I have failed again. I had a chance to piece things back together and I’ve let everything unravel instead. I’ve failed at recovery. I’ve failed at therapy. I’ve failed at work. I am a disappointment. I’ve let people who care about me down. I am letting myself down too. Not that I care so much about that, but then I suppose that’s the problem.

This morning I was signed off work again. That hasn’t happened since I had a breakdown over two years ago. Last time was the same; it began with just a few weeks of breathing space to get myself together. That turned into 6 months off and a phased return starting at an hour per day.

Yes, I know this doesn’t have to go that way, but it’s hard to argue that it won’t when this all feels so familiar.

I had to call my boss to tell him I wouldn’t be at work for a while. That was horrible. He’s not a caring person. He is hugely driven and ambitious, and he doesn’t really understand that not everyone feels so passionate about work. He pushes me hard and expects a hell of a lot from me. So I know he will be seriously annoyed that I won’t be there in the coming weeks. He listened to my feeble explanation and said the right things, but I know him well enough to read between the lines for what he really thought.

While knowing that I definitely need some time off, I still feel crap about it. I can rationalise a few days at home; I am not so important that a couple of days would cause a problem for anyone. But I’m the only one who does my job, in a multinational business with several hundred employees and thousands of clients. There are a lot of people who rely on me for certain things, and just won’t get them while I am on leave. I hate feeling like I’m causing a problem for them. And wondering what they’ll say about me.

The other side of it is my sense of embarrassment, and the damage to my pride. When I returned after my leave two years ago; it was so hard to rebuild my professional reputation. Nobody said anything, but I knew they were all wondering whether they could really rely on me. I felt like they were waiting for me to fail, they were all aware that it was likely I’d not be able to handle things like the rest of them. And now I’ve proven them right. My colleagues know why I was on leave the last time around, so they will correctly assume what’s going on now. And if I can ever face going back there, I will have to start this whole process again from the beginning. Right now, I’m not sure I will even be able to walk back through the door if this leave goes on for too long.

This is rambling, I know. I apologise. I just feel very overwhelmed with all of this today. I feel like I’ve been dragged back to square one. And I am shit scared of what it feels like to have to put everything back together again. Not the awful in between bit where you lose the plot, fall into a pit of despair and stop functioning. Not that. The having to figure out how the fuck you did it all in the first place – all over again. That’s what scares me most.

Oh and then there’s the likelihood I’m going to have to get treatment at an eating disorders clinic. As if the work stuff wasn’t enough to get my head around, my GP is also referring me for anorexia treatment. I don’t even know whether I want it. But I’ve been pressured.

J ambushed me with this topic in our session on Thursday. Seeing her on Wednesday had been rough, because I felt like she was trying to justify or excuse the behaviour of my family and worst of all, my brother. She did say things that came across that way. I’d also felt like she was accusing me of causing all these problems for myself, by not communicating more clearly with my family. It was like she had run out of patience to tolerate me being a coward in my relationships with them, and was basically telling me that I’m choosing the situation I am in.

A lot of that came from my irrational, oversensitive parts and I know this. But those feelings were still there. I still felt let down by her and angry with her. I didn’t want to go to my session on Thursday, but I also didn’t want all that stuff hanging over me for the whole weekend. So I forced myself to go and face it, to work it out with her.

What I didn’t expect was for the whole session to be about anorexia and whether I am willing to get treatment or not. J had drafted a letter to my GP and wanted me to read it and give her the green light to send it to him. Everything she wrote was true, and it was hard to see it in black and white like that. It was hard to sit and listen as she told me how sick I am, how weak I am, how I am not strong enough to do therapy, how worried she is about me. I didn’t know how to respond. I wanted the ground to swallow me up.

I felt like I was being given an ultimatum. One that comes from a caring place, but an ultimatum nonetheless. J said she doesn’t know of anyone in private practice who would work with someone who has a BMI as low as I do. She said we can’t do therapeutic work until I am healthier. She told me she respects my choice whether or not to have treatment, and she would help me access that if I decide I want it. But essentially, the message was; ‘we can’t do therapy until you start eating again’.

That means I have the choice of ED treatment, or no treatment. I can’t continue doing the work with her, without getting anorexia treatment. I don’t want that treatment. I don’t want to have to go to an unfamiliar place and talk to people I’ve never met. I can’t make myself feel OK about that, after being let down time and again by healthcare professionals who should’ve helped. And the core issue is, I don’t want to have to start eating again. I’m not ready to make that sort of commitment to myself.

This probably sounds like I am angry with J. And I guess a part of me is. I’m angry she’s making me look realistically at this situation. I am angry she can’t be the one to help me, because I trust her and I don’t want to have to build trust with someone new. I’m upset that she has taken therapy off the table for the time being. I don’t know how I feel about paying to go and just sit with her and talk about unimportant stuff. I want to see her, but I’m not sure I can justify that expense if I’m not working on things.

It just feels a bit like J has got to her wits’ end with me. And I don’t blame her. It must be exhausting being my therapist.

What really didn’t help was that she finished our session yesterday by telling me about how her practice is changing and she’s moving more into supervision. She’s seeing fewer clients, and I’m the only one on a Thursday now. I suppose it wasn’t the best time for me to hear this. My self-hating, cynical interpretation is; ‘she’s sick of working with miserable, demanding people like me, but she’s keeping me on out of some sense of obligation’. I have been trying to reason with myself, but I can’t close down the voice that says she’d probably be relieved if she didn’t have to see me again.

It’s just really hard to get my head around everything that’s going on right now.