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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Why the Christmas therapy break can be particularly hard

I’ve just entered another therapy break – twenty-six days this time. Though the summer therapy break is longer, the Christmas break is more challenging in other ways. My latest post for the therapy website welldoing.org is an open letter to my therapist, explaining why it feels difficult, and how she has helped:

https://www.welldoing.org/article/letter-to-my-therapist-christmas

 

[This article was inspired by a post I wrote at a similar time last year; that post was prompted by an intense set of emotions that arose after I caught a glimpse of my therapist’s daughter, who had come home for Christmas. Families – both the ones that we are part of, and the ones that we are not – can lead to such strong emotions at this time of year….]

 


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

It’s time for a therapy break – again. But along with the usual feelings of loss and separation, this particular time of year heightens the feelings of being excluded. My therapist is not just on a break – she is spending time, as so many people do over Christmas, with family. She will be surrounded by the people she loves; she will be engaged in family traditions that bind them all together as a unit. They will talk, laugh, remember, and sit close. And I will think about them doing that, as I have been thinking about the prospect of it already, and it will be painful – very, very painful. Of course I want all manner of good things for her – including opportunities to rest and spend time with her children! But what hurts is the fact that that is a part of her life that I will never have access to, and that not being a family member, friend, or even a casual acquaintance, there are certain types of access I will never have to her.

I described that pain of feeling excluded a few months ago, in my post ‘Being excluded from your therapist’s life: you’ve read the reasons – this is how it feels’, which you can find here:

https://lifeinabind.com/2015/04/18/being-excluded-from-your-therapists-life-youve-read-the-reasons-this-is-how-it-feels/

I think that at this time of year, exclusion feels heightened because it is so much easier to make comparisons with others and therefore to focus not just on what I can’t have, but on what others have instead. And as my therapist has pointed out, the unspoken (and for me, barely realised) undertone of that comparison, is a belief that I compare unfavourably with those who have what I desire. That somehow the reason for that insufficiency, is my insufficiency. That I am less acceptable, less worthy, less deserving.

In my post on feeling excluded, I spoke about being a ‘therapy daughter’ – a wonderful phrase my therapist sometimes uses to describe my relationship to her. But at this time of year, my identity as a therapy daughter can feel less like a special bond, and more like a differentiator between me and her ‘biological daughter’; a painful reminder of everything that she (her biological daughter) has access to, that I do not. For a number of reasons, I have been thinking  a great deal about that comparison this week, and having sessions in my therapist’s home makes it easier to indulge in imaginings about what Christmas will be like in her house, with her daughter; and that includes imaginings about the details of what I will be ‘missing out on’.

You see, when it comes to being a therapy daughter rather than a biological daughter,  it’s hard in so many ways. It’s hard being in that house when I know it’s not my space – even if a bit of it is my space for an hour, here and there – but it is and has been her space all along. It’s hard to know that the arms that she will be drawn close by, are the ones that I will never feel around me, and that the kisses in her hair, softly planted, will be, for me, only imagined or dreamed of. It’s hard to know that when I leave for the ‘therapy break’, she will be there even when she isn’t – because they are a part of each other. It’s hard to know that I am kept in mind during that break, but she is always kept in body, heart and soul; hard that I can be known, but she can really know. Hard that she can only ever be beautiful, because of how she is seen; whereas I constantly fear that my ugliness will betray me. It’s hard that she is a daughter, while I am only playing the part. Hard that, save ultimately, they never have to be parted; whereas for me, parting is not just something that takes place over Christmas – it is the end that was there from the beginning and that haunts every hello and goodbye.

I feel that lack of what I don’t have, particularly this Christmas time. And yet – I have the most wonderful therapist in the world, for me. Why do I say that? Because of this: “The reality is that difference, or not being my biological daughter, is no barrier to being connected, accepted or significant“. I can say without doubt that that sentence, and everything it means, is the best Christmas present I will have this year.


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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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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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