Life in a Bind – BPD and me

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


24 Comments

Two sessions become three – changing gear in therapy

I remember a friend telling me years ago how much it annoyed her when people regarded therapy as a bit of ‘tea and sympathy’, and had little appreciation of the immense effort of mind, body and soul that it takes to do therapy, and to keep going. I still find myself a little shocked and irritated on the odd occasion when my husband almost seems to put therapy on a par with ‘a night out’, or implies that it is fun or enjoyable. It can be fun, and it’s true that I look forward to going. But as with the ‘tea and sympathy’ remark, I think his words betray a deep lack of understanding (which to be fair, I have felt unable or unwilling to address) of how gruelling that therapy hour can be, and how much hard work is involved.

My friend’s descriptions, and the short courses of CBT I had had in the past, meant that when I started psychotherapy in 2013, I knew that I wasn’t in for a walk in the park and that there was a long, tough road ahead. But I still had no idea how the open-ended ‘talking cure’ actually worked –how long the process could be or how intense and all-consuming it could become. I remember reading ‘Get me out of here: My recovery from Borderline Personality Disorder’ by Rachel Reiland, just after receiving my diagnosis in early 2013, and wondering how on earth anyone could have three psychotherapy sessions a week. Surely no one but those in the worst difficulties imaginable (and I have no idea who I thought those individuals might be) would need three sessions a week!

And yet here I am, recently having moved from two to three sessions per week of psychoanalytic psychotherapy. I have joked with myself that this ‘worrying trend’ will not continue: in my first year with my current therapist I had one session a week; in my second year I had two; and now, in my third, I am up to three. Unlike the move from one to two sessions, this one was suggested by me, and the decision felt nowhere near as obvious. It was patently clear after a few months with my therapist, that one session a week was not enough – the gap between sessions was simply too long and too disruptive to the work, which felt very unconnected from week to week. Two sessions worked much better and my second year in therapy was a revelation, in so many ways.

Nervous though I still was of change, when something is working and is productive, you end up wanting more – or at least, I did. It felt as though we had a huge amount to cover; my two sessions were quite close together and the long gap over the weekend felt very hard to get through; my trust had deepened, the relationship had become stronger, and it felt as though we were making really valuable progress. All of which prompted me to make the suggestion of a third session, in the full knowledge that what might actually lie behind the request, might simply be my intense attachment to my therapist and the desire to see her for an extra hour a week. Because when it comes to my emotional connection to her, any amount of time with her, would never be long enough.

As soon as the suggestion went from being just a possibility to being an agreed upon course of action, I started to get cold feet. It wasn’t about the time constraints or the finances, all of which had taken a lot of thought and working out; it was about the feelings that suddenly arose in me in connection with that ‘extra session’. It very much started to feel like an ‘extra’ – like an unnecessary indulgence. I didn’t really need it; there were so many others who were ‘worse off’; it didn’t feel right that I should give the impression things were ‘that bad’ that I needed three sessions of therapy a week. We trialled a third session a couple of times over the summer and each time, as I approached my therapist’s front door, I had a huge sense of not being worthy of that extra time; a feeling that I really shouldn’t be there, and that I wasn’t really wanted. Once I was in session I felt as though I was depriving potential clients of a valuable morning slot; and that I was depriving her of an interesting new client. Instead, she had to put up with ‘more of the same’ from me. I was afraid of her getting bored, and of her getting resentful. I was afraid that as she hadn’t suggested it herself, that she didn’t really think that I should have a third session.

I brought those feelings up with her – it was hard to avoid, as they left me in tears right at the start of those trial sessions. We talked about where those feelings might have come from, and why I felt that my needs were less important than those of other ‘potential clients’; and about why I often felt as though I ‘forced myself’ upon people and that my presence was unwanted. She told me that there was not another client waiting for that slot; that it was free, that she had genuinely offered it, and that I should accept what it was that I wanted and was being offered, without feeling bad about it, or giving myself a hard time. Thinking about it now, perhaps this was another example of my putting a course of action into a ‘moral category’ where it did not belong (as described in my recent post ‘Staying connected to my therapist – and trying to be kind to myself‘). This allowed me to ‘legitimately’ beat myself up about the decision I had made and even gave grounds for backtracking upon it, both of which were easier options than dealing head-on with my feelings of being unwanted.

