Tuesday, February 17, 2009

Choices ~ Stay or Walk Away?

I am the one who put everything behind me and moved on with my life. I am the one who is now in the midst of trying to piece the fragments of myself back together. I realize that I have, perhaps, been a *burden* to Dear Therapist, that she tried to support me, until last summer. When suddenly something changed….and, of course, as a “client” it isn’t appropriate for me to ask – WTF? So I began to research. And I have been trying to “analyze” my therapist – I have researched treatment for trauma, complex PTSD, BPD…I have spent hours in the library, days on the internet and lots of money on Amazon – trying to find out what the hell she is doing in MY treatment plan. Because ultimately, I know it is MY responsibility to “repair” EVERYTHING that has been the result of my childhood abuse. Mine! And recently, I have found myself wondering if therapy is doing more harm than good. I find myself not only trying to deal with the fragmented parts of myself, and the memories and the inner voices, but also the frustration, week after week, in therapy. I honestly question if she knows how to help me.
After I leave her office, I still have to function like a “normal” human being. I have a job, family obligations, friends….. And in addition to those responsibilities, I have to deal with the memories, the flashbacks, the intrusive thoughts of what was done to me in my past. I am the one who has to take care of myself and my family. I am the one who has to deal with the nightmares and I am the one who has to talk myself back to the present when I wake up in the past. I am the one who has felt like the only way to deal with the overwhelming emotional pain is to literally cut my own skin. And I am the one who has to live with the scars and the questions.
I am the one who has a *team* of clinicians who consult and decide what to do *TO* me and I am the one feels like a rat in an experiment gone wrong. I am the one who has to endure the side effects of ALL the medications I’ve been “put on” – the nausea and vomiting, the dizziness, the sleeplessness, the irritability, the migraines, the inability to concentrate, the weight gain…… ME! I am the one who has to *fake* being ok- when my therapist threatens to put me in the hospital….or *ordered* into IOP classes for ED, or DBT. I am the one who I am the one who trusted a therapist and laid myself bare for her to see and I am the one who must deal with the feelings of being ignored, invalidated and treated with disregard – now – in the present. And I take responsibility for all of the above.

But I will NOT take responsibility for HER behavior, for her seemingly lack of understanding about me. Nor will I take responsibility for her lack of communication of her treatment plan, new approach, or her newly developed boundaries, which are apparently a moving target. I will not take responsibility for she has decided is “therapeutic” in her mind, or her “ideas” about how things should be done in MY treatment. I will not continue in a “therapeutic relationship” with someone who clearly does not even know me after 3 years!
There is no logic to this treatment – there is no “one way” to treat trauma. It isn’t like a physical ailment. I have read Judith Herman, Marsha Linehan, Peter Levine….and others! I’ve read everything Van der Kolk has written! And everything is subjective! EVERYTHING! Read about borderline personality disorder – no one knows what “causes it” (I think it’s just a way to label “difficult” patients, patient’s who don’t just roll over and accept what their therapists say, but instead question things, try to educate themselves, and even *GASP* have the nerve to disagree with something a “trained professional in the field” says.) Everyone has an opinion on treatment: Schema is the answer, no it’s cognitive-behavioral, well, maybe it’s “supportive”, no the real answer is transference therapy, nope DBT. There’s no answer – no consensus on what actually helps.

Some “Mental Health Experts” say, “you must talk about and process the trauma”, others say, “no – don’t talk about it, stay in the present and manage the behavior in the present”.
Of course the past shapes the present, which will shape the future – and the life I am living now and who I am. And I am the person who is FORCED to take responsibility for the harm that was done to me and to my life and not just from the abuse of my past. And I shouldn’t have to fight my therapist, but alas, I have had to repeatedly, and it is exhausting. Why? Because NO ONE wants to listen!

And despite what is “said” by the MPH – “if you’re treating a pt w/BPD, 99% of the time, you are to be silent – don’t fall for the “sense” of urgency or their “demands” – you treat them by “standing still”. Do not respond or intervene even when the patient virtually demands some help for some relief! Yes, why would anyone do that? If a PERSON, a F***ING HUMAN BEING is having intrusive memories that won’t stop, and the only way to get them to stop is by cutting their own flesh – why would anyone need to respond to that? As long as the MHP is “the same” when the door to the office is opened, and the “crazy pt” is asked to come in, as long as the MHP is “present” during that 50 minutes each week. If the “borderline” expresses feelings of “abandonment” do not make any unusual interventions to calm the patient – this is a mistake. The MHP should ‘stand still’ and take no action in the face of the patient’s demands for help. The MHP must not “saddle” themselves with the role of trying to make the patient feel better”….. ALL PATIENTS – NOT “therapy as designed for each individual”. High functioning BPDs, quiet and loud BPDs, IP and OP BPDs….just *stand still*. “If you build it, they will come.”

I don’t know where I will go from here, but I am NOT an diagnosis, I am not a “plan of treatment”, I am not intellectually challenged - I am a PERSON and I will not be placed into a treatment plan that was developed by professionals who have no first hand experience of abuse and are not interested in what I say works or doesn’t work for me. No one listens – and yet I am still talking – and just because you, dear therapist, are standing in your office week after week, always the same….”Here I am, crazy girl. I am standing here, the same – it doesn’t matter which “you” shows up (angry, sad, happy or frustrated) – I am the same, I am here, “standing still” acting like I am happy to see you" - does NOT make you the "expert" on what I need!

You tell me it’s my “choice” – yes, my choice – you give me 2 options, both of which are ridiculous and clearly not what I need and tell me to “choose” one – but tell me again, it’s my choice! Of course, what do I know….I’m way to “volatile” and “fragmented” to know what I NEED from this process.

Well, turn up your whisper 2000 and “stand” or “sit" still and LISTEN to me, HEAR me, interalize, and PROCESS what I have to say because it is important! You tell me what I “need” from you, now let me tell you what I thought I “needed” from you. I thought I needed someone to listen and hear me, someone who would allow me to speak, to believe that I mattered, and someone who would support me through this process. But I was wrong……
Clearly, by your recent “behavior” – what I really needed was someone to tell me to “regulate my emotions” and “stay in the present”, control my unruly, abnormal behavior so no one, including you, would be ‘bothered’ by it. What I needed was for you to teach me to feel, and have you tell me that ‘feelings are always okay’ and then stuff it all back down again when it was ‘too much’ for you to ‘deal with’. What I really needed was a strong mood stabilizer and an anti-psychotic, and an anti-anxiety – which would take away my ability to *escape* the pain, but not provide me with the tools to *deal* with the pain I can no longer escape from.

Of course, it’s all transference – I must be transferring my feelings from my past onto you – therapy interfering behavior – but it’s all me – you know what you’re doing. I’m the “client”, you’re the ‘expert’. And the pain I feel, it has nothing to do with your recent sins of omission, or misplaced trust. Or your sudden lack of communication and your “change in approach” that you won’t even admit has occurred!
You want to talk about ‘choices’ - yes, there is always a choice. I’ve always had choices.
“Do you want to lie there quietly, or would you rather scream and fight me and I will beat you and then F*** you.”

I can *choose* to call you and ask you for help and you can *choose* whether or not to call me back. I can *choose* to continue to be frustrated by the fact that you *chose* not to call me back. I can *choose* to continue to be frustrated by the fact that you *chose* not to call me back – or I can *choose* to accept it.

I can choose to stay, or I can choose to walk away….. Sometimes both choices suck – but you’re right – there’s always a choice!

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