Since it long (+3000 words) I’ve put a summary at the end because I’m nice like that. I said in my post yesterday that my appointment with my CPN on the 15th was cancelled and I finally saw her on the 26th. The 15th was a Friday so there was plenty of time to cancel it in the week and yet 20 minutes before she was supposed to arrive at my house, the receptionist called and said my CPN couldn’t make it because of [perfectly valid reason] and she’d give me a ring on Monday to reschedule. I did consider asking for her to use e-mail instead, but I’m just no good at being assertive. Besides, she would’ve called me anyway. She knows I don’t use phones because of anxiety but I guess she’s not supposed to let me avoid these things. Thankfully, my mum was home so she answered but it was still difficult.
Something I found strange, was that in our appointment on the 29th Dec she said she might have to cancel and she told me why, but when she called she started to say why, paused and said “I just had to take some time off.” She told me why about 2 weeks earlier, the receptionist gave me the same reason but on the phone she didn’t say it? In our appointment the cancellation came up, but she sounded like she’d forgotten.
“Ah yeah…Friday.” She just stared at me with this anticipatory, anxious smile as if waiting for me to explode into a rant about her abandoning me, but I kept a completely blank face, “Did I tell you why?”
“You warned me last month and the receptionist told me.” She didn’t really want to talk about it, well actually she did but not with me. Still, I asked the polite questions and pretended to be interested (which she probably saw right through because I didn’t really care about convincing her).
Anyway, I’m back tracking already. She arrived 20 minutes late and as usual she apologised but I didn’t say my usual response. Normally, I’d say “That’s alright/ok/fine” but this time I thought ‘you know what, no, it’s not ok. I was panicking out of mind because of your poor time keeping!’ I just stayed silent and we settled down in the living room which took a while because the cats were being awkward. She just stared at me the whole time so I’d look over and smile. Clearly, it did nothing to help the situation because we sat in near total silence for about 10 minutes.
Finally, she asked me what I wanted to talk about. It didn’t really work at getting me talking so she commented on the lack of the rabbit in the room. He was outside and I figured I’d make an effort so I briefly talked about how he had loved the snow a few weeks ago. Then it was back to silence.
“Are we just going to stare at each other, then?” I found that quite funny since I had barely looked at her, but I thought it might sound a bit hostile if I’d been pedantic and said actually, I was staring at the floor.
“What do you think we should talk about?” I didn’t really want to ask because the profs are always so careful about helping me make decisions. If someone gives me a cue, then decision-making isn’t a problem. If I’m left to make up my own mind, I get no where so the profs seem to think it’s a good idea to pressure me into the latter situation. It seemed like this was what the outcome was going to be, but she ended up having a mini-rant.
At first she just commented that she doesn’t know what’s being going on with me recently so she doesn’t know what needs to be said (something I felt was a bit of a dig because I didn’t e-mail her with my usual updates for about 3 weeks) and that means she needs me to take responsibility for the session. This is what I expected and throughout the silence I had thought about this power game we seemed to be playing.
This silence at the beginning of an appointment is nothing new to me, but it does make me uncomfortable. It used to happen a lot with the CAMHS team in the beginning (occasionally later if they wanted to test the waters again), but either they learned that I’m too stubborn to give in first and lead the session (or I’ll purposefully bring up something unimportant) and so gave up with the game or they pretended to be ‘playing the game’ but actually let me ‘win’ on purpose so that I felt safe and in control.
I’m probably using the phrase ‘game playing’ a lot because my CPN mentioned it. It was kind of under her breath and hidden in between something else she was saying, but obviously I catch these things. The curse of being observant. Now it’s in my head that I’m playing games with her and being manipulative. I don’t know if it’s true.
Anyway, during the mini-rant she was going on about how she can’t just sit here chatting to me with no target because she has to go back to her manager (what a horrid title in this profession. I prefer ’supervisor’) and prove that she’s doing worthwhile work. She’s said this before, I think it was in our 2nd or 3rd appointment and it scared me then. It still scares me now, because basically what she was saying in this mini-rant was that either I do as she says or she’ll leave.
She said she was trying to motivate me so I commented that I wasn’t sure if the method was really ethical. As usual she interrupted to defend herself and I lost the courage to explain, but when she finished her self-righteous spouting about “It’s got nothing to do ethics” she said “but go ahead and talk about ethics if you need to.” Erm, excuse me? Are you seriously sitting in my living room, criticising me and defending yourself when just earlier you were saying you were trying to be supportive? I think someone needs to try harder ¬_¬ or sort out countertransference issues with someone other than the patient. *Deep breath* That’s the first time I’m reacted angrily to this appointment…and now I feel guilty.
