Archive for May, 2012

How to assert a right you don´t have: Making people like you

Posted in health, mental health, rants, social life with tags , on May 23, 2012 by theweirdphilosopher

Finally something other than psychotherapy, but it will still be a rant. Oh noes, I guess that will deter even the brave readers who made it through the posts about Dr. Stoneface. At least according to the “social skills manual” I want to rant about.

I would post the exact source, but the girl who wrote it is a blogger who I believe isn´t an arrogant jerk, but genuinely wants to help socially awkward people, so it doesn´t seem nice to shoot down her article with all my sarcastic remarks; and besides, her advice as well as the tone in which she delivers it are fairly interchangeable, so you´ll basically find similar stuff anywhere.

Now, what she said was basically the following:

1) Social skills are not a talent, but, well, a skill. You can learn them. Anyone can learn them.

2) Telling people sob stories about how shy you are or about how difficult your life was (being bullied and stuff) might make them pity you, but it won´t make them like you.

3) Be [this], but don´t be [that]. Practical advice, such as “be polite”, “don´t be negative”, “be average”, “don´t talk about your favorite subject all the time”, “don´t talk about controversial subjects such as politics”.

Part of this had me cry in frustration, part of it made me feel – destroyed. I might be the only person on earth who feels like that, and maybe it is just because I am such a negative, rude, sarcastic person who hates small-talk, constantly waffles about Jack the Ripper and genuinely wonders why she wasn´t elected prom queen. Well, I will dissect this step by step (so much for JTR, at least I won´t send the article´s uterus to the police, and I bet dadaistic humor is a taboo as well, even at 2:30 a.m.).

Good, alright. I don´t even disagree with her first point so much. I guess you can learn a certain amount of agreeable behavior. There are some things she says which I don´t agree with, though. First of, she writes this article as someone “who once was socially awkward as well”. To be honest, I cannot stand it when people who have gotten oh so far in terms of overcoming their weaknesses graciously give advice to those who are still stuck within their social awkwardness. Not only does such advice tend to come across as very preachy and very condescending (probably against the author´s intentions), it also has a tendency to be particularly offensive and hurtful. Why?

People who have overcome a weakness you are still struggling with know that weakness by heart. They know everything that you are thinking, every “dysfunctional” thought, and they also know everything you tell yourself in order to minimize your feelings of shame and inadequacy. And they will target precisely those thoughts and strategies. “You might be thinking that xyz, but in fact…” Seeing all your thoughts spelled out and dismissed doubles and triples your feelings of shame and inadequacy, I can promise you that much.  Especially if they don´t even give you reasons. Reasons that go beyond “I used to think so, too, but now I have moved on to some kind of superior wisdom and I´m more successful and much happier than you!” I guess this lack of proper argumentation is also what makes such advice-giving look so condescending. “I have thought about it for a long time and I think my belief that everybody else was just stupid was wrong because…” sounds a whole lot less condescending and offensive than “I know you think that everybody else is just stupid and this is why they don´t like you, but really, that´s bullshit! It was only after seeing that I was the problem that I managed to make friends – but so can you!” (No, this is not what that specific girl said, but you get my drift, I hope?”) The latter sentence sounds a bit as if you only had to blame yourself for all your problems in order to solve them, and that, apart from being cruel, is way too simple as well. I blamed and shamed and hated myself for my problems long enough, and it didn´t get me anywhere near solving them. If anything, it made me feel like I deserved my problems for being such a useless, unlikeable person.

Now for the second problem with the idea that you can learn social skills. Social skills like polite behavior might make people grudgingly acknowledge that they cannot really criticize anything about you. What social skills can´t do is magically force people to like you. There are absolute jerks who, for some reason, are extremely popular (maybe they are entertaining?), there are polite, helpful people who I´d much rather not be around. Why? Well, the guy in question honestly tries to be polite and helpful, and he even is, but I feel, I simply feel that this is a facade. I don´t rationally think that behind that facade he is a serial killer, but he still gives me the creeps. I feel like his politeness and his help come with some kind of demand or expectation, and that makes his presence very uncomfortable. I don´t know why this would be any different with someone who tests his newly learned social skills on people.

This leads us directly to her second point. She basically says that you have no right to be liked (respected, treated with decency, yeah. Liked? No.). I second that. A world in which people could be forced to like another person would be about as creepy and inhumane as 1984. You can basically go two ways from there:

1) “Well, of course I will try to be a decent human being, but whether or not people like me is out of my hands. Affection is an feeling that follows no rules, it is nothing I can force, and if a person should have affection for me it is a gift, not something I earned. This also means, however, that my self-worth does not depend on whether or not other people like me.”

2) “If you believe that people should (or would?) like you just the way you are, you are a complete asshole with a massive sense of entitlement. If you want people to like you, of course you have to do something for it!”

It is so fascinating how differently the idea of a “right to be liked” is interpreted in these two approaches. The first approach sees a right as something that you can enforce, and the idea of enforcing the right to affection seems bizarre if not scary. In the second approach, a right is the basis for selfish, egocentric demands. In a way, though, the second approach is highly paradoxical: Since we aren´t entitled to anybody´s affection, we are supposed to earn it. But this suggests that we can actually force people to like us – if we´ve earned it, they will have no other choice than to like us. Isn´t that a bit like enforcing a right you don´t even have?

The article unfortunately adopts the second approach, though it doesn´t use quite the same words. And it tells me what to do and who to be in order to be liked, as if other peoples´feelings could be operated just like that.  Apart from that, I have two major criticisms of her third point:

1) She says stuff like “be this”, and “don´t be that”. It is one thing to give people recommendations as to how to behave, such as saying “hello” and “goodbye”. It is another thing to tell them what kind of person they should BE if they want to ever be liked. It is these parts of the article that made me feel destroyed. “Don´t be negative.” Well, I am a pretty negative person. Watch me, right now, I´m dissecting another person´s hard work with my butthurt remarks instead of just going to sleep (it´s 4 a.m. by now). I am cynical and sarcastic, I constantly talk about how I hate this and that and how some stupid commercial pisses me off to no end each time I see it, and now I publicly display myself as a difficult, awkward, annoying person instead of keeping my self-doubts and my negative self-image AAAALLL under tight wraps. So when someone says “If you want to be liked, don´t be negative!” I feel rejected. Rejected as in: Nobody could ever like you and you even deserve that because “ha ha, now, I know we have all seen those disgruntled naggers before, and, really, you just don´t want to be like them, do you? They are a real pest, don´t we all think that?” *social skills students nod and mutter in heartfelt agreement*

Telling me what to be and what not to be suggests to me that certain traits are inherently bad or ridiculous or that people with such traits can never be liked. In fact, many of the things she touches upon are not bad character traits at all. There is nothing wrong with having a special hobby or being extremely interested in a completely exotic subject. It´s actually quite beautiful. And being sarcastic can be a coping mechanism – or a special talent for comedy. Giving people advice how to use such character trains is fine, but telling them not to BE nerdy or sarcastic is judgmental, and a form of shaming.

2) She conveniently assumes that everybody likes the same kinds of behavior in a person, or even the same character traits. Let´s stick with “don´t be negative”. The assumption behind this advice is that everybody likes positive and dislikes negative people. This, however, is simply not true. I, for example, like negative people. When I´m surrounded by do-gooders who are all buzzing with harmony and brotherly spirit, I am extremely grateful for anybody who mutters a disgruntled comment about how this constant optimistic smiling and the exaggerated kindness remind him of a cult. Then again, I am just a loner socially awkward loser who won´t even admit he has a problem, so my standards probably don´t count.

