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 under the name Clara Bridges.


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Twitter chat 6 March: Connecting in therapy – do touch and love have a place?

I’m really looking forward to my Twitter chat with Alison Crosthwait today, on the subject of connection, love and touch in therapy. Please do join us at 9pm GMT/ 4pm EST if you can, using #therapyconnection !

Life in a Bind - BPD and me

It’s been ten months since psychotherapist Alison Crosthwait and I held a Twitter chat on the subject of therapy breaks; we said then that we enjoyed it so much we would do another one, and finally, we’ve set a date, time and subject!

Our next chat will be called ‘Connecting in therapy – do touch and love have a place?‘  and it will take place on Monday 6 March at 9pm GMT/4pm EST. We will be using the hashtag #therapyconnection.

I believe these are difficult and contentious topics, for both therapists and clients, and I’m very much looking forward to discovering Alison’s take on them. From a personal perspective, they are subjects I have struggled with in my own therapy, and touch, in particular is a ‘live issue’ for me at the moment. But I won’t be bringing my therapy into the chat – the…

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Twitter chat 6 March: Connecting in therapy – do touch and love have a place?

It’s been ten months since psychotherapist Alison Crosthwait and I held a Twitter chat on the subject of therapy breaks; we said then that we enjoyed it so much we would do another one, and finally, we’ve set a date, time and subject!

Our next chat will be called ‘Connecting in therapy – do touch and love have a place?‘  and it will take place on Monday 6 March at 9pm GMT/4pm EST. We will be using the hashtag #therapyconnection.

I believe these are difficult and contentious topics, for both therapists and clients, and I’m very much looking forward to discovering Alison’s take on them. From a personal perspective, they are subjects I have struggled with in my own therapy, and touch, in particular is a ‘live issue’ for me at the moment. But I won’t be bringing my therapy into the chat – the aim of these chats is that they are an ‘equal’ exchange of views, looking at a subject from different perspectives. They are about therapy, but they are not therapy, and both Alison and I are careful to avoid ‘falling into’ our respective roles of therapist and client, which, as I personally discovered during our last chat, is a real temptation!

We would love for you to join us in our chat, and let us know your thoughts, whether you are a therapist or a client. Please do just ‘turn up’, even if you feel more comfortable observing rather than joining in. If you’re interested in the chat but will not be around during that time, we will be publishing a ‘transcript’ using ‘Storify’, shortly after the chat.

We look forward to seeing you there!


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Feeling untouchable – touch in psychotherapy, Part 2

[This is a follow-up post to ‘The desire for touch – touch in psychotherapy, Part 1‘]

Even before touch became a subject of discussion in my therapy, I was always acutely aware of any occasions when my therapist and I were in very close proximity, or when we touched fleetingly or accidentally. Once, as I got up to leave, she pulled down a book from her shelves to show me something. We stood side by side, very close, not quite touching. As well as the physical proximity, I suddenly became aware of the height difference, particularly as I was wearing heels. When sitting down, that difference is not at all apparent, and it felt strange being taller; somehow incongruous with the fact that I often feel like a child in her presence, and she feels like my shelter and high tower.

On another occasion, as I sat on the floor next to her chair to show her some photos, our shoulders touched. A number of other times, our fingers and hands made contact as we have passed objects – a photo, a ring, a card, a rock – from one to the other, to look at. I’ve always wondered whether she noticed, and whether she wondered if I noticed, and what it meant to me. The moments have always been fleeting, and I have been careful to try not to do anything or use anything as an ‘excuse’ to grab more of them. Of course I’m aware that if I pass her something to look at, touch may happen. Do I want it? Yes. But I am as fearful of being accused of engineering situations specifically for this purpose, as I am convinced of the fact that I would not feel comfortable or respectful doing so. I make the choice to pass her something to look at, directly into her hand, rather than by putting it on the table beside her, or waving it in front of her. In that sense, I am choosing to ‘risk’ touch – I might even be hopeful for it. But it happens as part of an ordinary sequence of events – in those situations, to act otherwise would be to specifically try and avoid touch, and that in itself would feel uncomfortable and ‘forced’.

I’m not sure it would be accurate to say that I ‘enjoy’ those moments of touch – they are incredibly fleeting and too laden with complicated feelings, for that to be the case. I appreciate them and treasure them – as ordinary but special moments of connection and interaction; as grounding moments of her reality and humanity; as part of a memory of something that we have shared. I’m often very unobservant, but in those moments I notice things like the smoothness and neatness of her nails, or the softness of her skin.

