For A Good Time Call...

There are prescribed ways to break up romantic relationships. Culturally speaking, there are also rules for what friends do when a couple breaks up. But there aren't  really any norms for breaking up with one's therapist, or how to support someone in the middle of a breakup.

Dr. Therapist and I have been together for a really long time. Around 10 years or more, off and on, but mostly on. For a while, I've been wondering if I'm really getting what I want and need out of this relationship. The therapy relationship is unlike any other you'll ever be in. It's all about you (if you are the client/patient) but both people in the relationship are open to being changed by virtue of being in the relationship. For a while now, I've not felt like some of the basic must-haves in therapy have been happening for me. We often talk about the basic therapy triad: three things that are essential across therapy modalities for it to be successful. They are, basically:
1. Unconditional positive regard - the idea that no matter how awful I am or what nasty, horrible things I say or do, the therapist will find something about me to think positively about, and will see my ugliness within a framework that says I am ultimately loveable.
2. Genuineness - that the therapist is honest, real, and in the moment with me.
3. Respect - the therapist is a model for respecting others and myself. This touches on the first point but is a little different. Respect also means that the therapist honours that this is MY therapy as well as me as a person.
The sad truth is that I have never felt unconditional positive regard from Dr. Therapist. He takes an old-school psychoanalytic psychotherapy approach and adheres to the "blank slate upon which to project" thing waaaay more than is useful with a client like me. I've brought it up and attempted to discuss it. But Dr. Therapist insists that I have hit upon the "limits of what therapy can do" for me. I disagree. The more I learn about my profession, the more I learn that there are many different ways of doing therapy and that client/therapist relationship "fit" might be more important than any other aspect of therapy (including modality, but I'm not entirely sold on that near-dodo-bird argument yet). I think it is important to feel prized and honoured (read: special) in the therapy relationship and I don't think more blank slate is going to do it for me.

So I started therapy-dating. I went on line and found the profiles of a few people I thought I might connect with, and essentially dated them in the therapy context. Most people (as is the case with online dating) I saw only once. Most of the time, the therapist looked fine on paper, but we didn't really seem to connect in the therapy room. This is an expensive thing to do, since more psychologists charge in the $160-$210/hr range. And on these first dates, I'm always the one who is paying. I had a couple of first date disasters... One specialist in sleep and anxiety that I waited MONTHS to get a date with -- I arrived early, as she requested in an email, so that I could fill out some forms, but the receptionist had no idea who I was. I waited for an entire hour (asking the receptionist twice to confirm my appointment and ask where the Dr. was) before I left. I told the receptionist that this wasn't exactly a professional way to treat a first time client... When I arrived home, there was a call from the Dr. "reminding" me about our appointment the next day. When I sent the Dr a copy of the earlier email confirming TODAY as the date, she attempted to blame the mix up first on her new receptionist, and then on the fact that she had just returned from a medical leave. This is a huge no-no as the therapy hour is supposed to belong to that individual client and the FIRST appointment is all about getting to know each other and establishing trust.
I had another female therapist that I thought was going to be a good match as she said she felt comfortable addressing my sleep issues and anxiety, she worked with a lot of graduate students and atheletes, and practised from a feminist perspective. Only in the second session did she bring up the fact that she wanted to use EMDR (look it up and laaaaaaaaugh) on me. If it had been a real date, I would have left before ordering. As it was, learning this about Dr. Pseudoscience cost me 2 X $105(student rate).

So I played the therapy feild for a while.

And then I met Dr. Dick. [And yeah, I laughed too, when he invited me to call him by his first name. I mean, c'mon, if there is a name with more alternative variations, I don't know what it is. The English has come up with at least a dozen alternatives to names like this just to keep God's Frozen People from having to say a word that is a euphemism for genitalia in polite company!] Dr. Dick was friendly and patient on the phone. When he accidentally scheduled another client at the same time as my first appointment, he took full responsibility and completely unpacked the impact of the incident with me in a mature and caring way. It also doesn't hurt that he looks like he could be the twin of one of my favorite high-school English teachers (who also happened to look a lot like Raymond Burr when he was relaunched the Perry Mason franchise). I felt immediately respected, immediately well-thought of, immediately like he was being honest and straight-up with me.

