Monday, July 20, 2009

You set the boundaries and limits – and based upon the limits you set, I decide my level of safety and the TR

Session today didn't go I find myself struggling tonight...

Tired, hurting, wanting to SI... just trying to get through the 'moment' and then the next one, and the next one....and on and on and on...and I find myself flat on my stomach, lying on the bathroom floor, lost and alone...
DT: There continues to be a big part of you that is convinced that I could not possibly care about you beyond what things I say because "that is what I am supposed to say" per your perceptions of the tx process.

Grace: Incorrect! It actually has much more to do with the way you USED to “respond” vs how you now respond. Both IN and OUT of session. If you would like me to provide examples, let me know.

DT: I can imagine that it is very scary to think that I could possibly want to know what you are feeling or thinking, it is scary and shameful for you to be in these feelings/thoughts.

Grace: No , it’s not *scary* at all! Nights – that’s what’s scary – why would I be “scared” of what you want to know about what I’m thinking and/or feeling? That doesn’t make sense to me.

DT: It must also be difficult to put together the idea that I care, but yet not be willing to stretch my limits after 10, let alone be unable to keep you safe when you are grappling with the thoughts of ending your life.

Grace: Again, the “limits” have nothing to do with my thoughts of your “caring” – again, it has more to do with the way it WAS then vs. NOW . And I don’t really expect you to keep me safe – in fact, I don’t really give a fuck about that. If I want to kill myself I WILL DO IT, and there’s nothing you, or anyone else could do to stop it – that’s just reality. And I will NOT be *begging* for your help. It’s your JOB to act like you care. That’s not REAL. It’s your J-O-B! I’m not stupid! Nor do I ASK you to “Keep me safe”…in fact, I think my “expectations” of you as well as my “dependency” upon you, and the TR, have changed dramatically recently. Again…I’m sure it’s all “part of the process”.

DT: As much as you may not see this, I don't have rose-colored glasses on. whatever extent they may be "pink tinged", will be partly due to the fact that I am not you and have not gone through what you have and still go through (harkening back to part of the conversation in last week's session). This is a fact that can not be changed and so what you choose to bring to session will best allow me to better understanding this affords 2 way real time communication and clarification, etc. As I know I have said many times, it is my clinical judgment that safety, containment and titration of emotions/physical sensations is of utmost importance and I have to continue to strive toward creating this during our "real time" interactions and conversations. I will continue to read your emails while I need you to recognize that the content that you write about here is also good material for session...

Grace: When did I ever say you had rose-colored glasses on? If it’s 2 way communication – you knew I was pissed off today–but you don’t ask why? Seems kind of like “one-sided” communication to me. And whatever on the “clinical judgment that safety, containment and titration of emotions/physical sensations is of utmost importance” – I must be a bit confused – since it doesn’t seem important to you any other time. This is good communication for session? I thought you said I could email whatever I want too as long as I don’t “attack” your personal life, which we’ve both established…I know nothing about.

DT: Let me also remind you that the pain and fear that you experience is "real" and I have never suggested otherwise.

Grace: I never said you “suggested otherwise.” I was simply stating that when you say “it *seems* real to “YOU”, Grace” that’s pretty much implying that I’m on some sort of LSD flashback – and it is NOT real- nor do you think it’s real at all to me.

DT: I have however reinforced that there are often situations that occur where there is actually no "real time" danger or threat and that these perceptions need to be gently challenged and reminded that they are old programmed trauma responses that need reframing or proactive management. Much of this is through continuing to work with your stream of thought processes and compulsion to prove your "belief" or "perception"....when sometimes this doesn't serve you best.

Grace: Yes, DT, would you have said that same thing to Laura Black right before her co-worker shot her and killed 7 of her co-workers?

DT: Your email is a small example of this. My words "when and if" were heard and processed in such a manner as to feel rejection/abandonment and because this is your expectation, you will go to great lengths to prove this... at least to whatever extent you can with words/thoughts....which ultimately seem to make you feel worse...which I know you don't want.

