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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How do you pay your therapist? The answer could be part of your therapeutic work.

In therapy, anything and everything is up for discussion – whatever happens in and outside the therapy room, provides ‘grist to the mill’. But the material of therapy is not just about the experiences we bring; it can include how we experience therapy itself. The context in which it occurs, the practicalities that govern it, and the boundaries that contain it, can provide fertile ground for exploration and self-discovery. In the interactions that take place between two people in one room, even the practical and the mundane can become a vehicle for expression and a means of unconscious illustration of what is going on for the client, and what is going on in the therapeutic relationship.

Unless the therapist is using an online payment system such as that provided by welldoing.org, for many clients one of the first practicalities they have to contend with, is payment. Even those who are comfortable with the ‘great British taboo’ of talking about money, may find it awkward or jarring discussing payment in the same session as covering very personal or emotional issues.

In addition, the fact that they are paying for a ‘service’ can make it difficult for some clients to accept the very genuine nature of their therapist’s attention, interest, and caring. It is also a reminder of what many clients would rather forget – that despite the real closeness and intimacy that can be involved, the interaction is not a friendship, and it must retain some of the distance and imbalance of a professional relationship. Raising these issues and talking about them can feel embarrassing or painful, but they can be ‘therapeutic gold’, resulting in a rich exploration of clients’ doubts and fears around relationships, intimacy, and boundaries. They are also important to tackle because overcoming them and achieving a positive and secure attachment to their therapist, is what enables many clients to heal from past and present relational trauma or other difficulties.

The practicalities of payment can also function as the non-verbal equivalent of a Freudian slip and can be revealing of a client’s feelings and attitude at particular points in time. A few examples come to mind from my own therapy. Early on, my therapist wrote a note on one of her monthly invoices, asking me to pay by cheque or bank transfer (rather than by cash). Her simple request – made in that way, I am sure, to save me the potential embarrassment of discussing it face to face – triggered intense feelings of shame, anger and distrust. We spent a number of sessions talking about the childhood origin of those feelings, and my fear of ‘doing the wrong thing’ and not being communicated with directly. The same issues have come up again and again in the last four years, in a number of other guises.

I now pay by cheque, and I do so within a couple of days of receiving an invoice; however, my therapist recently remarked on how my payment wasn’t always this prompt. It used to take me several weeks to pay, though she kindly never mentioned it at the time. I felt too unwell to be organised; I kept losing my cheque book; I didn’t have time to look for it, or I kept forgetting. My therapist’s comment was not a complaint, but an observation on how things had changed. She interpreted the change as evidence of my commitment to and investment in the process of therapy and the therapeutic relationship, and the priority I now give to it. Though I never delayed payment deliberately, I think she is right in seeing the difference in the way I now approach it as a reflection of more than just an improvement in mental wellbeing, or greater organisation. It is a matter of the regard in which I hold her and her role in my life, and the importance of the task we are engaged in together. This has impacted me in several ways – including making sure I never misplace my cheque book!

I’ve also had a very recent realisation about the significance of a past payment habit of mine. I now feel comfortable handing over cheques in person, but for a while I used to send them in brightly coloured envelopes, imagining them dropping through her letterbox and onto the doormat and being instantly recognisable as having come from me. I was aware at the time of a desire to be seen as creative, and perhaps a little quirky. I shared a feeling that many clients experience – a desire to be ‘special’, their therapist’s ‘favourite’, and to stand out from the ‘crowd’ of other clients. It’s interesting to me now that it didn’t even occur to me that my personal qualities, our interactions, and the time we spend together in sessions, could be sufficient and special in their own right.

What I recently realised is that my behaviour was also driven by a powerful desire to be present to my therapist, when we were not together. The envelopes were a way of making contact, and of trying to ensure I was remembered, and kept in mind. This hunger for remembrance has become more obvious as I have become more adept at ‘keeping my therapist alive’ between sessions and holding onto a feeling of connection. It is as if my previous preoccupation with needing to keep her in mind was masking an underlying preoccupation with needing to keep me in hers. It’s a realisation I’ve come to after the fact, but it’s also another potent example of the way in which deep fears and desires can be communicated through the vehicle of the most ordinary and seemingly mundane things. I continue to realise that how and when you pay your therapist, can be so much more than a purely financial transaction!

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