My conditions were met. I've got a new therapist.

It's hard to make this decision for a lot of reasons. I have to "start over" with a new person. I have to talk about things that I haven't spoken about for a long time. I have to find a new common language with someone. I also have to find a way to pay for all of this whereas Dr. Therapist was an MD and billing my provincial health insurance over the past decade. I think the weirdest thing might be telling Dr. Therapist about my decision. My biggest fear, of course, is that he won't seem to care. But then again, that's why I needed a new therapist. After talking about this kind of fear for years now, nothing has changed. I think maybe that's why it wasn't working... some of these older (psychoanalytic) styles don't allow for the therapist to become changed in therapy themselves. Anyway, it feels so strange. And it reminds me of many other relationships I stayed in long past the point of them being good -- just because I was afraid of change, afraid of hurting the other person with my feelings, needs, and wants, afraid of asking for what I needed because I thought I didn't deserve it. There have been a lot of times in my life when I stayed because I made the relationship all about the other person when it should have been about both of us. I can't stay like that in a therapy relationship when it is SUPPOSED to be all about me and what I need.

I won't see Dr. Therapist for a few weeks yet becuase he is away (another complaint I had was his frequent absences and interruptions to therapy). I have some time to think about how to put it to him in a way that is:
1. Respectful
2. Genuine
3. Regards both of us positively

... but mostly me.

Back In The Saddle

For the longest time, I resisted taking a break because I was afraid that if I stopped working, stopped the stress, stopped constantly DOING, that I would not be able to get back up to speed when school started. I was both right and wrong. I can get working again, but it sucks and I don't think I can get up to the crazy amount of working constantly and never taking a break again. That's actually probably a good thing. My break was excellent. Once my Dad's funeral was over and things settled down with end-of-life responsibilities and crying, Mr. Husband and I went up north for a week. We did not answer cellphones or check emails. It was actually rather glorious. When the toilet in our cabin broke, the resort had to give us the key to the nearest building with a toilet... the SPA. So we had access to a 24 hour hot-tub! Hey, make the best of the situation... right? It was difficult to pry me away from that glorious northern escape and my cache of white wine in little tin cans. When I got back home, I committed to maintaining a healthy "vacation of the mind." School started up and I'm tense. But I'm not the kind of tense I was.

PhD3. We are at that point where the noon bell has rung and we both stepped on to the dusty main street in town. All the townsfolk are indoors, peeking out from behind curtains. I flick my poncho to show my pistol as PhD3 chews on a cigarello.

Well, I have to get to work. I already have four articles to read, an interview to review, and a full-fledged data emergency to contend with. I wish I could use a laptop in a hot-tub.

You Can't UN-know Unless You Have Dementia Or Are Defending

I've been thinking a lot lately about how to have healthy boundaries with friends when you are in the helping professions. This is a particularly tricky thing for people whose trade is in listening and communicating, and even moreso for women, whose often trade socially in the same thing. When your job is being there for others it can strain friendships that are based on being there for that friend. Many of us in the helping professions find ourselves there for a reason. It usually has something to do with the fact that being there for others comes naturally for us. Many of us have been the "go-to" person in our families and with friends as long as we can remember. It might be so much a part of us that we never even consider the fact that we have a choice about it.

That is, until we start taking on our clients and seeing the similarities between them and people that we care about in our personal lives. Sometimes our clients will provoke reactions in us (COUNTERTRANSFERENCE) and we are trained to always be aware, always questioning, always seeking supervision about our own countertransference reactions. This is important because as a clinician, it's unhelpful for me to muddy the waters of therapy with my own provocations. So it appears that there are mechanisms built into the profession to prevent this from happening (as much as is humanly possible). When it does happen, we're trained to bring it up and deal with it withing the therapeutic dyad. We clinicians are always talking about our relationships with our clients because they are a stage wherein the client plays out past and current relationship problems that plague them.

