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.


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Why therapists frustrate their clients

“It feels as though you want me to learn through deprivation” I tried to argue through my tears. “But why can’t the same lesson be learned through positive means? If I ask a question, why not answer it first, and only then ask me to think about why I asked, and what it means to know the answer? That way, all the distress and disconnection of not receiving a reply can be avoided; we can start thinking about the matter, from a place of confidence and trust”.

“It’s a good theoretical question”, my therapist replied. “But sometimes I think it’s necessary to frustrate, to really get at what might be going on”.

***

Not just frustration, but distress. Distress that cut me off from her and immediately caused me to switch from a fairly adult mode, to a hurt child just wanting to protect herself. For the second time in the last few weeks I asked my therapist where she would be going on holiday, and for the second time, she did not answer. Instead – no prizes for guessing the stock therapist phrase that came next – she asked, “What does it mean to you, knowing where I will be going? Why is it significant?”

The distress was very real but it also felt predictable – it was a case of ‘here we go again’. I knew that precious time would be lost while I clammed up and found it impossible to speak. Whatever it was that I had come to session wanting to talk about, would be waylaid and sabotaged by that one question. It seemed to me that it would be a mark of progress if I could just put the distress to one side, and carry on – as if the question had never been asked. I wouldn’t let my internal saboteur win this one – my therapist had encouraged me to be wary of him, often enough.

But unusually, (as she tends to let me lead), my therapist seemed to want to steer me back into conversation about the question. She has an acuity of judgment that seems to be able to differentiate between the saboteur, and an altogether more straightforward, vulnerable side of me, even though the two often sometimes look the same. I think she saw the question not as a distraction, but as hiding something important. And she wanted us to work on getting to the bottom of it.

***

Years ago, her comment about frustration would have lit my internal touch paper and I would have seen red. It would have felt uncomfortably close to the idea that suffering can be good (which makes my skin crawl) as opposed to the idea that good things can inadvertently result from it. I would have wondered at how she could choose a path that she knew would lead to distress, when it seemed to me there was a perfectly suitable alternative. But I know her better than that now. I trust her vastly more than that. I know she cares deeply and will do what she believes is right and in my best interests. When I asked her why I needed to learn through ‘deprivation’, I couldn’t yet see why she was right. But I was willing to trust that she might be, and willing to work with her, to see what we could find.

***

It’s very easy to settle for the obvious, simple answers. I think it’s what I tend to do, when the time isn’t yet ripe for other answers. I said that in many ways, knowing the place where she would be on holiday was not in itself a hugely significant piece of knowledge. It meant that I could look up a picture of the place and envisage her there; it meant I could use that picture as the home screen on my phone, and it would be a helpful way of connecting with her during the summer therapy break. I said that much more significant than that piece of knowledge, was what it would mean if she told me. “And what would it mean?” she asked. It would mean a little less exclusion. It would mean feeling trusted. It would create a deeper feeling of relationship, and strengthen our bond. It would create another memory. All of those things seemed self-evident, natural, and in need of no further explanation. And yet she still seemed to think there was more to discover. That we hadn’t yet got to the bottom of it. She didn’t quite understand why the withholding of what still seemed to her a fairly insignificant piece of information, could create the level of distress that she was observing.

***

The pain lingered between sessions. Her belief that there was more, the fact that she still didn’t quite understand what was going on, troubled me. I wanted, desperately, to understand. Despite myself, her curiosity became my curiosity, fuelled by my despair. I’m not sure whether I thought that an answer to my question would ever be forthcoming, but the desire to know the answer was soon completely eclipsed by my desire to understand what was going on.

Why did it matter so much that she should tell me? Why was it significant? What on earth did it mean? My mind buzzed with the questions; I was taken over by them. In the car, at home, carrying out tasks, moving about. And quite suddenly, an internal voice – definitely me, but appearing out of the blue, somewhat like free association – gave me an answer. And it stopped me in my tracks. It was blindingly true, but also difficult to swallow, as it ran counter to my ‘natural’ way of thinking. It was unexpected, staggering, and it put not just one thing but many things, into a completely different light.

