of indication that she was still okay.

A few months ago, ‘Sunny Spells and Scattered Showers‘ wrote a wonderful post about searching for her therapist on Facebook. I was struck not just by how much I related to how she felt and acted, but also by her honesty and courage in writing about it so openly. It challenged me to write about my own experiences in this area, and to be honest about events I had not yet dared write about.

Judging by what I have read on other blogs, trying to find out about one’s therapist (most often online), is not unusual. Technology, search engines and social media make this so much easier than it has ever been before, and it must be an extremely rare therapist these days who has virtually no online presence at all. I suspect too, that it is extremely rare for a therapist not to realise or perhaps even to expect, that many of their clients will behave in this way. I think it’s important to remember that the online searching is not just about information: it’s about trying to become closer and feeling connected; and keeping the therapist ‘real’ in between sessions. That’s why the ‘searching’ does not just happen online – behaviour can extend to walking or driving past the therapist’s house, or waiting around places where he or she is expected to be, for example. The client may even dread what they could see or find out, or they may dread being seen; but the feeling of greater physical proximity may over-ride that dread.

Leaving my children out of the equation (because to try and put them on one side or the other would make me feel like an even worse parent than I already do) –  my therapist is the most interesting person in the world to me, and I have a very strong desire to know more about her. ‘Sunny Spells and Scattered Showers‘ called this a ‘craving’ and sometimes, that is exactly how it feels. Most of the time I can control the craving – if I want to know something and if I decide I dare to ask, I do so in session, fully expecting (though at the same time dreading) not receiving an answer. But occasionally that craving takes hold and I feel I’m in the grip of an urge too powerful to withstand. That has happened a couple of times in my current therapy, and both times I ‘confessed’ and we had a very helpful discussion about my ‘googling’ activities. My therapist took it remarkably well – if she was perturbed, she didn’t show it. If anything, she seemed completely un-phased by it – for which I am extremely grateful, as my behaviour carries with it both feelings of great shame, and great fear that she will want to leave, or at least withdraw and close herself off from me. Today was the second time I found myself on a walk near her house – when I told her about the first time, she commented not on how close I’d come, but on how I’d stayed away. I was within sight of her house – but turned and went back. In her words, I didn’t ‘close the gap’ – and perhaps tolerating that distance was more significant than trying to narrow it a little in the first place.

I am grateful for my therapist’s approach to this issue – and for the fact that I can bring these occurrences to session, and deal both with the feelings that lead to them, and the feelings of fear and shame that result. But there are some situations that can’t be resolved in that way. I wish I could say that the story of my therapy relationship with Jane ended with the ‘love letter’ I wrote to her in June last year, and with that recent realisation of the gradual passing of my grief. But it didn’t – in between those two events is a story about which I still feel great regret, and which I fervently wish I could change. That story took place on the first anniversary of our last session together, a day I knew I would find immensely difficult, but wanted to use to ‘honour’ her and the work we’d done together.

However, far from honouring either her or our work, I found myself caught inside an intense desire to find out more about her (triggered by accidentally finding out more than I had before, when I googled her to simply get that sense of her existence and reality that seeing her name ‘in print’ had so often brought me, when I was grieving her). I succeeded in finding a few additional details, but it didn’t stop there – I actually paid money to a well-known and widely-used directory enquiries website to receive a brief report compiled from ‘public information’ (e.g. company director listings and census data) which listed individuals of the same name, and current and previous addresses. To cut a long and rather distressing story short, I thought I’d discovered a couple of things which didn’t fit with the picture of Jane I had created in my mind, one of which I soon realised was an error, the other of which I still find hard to believe. I remember rocking backwards and forwards, repeating the phrase ‘I don’t understand’ to myself – it was a fairly minor fact about her professional life, but it felt as though my world had been turned upside down.

But even worse than the ripples in the picture I had formed of Jane, were the feelings of guilt and betrayal that I felt. I hated myself for letting her down; for acting in a way that I was sure she would not approve of, and that I was sure would have disappointed her; for invading her privacy in way that I found abhorrent, despite the fact that the information was essentially publicly available. I was deeply ashamed for what I saw as my betrayal, and deeply upset about the way in which I saw this as ‘sullying’ what I had previously seen as a very honest and trusting (and yes, perhaps a little perfect) relationship.  Looking back, I find it hard to ‘let myself off the hook’ and to have sympathy for how I felt. My situation was entirely of my own making – if I didn’t like what I had found, I had only myself to blame. And yet, I have a sincere sympathy for others who are going through the same thing. I know how hard it is to have that intense desire to know more, and to feel so very bad for having it and for acting upon it.