I would love to finish this with some great words of wisdom, but it´s half past four in the morning and I´ll fall asleep with my head on the keyboard if I don´t go to bed. I might come back to this subject at another point, but at the moment I cannot keep my eyes open anymore.

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A destructive relationship – Therapy with Dr. Stoneface, part IX

Posted in health, mental health, personal with tags , , , on May 20, 2012 by theweirdphilosopher

I guess it is about time to bring my account to an end. I will try to do so with this post.

What I will describe here are not so much concrete sessions and arguments with Dr. Stoneface, but rather the style of arguing which really show how destructive our therapeutic relationship had become. I don´t know when exactly most arguments took place, I don´t remember their correct order. I only know that there were immensely destructive sessions already after one year of seeing him, if not all the time. Nonetheless I stayed for another year and about three months. I quit on some day in December over two years after I first consulted him, and I quit during an argument. I will talk about that, too.

So. I don´t remember the exact content of many of those arguments, but I certainly remember the style and my responses. I would try to get a point across, and he would interrupt me all the time, asking me questions (it could be as simple as explaining a word), and while I was trying to answer those, he would ask me additional questions until I had no idea anymore what we were talking about. In order to clarify my point, I can give you an example that never happened in quite this way, but definitely depicts his style of arguing.

Me: “I don´t want to lose the ability to enjoy safe, non-compulsive cutting for pleasure and turn into…”

Him: “Wait, what do you mean by “safe and non-compulsive”?”

Me: “I mean that I don´t feel like I have to do it because of some kind of inner pressure, but I decide that I…”

Him: “But what is inner pressure? Is a sexual urge not inner pressure?”

Me: “Okay, maybe what I mean is a destructive impulse…”

Him: “An impulse to cut is always a destructive impulse, it is an impulse to cause harm to your body!”

Me: “I´m talking about destructive on a different level, a psychological one, not the immediate physical level…”

Him: “But is it possible to separate mind and body? There is always a bodily correlate of emotional states. When you are angry, your muscles go all tense and…”

Me: “But that is an entirely different subject! Are we talking in two different languages or something?! Don´t you realize that I´m simply trying to say it makes a difference if you do something with the intention to harm yourself or with the intention to get pleasure out of it?!”

Him: “Now I´m feeling all stupid. You make me feel like I´m just a useless nitwit who has no clue about anything and can´t understand anything.”

This last line is something he indeed said quite frequently. Basically whenever I told him that something he said was nonsense. I didn´t know yet that using your brain constitutes emotional abuse. I do believe, though, that destroying your opponents intellectual abilities by systematically interrupting and overloading them with questions that distract from the point they are trying to make – does. As I recently learned thanks to an awesome post in another blog, there actually is a name to this: It is part of a thing called “confusion technique”. As I looked for them term in Google, I came up with this article, a pretty well description of what Dr. Stoneface did to me.

I also know now that Dr. Stoneface´s remark about me making him feel useless and stupid was probably not a mere passive-aggressive outbreak, but part of a therapeutic strategy. A few months back I already wrote about this article on treating narcissism. The article basically describes the approaches of two different psychoanalytic schools, the one by Kohut, and the one by Kernberg. With the help of some Internet research I found out that apparently Dr. Stoneface is an adherent of Kernberg. Kernberg´s approach suggests that the patient might evoke feelings of helplessness, frustration and incompetence in the therapist. The therapist should respond to this by pointing out that it feels to him like the patient is trying to make him feel impotent and defeated.

The assumption behind this approach is that the therapist´s reaction reflects the emotions of the patient:

“Because the patient treats the therapist as an extension of the self, the patient is likely to induce in the therapist certain states that reflect what the patient is struggling with.” 

So, basically, Dr. Stoneface might have assumed he was expressing how I was feeling. In a way, he did. Being bombarded with questions that undermine everything you could build an argument upon and an opponent who is completely unwilling to try and understand your the point you are trying to make necessarily makes you feel kind of stupid and helpless and defeated. So what Dr. Stoneface reflected back to me was a feeling he himself had induced in me through his own abusive behavior.

From afar, this either looks like utter incompetence – or like a very subtle and intelligent form of sadism. One mustn´t forget, though, that Dr. Stoneface (probably along with most other psychoanalysts) assumed that there was no difference between therapy and real life. He probably thought that if I felt stupid and helpless in therapy, I always felt stupid and helpless. The idea that he could do that to me all on his own was probably unimaginable to him. It must be transference. He also assumed, after all, that just because I didn´t trust him I didn´t trust anybody at all.

There were times when I refused to continue arguing. Sometimes I pulled out my mp3-Player, inserted my ear plugs and listened to Rammstein at full volume. Sometimes I just sat there, staring into the void and refused to answer. He continued talking to me, giving me easy baits or trying to provoke me, but even when I was fuming or shouting angry replies in my head, I kept my mouth shut. I didn´t even look at him. Nonetheless, I stayed until the session was over. I would leave exactly on time. And I always returned. Only once I left a session early, and while storming out I anxiously asked him if I would have to pay a fee for that. I was basically asking him for permission to “act out”, which rendered my “acting out” fairly inauthentic, ridiculous even. I still don´t fully understand my behavior, and I guess investigating this will require an entry of its own.

At other times I was trying to persuade him to let me go. To make him agree that I should leave therapy, that we were a complete mismatch. He, however, refused. Such a discussion could go about like this:

Me: “We are making no progress. I´ve been seeing you for two years and we´re still not getting anywhere!”

Him: “Well, what is your goal for therapy? Why are you here?”

Me: “I don´t even KNOW why I´m here! I don´t WANT to be here!”

Him: “Well, you ride through half the town once a week to see me, that is quite an effort. I´m pretty sure you wouldn´t do that unless at least part of you wants to be here.”

Me: “What if it is a compulsion? What if I merely feel compelled to come here, just like an alcohol addict feels compelled to drink!?”

Him: “I´ve never met an alcohol addict who  didn´t on some level want to drink or enjoyed it!”

Even if “part of me” wanted to be in his office that part could still have been wrong, but he didn´t take that into consideration. Neither did I, at the time. I find it remarkable, though, that he would speak of parts. He would say that “part of me” wanted to be in therapy, and then he would speak of another side of me who “wanted to destroy the relationship we built up in therapy and everything we achieved”. I wasn´t aware that we had achieved anything or that our relationship was anything other than destructive itself, but the more interesting point is that – wait a second? A goddamn wise, mature, analyzed, cured, neurosis-free psychoanalyst resorts to a “primitive” defense mechanism like splitting?!?! May I laugh for a moment?

Yes, I am being mean. Attributing a “destructive side” to me, however, was indeed a way in which Dr. Stoneface could make himself believe that he was the right therapist for me, so it actually did serve some personal purpose for him. I found that out during a discussion about just that subject: Maybe we were a therapeutic mismatch. Maybe this simply couldn´t work out. Dr. Stoneface denied that, saying that he felt he could cope and work with me very well.

“No, you can´t,” I said almost sadly, not really knowing where the words were suddenly coming from. “But you don´t realize that because each time you cannot cope with me or things get too rough you simply accuse me of destroying everything.” It was the first time I actually managed to shut him up.