***

I went to bed shortly afterwards, my mind still buzzing, feeling blown away. It’s fairly rare for me to remember dreams, particularly in great detail, but that night I had three dreams which I remembered vividly, and which I knew the minute I woke, were inter-related. I usually struggle to interpret my dreams and to link them to the work of therapy, but as I drove to session that morning, the meanings started unpacking themselves with startling clarity. I was awed by the way in which our minds can put together images with purpose to help meaning float up out of them. I felt fortunate that a couple of weeks before that, I’d had a similar sequence of three dreams in which I realised that what was important was to pick out what was consistent across all three sequences, rather than pondering the meaning of each detail. Sometimes the details were there purely in order to demonstrate that the details didn’t matter – what mattered were the themes.

The dreams added further layers of understanding to the flash I’d had the night before. I’d come to a surprising realisation, and the dreams helped me to see the different ways in which it was true. The dreams showed me the less self-evident, and vitally important ways, in which it really did matter that my therapist talked to me about where she would be going on holiday.*

***

What followed was a session that was both very moving, and deeply joyful. It felt as though something had finally clicked into place; as though a missing piece had been found. There was a clarity of vision I rarely experience, but which always feels striking and humbling when I do.

And part of that clarity was the slightly reluctant but unequivocal realisation that my therapist had been right. Of course it’s a matter of conjecture, but I tried to think honestly about what I thought might have happened, if my therapist had answered the question first, and asked me to analyse, second. Much as I wanted to believe that the outcome would have been the same, I knew that I didn’t really believe that.

I had been very distressed, and I wish that there had some way around that. I imagined how good it would have felt if she had replied to my question straight away, and I imagined turning my attention to thinking about why my question was important, with a joyful heart, and feeling close and connected. And yet lovely though that picture was, it lacked the all-consuming motivation, the fierce curiosity, the absolute drive to understand so that I could somehow try and make sense of my pain, even if I couldn’t make it go away. I can’t honestly say that I think the same outcome would have been achieved if I had had her answer first. In fact I believe the opposite – that it’s unlikely the breakthrough would have happened – at least, not at that time. And I’m very glad that it did.

***

As my therapist is prone to reminding me, ‘good therapy sessions’ aren’t defined in terms of whether I go away from a session feeling uplifted and joyful. ‘Good work’ in therapy is very often painful, very often involves distress. I know that my therapist does not like seeing me in pain; I know that she would never cause it intentionally. Sometimes, pain is the unintended consequence of her being just as human as I am; sometimes, it is the by-product of a sound therapeutic judgment and the decision to withhold and frustrate rather than to provide and satisfy. And all these situations are absolutely compatible with wholehearted caring and commitment, which is what she continues to show to me, five years down the line.

I didn’t ask her again, where she would be going on holiday. She did tell me, in a subsequent session, and I thanked her, without asking her why. I know that withholding the information was never a matter of principle, the information was never a secret. I think she told me because it felt straightforward to do so. I don’t think there was an ‘agenda’, or a particular reason. I think it probably just felt like the right thing to do at the time, and there was no good therapeutic reason for not doing it.

For both of us, therapy is hard work, and very often involves sifting and working through a great deal of non-straightforward conscious and sub-conscious ‘stuff’. But sometimes it doesn’t. Sometimes things just are. Sometimes, we just are. But to get to ‘just be’, we often have to bear with the frustration of not knowing quite how, who, and were we are at, and why. At those times we need to try and trust that even though it may be our therapist ‘doing’ the frustrating, they are not the same person as the many others who may have frustrated us in the past, for quite other reasons. They simply know that we will be more likely to gain insight into our pain and to heal, if we can stay inside our predicament and our hunger to understand our dilemma, rather than observe it from the sidelines, from the perspective of satiation.

 

*[Interestingly, when I proof-read this post I realised I’d written ‘where we should be going on holiday’, instead of ‘where she would be going on holiday’, transposing the ‘sh’ and w’ of ‘she’ and ‘would’. A Freudian slip? Perhaps it was the echo of my therapist’s light hearted comment that unlike Freud, she didn’t take her patients on holiday with her!].