I’m afraid of doubting her professionalism and competence. On one hand, I don’t want to insult her. Doing so would make her dislike me and leave, while also making me feel very afraid, remorseful and alone. On the other hand, I do want to insult her! I’m fed up of giving her excuses for all her invalidating and insensitive comments and blaming myself for them. I’m fed up of being criticised all the time for not doing as I’m told or ‘giving things a go’ when clearly there must be reasons that need sorting first to enable me to take direction and to take the risk of trying. Profs are trained to treat the causes not the symptoms and yet she seems to just be ignoring that. Look! There’s an example of me being reluctant to criticise her. I said she’s ‘ignoring’ it, instead of saying she hasn’t noticed. The former suggests it’s purposeful and the second is unintentional through ignorance. I guess it’s easier to believe she dislikes me or is punishing me and not being incompetent.
I’m also afraid of doubting her professionalism and competence because maybe that makes me superior to her in a way. I know I act with a sense of superiority a lot of the time in person, but it’s just an act because everyone knows that my self-esteem is so low it barely exists at all. In reality, I can’t bear to be better than others. If I sense that this is happening then I’ll self-sabotage so that I am lesser than whoever has made me feel superior. I tell people I’m a bad person and why to convince them that I’m not the amazing person they thought I was. That pushes them away, I fear abandonment and we get into that wonderful relationship cycle. In fact, my acting superior is a way of pushing others away as well. Who wants to feel inferior all the time? Oh wait…I walked right into that one!
Anyway, back to the appointment. I’ve actually not written this chronologically because before she started telling me that I’m not trying hard enough, that I’m difficult and awkward, she was actually blaming herself. This is where my title comes in.
She sat there leaning forward, looking at the floor, brow tense, wringing hands, saying that she doesn’t believe she has the ability to help me and maybe she should pass me on to someone else. Well…shit. Not only have I been doubting her and ’self-soothing’ by giving her excuses and blaming myself, now she’s actually telling me that she’s incompetent! Dammit! Isn’t she supposed to be convincing me she’s trustworthy and that I do have a chance?! She sounded so frustrated and sad.
The thing is, if you’ve read this blog post (or at least the end before the edit addition) then you’ll know that I discovered that I’d been trying to be a burden on her so she would pass me onto someone else. I’m in a state of shock that it actually appears have worked. I can’t decide if it really has worked or if she was acting. Maybe she knew what I was doing and so pretended to be all self-doubting so I’d realise that I don’t really want to push her away and I’d open up to her. Thing is, I can’t tell if that’s giving her too much credit. I know she knew I’ve been pushing her away to test her (she said so in the appointment eventually) but is she really capable of putting on such an emotive act? If she is, I reckon she chose the wrong profession.
Regardless of whether she was truly doubting herself or testing me, I felt for her. I don’t know if it was sympathy, empathy, pity or whatever other words there are but I know I felt sad and guilty. It’s my fault she doubted her abilities. I’m the one being difficult and awkward. I’m the one being a burden. I’m the one playing games. Damn, I’m such a horrid person.
Well, after she went through the self-doubt she started suggesting things like seeing a Psychologist or Art Therapist or if I’d decided about medication and a referral to the GIC. When I either didn’t respond or didn’t agree to give them a go (can’t recall now), that’s when she went into criticising me. I’m sure you can guess the things she said. All those wonderful things like I don’t try hard enough, I’m helpless/hopeless, I play power games (try to outsmart her) and she either said I’m a ‘waste of time’ or I’m a ‘time waster’. I’m not quite sure since there was no way I was going to interrupt her mini-rant and get into a fight just because I wanted clarification. I was upset enough as it was.
We’re now back at the ethics issue and I’m going to quote parts of an e-mail I wrote last night to her. I haven’t sent it yet because it’s unfinished and basically an incoherent mess.
It’s like you were threatening me into doing what you wanted me to do to. “Either you do this or I’ll leave.” I realised while we were talking, that it worked. I agreed to see the Psychologist. [My old therapist] used this tactic on me quite often so I resent that you have too, intentionally or not (right now, I trust you that it was unintentional).
There was also something else that happened a while ago now. You suggested (read: threatened) to end an appointment early because I was being ‘difficult’ [...] As soon as you suggested ending the appointment I panicked and got talking. Afterwards, I got really angry at myself for essentially giving you a tactic to get information out of me.
These things get in the way of me trusting you. You have control over me. By simply saying you’ll end an appointment early, you won’t see me any more, I’m a waste of time/hopeless etc you can get me to do whatever you want.
