I’m listening to a hefty thunderstorm as I type this. It’s the middle of the night. I’m wrapped in a blanket on my sofa, with my dog asleep in my lap. She came to me for protection from the storm. It’s nice to be able to give her that. I love that she seeks me out when she needs to feel safe.
Another reason I am wide awake at nearly 3am is that I am having a therapy crisis (again). After my session today, I felt so upset with J that I just wanted to quit the whole thing.
On Friday, J spoke to my GP about my problems with food. She did this because she has a professional responsibility. I wasn’t happy about it, but I knew it was necessary for her. Since then, I’ve had this uneasy feeling, because I hate knowing that I have been talked about. J insists that my GP only wants to help, and he apparently told her he will ‘do anything’ for me. But still I hate knowing they talked about me and not knowing what was said.
J said that she and my GP discussed their roles and obligations. That felt cold and clinical. She talked about their respective NICE guidelines. I’ve not heard her speak like that before and I felt upset by it. It left me feeling like a problem, like neither of them probably wants to have to be responsible for my care. I am already in a place of feeling like I need to apologise for just existing, and hearing this amplified that feeling for me.
During this conversation, J also referenced the fact that I am not the only person they both see. For some reason that felt like a punch in the gut too. I guess it made me feel like just one in a long line of people.
Then she made it all worse by mentioning law suits. She said she feels it is important for me to know how she is feeling about me not eating. She said something about it being unclear who should be accountable for me, and how it is easier for my GP because he works for the NHS and she is in private practice. She said that she could be sued if something happened to me. Suddenly I felt like all of her concern for me around my food issues is actually concern for herself. Concern that she can’t help me and therefore I am going to get worse and she’s going to be blamed for it. That notion is drenched in fear, insecurity and rejection for me.
Lately, it also feels as though J is trying to coerce me into eating better by telling me about the impact my eating disorder is having on her. She has told me she’s scared for me. She’s worried about me. She wants to understand but doesn’t. Every time she goes down this road, I feel guilty. I feel guilty that I’m impacting her in a negative way. I feel guilty that I know this and do nothing to rectify it. J knows how much I struggle with the idea that I’ve upset people I care about. So it almost feels like this guilt is a subtle weapon. It’s the same sort of low level emotional blackmail my mum has used on me my entire life.
I wrote J an email explaining some of how I’m feeling and sent it earlier this evening. Normally, she replies within a few hours, but I have heard nothing from her. Not even a simple acknowledgement that she got the message. So, assuming there was no kind of technical failure, my conclusion is that this email has overstepped the mark and she is now angry with me as well.
Either way, I can’t see me making it to my session today. After this sleepless night, I will probably just stay in bed.
Here’s what I said in my email.
I’m feeling crappy about our session today. Actually, I am feeling worried about therapy in general and how it has been in the past few weeks. When I was walking home earlier, I started thinking I should just quit. I followed that train of thought and realised that my relationship with you doesn’t feel good at the moment.
Maybe that’s because I feel like I have been demanding, emailing you a lot during your holiday and after. I don’t like doing it. But when things are really bad I feel like I need to. I get reassurance and comfort from knowing that you’re aware of what’s happening for me.
But I don’t feel like that’s all of it. It feels like I haven’t managed to reconnect with you since your leave. Instead of me gradually feeling more secure and connected again, it’s going in the opposite direction. I’m feeling angry and resentful towards you and I hate that.
In our recent sessions, I’ve been feeling like you are distracted. I don’t feel like you are as focused on me as usual. I feel like something has changed. Maybe it’s because you’re concerned about me not eating and you want to focus on that. I feel like the fact that I have so much happening around me at the moment is therefore a sort of inconvenience.
For a while, I have been wondering why you are more concerned about my food issues than you ever appeared to be about any of my other self-destructive behaviour. I thought it was maybe because you’d seen something similar before. Or maybe just because you really care and are worried for me. After you talking about obligations and law suits today, I’m left thinking you’re actually more concerned about responsibility and culpability. That feels horrible for me.
I feel like a burden to pretty much everyone in my life. Especially at the moment. At best, I am annoying to people, and at worst I am a chore. Now I feel like I am a chore to you as well.
I’m not sure how I am going to feel better about all of this. Normally I’d know I should come and talk to you. That would make me anxious, but I’d do it anyway because I would anticipate it having a positive outcome. Now I just feel like you’ll say that you didn’t mean for me to hear what you’ve said in this way. I don’t feel like that will help at all, it won’t make me feel less like I am a problem. I’m not doing my usual desperate plea for reassurance. I don’t think anything will feel reassuring. I just felt like it was important to write and explain.
Image: John Fowler, Creative Commons.
blackspotsite 
J’s approach really doesn’t seem helpful and it does come across from what you’ve said that she is looking to cover herself more than work with where you’re at.