**I haven’t given the details of the realisation I mentioned here, but only because it will be the subject of another post in future.

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Summer therapy break 2018 – one third of the way through

Somehow I managed to completely miss the fact that Storify disappeared in May, and along with it all my previous compilations of #therapybreak tweets! However, I’ve discovered Wakelet, an excellent alternative, and this is installment 1 of 3, of my #therapybreak tweets from my current break, which started on 18 August and will end on 24 September:

https://wakelet.com/wake/13b05313-b87e-4724-ae16-1dcdfab1b6cf

As usual, it’s been lovely sharing stories of therapy breaks on Twitter, with others who are also in the midst of their own breaks. It’s also been lovely seeing the steady presence, #therapybreak after #therapybreak, of those whose stories I do not know, but who ‘like’ tweets, whether or not they comment, and who by those actions show their support and let me know they are thinking of me.

Some aspects of therapy breaks have become a little easier  – for example, I no longer have to fight an internal battle to maintain a clear perspective on who my therapist is and on our relationship. However, life has got harder, and so despite feeling close to my therapist, I still spent much of every day of the first ten days or so of the break, fighting despair and the feeling that I did not want to be alive.

I’m glad that as has happened in the past, my #therapybreak tweets have captured the beautiful, grateful, moments that have struck me, in amongst the more difficult feelings, as in this way they function as an act of self-care, as well as a means of connection.

A couple of others are also using the hashtag #therapybreak to share their stories – it would be lovely to build up a collection of experiences in this way!

 


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My past experience of CBT – Part 2

A little while ago I posted a link to a short article I wrote on a positive experience I had of Cognitive Behavioural Therapy (CBT) around fifteen years ago. In this second article, I describe a very different experience which took place around six years ago, during the period when my mental health was at its worst, and just before I was diagnosed with Borderline Personality Disorder:

https://healthunlocked.com/mental-health/articles/how-therapy-helped-me-through-postnatal-depression

There are a large variety of therapeutic models, and for the last five years I have been in open ended psychoanalytic psychotherapy, with a significant emphasis on the healing nature of the therapeutic relationship. Across these two articles, I aim to show briefly my belief that “having the right tool for the job, is just as important in therapy as anywhere else. Sometimes that tool is the application of a structured model such as CBT; and sometimes it’s the experience of a transformative and trusting relationship”.


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Therapy and the clock

For a while I’ve been fascinated by the therapeutic material that can be provided through encountering the practical parameters and circumstances of therapy – for example, how we pay (which I wrote about here), and what we wear (which I wrote about here and here). In my latest article for welldoing.org, I wrote about what we learn through our response to the time-limited nature of a session, and the 50 or 60 minutes that circumscribe it. I enjoyed reflecting on this, and on how my response to the clock changed as trust and my therapeutic relationship developed. The article can be found here:

https://welldoing.org/article/watching-clock-time-keeping-trust-relate-therapy


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Breaking and remaking

This process happens repeatedly during therapy. Even after three, four, five years, the breaking and the remaking happens. The shattering and the putting back together.

After time, it becomes a little easier to bear. Familiar in its recurrence, less shocking in its predictability. Maybe a little less painful – as if the pain has had its edges knocked off by repetition.

If only it were the mirror that could shatter and by putting itself back together could show me a different me. Instead the mirror stays steadfast and it is I who must repeatedly break and reconfigure until what I see reflected bears more resemblance to the truth. Or at least, what my mirror tells me is the truth – my breaking is far from finished.

The mirror flashes back at me all the different shards of myself; the ugly, jagged parts which I have to hold gingerly, but firmly, like infant selves, to fit them back into a whole.

The trouble with being broken in order to be righted, is that it can feel like the old breaking – the one that left us scarred and misaligned. The solution can feel a little like the cause, until we see that it’s the presence of the mirror, waiting to show us our true reflection, that makes the difference between the two.

It never fails to hurt me, this breaking. It never fails to amaze me, either.