But what about the other direction? If we have mechanisms in place to protect the client, why are there not similar mechanisms in place to protect the clinician? I don't mean supervision for how the therapeutic relationship affects us. What protects the clinician from carrying what they learn in courses, practica, and therapeutic experience back into their own personal relationships such as those with their family, spouses, and friends?

My training in therapy and my own experience as a therapy patient has taught me to actively listen, to carefully consider the usefullness of anything that I say, and to be hypersensitive to diagnostic issues as well as defense mechanisms. This is stuff I really can't un-learn. I've practiced it so much that it's a part of me, the way a virtuoso violinist feels the instrument is part of his or her arm. The difference is that the virtuoso can put their instrument down. I can't put my brain down. It comes with me whereever I go and whatever conversation I enter into. And so when a loved-one approaches me to talk about a personal problem, I have two -tracks running in my conscious brain: the one that responds like a normal human being and friend, and the one that gets a running commentary of "shrink think." Before I entered training, I thought that it was SO COOL that I was analytical and insightful and a good listener. People appreciated it and sought me out to talk about their problems and I felt special. I had a place in our little community that felt shammanistic and wise-womanish, and really fed my naricisstic longings to be important and wanted. Then I started training and practiced for almost 10 years. I honed my skills and refined my art. Like all little, anxiety-ridden, high-achievers, I practised self-care with the same dedication and discipline with which I studied. I began to notice that I had all the patience in the world for my clients -- even the ones who were "stuck," or "borderline-y."

But friends and family started to drain the life out of me.

Not all friends, not all family, mind you. There seemed to begin to emerge a delineation among the people I know and care about. There were those who "got it" and those who didn't. Those who "got it" noticed my stress levels and inquired about them. They seemed intersted to know what the stress of grad school was like and how I was coping. Our conversations ebbed and flowed in terms of who needed support. But most of all, the ASKED before they began a emotionally draining conversation if I had the reserves to listen to them or if it was a good/bad time for that kind of friendship activity. Those who did not "get it" continued to talk, talk, talk at me oblivious to the signs that I was flagging or unable to cope with being there for them in that moment. I realized that I had to do something about this or I was going to start resenting some of the people I cared about. So I did what most therapists do; I opened up a discussion about our relationship and attempted to articulate my needs while still respecting the other person's feelings and needs for support. What I needed people to understand was that I love them, care about them, want them to be happy, and yes, even want to be there for them. Because of the work I do, and particularly when my own emotional resources are low because I am experiencing my own personal troubles, I can't always martial the psychological stamina to be there for them in a way that mimics or takes on elements of therapy.

We often talk in therapy about the consequences of setting boundaries. When people make changes in their lives (hopefully for their own health), it means that relationship with others can change. I often talk to patients about how they may be surprised at who cheers on their changes and who protests them. After all, we've been relating to people in a certain way for a long time. People are going to notice the change, even if they can't articulate it. Some people will have been wishing for us to change and others may have really liked how they could relate to us pre-change. And who will react like what is often tricky to predict. Most people are living in transference most of the time and so not necessarily in possession of the self-awareness to think of what they bring to a relationship and not necessarily secure enough to accept that another person's change is not necessarily about them.

In the past little while, I've been attempting to talk to the people in my life that I care about to let them know that boundary-setting is something that I need to do to be healthy while I do my job as a therapist. Some of them really get it and we've had some fantastic discussions about how to navigate tricky situations and recover from misunderstandings and misteps. A few people have completely shit on my head about it. Ha, I recall when I had a miscarriage back in March and I was trying to explain to a friend that I was too "out of it" to listen to her (the miscarriage had just happened a week previously). This was the first time the friend has heard about the miscarriage and she said, "Yeah, yeah, but I really need to talk you. I'm very upset!" I can laugh about this now, but at the time, I was frozen -- unsure if I was going to cry or punch her in the face.