After re-reading the article on narcissism I referred to further above, I realized that this client-blaming behavior is actually enabled by the Kernbergian theories Dr. Stoneface adhered to. In the article, it says:

“The therapist may begin to experience himself or herself as ineffectual, incompetent, invisible, and needing to work harder, with feelings of anxiety before the patient’s sessions and impotent frustration and self-doubt afterward.”  

These, in my view, are all signs that maybe the therapist shouldn´t be working with the patient. Neither should a therapist continue working with a patient at the expense of his own well-being, nor do I believe that it is of any particular help to the patient if he does so.  The article, however, goes on like this:

“These countertransferential feelings are important diagnostic and therapeutic data that the therapist ignores at the peril of the treatment. Indeed, the recognition and proper use of countertransference in the treatment are critical in working with narcissistic patients.”

So – the fact that the therapist feels useless is important data not for diagnosing the therapist (“apparently he is not the right person to work with this patient”), but for diagnosing  the patient?

The reason for this is that all the negative feelings the therapist experiences are seen as a result of the patient´s projection of his or her own inner states onto the therapist:

“Because the patient treats the therapist as an extension of the self, the patient is likely to induce in the therapist certain states that reflect what the patient is struggling with.”

The resulting treatment recommendation:

“Because narcissistic patients are likely to “bring out the worst in their therapists” by inducing in them feelings of anger, confusion, boredom, or lifelessness, it is especially important to scrutinize one’s countertransference responses before using them for therapeutic purposes. In particular, via projective identification, the narcissistic patient can bring about insensitive, unempathic, attacking responses if the therapist loses sight of the fact that these reflect the patient’s inner state”

So basically it is my own fault that Dr. Stoneface attacked me? So he was only abusive because it is  actually me who is insensitive, unempathic and attacking? So he basically wasn´t abusive at all – in fact I am the one who abused him? If anything, he cracked under the burden that is working with me, but he didn´t really do anything wrong? I am so inherently toxic and hateful and aggressive that I make selfless, skilled and empathic people who only try to help me so miserable that they act out all my dark, hidden intentions and impulses? Wow. I should really go kill myself, but that would be passive-aggressive, now, wouldn´t it? Then again, I had no idea I had that much power. I must be some kind of super-villain. Gotham City, here I come.

On a serious note, though: What we see here is a normalization, a pseudo-medical justification of what Dr. Stoneface did to me. According to this theory, it is normal that therapists feel like they cannot cope with their so-called narcissistic client. It isn´t even just normal, it is essential, because it provides them with secret knowledge about the patient´s evil intentions. In a way, the therapist is just as stuck with the patient as the patient is stuck with the therapist. It is normal that the patient wants to leave therapy, and it is normal that the therapist feels incompetent. Wow. Just what the fuck, really.

Is there anywhere, just anywhere a reality check built into this? Maybe the therapist really is incompetent, at least for that specific patient. Maybe the patient is right wanting to leave. Maybe it simply is a mismatch, or maybe therapy is complete bogus in the first place. The ideology to which the likes of Dr. Stoneface adhere doesn´t leave room for any of those options. Maybe on a theroretical level, yes, but there is no way you can ever prove that any of those options apply. All evidence is subject to interpretation – the interpretation of the therapist, and the result is bound to be: “Yes, I believe there are people who cannot be helped with therapy/abusive therapists/completely disastrous and destructive therapies….BUT you aren´t/I am not/this isn´t one of them.” Proof? Zero. Can you prove him wrong? Nope. A theory that cannot be falsified, however, is about as scientific as a conspiracy theory.

A typical reply Dr. Stoneface might give here is: “Does everything always have to be about science?” It is obvious that this is a possible next step. You can point out that a certain theory is not scientific, and then you can decide whether or not it nonetheless has some value. Of course you can question if it is good that our age is so fixated on science. We do that all the time in philosophy. Coming from him however, such questions  weren´t a sign of intellectual openness and philosophical interest. They were mild accusations. In the admittedly fictional example above he would be insinuating that I always make everything about science, which probably isn´t even true, and his tone would suggest that this is somehow bad.

While we never talked about science, there was an actual conversation in which he asked me why it was so important for me who was right, or that I was right. One would think that it is fairly self-evident that it is important to a person if she is right or not. It does make a difference if you are right about something or not. Imagine you suspect that you have cancer. The question whether you are right or wrong might be a matter of life and death.

I understand that it is supposed to be part of therapy to “challenge” your beliefs and preconceptions. But not all beliefs and preconceptions a patient has are necessarily bullshit or pathological. They might be mere  common-sense, they might also be very elaborate and thought-out. And if you “challenge” such beliefs, then you´d better have a good reason for that. If you cannot in any way explain how the belief is supposed to relate to the patient´s pathology, then you are obviously just “challenging” random beliefs with run of the mill “critical thinking”; and that is mere filibustering. And even more so when you do that during an argument. Imagine a conversation like that in real life:

Wife: “How could you cheat on me, I feel so betrayed!”

Husband: “Why is it important to you not to feel betrayed?”

Now look at my argument with my therapist:

Me: “I believe x, you believe y, but because of factor a, b, c and d I believe that I am right!”

Him: “Why does it have to be such an issue who is right?”

Huh. Maybe not so much who is right, but what is right. It is a matter of x or y, not a matter of him or me. He didn´t even distinguish between those two questions, making me feel like an obnoxious, pedantic know-it-all. That aside, he also made me feel like an ignorant for having any beliefs at all. I know that most of our beliefs rest on a Mount Everest of assumptions; assumptions which we might or might not have thought about. I´m only starting to understand that he wasn´t entirely as dumb as he sometimes seemed to be, because he definitely could point out assumptions. He did it all the time. Or rather: He questioned my unspoken assumptions all the time. Assumptions like: “Yeah, it kinda sorta IS important if you are right or not.” Merely by pointing out the assumptions on which my arguments were based made me feel immensely insecure because I realized that I hadn´t thought about nearly half of them. I was quick finding arguments for these assumptions, but before I could make them – Dr. Stoneface would interrupt me with another question challenging the assumption my argument for my previous assumption was based on. My insecurity, my feeling that I was stupid and thoughtless just increased.

I know now that doesn´t mean that I am really stupid and thoughtless, not more than any other human being. Show me the one person who truly doesn´t make any assumptions! After trying hard for many years, I believe it is simply a psychological impossibility to not have any opinions and not make any assumptions – and having attended an epistemology class or two I also know that so far we haven´t found a way yet to prove that we aren´t all being deceived by an evil demon, or that we aren´t all brains in a vat, so all of our assumptions are relatively insecure on a larger scale. In order to cope day by day, though, we need to make assumptions and on a smaller scale, there are good and not-so-good arguments for the different assumptions we can choose between, and in order to decide what to believe, we have to rely on those arguments, or rather evaluate them; and if we don´t agree on something, we will use those arguments in order to sort it out.

In a normal argument, however, both participants use arguments which are based on epistemologically unproven assumptions. Of course such assumptions are sometimes challenged in an ordinary argument. But the one who challenges the other´s assumption typically has to provide some kind of argument or reason for challenging it. Like: “Do you really think that all kids are stupid, because I know some really smart kids!” Both participants are equally vulnerable to the epistemological skepticism that questions everything up to their own existence.