It occurs to me that this post is a logical follow-up to my recent post on how it feels to be excluded from your therapist’s life. Although separate issues, I think that the sense of exclusion and the harsh reality of the boundaries of therapy, can certainly fuel the desire to know more and the need to draw closer. If there’s one thing I hope to achieve by writing these posts, it is to try and encourage others to talk to their therapists about these feelings – however painful they may be and however much shame and embarrassment may be involved. When it comes to those feelings, I think that our fear of retribution and rejection leads us to greatly underestimate out therapists’ capacity for understanding and acceptance; and our twisted desire for uniqueness (I am uniquely ‘bad’ in my feelings or behaviour) leads us to think that we are our therapist’s ‘worst’ client, and least deserving of his or her love.

Whereas in fact what I’m coming to realise through exploring these issues in therapy, is that my therapist’s caring is neither conditional on me being able to please her by knowing more about her and what she likes; nor limited by her need to maintain boundaries and the restricted nature of our contact. This is progress painfully won, but I humbly submit that it is worth it. And I would suggest that the true value in trying to find out more about our therapists’ lives lies not so much in what we discover about them, but in what we discover about ourselves, and about our relationship with them, and theirs with us.

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Friendships with Ex-patients: Why I Say “No”

Although this post by Dr Stein was written last year, it feels like a logical conclusion to the series of posts I recently shared (both his, and my own), on the topic of feeling excluded from your therapist’s life, and the related question of whether a friendship between therapist and client would be possible. Even for clients who are persuaded (though painfully) by the reasons behind this ‘exclusion’, the question remains – why should a friendship be prohibited once a client becomes an ex-client? And if there are reasons for prohibiting it for a period of time, why should such a friendship not be permissible at a later point?

As with the reasons behind why therapists and clients would find it very difficult to maintain a ‘dual’ relationship, the reasons in this post are also very persuasive. I wish it were not so, because everything within me dreads and fears the day (hopefully far far in the future) when I will come to the end of my current therapeutic relationship. But I have been fortunate to have received an email from my ex-therapist, following a desperate plea from me for ongoing contact, that was kind and compassionate, and made the ‘no’ slightly easier to bear. I hope that if you too are in a similar position, the response that you receive is as honest but compassionate and caring, as the one described by Dr Stein above….

Dr. Gerald Stein

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I recently received an invitation from a former patient to meet for coffee. This warm-hearted offer came from a man who is as principled and decent as anyone I know. What’s more, he is funny and bright — just the sort of person I’d enjoy having as a friend.

I said no.

Now you might ask, why did I make this decision? This was not the first such request since I retired over two years ago and not the first from a person I thought companionable. I’ve said no to all of them. What I’m about to do is explain how I reasoned this out. I’ll finish with my response to this terrific guy.

First, nothing in the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct forbids me from having communication with former patients. Nowhere does it say I can’t be friends with them. We are, however…

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How Would a Friendship with Your Therapist Work?

Another very interesting post by Dr Stein, using a ‘thought-experiment’ to elicit the difficulties inherent in the notion of friendship between therapist and client. This follows on from both Dr Stein’s original post on the reasons behind clients’ ‘exclusion’ from their therapists’ lives, and from my own post on how that feels, from the patient’s perspective.

As with Dr Stein’s other posts, I believe his points are very well-made and hard to argue with, and are put forward both carefully and compassionately. In common with many, I think, the challenge for me is to somehow turn this intellectual knowledge and acceptance of ‘how things must be’ into an emotional understanding and acceptance. It will come, with much work and with digging deep; but in the meantime, every time, as clients, we come face to face with feeling excluded and ‘bump up’ against the boundaries of therapy, we have an opportunity to talk about how it feels, to discover the origin of those feelings, and to start to heal from them. It’s all ‘grist for the therapy mill’, as a friend of mine would say….!

Dr. Gerald Stein

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The fantasy of having a closer relationship with one’s therapist occupies the mental space devoted to imaginary things. It must, because few counselors permit such a connection. Professional ethics generally prohibit the dual role of therapist/friend and therapist/lover. Yet, there is value in fleshing-out what this double-bond would look like in practice.