The things is I CAN'T UNKNOW what I know about being a good therapist. When a loved one tells me something personal, my brain automatically starts churning through what I know about their history, their personality, their habits. I start making connections and wanting to point out insights as they occur to me. But that's what a therapist does. Unconditial positive regard, kind honesty, utmost reliability. I can do those last two things in a friendship or family relationship. But I struggle with unconditional positive regard. I don't want to react to my friends in a therapist-y way, yet I can't unknow what I know about what would be helpful when someone comes to me with a problem! So what is a therapist to do? Therapy relationships are one-way streets. The therapist is there for the client and NOT the other way around. But friendships should go two ways. What happens when one person in the relationship cannot tolerate that? Or worse, their defenses are so high and thick that they can't even see that this is a problem? We can UN-know things when we are defensive. Things that are too psychologically painful get shoved down, repressed, denied, transfered, projected to the point that the person defending literally cannot access the defended-against phenomenon in their conscious minds. And recently, I learned first-hand that people with dementia can also UN-know things that they previously knew. I learned this when my father didn't recognize me anymore when I visited him before he died this summer. But I can't pretend that I don't know how to be a good listener or see a connection in a friend's talk and behaviour.

So the question becomes what to do about what I know. One idea is to set it aside when talking to friends. To give myself permission to react like a friend and not a therapist. I struggle with this because sometimes my friend reaction is the complete opposite of helpful. Sometimes I want to say to a friend, "Go fuck yourself, you're being a douchebag." But I know that's not going to help the situation. Sometimes I can edit it down to something less reactive like, "I'm feeling really irritated by what you are saying and that makes me think that I don't have the resources right now to listen to you. Can I call you in a day or two when I'm feeling more refressed?" But that sounds so weird and forced "holier-than-thou."

Huh, do you know it's actually written in our college (Psychologist) ethics that we are supposed to hold ourselves to a higher standard than the rest of society in terms of how we conduct ourselves personally and professionally? No pressure there. I think we need to be taught, mentored IN TRAINING, IN CIRRICULA, to navigate these social difficulties and be prepared for the fact that some of our relationships may not survive our training. As far as I know, there is no written theory on navigating boundaries with personal relationships as a psychologist. And it's so tricky! Think about it. If I were a registered massage therapist, I could tell my friends not to ask me for a massage because I do that at work all day. Just like I would expect not to have friends demand me to look at that rash on their back if I was an MD, or do their taxes for free if I was an accountant. But massages, medical checkups, and taxes are not the currency of social relationships. Talking, listening, communicating is! And we naturally bond over discussing intimacies and supporting each other. And I don't want to have friends who never share anything personal with me! So where should this line be for those of us who communicate and support others for a living? THAT is the course I want in grad school. But there isn't one.

So I guess I need to either write it or find a really awesome mentor.

Schrodinger's Womb

I really thought that nothing else could happen, you know? Like the past 18 months have been so majestically shitty that there couldn't possibly be anything else to add to the pile of suckage that's been accumulating in my spare room. But it did, sho - nuff.

I'll cut to the chase. I'm going to have a miscarriage. I had a dating ultrasound last week that revealed a gestational sac but no live embryo/fetus. Either there was an early embryonic death, or the embryo didn't develop at all. Brutal. I had been simultaneously holding in my intense joy and getting used to the mind-boggling fatigue, urination, and bizzare dreams that accompany the first trimester. I had only told a handful of people and Mr. Husband and I were just gearing up to make the larger announcement as the end of the first trimester approached. Then I got the call from my GP. Bad news. It's not your fault. There was nothing you could have done differently. Sometimes these things just happen. Another ultrasound next week just to confirm. No reason to hope. There's nothing there. There is just a formality. Things might happen on their own. Medication. D and C. Fuzz. Fuzz. Fuzz. Can't think of the right questions to ask. Try not to freak out on the phone. Hang up. Cry. Cry. Cry. Cry some more.

