Unfulfilled needs – Therapy with Dr. Stoneface, part VI

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.

 

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