Grace: It doesn’t make me “feel worse” – really. “Initially” your “changes” made me feel worse, that I will admit…but I’m not going to great “lengths” to “prove” anything. Your changes and communication style with me are what they are – don’t need to be “proven”. I will state that you’re right about my “expectations” of not “depending” or “trusting” anyone have been “reinforced” by the change in the way YOU communicate with me – both in session and out. But, DT, those FACTS are based in REALITY – not “my crazy maladaptive thoughts” and you did say “IF”. Hello! That’s not a “fantasy” – that’s what you said! Just because I REMEMBER what you SAY – and you apparently DON’T – does not mean I’m trying to “prove” anything. Words are words. You say something with a look of disgust on your face (no judgment – you’re “human”) – that doesn’t leave much to “interpretation” does it?

DT: you will go to great lengths to prove this... at least to whatever extent you can with words/thoughts.... which ultimately seem to make you feel worse...which I know you don't want.

Grace: No pain, no gain – isn’t that right? It may get worse before it gets better, right? I told you – I respect your “changes”, I DO NOT expect you to “be there” for me at night, or “keep me safe” – even though you WERE before...back before your life changed (Grace struggling not to mention something specific she DOES know about DTs life - and her newly established relationship which happened to coincide with the new "limitations")! So, really, you can say what you want to say about “care” and “non-judgment” – and I will again say – that I don’t trust you like I did – and I have good reasons for that (whether you think that’s “maladaptive” in your “clinical opinion”, or not). You changed when I needed you! You didn’t give me an explanation, you just did it. How am I supposed to “trust” your “care” after that?

No worries – I get it – it’s your “job” ~ I’m the patient – you’re the expert. It’s cool. Your life changed when the border wanted to kill herself – so you decided I didn’t need your help, which lead me to believe you didn’t care. I didn’t *prove* it – you did it. You were “Professor Plum”, in the “study” with the “poison”. I think it sucks, the way you *killed my trust* - but can’t change it – so learn to “work” with it. And I think that’s what I’m doing. For the most part, I have “abided” by the “rules and regulations” you have established, I have stopped “acting out” my anger by calling you every night at 9:55, I have stopped *attacking your personal life*, again, as we’ve acknowledged, I know nothing about. I have stopped emailing your photos of bloody limbs and a multitude of pills. I don’t ASK you to *save* me anymore, do I? I don’t *fantasize* that you’ll *rescue* me, and I’m clear that you will not respond to any emails other than on Mon, Wed and Fri – right?

I’m not saying I don’t *trust* you at all – for the most part, you do what you’ve said you would do, are dependent…blah, blah, blah – I’m just saying there is no way in hell I will ever be *dependent* on you (or anyone else) to help me, beyond what you’ve established, or rescue me, or save me as though I am a child. I sincerely regret that I ever did trust ANYONE to that level. A learning process…I know now – maybe that was your intention in doing that. I’ve been pretty damn independent since I was about 3 years old…so I’m good with that. You are not my “mother” or my “caretaker” – you are a “mental health professional”, trying to do your job. I will freely admit I don’t make that easy for you. And like I said, I appreciate what you do for me, but if you did not want me to think you weren’t reading my emails, then you shouldn’t have said “IF” you read them.

But it didn’t make me feel worse - you just reinforced what I already knew. No judgment and no offence…but you’re no longer “with me in spirit” and I don’t “carry you in my heart” – not now – not anymore. You are DT ~ I am “client” that’s all – just like any other client – not your job to “be here with me in spirit”. So, I appreciate your agreement to the 3 emails per week, and the “sessions” in your “office” – but I’m clear on the relationship – that’s all I’m saying – you sit in the leather chair, I sit on the couch. You are the clinician, I am the crazy client. You set the boundaries and limits – and based upon the limits you set, I decide how much I can trust you, how safe I feel with you, and what I am comfortable disclosing to you. As you've said, the process is "cyclical" - and right now I'm back to early 2007. But "It's not you, it’s me".

DT: Hope these thoughts can help -

Grace: no, not really – but I appreciate you trying to help, “to the best of your ability” and “in the limited ways that you can.”

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