For 9 weeks I couldn't believe I was pregnant. Now I can't believe I'm not. Or rather that I'm not going to be. That's the funny thing. Technically, I am still pregnant until the miscarriage actually happens. I'm living in a limbo where I am both simultaneously pregnant and not pregnant at the same time. At least I'm pretty sure there isn't a cat in there.

I am in comprehensibly sad. And resentful. And angry. I wish I wasn't. I missed my nephew's birthday. And missed meeting my new nephew for the first time. And I didn't go with my family to take my dad to long-term care. I just can't be around people right now.

I have no idea how I am going to see clients this Thursday. It's like the biggest test of being a therapist ever. Being able to put your own baggage aside to be there for someone else. Actually, I've always been really good at that. And that fact has caused me a lot of resentment. And that's why it worries me. I hope I can get through it and no go off or just shut down.

Inspiration a la CK, Wisdom a la Carlin

http://www.openculture.com/2012/02/how_the_great_george_carlin_showed_louis_ck_the_path_to_success_nsfw.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:%20OpenCulture%20(Open%20Culture

One More Thing

I fell at practicum the other day. It was just after 5 and most people had already fled Dr. House's evil sanitorium. I had been summoned and dismissed, just walked out of his office. Then I stepped in a puddle of mopwater and went down like an incredibly graceful ton of bricks. Got nice bruise on my thigh and another one on my ego to match.

Dr. House saw it. Just went back into his office.

Another intern came and helped me up.

About ten minutes later, Dr. House comes into my office under the pretense of leaving something for my deskmate.

Dr. House: Did you fall?
Me: Yes and rather gracefully I might add.
Dr. House: Why?
Me: I slipped in a puddle of water.
Dr. House: What kind of water?
My brain: I'm fine, by the way, Asshole.
My mouth: Seriously? How many kinds of water do you keep in this place? Mop water.
Dr. House: Oh. [Leaves]

This is why I have the Conan phantasy about cutting his head off with the sword of Crom. It's so great that I'm a psychodynamicist by nature and we think it's healthy to acknowledge the shadow side of our phantasies, isn't it?

Conan The Barbarian

I'm watching Conan The Barbarian for the millionth-ish time right now. The first time I saw it, I found it to be high cheese. Now it is such an integral part of my life that I want to rename my first-born cat Mako.

I'm serious. Since I started my practicum with Dr. House, I play that soundtrack on my iPod on transit with every trip in. I leave my house to, "Between the time when the oceans drank Atlantis..." and reach The Wheel of Pain by the time I reach the spot I board. Just as I come up on the waiting area, the music swells. It's the part where Conan is at the giant wheel, just pushing it around as the years of his childhood and adolescence pass by. The music hits a brilliant, purcussive swell and we see Arnold's face for the first time. I always get this feeling that I can survive it. That these days with Dr. House are like my days on the wheel. Painful and dull and abusive. But making me strong enough to face what is in front of me.

I know. I'm incredibly high-schoolishly dramatic, aren't I? Can't help it. You try watching this movie with the world's best soundtrack by Basil Pouldouris and see if you don't start believing in yourself, friendship, and undying love.

Cause, I really fucking need to believe in that shit right now. I need to believe that steel is nothing compared to the hand that weilds it. When I got married, Mr. Husband took my hand and said, "Nothing in this world can you trust. Not men, not women, not beasts." Then he pointed to our rings and said, "But this. This you can trust." In the movie Conan's dad is talking to him about the riddle of steel. But I prefer Mr. Husband's take on it. For some reason, this super-cheesy film just fills me with so much steadfastness.

I've thought of quitting so many times this year. But I prefer to imagine Dr. House going down like James Earl Jones at the end of the movie. I'll keep playing by my own rule (actual morals, ethics, and responsibility) and we'll just see what happens.