But there is one overriding reason why I appreciate those small moments of touch; one key reason why they are so significant, as well as special – she never pulls away. When our shoulders touched, she didn’t flinch; she’s never drawn her hand back faster than she needed to. Either she didn’t notice the touching, or she didn’t mind. Either way, my fear and unconscious expectation was that she would both notice, and mind. It felt surprising that she didn’t draw her shoulder back; or that she didn’t try and grab the edge of a passed object so as not to come into contact with my skin. I didn’t expect her to lean forward palm up and open-handed to receive what I had to show. I didn’t expect her to stand so close. I didn’t expect her not to pull away.

***

I spent a long time pondering why it was that I felt so ‘untouchable’; why I thought that my therapist would feel uncomfortable or threatened by my close presence, and would back away immediately from any contact. It didn’t feel logical that I should be so surprised at the fact that she did not seem to find contact distasteful. My parents never showed a reluctance to touch me or hold me – if anything, the reluctance was mine, as my mother has always desired much more physical contact (such a hand-holding or hugs) than I have felt comfortable giving. I could see plenty in my upbringing that would make me feeling ‘unlikeable’, but nothing that would make me feel ‘untouchable’.

And then one day as I was sitting in a café reading an article on touch in therapy, I had an unexpected memory of secondary school, and suddenly the feeling of being ‘untouchable’ made sense. There is so much in my life that I have discounted from being significant or formative, simply because it happened in not-so-early childhood, or because I survived it and never thought about its import at the time. I loved school – my love of learning over-rode everything, as did the existence of my own group of friends, the support of teachers and the structure of the environment. A child gets through something because they have to – I’m not sure I’d have the same strength now.

***

I was not the only one who experienced bullying; my friends did too, though it was something we never talked about, and I don’t think we even really saw it happen to each other – we were too busy trying to emotionally protect ourselves. The bullying was never physical and it wasn’t even that frequently verbal. But every day when lining up and filing into the school hall for assembly, I was aware of the gap that was left where people were trying not to stand too close. When sitting down in our lines on the floor, some would leave a large gap or try and start another line, not wanting to be near me or occupy the same physical space. I would try to think where to position myself so that this was less likely to happen, or less obvious if it did. How could I arrange to be at the beginning, or at the end, of a line? How could I make it so that what was happening to me wasn’t as obvious and so that I didn’t need to feel any more ashamed than I already did?

There were the science classes where a larger than average gap would be left at the lab bench between me and the next person; or the fear and sick feeling in the pit of my stomach when classes involved ‘pairing up’ and I had no allies because none of my friends were taking the same subject. And for a long time there was that awful art class where the teacher would simply go away and leave us to it for a couple of hours and some of the others would talk about me as if I wasn’t there and would pick up strands of my hair with a pencil, to avoid touching any part of me. I’ve never had much admiration or liking for my ‘inner child’, but as I write this crying, I have no idea how she went through that with even a semblance of staying intact, and for that I have to give her some credit and respect.

***

When the subject of touch has come up in my therapy, it has often seemed to arrive out of the blue – partly, I think, because it is often brought to the surface when I come across posts or articles that others have written, that bring my mind back onto it again. My therapist has made it clear that touch is not a part of how she works; and although I know she is happy to talk about the subject, at the same time I suspect that she thinks an intellectual debate, triggered by the experiences of others, is of limited therapeutic value. But when my own lived experience interacts with my desire for touch in therapy, that’s when I know she feels the subject is present and relevant, and the discussion can bear fruit. It can address what is happening in the room and in my head; it’s something we can both engage with, in the here and now. It is something we can pass between us to look at and examine more closely. It is no longer a discussion about what I want and what she won’t give me; but about what has happened to me and how she can help me understand what it means. In these times, the subject of touch connects us, even if physical touch does not.

Personally, I don’t think it would be detrimental to my therapy if there was the occasional moment of touch, to express connectedness. In some ways, I’m not convinced that my therapist thinks that would be detrimental, either. If we happen to touch, and want to talk about it, then we can. What is detrimental – and this applies to numerous areas of my therapy, as well as to other aspects of my life – is my constant focus on what I can’t have, to the exclusion of all else, rather than on what I can and do have. What is detrimental, is my refusal to accept reality, and my difficulty and resistance to bearing the frustration of boundaries, limits, absences and losses. Though I can’t speak for anyone apart from myself, that’s where the real work of my therapy needs to lie, and I need to try and use the subject of touch as an enabler to that work, and not make it a stumbling block. It’s in that context that I will experience my therapist not just not pulling away, but coming closer to meet me on the road, and standing by me while I try to figure things out – shoulder to shoulder, you might say, and heart to heart.


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ten

I am very grateful to ‘how to be an analyst‘ for originally raising the subject of touch in psychotherapy with me, in a series of comments on one of my blog posts. I am also grateful for the excellent reading list suggestions!