Honest and trust were big topics in this appointment. I don’t mean ‘big’ as in we talked at length about them, but they seemed to be the most important. I couldn’t really express myself here verbally and I can’t say I’ve done well in the e-mail either. It’s just in bullet points really. In order to even get started on the trust topic, I had to write out 6 different definitions!
I have very strong conflicting views and feelings on these subjects, but I’m going to summarise (I’m so tired. I got about 1 hour of sleep last night and whatever I have, cold, sinus infection, flu, I don’t care, it’s giving me hell).
The whole honesty thing links into identity. If I don’t know who I am (and therefore, what I believe) how can I be honest? What I see as ‘truth’ changes on a daily basis at the longest. Normally, it’s several times a day. So which view/thought/feeling etc is the true one? I wish I knew because it drives me up the wall how I can be so contradictory!
This also links into our trust discussion. I said that I can hardly trust others when I can’t trust myself. She believes it’s easier to trust others because according to her, I can do more damage to myself than she can. I beg to differ. I’m accustomed to my barrage of constant self-hate, I’m used to the voices in my head telling me how bad I am. However, I’m not used to real people telling me those thoughts and feelings are true. It’s hurtful when someone else says all the things I use against myself because at least when I do it, I can think back and tell myself it’s not true. If it was true, then why would people be telling me the opposite? Why do people always tell me I’m intelligent, caring etc if my thoughts of self-hate were true? Are they just lying to me? In which case I’m justified in not trusting people.
You see, she believes that I should trust her. It started off when we met that she was saying trust is earned and she doesn’t expect me to trust her or to open up straight away. Now, she expects it. Does she really think she’s earned my trust? I can’t think of anyone that I trust fully so why would I trust her? I haven’t known her all that long and in the time that I have known her, she’s been invalidating, insensitive and pressuring. I really don’t cope with pressure well, but I’d cope with it a lot better if she wasn’t criticising me as well.
I used to trust her to be honest and I trusted her to hurt me (technically that’s not trust, as one definition is ‘to allow without fear’ well, I fear being hurt…though I suppose I ‘allow’ it! Still, another definition is ‘to expect/predict’). I still believe the latter, but the first is now really confused. After all her self-doubt and her blaming me, in a squeaky, cracking voice I told her my view on the ethics bit. I said I didn’t think it was right to scare someone into ‘motivation’. Then came the tears as she apologised and explained that it hadn’t even occurred to her that what she’d been saying could be taken that way. She said she didn’t mean to scare me or bully me.
Here came the contradictions.
You said that you don’t know what to do and you don’t feel able to help me [...] One minute you say ‘we’ll get you through this’ and the next you’re telling me you doubt your ability [and mine]? That’s not a criticism. I simply can’t understand this in relation to the honesty and trust conversations. I mean, you expect me to trust you and to believe you’re being honest, but you contradict yourself.
[...] it’s hard to trust you when you don’t always say what you mean [...] like when you said I challenge you to get a fight out of you, but when I pointed out that wasn’t quite right, you said you knew and explained that it was because I was testing you.
Your argument near the beginning was that you needed to convince your manager that you’re doing useful work with me and that telling them that I want to get more depressed was conflicting with your job, but later on you proved to not believe that I really want that. You’d said that you didn’t really believe it when I said it on the 29th Dec, but yesterday I didn’t really know whether to believe you honestly thought I want to be more depressed or if you actually did see through it.
[...] when I basically called myself a liar you agreed, but later when I said I don’t mean to lie, you said you know and that I just do it to protect myself.
Maybe you’re taking what I say to be the truth and pretending to fully believe it so that I get frustrated with you supposedly misunderstanding and just tell you the truth? Is that not manipulation? Kind of like what I was saying earlier about ‘threats’ of ending appointments early or not seeing me any more.
Summary
- Silence as CPN tries to get me to take a more active role in our sessions.
- CPN blames herself for me not getting better. She doubts her ability to help me.
- CPN blames me for not getting better. I don’t make enough of an effort, I’m a waste of time/time waster, I’m helpless, I’m a liar, I’m awkward and difficult.
- CPN calms down when I blame myself. She says she thinks we are equally to blame (our characters/personalities are antagonistic) and then contradicts much of what she has previously said (though doesn’t take back the blame onslaught).
- I’m going to be seeing a Psychologist for an assessment on what type(s) of therapy could be useful to me. Apprently, she specialises in CBT and EMDR which doesn’t impress me at all. I think I might go for the art therapy just because it might be good for the shits and giggles.
I make my CPN sound so nice, don’t I?
~FD~