Responses to my recent post, Being Excluded From Your Therapist’s Life, suggest the fantasy dies hard. What follows is an effort to describe how the relationship would function if brought to life — the day-to-day lives of a shrink and his patient. I invite you, dear reader, to think along with me. Let me know if my concerns are off-base. Even more, once you finish reviewing my ideas, I’d love to read your own notion of how to create the connection some of you want with your therapist: an outline better than the current prohibitive model you…

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Being excluded from your therapist’s life: you’ve read the reasons – this is how it feels

[The ‘reasons’ referred to in the title of this post are described in an excellent post by Dr Stein, reblogged here]

The thing about feeling excluded from your therapist’s life – it’s triggered by the smallest things.

I was usually early for my appointments with my ex-therapist, Jane, and I was used to the feeling of annoyance and jealousy when the client before me walked out of her office, saying ‘goodbye mate’ (‘mate’ – how dare he?!) as he left. On this occasion, though, he had what could have been no more than a ten second conversation with Jane on his way out of the door. I heard her interact with him – she said something kind and empathetic, as you might expect, though I can’t quite remember what.

She started our session in the usual way, asking me how I was and how my week had been. I went to pieces and started sobbing. I couldn’t talk – it physically hurt, right in the pit of my stomach. The emotional pain was intense, but so was the shock, surprise and embarrassment of what I was experiencing. It was the first time I’d had those powerful feelings of exclusion with regard to therapy, which seemed to just rise up instantly the moment I heard that interaction.

It wasn’t long before I had a similar reaction before another session. This time, thankfully, the client who called her ‘mate’ was absent, and Jane and one of the other therapists started talking while waiting for the next ‘therapy hour’ to begin. It was the end of the day, and there were no other clients or counsellors around. The conversation was perfectly innocuous – I don’t think they had met properly before. Jane explained she only worked a few hours a week and they spoke about attending some kind of staff event in the coming weeks. As I listened, the pain mounting, I put my finger against the glowing lightbulb of the reading lamp on the side table in the waiting room, drawing it quickly back when the pain hit, and replacing it with the next finger, and the next in turn.

***

A few weeks ago, my therapist mentioned that she would be out of email contact over the weekend as she would be at a conference. I normally find the gap over the weekend difficult, but this time, knowing where she would be, interacting with lots of other people, powerful feelings of exclusion kicked in and the pain and desperation were intense.

The following week, I arrived early for my appointment, and so I parked my car across the road from my therapist’s house and took out a book to read. Occasionally I glanced in the rear view mirror and stopped short when I suddenly saw her coming out of her gate and start walking in the direction of my car. She passed by, headed for the post-box further down the street, letter in hand. I don’t think she saw me – and I pretended to read, not taking in single word of the paragraph my eyes kept skimming over.

My therapist normally waits for me to start sessions, but this time I felt even more lost and incomprehensible than usual. I started to cry, just feeling like a jumbled mess of emotion. Feeling ridiculous because I was so upset, and because my upset my triggered by the fact that I had seen my therapist outside the context of a session, walking to a post-box to post a letter.

***

It’s like the feelings you had last week, when I was away. I’m sending a letter to someone – there are other people in my life’. Posting a letter; chatting with conference delegates; meeting a colleague; talking to a client. In his helpful post about the reasons behind the ‘exclusion’ of clients from therapists’ lives, Dr Stein (a retired psychotherapist), states that it is not unusual for clients to feel jealous of those who claim more of the therapist than they have access to. Yes, I feel jealous. But I feel so, so much more as well. Intense desperation, longing, frustration, helplessness. And pain. So much pain.

I want to scream and cry. I want to claw my way out of my body. I want to try and understand, but also fight desperately against the fact that what might in other circumstances be simple and ordinary human interactions, are completely outside the bounds of the unique (and in this case, uniquely tortuous) nature of the therapeutic relationship. It’s not just those that have more of my therapist that trigger these feelings. What drove my frustration and pain during the time when my therapist was at a conference, was the fact that complete strangers would have the opportunity of spending time with her without the stricture of the clock; engaging her in conversation about topics of mutual interest in which she would talk about herself and her views, as much as they would talk about theirs; asking her questions which she would reply to without holding back or wanting to know why they were asking.

My therapist sometimes speaks, in the context of my high and often unrealistic expectations, of finding meaning in the ordinary, particularly, for example, when it comes to evidence of her caring. But it is precisely the lack of opportunity to be involved in the perfectly ‘ordinary’ aspects of her day to day life that causes me so much pain. Unlike those strangers at the conference, I can’t strike up a conversation in which I ask her how long she’s lived in this city; whether her children are nearby; what type of food she likes or what sorts of things she gets up to at the weekend. I don’t know what her favourite colour is, or if she has one; whether her children grew up in the house in which she’s now living; what book she read last week; or where she goes to church.