Ever since that time, a few months ago, I have been thinking, reading, and talking to my therapist about it. I have also been meaning to write about it, and am grateful to ‘Lou’ for her email on the subject, which raised it for me yet again, and led to me writing a recent post about the desire for touch, which will be followed by another post on feeling ‘untouchable’.

This post from ‘how to be an analyst‘ draws together her very helpful and informative comments on my older blog post, which initially sparked my interest. I am very thankful and appreciative for the time that she spent writing those comments, and for her honesty and courage in speaking about her own past experience and also her struggles in therapy. I very much hope that her comments will be as interesting and helpful for you as they were for me, irrespective of your own views on the subject. Touch is not part of my own therapy experience, but it has been very valuable to think about it, talk about it, and to try and understand the views of those who advocate it, and those who are hesitant…

how to be an analyst

It has been five months since I’ve posted. Motherhood keeps me busy! Also, analysis five days a week is incredibly complex and so hard to encapsulate and put into words, especially while one is in the thick of it.

But, I am grateful to the author of lifeinabind for bringing up the topic of touch in therapy. It has long, long been a source of both pain and pleasure for me, and I think it should be something that is considered as part of talk therapy far more than it actually is.

I don’t have time to explain or write a full post, but I will edit and take some of my comments that I wrote on lifeinabind’s post to explain my experiences and thoughts on touch in analysis (wow! This ended up being very long!). Also, for anyone who is interested, I will include the list of research…

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The desire for touch – touch in psychotherapy, Part 1

[It’s important to note that in this post I am not talking about ‘body psychotherapy’, which is its own branch of psychotherapy in which therapists are specially trained to work with the body and with experiences and memories stored and held within it, in order to enable emotional release and healing. Instead I am talking only about ‘ordinary touch’ in other branches of psychotherapy, by which I mean a touching of hands or of fingers, a hand upon a knee, an arm around a shoulder, a hug, or other similar instances. I am also assuming, by and large, that the touching is not necessarily of a prolonged duration or a very regular occurrence.

To avoid writing a very long post, I have skimmed over the surface of what is becoming a more frequently written about subject, and I have not commented at all on the one very well-known and discussed case of Patrick Casement (1982) who refused to hold his patient’s hand when requested, in order to facilitate reworking a childhood trauma. Descriptions and discussions of this case can be found in a number of places including in two papers I have found particularly helpful, ‘The Meanings of Touch in Psychoanalysis: A Time for Reassessment’ by James Fosshage and ‘Physical Touch in Psychoanalysis: A Closet Phenomenon?’ by Kati Breckenridge]

I remember a painful therapy session from more than a year ago, in which my therapist made it very clear that hugs lay outside the boundaries of therapy. Up to that point I think I had still held on to a hope that it might be possible, if I waited long enough. If I’m completely honest, I think a part of me still hopes that perhaps she will ‘declare therapy over’ five minutes before the very end of the very last session, and will hug me before I leave. Hope can be very hard to stamp out – even if it turns on a technicality.

Since then, and until a few weeks ago, I’ve spent less time hoping for a hug or thinking actively about the subject of touch in therapy. And yet it’s been a subject that’s often been there in the background and I have felt a great need and desire for touch, on a number of occasions. Sometimes the need for touch feels simply like a desire to sit close to her, perhaps shoulder to shoulder, and sense her next to me. Sometimes it feels like wanting to have my hand held for reassurance or comfort; and at other times when I am very distressed I just want a hug and long to be held close for a little while. Most of the time I sit through those moments and we muddle, fight, wade or cry through them with silence or with words, or both. Occasionally, though, the need for physical contact feels so powerful it feels undeniable – as though it should not be denied. As though it’s absolutely vital in order to help repair a past or present experience, and cannot be replaced by words. I can feel that way both in and outside of session, but until a few weeks ago it wouldn’t really have occurred to me to talk about it – because since that time more than a year ago, it has felt as though there would be no point, because I know there is no chance of the undeniable becoming permissible.

Which is ironic, really, because so much of therapy consists of talking about needs that cannot be met – so why should this be any different? I am very grateful to ‘How to be an analyst‘ who raised the subject of touch in therapy in a comment on another one of my blog posts, and who happened to do it at a time when it was very pertinent for me and I was feeling a great need for touch. Since then, I have read a number of articles and papers (forwarded, with many thanks, by the author of ‘How to be an analyst’); and posts and comments by other bloggers and readers have continued to keep this very much a ‘live’ issue for me, even when, if I’m completely honest, I sometimes want to try and ignore it.