This was not the case with Dr. Stoneface. I was doing all the arguing, and he was merely asking questions. He didn´t have to justify his questions, he didn´t have to explain his own point of view. I guess I asked him many times what his take was on things if he believed I was so wrong. He could always block such questions by telling me that 1) he never said I was wrong and 2) therapy was all about ME and MY beliefs. Or by asking me why it was so important to me to be right.

This rendered me powerless. I couldn´t return the challenge. All I could do was trying to justify and explain my views in a fight which was designed in a way that made it impossible for me to win. Basically I spend two hours a week subjecting myself to a sophisticated intellectual humiliation. I sometimes wonder if Dr. Stoneface was aware of this. Even did it on purpose. It must be quite obvious, after all, that my intellectual abilities are what my “narcissism” is clinging on to. Did it merely give him some aggressive kind of satisfaction to obstruct and defeat them, or did he even believe it was therapeutic? Maybe helpful in battling my resistance? Or wasn´t he quite as almighty and omniscient as I sometimes see him as? Maybe he had lost all control over the sessions long ago?

Provoking him into losing his cool was the only way I could feel some kind of power again. Sometimes I would simply sit there and eat and watch with a mixture of satisfaction and wonder as he started to raise his voice and demand that I stop eating in session immediately. Another time he gave me a questionnaire and asked me to fill it in without thinking much about it. I, however, comfortably read through the questions, and he started to yell at me that I was abusing the questionnaire in order to avoid talking to him. His accusation (“abuse” is a very harsh word) shocked me, but it also gave me an sick feeling of satisfaction that I could make him behave like an idiot by doing fuck all. I simply couldn´t take him seriously. How could anyone be that upset over me eating in session, or for looking at a questionnaire? I had a feeling that he was merely displaying anger in order to affect me in some way, and sometimes I felt like I was part of some stupid play or some secret melodrama.

The situation when I finally left for good was very similar. We had been arguing in a destructive fashion, I had probably been quite a bitch and I had somehow accused him of being arrogant. He really lost his cool and yelled at me: “Why, it´s YOU who is arrogant…” Once again, I had this weird, mixed reaction. On the one hand, I felt adrenaline shoot all through my body, a mixture of shock and rage. On the other hand, though, I felt like I was part of a staged therapeutic outbreak again. I felt reminded of the movie “Girl. Interrupted.”, where people are healed because they provoke someone into screaming the ugly truth into their faces. Wow, I thought. This is probably the moment where I should crumble because suddenly I am shown my true face. I didn´t crumble. I grabbed my stuff and said: “So you´re trying the asshole method? Fine. I´m outta here. It´s useless, and we will never get anywhere. I quit!”

Dr. Stoneface tried to argue me into seeing him for four more sessions in order to talk about how to cope with the break-up and why it had happened. I declined. He tried to pressure me by saying that I had agreed to have those sessions if I should quit, and indeed I had back then, over two years ago. I didn´t nearly respect him enough anymore, though, keep my “promise”. I asked him if I would have to pay him a fee if I didn´t have those sessions. He asked me why that was so important to me, as he always did when we talked about money. I told him to cut the crap and asked him again, and eventually he told me I wouldn´t have to pay. I left his office for good.

A few weeks later he sent me a letter asking me to pay a fee for a session a few months back which I had supposedly missed. I had no idea if that was true or not, but I seriously didn´t feel like arguing. I just payed. Just days afterwards, he sent me another letter.

“I forgot to mention that I wish you all the best. It is important that you pull through your own thing.”

Or something the like. I cannot be arsed to dig up that letter now. I have no idea why he wrote me. Maybe he wanted to end our therapeutic relationship on a more positive note. Maybe he also wanted to retrospectively own my decision to leave by approving of it. Me doing what I thought was best for me, even if it meant leaving therapy, had never been one of his top priorities while I was still seeing him.

I never regretted leaving therapy. I am once again struggling with several mental health issues, but I´m fairly sure Dr. Stoneface would not have been of any help.

I have hereby finished my account of my time with Dr. Stoneface, though I might add another entry or two if I remember more stuff. What I am not done with, however, is dealing with the aftereffects and the issue of therapy in general, and I will certainly keep on writing about that, though maybe not straight away.

So long.

 

 

Arguments – Therapy with Dr. Stoneface, part VIII

Posted in health, mental health, personal with tags on May 11, 2012 by theweirdphilosopher

My memory of the two years with Dr. Stoneface is fairly weak. I remember certain incidents, certain things he said, and the general mood. I´m having a hard time putting these things into context or into a clear time line. It is something that bugs me a great deal because that way anybody could say that maybe my memory is very selective or distorted – and I couldn´t really prove him wrong. And how could I, given that not even I myself trust my own perception and memories? Sometimes I wonder if what I am doing here, writing this blog, making him look so bad, being so sarcastic and vicious – is highly immoral. Sometimes I feel like a witty lawyer who can twist around the truth in order to cast his client in the best light, a lawyer who might have the superior arguments, but who is still wrong. I feel like there is a deeper truth that I don´t tell my readers; a truth I cover up with clever arguments. And I feel like while on the surface, that is, on a rational level, I might convince everybody that I am right, their gut feeling will tell them that this is not the entire truth. That I´m hiding something. Something that would completely change their view on me if only they knew about it. A hidden evil inside of me that justifies Dr. Stoneface´s behavior.

This taken together, my weak memory and my feeling that I´m being dishonest makes writing about my time with Dr. Stoneface a little difficult. I do, nonetheless, want to finish my account. Today I will write about arguments we had about the general setting of therapy. Next, I will write about the destructive dynamics that developed between us – my “bad behaviors” and his reaction. Then, I also want to write about my general issues with therapy – emotional as well as intellectual issues.

So now for today´s topic: The arguments about the general setting.

Money, Missed Sessions and Responsibility

While my therapy in general was payed by my health insurance, I had to pay Dr. Stoneface a fee whenever I missed therapy. His policy was that when I told him in advance the fee would be smaller than if I simply didn´t show up. He had also told me that if he managed to use the session for something else, like another patient, or supervision, I wouldn´t have to pay the fee. When I asked him if I also had to pay if I was ill, or if I told him months in advance, he said yes. I told him that I didn´t think it was fair, and he, with some irritation, responded that “everybody” handled the matter like this. When I spoke to a patient who was seeing a different therapist, I found out this wasn´t true.

Now, in my second year in therapy Dr. Stoneface suddenly told him that I still owed him a fee for a session I had missed by the end of July. I´d like to mention that by the time he told me so it was October or November. At first I was shocked – I felt like a thief or a crook – but then I got angry. Why hadn´t he told me before?! Did he assume I had done this on purpose?! I had simply thought that if he didn´t mention the fee it meant that he had been able to use the session for other purposes, which wasn´t unlikely since he had known I was going to miss the session a few weeks in advance. I told him it was a misunderstanding; that I had thought he had been able to make use of the session, and I asked him why he hadn´t just told me earlier. His reply:

“If you miss a session, it is your responsibility that I get my money!”