I know I can’t be her daughter – however much I might desperately want to be. I know I can’t share in her life in the way a partner might. All of those things cause a great deal of hurt – but it’s difficult to be resentful of those whom she loves, and it’s more difficult to argue against genetics than it is to argue against the boundaries of therapy. But to know that in theory, every other person on this planet apart from me and her other clients (how many, I wonder – another question I cannot have an answer to) has access to her in a way that I can never have – that’s incredibly difficult to deal with and to face full-on. Clients aside, everyone else is a ‘potential’ friend – from the person she meets in a hotel on the other side of the world, to the person who lives in the house next door. They wouldn’t need to worry about asking her whether she actually hates the colour purple – the colour which, for some reason, I have come to associate with her. Clients aside, there is no one else who knows, with absolute certainty, that their relationship with her has a definite end (not related to both parties’ inescapable mortality), after which point further contact will not be possible. She might put her arm around someone she’s known for a few months – but even if I see her twice a week for the next few years, that will never ever happen to me.

***

I don’t understand why this exclusion is so painful – where it comes from, and what it means. I have a feeling it will take some time to get to that. And so in the meantime, I keep trying to hold on to the words my therapist said when we discussed these feelings in session. Rather than focusing on the things that being a client excludes me from, I am trying to remind myself of the things it gives me access to. Although I don’t get to know all of my therapist, what I do see is real. As she said to me, she may only see me for two hours a week, but that is more than she sees her very best friends. And as Dr Stein also mentions in his post, clients experience the individual as ‘therapist’ – an aspect that comparatively few people will come to know. In that capacity, therapists may only give their clients a limited amount of their time, but in that time, they are focused exclusively and intently on their client, giving them their full and undivided attention. Much more than that, giving them their unconditional acceptance, and listening with empathy and without judgment. And even more than  that – sitting with them in all their strong emotions, whatever they may be, holding those feelings and keeping the client safe.

And though I may not be able to talk with my therapist about all the ‘ordinary things’ I want to ask her about – when she does share something about herself with me, it feels very special, and it creates a deeper bond and a sense that she trusts me too. That’s not something that happens simply in ‘ordinary’ conversation. And often when she tells me something about herself, because it’s in the context of a session it may not be something that would come up in casual conversation. It’s a memory about an event or a feeling, it’s an association, it’s a recollection about her own therapy, or about her own children. It feels more intimate, more as if it came from a deeper place. Maybe I do have more of my therapist – more than many, and certainly more than any ‘potential’ friend. Not in terms of volume of information, but in terms of meaningful, important memories and thoughts. Does it feel like enough? No, no of course it doesn’t. I’m not sure anything short of actual kinship would feel like enough, and Dr Stein makes some very good points about why that kind of relationship may start to lose its appeal! But in time, but I hope it will be enough to reduce the pain, frustration and desperation that comes with the feelings of being excluded from my therapist’s life.

I am a ‘therapy-daughter’ – member, by adoption, of a bizarre but special sort of family. All families have their limitations – goodness knows that’s one of the reasons that brings so many of us to therapy in the first place. But the quirky intimacy and joy of this unique relationship is one I wouldn’t be without – and I just have to keep reminding myself of that. Over, and over again.


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Stigma

I came across Cavelle’s excellent and memorable description of what stigma involves and how it can affect the experience of those with mental health difficulties, and I wanted to share it. I can strongly relate to the feeling of isolation that comes from the need to be guarded about my mental health difficulties, and to the anxiety over who to tell, and when. Apart from my husband (and even he didn’t know how far back my difficulties stretched), no one knew about my mental health issues until three years ago. Even now, there are around ten or so people who know I suffer from anxiety and depression, and a smaller handful of friends who know about my BPD diagnosis. No family members (other than my husband) are aware that I have ever had mental health issues.

My work with my ex-therapist, Jane, was the catalyst that prompted me to think about opening up to a few more people, whereas in the past the idea of letting anyone know had been completely inconceivable. My relationship with my current therapist has enabled me to continue along that road, in a very small and gradual way. But the questions are always there: who should I tell; when should I tell them; how much should I say; what will they think…..

Like Cavell, I believe that education and talking about mental health are key factors in the struggle to try and reduce and eventually eliminate mental health stigma. I feel privileged to be part of a community of bloggers who are trying to do just that!


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Being Excluded From Your Therapist’s Life: Reasons You Haven’t Heard Before

Another fantastic, illuminating and thought-provoking post by Dr Stein, this time on the topic of feeling excluded from your therapist’s life. This is an issue that brings me a great deal of pain in my own therapeutic relationship, and which I have been trying (for several weeks!) to write about. Sometimes, however, things are just too close to home at a particular time, or simply too difficult to write about. Sometimes a little bit of distance or perspective (or a different angle) is needed, before the experience can be put into some sort of order, and written down.