I remember from my early reading on psychotherapy, being struck by the idea that a client’s feelings about the practical arrangements governing therapy – time, place, payment – can often provide valuable therapeutic material. I have certainly noticed how the practical differences in my third session have triggered feelings that were not as present before. My other two sessions are at the end of a day: I turn up having had a busy time at work, with my ‘work persona’ still in place. That persona takes a little time to fall away, and when I get home it doesn’t have to be ‘put on’ again; I can process therapy, and then go to bed. My therapist too, can put her ‘work self’ aside once she has seen me on those days.

In contrast, my third session is at the start of the working day for both of us – following a spare hour or so afterwards in which to ‘process’, I have to get to work and be productive, however challenging or distressing that session might have been. And my therapist has other clients to see. Which, I am slightly ashamed to say, has given rise to strong feelings of ‘sibling rivalry’ with regards to her other clients. I have felt distress and resentment after that third session: because while I struggle to focus and to put aside my post-therapy feelings, and while I feel very alone with those emotions; she ‘gets on with her day’ and not just that – at some point, even if I am still in her thoughts, she has to physically evict me from them, in order to ensure that her focus is completely and utterly on someone else. I always knew, of course, that that is what she does for every client – and I am grateful for it, because she does it for me, too. But it feels completely different when you know that that eviction will be happening imminently, and you start to imagine the faces and the stories of those who are responsible for it. It has been another illustration of the lesson that, just as with a mother’s care and attention, hers isn’t finite and carved up into an increasingly smaller number of slices, depending on the number of clients she sees. Her other clients aren’t a threat to me – however impossible it can feel to accept that truth.

Having said all of that, and difficult though it still feels to accept that I have a right to that third session, I think that it is already proving helpful, and that in itself is frightening. Frightening, because if therapy progresses more quickly, the end of therapy will come sooner and that is an eventuality that I still cannot bear to think about. Twice now, that extra session has allowed a topic that came into play at the start of the week, to conclude or resolve in a way that simply would not have been possible in just two sessions. I asked my therapist what would have happened if we hadn’t had that third session, to which she replied: “It would have taken longer”. But how much longer, I wonder? It’s not simply that the discussion would have been postponed until the following week. Depending on what else happened during the gap over the weekend; how my thoughts or feelings changed; and how long it took to ‘peel back’ the layers of the working day and my working self – it might have been quite some time before we reached the same point. The third session follows quickly on from the second, and no time is wasted ‘changing gear’ from the day – it feels as though my emotions are more readily accessible. I think that, as well as the additional time, makes it possible to get to the heart of things and to start challenging and changing, much more quickly.

Changing gear in therapy is always difficult, and that third session has really brought home to me again, how emotionally and physically exhausting therapy can be. That gruelling hour I referred to at the start of this post can leave me feeling wiped out for days, and it’s also having a temporary impact on the way I’m processing therapy, and how this comes out in my writing. There was a similar effect last year – looking back, I wrote slightly fewer posts in September 2014 as I adjusted to the move from one to two sessions a week. Right now, I cannot even begin to see how to write about some of things I have been exploring in therapy over the last few weeks. As my therapist has said, a number of markers have been put down – issues which are not ‘done with’, but which have been brought to a helpful conclusion for now, to be visited again later. And when that happened I felt I really needed to take a breath – to leave the subject while it either lies dormant for a while or is worked on subconsciously. In the past, the material of therapy used to occupy a very large part of my thinking space in between sessions, and that came out in my blog posts which themselves were part of the processing. Over the last couple of weeks I have hardly thought about the material of therapy in between sessions, and I haven’t yet felt able to write about it.

I know that that will change – and there is so much I eventually want and need to write about, that has happened over the last few weeks. Some very important work has been done and I have come to a number of valuable realisations. I feel as though I have crested wave after wave of a therapy storm, and those waves are still coming. In the meantime, for those who may not have experienced therapy, but who want to know a little of what that can feel like, I can do no better than refer you to a couple of excellent posts by psychotherapists who, having been in both the client’s and the therapist’s chair, can attest to the fact that what it takes to weather that storm and to stick it out, is courage – with not a cup of tea in sight, for it wouldn’t survive those rolling seas. And as is beautifully described in this post by Dr Gerald Stein, what you reap is what you sow – therapy doesn’t just take courage, it fosters it. It enables you not just to take the road less traveled, but eventually to be the road less traveled – a more authentic version of yourself.

Advertisements