I don’t know a lot about working with ED’s. The only point of comparison I can find is with feeling suicidal. The one and only time that Dr L pulled the “how much it will hurt other people” card I got quite annoyed with him, because that’s just saying that not only do I have to deal with feeling bad enough that I want to die, I’m now also responsible for other people’s feelings as well. You have to work with the part of the person that wants to hold on, that wants to change, and offer ways to help them get through until they are able to do that. It requires enormous strength on the part of therapist to sit with a degree of risk and not be heavy handed, and to know just the right point to intervene, and how to do it the right way. I don’t know where you’re at in terms of medical risk from your weight and eating pattern, so it’s not my place to comment on what intervention is or is not right, but it doesn’t sound as if J is getting it right as far as supporting you enough that the need for the ED behaviour is less.
I’m not sure if this is helpful or not to share, but I’ve had a quite frank discussion with my sister as far as medicolegal risk and holding my treatment team accountable. Her own mental health problems mean that she has a clear idea of what the issues are for me, she knows what sort of interventions I will and will not accept and she has medical power of attorney for me. We both acknowledge that there is always a risk that I might die by suicide, and I’ve said that if it occurs in a setting where I was permitted autonomy and I didn’t reach out for help and it was an impulsive act they are not to sue – this covers the most likely scenario with my current therapist. However, they can be as harsh as they like if the reason I’m at that point is that I’ve asked for help and been refused, or I’ve been forced into hospitalisation or treatment which I’ve made clear when I’m well that I would not accept.
I’m sorry things are so hard for you at the moment and I’m thinking of you. xx
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Thanks for your thoughts, it was useful – as always – to have your input. It’s validating that you understand the experience of being made accountable for other people’s feelings. I’ve also had that in the context of feeling suicidal too. I don’t think in the whole of human history that has ever helped anyone! But I’ve worked through a lot with J in the past few days and I am feeling much better about things.
It’s interesting what you say about the legal stuff. I’d never want anyone to sue J for something I’d done. That’s because I am actually confident that she wouldn’t decline to help me if I was feeling really desperate. But I have no sort of power of attorney set up, I suppose that my wife would get that by default and she knows already what I do and don’t want. I should probably look into whether I need to put something more formal in place.
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I think my discussions came from the same place – of *not* wanting my therapist to get sued. On the other hand I think there are not nearly so many situations which are life-threatening as the mental health system would have us believe, and they can be quite heavy handed once they get the idea into their heads. I know when I felt myself starting to be pushed around by my GP as far as treatment options, I started researching lawyers who had a reputation for mental health advocacy in case that became necessary. That’s rather off topic from where you’re at now though. Even if J isn’t quite getting it and is being a bit defensive it sounds like she’s on your side.
It is a good idea to have something written in place (whether that be advance directives, medical power of attorney or whatever) and to know exactly which situations it is valid in and which not. Here in Australia same-sex partnerships are not recognised and you can end up with estranged family who despise both you and your partner having the legal right to make decisions about you rather than the personal who loves you and knows you best, so having legal power to make decisions pre-arranged is extremely important.
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“I feel like a burden to pretty much everyone in my life. Especially at the moment. At best, I am annoying to people, and at worst I am a chore”. Insofar as followers of your blog constitute ‘people in your life’, I can assure you that your statement I quoted above doesn’t apply. At worst, you are an interesting writer, and at best, you are an enormous help and inspiration to those of us who struggle with mental health issues.
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I was really very touched to read this. It’s hard to believe that about myself, but it means a lot that you said it. It brought some much needed reassurance to this very insecure place I am in. So thank you.
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Ah Laura. Maybe you can explore the relationship with her in a therapeutic way?
as Desertcurmudgeon says you are inspirational to me.
The fears, pain ambivalence, anger-all of that you express, you express for me.
The relationship with the therapist is so hard. So fucking hard.
Also, what I admire as well is that you are staying in the adult: for example you have written a really “good” email to your therapist. You’ve shown, actually, that you have genuine concerns. And now the ball is in her court and she needs to respond.
Finally Laura, your honesty in expressing things that are sometimes (for me anyway) unspoken.
Take care xxxx
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“J also referenced the fact that I am not the only person they both see.” Not cool, not cool at all. I would have felt so bad.
I wonder if she is feeling like you’re a critical at this point, to a life threatening point and they’re trying to figure out how to get you to understand that. Clinical words don’t help you. I wish she’d said it differently, thought about it more before saying it.
Maybe what she and the GP were trying to figure out is who needs to take the lead and is more qualified to with your eating disorder. Maybe they’re trying to figure out how to treat the whole you. There may have been a question because of the clear medical emergency unfolding. They may be putting their heads together to see whose skill set should be where. Maybe that’s what they were trying to figure out. If this is the case, J worded it in the worst possible way.
Don’t give up.
Faith
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Thank you Faith for sharing your thoughts and sending some enoucragement.
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