Another of those sentences that both leave me helplessly angry and deepen my self-doubts. On the one hand, I simply knew, knew that this was bollocks. When people don´t pay their debts, you remind them of it.  You cannot expect somebody to give you money if he doesn´t know he owes it to you. Therefore, you write him a bill, and if he doesn´t respond to that, you remind him of the bill.  “Everybody” handles it that way. So what Dr. Stoneface did here is a textbook case of passive-aggressive behavior. Don´t remind the patient of the money she owes him, wait a few months if she realizes it, then suddenly bring up the subject and: Make her feel like shit. Like she cheated you. Like she doesn´t accept her responsibilities in life. And here´s my “on the other hand”. I immediately felt like it was my fault or might be my fault somehow, on a deeper level which is somehow not touched by rational arguments.  I still feel like I need to justify myself, clear myself of the accusation that I´m a person who doesn´t accept her responsibilities. I can never win that internal argument. I always find some way in which I could have known, could have thought of, should have made sure. It is driving me crazy.

There was another occasion when the roles were more or less reversed. I had overslept, woken up only five minutes before the start of the session, called him and canceled. In the next session, he demanded the full fee. I told him I only owed him the reduced fee since I had canceled the session before, if only five minutes. He had never told me, after all, there was a certain deadline before which I had to cancel a session. My argument was fairly indecent; while I had not broken the letter of the law, I had not conformed to its spirit. The point of giving him a warning in advance, was, after all, that he wanted he chance to make use of the session in another way. It illustrates, though, our style of communication. We were arguing as if we were in a court room. While he grudgingly agreed that I only had to pay a reduced fee, he next grilled me about the deeper meaning of my oversleeping. My point of view was that sometimes people oversleep, full stop. His point of view was that it was no coincidence that I had overslept and missed therapy (!!!), thus indirectly making me responsible for oversleeping.

The third incident I want to talk about happened shortly after my aunt had died. I had caught a cold during the funeral and when I was sitting in Dr. Stoneface´s office I realized I probably had a temperature. Quite frankly, I was feeling miserable. We were, once again, arguing about something, and at some point I stated that I probably should be at home in bed anyway. He told me it was my responsibility to show up for therapy in a state that made therapy possible, and when I told him I hadn´t wanted to pay a fee again, he said it was my responsibility not to get ill.

I can see how on some level he had a point. It happens that people get ill, it might be none of their fault, but still they have to deal with the consequences. It´s a sad fact of life. He didn´t present it as a sad fact of life, though. He said it in a seemingly matter-of-factly way, but there was also a trace of self-righteousness, even satisfaction in his tone. We were still in the middle of an argument, and I was the one who was about to lose.  In turn, I angrily told him that I had caught that cold on the funeral of a relative, feeling that this should shut him up. Even make him feel a tad guilty. I was sort of ashamed of my behavior, though, since I hadn´t been very close to that aunt after all. And of course my outbreak didn´t affect him in the slightest.

Something Dr. Stoneface was completely lacking was benevolence. He was never ready to accept that any kind of failure on my part (not paying the fee I didn´t even know I had to pay; oversleeping; getting ill) was a coincidence, or down to a misunderstanding. I probably made the first mistake by being late to the first session. He might have seen it as a sign of resistance – I, on the other hand, see it as a result of me having been in a state of crisis, confusion and inner chaos. He never showed any kind of empathy, leave alone sympathy for me. He never treated me as a person who is suffering. “Can´t you look at yourself with some compassion,” he once asked me, “can´t you look at your flaws with some leniency?” Well; could he? It is not enough to assure the patient that nothing the therapist says is to be taken as an insult because, after all, it is just unconsciously  that the patient is being irresponsible, sabotaging therapy or oversleeping on purpose. If the therapist seeks any deeper meaning behind those failures, the patient can´t help but feel like he must have done it on purpose without knowing it. And feel responsible for things he cannot do much about, like oversleeping or being ill at times. How does that help anybody to be easier on himself?

Timing and frequency of sessions, taking breaks 

Apart from money, there was another thing Dr. Stoneface and I were frequently arguing about in the first months of my second year with him, and that was both the timing of the sessions, and their frequency.

One year after I first consulted Dr. Stoneface, I had started studying. My schedule changed frequently and I asked Dr. Stoneface if we could re-schedule my appointments with him in accordance with my university schedule, just to make sure I could attend all the classes I wanted. Dr. Stoneface, predictably, declined, and in a way that made me feel as if I was impertinent for even asking. There might have been a million reasons why it was impossible, but he didn´t give me a chance of respecting those reasons because he didn´t tell me even one of them. And so I once again arranged my life around my therapy and not vice versa, which is ironic, given that therapy actually should help you lead a more fulfilled life.

Around Christmas I was sick and tired of Dr. Stoneface, of our sessions and of therapy in general. I was very unsure, though, if I could really do without therapy. I was feeling better, but wasn´t I highly disordered, even on a personality level? Wasn´t I sure to mess up my life again as soon as I left therapy?

I started to ask him tentative questions, like: “Are there people who are incurable, who cannot be reached through therapy?” Dr. Stoneface would typically agree with the general statement, but he was not willing to agree that I was one of them. With some kind of circular reasoning he told me that you only knew a person couldn´t profit from therapy when that person dropped out. As long as the person was still in therapy, there was still a chance it would help. So – the only people who cannot profit from therapy are those who drop out? That was probably very much a therapist´s point of view, but it didn´t help me make a decision. How could a patient know, after all, that he wasn´t profiting from therapy? How could he make the decision it was time to drop out? One has to look at the consequences of this twisted logic:

1) You never know if a patient is incurable unless he drops out and refuses to undergo therapy.

2) In order to drop out, you have to make a decision to do so. It doesn´t just happen. And you will want to base that decision on the justified true belief that the therapy you´re currently undergoing doesn´t help you and very likely won´t help you in the future.

3) It is impossible to determine that therapy isn´t helping you or won´t help you in the future. Unless you drop out for good, there is always a possibility that therapy will change your life for the better.

4) You cannot make the decision to drop out.

Faced with this dilemma, I tried to find another way to see if maybe I could do without therapy. I asked Dr. Stoneface if maybe I could take a break to see if I was really capable of going on without him, and if it didn´t work out I could start seeing him again. Of course he refused. I learned since then that this, too, is not how “all therapists” do it. There are therapists who allow their patients to take breaks, or who “ease them out of therapy”.

What I tried next was that I asked Dr. Stoneface if maybe I could just see him once a week?  I didn´t feel like I needed to see him twice a week, and I wanted to get slowly used to coping without therapy. At first he was completely against it, but after a long and tedious argument which I do not remember he finally gave in. From January on, I would see him only once a week.

More to follow.

 

 

 

Keeping me in therapy – Therapy with Dr. Stoneface, part VII

Posted in health, mental health, personal with tags , on May 10, 2012 by theweirdphilosopher

I didn´t have much time to write over the last few days, but today I want to describe two incidents where Dr. Stoneface actively kept me in a therapy which was basically ineffective.

Keeping me in therapy, part I

The first incident happened sometime in the first half year, probably in June. I had just graduated from high school and I was thinking about moving to another city in order to study at a college that offered a special program for students who didn´t know yet what they wanted to specialize in. It seemed perfect for me. The only problem was my therapy. Would I be able to continue?

My parents told me to not let therapy stop me. If I felt I still needed therapy, I could look for a new therapist in the town where the college was. Indeed I wasn´t so attached to Dr. Stoneface that I would have particularly minded. It seemed very wrong, though. I knew that at least my father didn´t think much of therapists, I suspected that he had “reasons” for this, and so I assumed he was biased. I assumed that career came before psychological cleansing in his book, and I didn´t want to be that kind of person. Mind you, I believed at the time that academic success was pretty empty; something I only aimed for in order to feed my narcissism. It was my parents, after all, who had probably instilled this narcissism in me, so why should I trust them now? Also, I didn´t want to change therapists once again. Just for once I wanted to stick to a decision, not run away as soon as I felt just a little bit better.