Dr Stein’s post brings the ‘therapist’s angle’ into focus in a way that provides reassurance and some key points to try and hold onto, when that feeling of exclusion feels overwhelming and distressing.

Dr Stein talks about the ‘healing art’ of therapy, but I am hoping his artful way with words will have released my writer’s block on this subject, and that I will be able to write about the ‘client’s angle’ on this topic, very soon!

Dr. Gerald Stein

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We’ve all had idols. Perhaps a sports hero, an older sibling, a teacher, or — God help you — your therapist. In the latter case, authorities tell you why a relationship outside the office is not permitted:

  • The shrink might exploit you.
  • Progress would be hindered if your therapist occupied the dual role of therapist and friend.
  • A healer needs downtime.
  • Personal information about the counselor complicates the transference relationship: the extent to which your issues will play out in session.
  • The therapist would be of little help if he feels too much of your pain, as he will if you become more than a patient — an important part of his life outside.
  • The ethical guidelines of the therapist’s profession prohibit intimacy.

Much of this sounds unfair and unfortunate to the patient, however true. Many believe they would benefit by having MORE of the therapist. Jealousy of those who…

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Memory Monday – “Hope”

As I think about resuming therapy tomorrow after a two and a half week break, I am thinking back over what has been one of the hardest but also one of the most encouraging therapy breaks I have had. My sessions over the period January to March were difficult and mixed – starting off with a great sense of disconnection, then a ‘repair’ and reconnection in the therapeutic relationship, only to find myself in the same disconnected state a few sessions later. At one point I felt as though I had taken ten steps back and no steps forward; and that I was back in my pre-September state whereby my view of therapy and my therapist was changing and alternating from one extreme to the other, on a session by session basis. Then, a few weeks before the Easter break, as happened before Christmas, a seemingly small or chance occurrence took place that uncovered a wealth of intense and valuable therapeutic material that transformed the course of sessions for a while.

Over those three months, my experiences often felt disjointed. We ranged over many topics, some feeling still incomplete even though the conversation came to a natural end and we moved onto other things. But taken as a whole, it was an immensely important period for my therapy, and each and every part of those three months contributed in its own way to the work that we did and the realisations that I came to. As my therapist noted, my posts on ‘BPD and testing those we love‘ and ‘Progress can be painful‘ showed how far I have come since she and I first started working together, and although the work has been ongoing for eighteen months, I think much of it has only started to come together since January.

As I think back over the last three months I am reminded of my post ‘Hope’, from July of last year:

https://lifeinabind.com/2014/07/06/hope/

I remember a friend telling me she had done a ‘happy dance’ when she read it – it was the first time I had really expressed hope and a sense of feeling cared for, within my current therapy. I had struggled greatly with not feeling cared for or understood by my therapist, as described in ‘Waiting‘, and so ‘Hope‘ marked a significant turning point for me. It was a turning point, not a destination – and so I continued to struggle with this issue for some time, and sometimes, to a (much) lesser extent, still do. But it was a vital milestone nonetheless, just as the experiences of the last few months (and particularly the last few weeks) have been vital for me as well.

This break has been difficult because with a greater investment and attachment to my therapy and therapist, and a greater immersion in our twice-weekly sessions, comes more pain and greater feelings of loss, upon separation. But this break has also been encouraging because despite the gap, I still feel connected to her, and that in itself feels like a huge achievement. I don’t think that sense of connection and of her ongoing caring is something I have sustained in any other previous break. I think it’s partly a function of changes within me, and partly a function of trying to receive what she gives me – in terms of a limited degree of email contact between sessions, for example – and using it to remind myself that despite not being physically present, she is still real, and she hasn’t changed.

I have no idea what the next few months of therapy will bring. Thinking about tomorrow, I am at a loss to know where to even begin, given the vast number of things I would like to talk about, including not just what happened over the break, but topics that came up in the few sessions before the break that were not fully explored. But given my recent experiences, I am no longer as nervous about the possibility of skipping between issues and then coming back to them; or of the pace and intensity of sessions changing at different times; or of sometimes not having a plan of what to talk about and at other times having a long list and covering only a fraction. Given my recent experiences, I dare to hope that my next few months of therapy will be as productive as the last. I dare not hope, yet, that my next therapy break will be any easier, or will be just as encouraging.

But hope I do.