 

 


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My past experience of CBT – Part 1

Though I’ve written extensively over the last few years about my experience of open ended psychoanalytic psychotherapy, I’ve never really described my brief experiences with Cognitive Behavioural Therapy (CBT), the first of which occurred more than ten years ago, and the second of which occurred around six years ago. As with the many other different modes of therapy, I think it works well for some people and some situations, and less well for others. It was successful for me the first time, but utterly unhelpful the second, and I believe I now understand the reasons for that difference.

I recently wrote a couple of brief articles for the site Health Unlocked, about these two experiences of CBT. The first details my positive experience, and what I found valuable about the process, and can be found here:

https://healthunlocked.com/mental-health/articles/how-cbt-helped-me-get-out-of-my-head-and-see-different-perspectives

 


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We are incomplete stories

I recently encountered the second person, over the lifetime of my blog, who has had a less than complimentary view of what I do and how I approach life. I feel very fortunate to have had so little criticism; in fact the individual I just mentioned believed that their comment would not be published because they couldn’t see any negative comments and therefore assumed I simply deleted them all. That is not the case – I’m very happy to have an open discussion with anyone holding views either similar or very different to my own, and I’m happy to be challenged. But I believe that that conversation should be respectful, and always mindful of the fact that while differing views on therapy abound, no one knows really knows a therapeutic relationship apart from the two individuals engaged in it, and I believe strongly in choosing words carefully such they uphold rather than undermine that relationship. On the couple of occasions I haven’t published comments, it was because they were not made respectfully, but aggressively, and because I believed that they had the potential to undermine not just my own, but others’ therapeutic journeys as well.

On this occasion, the commenter said (amongst other things!) that they were concerned that my posts would encourage readers to live in a fantasy world and not try and make any changes to their lives; the fantasy world in question, was the way in which I see my therapeutic relationship. Though I disagree with the individual’s point of view, I think it is, in part, understandable. It’s impossible to gain a complete picture of my therapeutic journey, even if one were to read every post I’ve written over the last four years; not just because one cannot capture the essence of a relationship, in writing, but also because I write about only a fraction of what takes place either within session, or outside it. Someone reading a handful of posts without the context of what came before or after, might gain an inaccurate or partial picture of what I believe, what my life and therapeutic process are like, and how (or whether) things have changed. I have written posts when feeling hopeful and optimistic, but I have also written posts in the midst of suicidal ideation or profound despair and grief. Drawing broad conclusions about my beliefs, attitudes, or worldview, from these snapshots into my life, is like opening the pages of a book at random, and making assumptions about the characters and the ending of the story, based on what happens in a single chapter.

I would be saddened and mortified if I thought that what I’ve written implies that change in therapy isn’t vital or necessary. It isn’t a point I make overtly, or in a directive way, because I believe that everyone has to take change at their own pace. We cannot force ourselves – let alone others – to be open to the enormous shifts involved in therapy, before we are truly ready. For my own part, I believe that I have made significant progress in therapy over the last few years, and I hope that that is evident in at least some of what I write; some of the comments I have received, indicate that that is so. But this particular commenter’s barbed remarks did prick my conscience, and brought again into the foreground, the uncomfortable feelings I sometimes have when I think about how my blogging has developed over time.

It’s a pattern that I see not just in myself, but in a number of others who write about their therapeutic journeys. And it’s fundamentally a positive pattern, indicating recovery, growth, and a necessary deepening of relationship and trust within therapy. But how does that pattern impact upon others?

It seems to be, that as we get better, and as we bring more of ourselves into therapy, we put less of ourselves out there in our writing. Sometimes this is a conscious decision; often it is not. Some like to claim that suffering and creativity go hand in hand – I don’t necessarily agree, but it’s certainly true that I wrote most, when my mental health was at its lowest point. Another way of looking at it is that writing can be a coping mechanism, a way of releasing and processing powerful emotions, particularly when there is no other mechanism for release. It can be a source of comfort and solace, a means of expression. It can be many things, that is, that therapy can also be – which is why in many ways, it can be a helpful companion to therapy. But it also runs the risk of taking the place of some of those things that therapy should be providing instead, potentially diluting both the process and the relationship, or at least circumventing some of its lessons and the bonding quality of spontaneous relating.