Therefore, I was looking for a possibility to combine both my ongoing therapy and my desired course of study. The town where the college was was only a two hour train ride away from my home town. My appointments with Dr. Stoneface were on Mondays and Fridays. If I could have an earlier appointment on Monday and a later one of Friday, then maybe I could still see Dr. Stoneface if I went home each weekend.

When I asked Dr. Stoneface if this was possible, he just plain said no. When I asked why, he, in an irritated manner, said: “I´m not going to do this.” As if “this” had been a complete abomination. I mean, I hadn´t asked him to kill babies. I had just hoped for his cooperation. Make it possible for me to stay in therapy and find out what I wanted to specialize in. I don´t see why the question should have offended him; it showed, after all, that I was still motivated for therapy. I said that maybe, if he didn´t want to do this, I should rest therapy for a year (the program ran only for a year) and then return, or possibly see someone else in the meantime.

He shook his head. “I don´t think you are ready.”, he said. I was getting somewhat irritated. “Well, how long do you think healing is going to take?” I asked. “When will I be ready? I cannot arrange my life around therapy forever.” He wavered with the answer, then he said: “Maybe about two years.”

His reply validated my feeling that something was severely wrong with me; I felt taken seriously. On the other hand, though, it hit me. Two years. So much time. I had just graduated from high school; should I not start to plan my life, live my life? And what was it that was so wrong with me? What was my diagnosis? When I asked him about that, again he didn´t give me a reply.

In retrospect, I notice a certain contradiction in him giving me a time frame and his typical behavior when I asked if he thought I was making progress. By the time the above described conversation took place, I had already voiced doubts and dissatisfaction several times. Whenever I did so, however, he would reply: “Why are you here?”, or: “What is your goal in therapy?” I had trouble answering those questions, which should have alarmed any responsible therapist. Aside from that, though, I also believed that he should know what the goal was. He had diagnosed me with an illness; and if he had a concept of mental illness, I expected him to have a concept of mental health as well. I expected that he knew what a cured narcissist/borderline/schizoid/neurotic or whatever he thought I was should look like. And the fact that he gave me a time frame, that is, “two years”, suggested that he did have a concept both of my illness and of a possible healed state which I should aim for; and a plan how to get there. How else could he come up with a time frame, after all? Unless he expected that my insurance wouldn´t pay longer than that…

No, I guess he oriented himself towards the common belief that personality disorders require at least two years of treatment. Nonetheless, though, he cannot expect me to know what my goal is if I don´t even know what my diagnosis is. All I felt was that something was wrong with me, but not what exactly it was. That´s what I would have needed him for, but he refused to give me any orientation.

I think that it is a great idea to offer counseling or advice to people who want to reach a personal goal (though that is called coaching and not therapy), and to leave it up to the client to decide what the goal is. I´ve become very skeptical with regards to psychiatric diagnoses anyway, and I don´t really trust therapists´ ideals of mental health. So if I had come there with a specific goal and Dr. Stoneface had said: “Fine, in order to reach that goal, I suggest this (treatment) plan.” – great. Unfortunately, though, this isn´t how therapy works, no matter how often Dr. Stoneface asked me what my goal was or assured me that the sessions were “my time”, “my personal safe space where I could completely look at myself and myself only”. The one time I had said what I wanted from therapy, or rather, what I didn´t want, that is, have my sexual preferences changed – he had reacted dismissively. This leaves me to conclude that Dr. Stoneface:

1) did have a treatment agenda and a concept of the desired result, but

2) kept me in the dark about it until the end while

3) seeing my goals as a sign of my pathology, even though he

4) suggested to me that it was all about what I wanted from therapy.

Whenever I complained, asked him about my progress or questioned the treatment, Dr. Stoneface would more or less return the question, asking me what my goal was or why I was in therapy. It reliably made me feel like the lack of progress was my fault; if I didn´t even know what my aim was, how could I expect to reach it? It made me feel like I was not participating properly, not being sincere enough, not giving therapy enough thought. And indeed I still felt fairly indifferent towards Dr. Stoneface. I didn´t know how other people managed to actually fall in love with their therapists. So maybe I was really just too passive. Too lazy. Incurable. Also, of course, “why are you here” can sound like he was questioning my right to be in his office. It felt a bit like “what are you even doing here?”, even though he didn´t make it sound like it.

Whenever I mentioned ideals of mental health he didn´t agree with, or, even worse, talked about the possibility of leaving therapy, however, suddenly Dr. Stoneface did seem to have a concept of mental health and a treatment goal for me. And he also seemed to be capable of evaluating my progress with regards to reaching that goal. But for some reason he decided to rather not tell me what the goal or the plan was. Only if I “threatened” to leave therapy, he gave me a tiny bit of what I was “demanding” (I´m not using quotation marks in order to quote him, but in order to signify what I think might have been his view on this). If I complained that he was keeping me in the dark about his agenda, of course, he´d deny he even had an agenda.

Keeping me in therapy, part II

Other than the title suggests, the second incident wasn´t an immediate attempt to keep me in therapy. It was pretty harsh, though, when you think about it.

It was September when it happened, I had been seeing Dr. Stoneface for one year. A lot of things had changed for me, but it didn´t have much to do with him. In July I had started a new relationship and compared to how I had been feeling before, I was over the moon. Thanks to my new relationship, I was now challenging the self-doubts and the self-loathing my failed friendship had instilled in me. Life had something new to offer, life was promising, worth living again. And I had a right to feel happy. I no longer had to punish myself all the time. I could listen to music whenever I wanted, and to whatever music I wanted to hear.

My life style changed around. I spent the nights out with my new girlfriend, we were sitting in the park, drinking, singing until the birds started chirping and the first joggers were passing by. Everything was more important than academic careers, and so, thanks to my new relationship, I decided to not move. This also meant, however, that I could still see Dr. Stoneface.

Dr. Stoneface had been on holiday in August, just when my relationship started to bloom. Naturally, I didn´t miss him very much at all. When he returned, it was quite awkward to be sitting in his office again. Did I even still need this? But then again, what if my relationship broke up again? Wouldn´t I be back where I had started?

At any rate, however, I didn´t quite know what to talk about and the session was difficult. I didn´t feel like sharing my joy with him, I wanted to keep it private, between me and my girlfriend. I felt that this was our business, not his. An area of my life in which he had no part. (Now that I´ve read a thing or two about psychoanalysis, I understand how analysts must react to this. “How naive! She thinks she can successfully undergo therapy if she has a relationship that is more intimate than the one she has with her therapist!”)

Dr. Stoneface somehow seemed to believe the silence had something to do with him, or with the relation between him and me. He suggested that it had to do with his long absence (whatever, maybe he thought I was punishing him for taking some holidays, poor lad, huh! I´m not that evil.) I denied that, saying that maybe it explained the awkwardness (hello, that´s normal!), but that there was no deeper reason behind my change of behavior, at least nothing that had to do with him. When he insisted, I got slightly irritated, asking him why he assumed that everything I did somehow referred to him (blessed naivety!). His reply:

“Well, I do believe I´m the most important person in your life at the moment!”

Okay, there must be some kind of misunderstanding. Let´s make sure I got this right: “So you think you are more important to me than my parents, sister and new girlfriend?”