The difficulty is this – I don’t want this to be an issue for my therapy. I want to protect my therapy relationship at all costs, and I don’t want there to be matters about which my therapist and I are in complete disagreement. I don’t want to resent my therapist, or blame her. And so I have a natural tendency to try and talk myself into accepting her position on touch, and to convince myself that she is right. It would feel so much easier if I could tell myself I may not like it, but I think her way is best. But I’m not convinced, and the most I seem to be able to do is to sit on the fence, which is not a particularly comfortable place to be.

***

Touch in therapy in complicated – there’s no doubt about that. It’s risky, for both patient and therapist; there is great potential for misuse and damage to be done; there are serious ethical questions to consider. But just because it’s difficult, doesn’t mean it should be discounted. How often should touch occur, who should initiate it, how is it possible to know whether it will be helpful or counter-productive in a particular situation? All good questions, but again, just because they are hard to answer and require careful judgement, doesn’t mean that avoidance is best. Touch is most definitely not part of ‘traditional’ psychotherapy; it has been pretty much taboo since Freud decided patients in session should be in a state of ‘abstinence’ and ‘non-gratification’ and that touch, amongst a whole host of other things, muddied the waters of analysis and departed from the model of the analyst as a neutral ‘blank screen’.

But if there’s one thing I’m convinced of, particularly after reading a number of articles on this subject, is that touch communicates, and lack of touch communicates. Lack of touch is not neutrality – it says something. Not touching is an action of the therapist just as much as touching is. Both therapist and patient are together involved in creating the environment of the session and everything that they do or don’t do is part of that creation and conveys a message and carries an impact. Is lack of touch an avoidance of touch? Is it a painful holding back or a hesitant relief at not needing to get any closer? Is it done for the patient’s benefit or the therapist’s comfort? A lack of touch has many possible meanings – but meaning ‘nothing’ is certainly not one of them.

My therapist may not use touch as part of her practice, but she doesn’t think it is wrong or ‘prohibited’. In that sense, I feel fortunate that this creates an environment in which it feels possible to discuss the subject more openly and more comfortably. I don’t think she will ever touch me; but neither do I think that she will show me the door if I touch her. Or at least, she has implied that she won’t. She has implied that if the desire for touch is there or if touch happens, it is something to talk about, in the moment, and to try and figure out and understand.

There are those who think that refusing to touch simply re-traumatises patients – that it reinforces the negative experiences of touch that they may have received as children, and that it doesn’t provide the positive healing experience they need instead. There are others who say that refusing touch allows the patient to fully experience the negative emotions from childhood in a way that enables them to be verbalised, thought about, talked about and worked through. This seems to be one of the key aspects of the debate over the use of touch in therapy and for me, it is intimately related to another key question (which I won’t go into here as it is a subject for another post!), namely: to what extent can therapy replace or re-provide what was missing in the past; and if it can’t, why is that? In what way is the process of learning or healing in therapy, different to processes or experiences that would have taken place in childhood?

But although these are key questions, they also make the assumption (made by Freud) that these desires, including for touch, are linked to infantile wishes. My therapist has said that although the child part of me may want a hug in session, it is made complicated by the fact that I am actually an adult. However, profoundly important though touch is in infant development, I’m not convinced that the desire for touch in therapy is always an ‘infantile desire’, and to describe it in that way can feel invalidating for the adult; as if the adult doesn’t have a right to feel the same need for affection. Touch in therapy isn’t there only in order to help heal experiences from childhood. It is also there to foster a sense of connection, a closer bond, and increased trust and openness, and there is evidence that it can communicate acceptance and enhance self-esteem. I don’t believe that all instances of my desire for touch come from a child-like place – and I wonder whether that makes the possibility of touch more difficult or more uncomfortable for my therapist to consider.

***

Even if nothing changes in my therapy with regard to touch – and I don’t believe it will – being able to talk about it has been a positive experience. It is good to know that my therapist doesn’t see it as a ‘prohibition’ or as something ‘morally wrong’, and it is ultimately bonding (even if it doesn’t feel so at the time) to be able to discuss this subject in a way that makes it (and me) feel acceptable. In addition, reading and thinking about this, and trying to get underneath the skin of how I feel about touch and how it makes me feel about myself, has led to an important realisation, which I will talk about in Part 2, on ‘Feeling untouchable’.

For now, I can think of no better way to end than by quoting from one of the papers I have found most helpful, ‘The Meanings of Touch in Psychoanalysis: A Time for Reassessment’, by James Fosshage: “Touch is a powerful form of communication. We cannot afford to eliminate a profoundly important mode of communication from our healing profession. As with any form of communication, verbal and nonverbal, we can use it advantageously or not for facilitating understanding, communication, and the analysis.”