It seems to be that we write less as we recover more, and as our therapeutic relationship deepens. We want to take things to our therapist, rather than to the page. We want our therapist to be the first to know what we’ve discovered; perhaps the only person to know, for a little while, about some important aspect of us that has changed. It is a private, bounded, intimacy – not just because of the vulnerability present within it, but because it is so precious, and many of us keep our most precious things, close to our hearts. Many of us do our growing up within the context of our therapeutic relationship; we grow into different people, or at least, whole people, living life from a different place. Who wants to do all of their growing up in public? We want to share aspects of our stories, we want to give and receive support; but we also want to cherish the safety and privacy of our intimate therapeutic relationship, as others might cherish the safety and privacy of family.

There is so much I haven’t written about over the last couple of years. Significant therapeutic ruptures, and even more significant repairs. Many lessons learned, but few written down. Important milestones, and even more important small, ordinary steps towards wholeness. And an absolute confidence and trust – not yet in myself, that is a huge work still to be done – but in my therapist, and in who she is. Projections still get in the way sometimes. Sometimes I still react as if she were like my biological mother, rather than reacting from a place of knowing who my therapy mother is – and she is very different. But I’ve reached the point where I feel there are no walls, and no fear – just a deep trust that I know her and can tell her anything, and we will be okay.

And so the picture that I’ve put forward in my writing, is incomplete. I can remember avidly reading blogs in the early years of my diagnosis and therapy, and that wonderful feeling when you find someone who seems to see right into your head, and puts down on the page the very things you’ve thought and felt. Comments from readers of my own and others’ blogs, shows how common this experience is. And so sometimes I feel guilty that I’m not offering up to someone who might need it, the encouragement of knowing that for every difficult and painful time I wrote about, there are many other moments of precious connection and progress. And there is a constant – sometimes bizarrely and frustratingly meandering, but still life-giving – thread of change and growth. And for my own part, I feel worried that if I need something to look back on, I will be missing, in words, the very best bits of my story. But that is part of my inner work that has still to be done – to develop trust in myself, in recollection, and in the presence of this experience, lasting through time, sustained internally and eternally, without the need for an external reference point.

And it occurs to me, too, that just as I have written less over the last couple of years, I have also been reading less about therapy, and about others’ experience of it. Honouring the precious intimacy of the relationship means not just keeping cherished moments within the bounds of the space, but to a certain extent, keeping other influences out of it. I don’t mean that therapy is a bubble, apart from the world – that would be to reinforce the commenter’s criticism about living in a fantasy. It is to say that therapy is about authenticity and finding our own way through the process – and that it is very easy to be influenced by others’ stories, and even to use them as vehicles for saying something about ourselves, thus circumventing tougher but ultimately more useful and personal forms of expression.

It is also true, I think, and demonstrated throughout life, both within therapy and outside it, that people don’t really hear or see what is being said, until they’re ready to do so. Many of us know that when on the very edge of despair, having someone meet us where we are, can sometimes be more encouraging than being shown the person who has already made it through. It’s difficult to relate to who we might be in future, when we cannot envisage a future; but relating to someone who experiences a similar present, helps us to feel another’s presence, and to feel less alone. In my earlier years of therapy, I would have found it very difficult to envisage and accept that things would change in certain ways; just as I find it difficult to accept even now, that the eventual end of therapy might be less traumatic than I currently imagine it will be.

And so perhaps it does not matter that I haven’t written much about how things have changed over the last couple of years. Perhaps this guilt and unease that the commenter triggered in me, is misplaced. Perhaps my posts are meeting people where they are, at a particular period in their therapy; and when that period is over, they no longer seek the same sort of meeting. My story is presented incompletely, and it is still incomplete – as all of our stories are. And if you don’t see change in its pages, perhaps that is because you have dipped into it at a point when change is moving incrementally slowly, inching its way into my being. Or perhaps you missed the lightning flash of revelation that came a couple of pages before, or that awaits you in the next chapter. I’m awaiting that one too – but who knows how things will unfold…..

Tell me, what is it you plan to do with your one wild and precious life?” Mary Oliver