“I don´t think anybody else devotes two hours of his time to you every week, focusing his attention just on you!”

I told him that this was obviously bullshit because I spend much more than two hours each week with my girlfriend, and even my family, no matter how difficult my relationship with them. Of course we both understood the subtext, though. “They don´t have the quality time and attention to offer that I have. With them, it´s not about you. Maybe they don´t really care about you and just spend time with you because they have nothing else to do.”

One side of me thought that this was complete bullshit; that he was apparently pretty egocentric. He had sounded like the caricature of a psychoanalyst, like he expected me to be in love with him. The other side of me felt that he probably had some deeper knowledge about my relationships (how, though?), knew they were unreliable or unloving on a deeper level and that he simply hadn´t put it right. Maybe I was unable to understand what he meant because of my illness, who knows.

And all in all, I would still stay with him for more than one more year.

I wonder what all this looked like to him, like, if he really thought I was a narcissist. Hm…”the princess” wants special treatment (have my sessions at another time so I can both study and go to therapy). She needs to be put in her place given a perspective of what she can reasonably expect from him (nothing). Her reaction: Narcissistic rage, she threatens to abandon therapy. You can always bribe her, though, by giving her something she has demanded at other times: Information on the treatment plan.

What about the other incident, though? If he really thought I was a narcissist he must have believed he had hit me horribly hard with this. I mean, telling a full-blown narcissist that her therapist is the only one who pays full attention to her for two hours a week….

And I merely wanted to defend my idea of quality time. Quality time is spending a night out in the park with my girlfriend, not “being payed complete attention to” by an old man who at times repeats what I say and refuses to tell me anything about himself or what we are even doing here.

I only wonder if he expected or even intended to hit me with his comment. I will obviously never know. All I know is that it was a very uninformed and a very irresponsible comment. I should have expected nothing else, though. A year earlier he had already told me that my sister Irene didn´t care about me, just because she had a different view on blood fetishism than he.

 

 

Unfulfilled needs – Therapy with Dr. Stoneface, part VI

Posted in health, mental health, personal with tags , , on May 4, 2012 by theweirdphilosopher

I certainly wish I remembered more details of my therapy. I barely have any significant memories from the first half year after the probationary sessions, that is from January until July. I´ll write down whatever I remember.

I saw Dr. Stoneface twice a week, on Monday and Friday, each time for 50 minutes. I had to drive through half the town in order to see him; and since I have no car, it was a train ride of almost an hour. Normally that would not have been such a big deal, I would simply have listened to some music and dreamed away. Daydreaming, however, was evil now. I wanted to avoid slipping away; and therefore I had to avoid everything that could make me do so. Including music. For almost half a year I barely listened to any music at all, and if I did, then I only “allowed myself” to listen to certain kinds of music, not the stuff that was most important to me. It was, once again, a mixture of supposed cure and punishment. So the way to Dr. Stoneface´s place and back was fairly monotonous. I remember that especially during the winter months I frequently fell asleep on the train. This hadn´t happened to me before, at least not this often. Also, I was constantly freezing, no matter what I was wearing. I don´t remember it being a colder winter than usual, so I guess I was simply very, very worn down and exhausted – which might not be a surprise, given that I was emotionally strained on the one hand, and on the other hand I was under a lot of pressure in school since my graduation was approaching.

Despite my attempts to avoid drifting off, I typically felt very empty and far away in Dr. Stoneface´s office. The atmosphere in there somehow invited drifting away; a comfy chair in a room flooded with light, the silence… It wasn´t always a pleasant drifting away, though. I would also sit there and feel a pressure to say something, do something meaningful, make progress; and yet I felt I had nothing to talk about, or at least no way to express anything. Just minutes before entering his office, I might have been involved in a hostile, painful, angry internal debate – but as soon as I was in that room with Dr. Stoneface, it was inaccessible. It was as if my mind simply switched itself off and suddenly my head was wrapped in cotton wool. I couldn´t think anymore, didn´t know how I felt anymore, and didn´t know how anything he said made me feel.

The hours had no structure, and there was no relation whatsoever between one session and the next. I guess I would desperately have needed some structure, especially in my thoughts. My thoughts were spinning around in circles; they were a wheel on which I was being broken, and I would have needed someone to stop them and allow me to take a good look at them. I probably would have needed some help looking at them. A small, saving glimmer of logic.

I had experienced the healing effect of logical thinking before, shortly before my friend broke up with me, while I was in a phase of acute breakdown. I hadn´t seen my friend for quite a while (she had troubles with her parents, but she also thought it was better if we didn´t meet), but she had “allowed me” to phone her once a day. In the end, I could barely make her talk at all. I desperately tried to get a conversation going, to restore a sense of normalcy, or just some feeling of who she even was, that she was real, that she was sitting somewhere in the same town with the phone in her hand. And this lack of connectedness, this complete alienation, numbness, loss of reality made me silently panic.  It seemed like another proof that I was unable to love – I didn´t even know who she was anymore, after all. I thought about how I was scared of her, how I didn´t know if I even wanted to see her, and I guess there was also other thoughts which were even “worse”. And during that phase, when I had just gotten off the phone with her, feeling some kind of relief that the horrible silence was over, feeling horrible for being relieved – Irene somehow started a conversation with me. I think I was crying and she asked what was wrong. I told her I felt so guilty because I constantly had horrible thoughts about my friend and I didn´t know what to do with them. And she replied: “But – if these thoughts are just there, if you can´t help them, then you having them doesn´t seem to be your fault, does it?” For a second my sanity seemed to return to me. I didn´t feel like a monster, a zombie or an emotionally hollow person anymore. For a moment, I even had a sense of self again. The wheels had stopped.  Naturally, given that the person I was emotionally so dependent on didn´t accept that kind of reasoning, Irene´s intervention didn´t help for long.

Dr. Stoneface, unfortunately, didn´t provide that kind of logic. In fact, we didn´t even talk about my fairly toxic relationship with that former friend. She had finally gone completely no contact with me, so at least there were no new, additional troubles. What had happened, however, burdened me just about enough. I had an internal representation of her in my head, constantly commenting on every thought I had in the most icy, disdainful fashion. I tried to reason with her, argue with her, convince that I was not such a bad person after all, but normally I couldn´t win. After that fatal e-mail, she was, above all, joined by her boyfriend, so it was two against one in my head.

Only now I even start to realize how isolated and alone I really was at the time. I literally didn´t have any friends. I was on friendly terms with some people from my class, but that was all. I never met them outside of school. This only changed slowly when spring approached. I went out several times with a friend from my childhood/early teens. These were the first times I ever got seriously drunk. Still, though, I didn´t tell her anything about what I had been through in the meantime. She was chronically troubled and everything was always about her problems. I, on the other hand, worried that I didn´t properly like her and that she would notice; that she might notice our friendship was completely fake and that she didn´t know me at all. I feared I would terribly hurt yet another person.

I´m realizing this entry is about anything but my therapy with Dr. Stoneface, but the reason probably is that nothing memorable happened in those sessions.  Nothing terribly harmful, but nothing useful, either. I seriously can´t remember anything. I have described his style before, and nothing changed during those six months. During this time frame, therapy with him was merely ineffective, for all I know. Given the shape I was in, this was bad enough, though. I don´t know how the guy who first evaluated me could seriously refer me to a psychoanalyst. With what – Adjustment Disorder!? I admit that I myself had demanded something that would go deep, nothing like CBT. Which makes sense to some degree, because my behavior really wasn´t the issue. I was highly functional, compared to how I was feeling. But is psychoanalysis really indicated for a person in acute, massive crisis? If my personality is already falling apart, is it a good idea to go analyze it, that is, take it apart any further? Shouldn´t it be stabilized? And if I didn´t see or know this at the time, shouldn´t the doctor, the expert, have made the right decision? Told me my diagnosis and referred me to someone who could have helped me? Why do I have to figure this out, years later? Why do I even turn to a therapist if he doesn´t know what he´s doing any better than I do?

I think what I would have really needed is the kind of support people get when they try to get out of a cult or an abusive relationship. Some years later I read the book Hostage to Heaven by Barbara Underwood , who was freed from a cult by her parents and an organization against mind control. She had the opportunity to talk to former cult members and this opened her eyes and she could see how she had been deceived and brainwashed. She describes how her ability to think for herself slowly returned and it reminded me an awful lot of the process I underwent myself. And it was not thanks to the sterile “empathy” Dr. Stoneface had to offer. It were genuine human contacts that eventually restored me. And logical thinking.

One of the people that helped me was my singing teacher. I was still taking singing classes at the time, one of the few joys left. My former friend, though, had been singing as well, and we had secretly been competing. Another thing that had made me feel like a horrible person. During one very difficult session with my teacher I started to cry, and when he asked what was wrong, I asked him if maybe I couldn´t sing properly because I was such a horrible person? Maybe my character was shining through? He looked as if he wasn´t sure if he wanted to laugh or to hug me. “Of course not!” he exclaimed. “Goodness, I´ve know great singers with horrible personalities, it´s got nothing to do with each other!”  I was extremely relieved. Indeed, it did make sense. It might sound weird that his reaction was such a relief, but then again, what if he had confirmed me? What if he had said: “Well, it´s true, only really good people can sing!”? It would have confirmed instantly that I was a bad person. Besides, it also meant that my training my voice was not an attempt at deceiving people. This, in turn, meant that I was allowed to sing. I was allowed to try to be good at it. I was allowed to enjoy it. Singing was not a privilege that had to be deserved. I didn´t have to be a good person in order to sing. That was one major mental blockade removed, by a  few nice words and a genuine emotional reaction from somebody who knew what he was talking about. It was something Dr. Stoneface hadn´t accomplished in over four months of therapy.

It was also helpful that I had started socializing with a few people from my class who would eventually introduce me to my new partner. She would turn out to be the main person to help me out of that deep black abyss. I will come to that somewhere in my next posts, but now I would like to say a few things about the patient´s responsibility.

I said before that I don´t understand how a therapist/doctor could refer a person who was in acute, deep crisis to a psychoanalyst, even if that person asked for that herself. I´m not even sure anymore if I uttered concrete wishes because I was so messed up my memory is pretty blurred. Sadly, though, whenever I look through online forums where people talk about bad therapy experiences, there is at least one person who tells them that it is their responsibility to choose the right treatment and the right therapist. “If you cannot take responsibility for yourself,” they might say, “then you should have gone to a closed ward. But the fact that you were looking for help shows you could still take care of yourself!”

Each time I read such statements, I get immensely triggered. And whenever I complain about my treatment or my therapists´ decisions, I hear echoes of those statements in my head. So I would like to – calmly – explain what is wrong with them. Let´s see if I manage the “calmly” part.

Okay, first about the question if a patient who gets the wrong treatment has the right to complain (I cannot believe I am typing that sentence…isn´t it obvious that he has this right?!). So. The title “psychotherapist” is protected by law in Germany. It is strictly regulated who may and who may not call himself a psychotherapist. Thus distinguishing laymen and hobby-psychologists from the real thing. Also, the methods which are payed by the state sickness fund (CBT, psychoanalysis, TFP) are said to be “scientifically validated”. All this suggests that therapists, just like GPs, have knowledge that the patient doesn´t have. They are experts.

Let´s say we go to a GP, and he tries a treatment on us that doesn´t work. Might even harm us. What happens? We sue the shit out of him and everybody shares our indignation. It is clear and obvious to us that he is the one who is responsible. Now if there is a group of professionals who have a similar status, who are called “soul doctors”, and they try some treatment on us that makes us worse – suddenly it is our responsibility? Unless the people who say so also claim it is our responsibility to know if our GP is doing the right thing, and that everything that goes wrong is our fault because we didn´t stop him in time, I don´t know how the hell they are going to justify their point of view. Once you´ve been harmed, be it by a therapist or by a normal doctor, you´ll probably know a whole lot about the practice that harmed you, naturally. And then, when you warn people about it – somebody snaps: “Well, if you know all that, why did you choose that treatment in the first place?”, or: “If you could find it out now, you could have found it out back then, too. But apparently you were just too lazy, huh? Well, that´s your problem!”

The whole thing gets even more bizarre when you look at how much the very same people emphasize the necessity to trust your therapist.  Those who warn others of the dangers of psychotherapy are regarded as paranoid or overly distrustful. A reply to a complaint I read today: “Could it be that you often feel misunderstood or insulted, also by other people? Did your parents ever ridicule you or were you bullied at school?” I kid you not.

So, let me sum this up: On the one hand, you must trust your therapist and it is paranoid or narcissistic to suspect he might be incompetent, mean, or otherwise unfit – and on the other hand, it is your responsibility to not get harmed by him. Wow. A double-bind if I´ve ever seen one.

Good. Now for the problem of how well you can take care of yourself when you are in crisis or when you have some psychic disorder. I believe there are several degrees between being fully capable of taking care of oneself and being completely helpless. If you are completely helpless, by the way, you will probably not go to a closed ward, either, even if it might be a good idea. Being unable to take care of yourself implies, after all, that you don´t know or cannot do what is good for you. Therefore, your behavior (seeking help in ambulant psychotherapy) is no proof of your accountability. You might or you might not know what you are doing.

Take my case. I entered therapy with self-destructive purposes. I believed that getting hurt would be good for me. I believed to know what was good for me, but did I? Why didn´t anyone contradict me? Stop me? Are they completely clueless, or do they, after all –  agree? And if they do – are they right? Am I delusional now?  The doubts remain.

So how about my accountability? Was I able to take care of myself back then? Make the right decisions for myself? No. I was extremely misguided, I was in an extreme state of mind, and I had destructive intentions for myself. I may not have been technically insane, but treating me like a normal, merely lovesick young woman was clearly a misjudgment. Does that mean I should have been sent to the closed ward? That I can permanently not take care of myself?

No, again.

I don´t think I was yet in a shape in which you´d have to put me into a straight jacket. I was in a shape in which I would have needed some orientation as for what I really needed and what was really good for me. Someone to tackle my obsessional belief that I was toxic and deranged. As Irene´s intervention shows, I was still open to such approaches. The tragic thing is that the experts I consulted didn´t attempt such approaches. They never seemed to question my horrible self-image.

I guess many people who enter therapy are in a similarly desolate state. They are very vulnerable and they might be unable to avert damage or harm coming from their therapist. This doesn´t mean, however, that they are delusional, or permanently unable to take responsibility for themselves. It doesn´t mean that they still cannot take care of themselves. It doesn´t mean that what they say now is bullshit. It might, however, be part of why, back then, they didn´t know what they know now.