3/08/2020
I would sit either in a yellow chair, or on a blue couch, usually with a hot drink, and respond to the opening question with every kind of answer from relaxed phrases to an agitated, ‘eugh.’ Some think that therapy is just a series of ‘How do you feel?’s, and while I do generally talk about my feelings incessantly, to an almost obnoxious degree, it is rarely that simple.
I worked with my therapist for over six years. Many major life events took place in that time and those sessions were a constant throughout, one to two times a week. It was an open space in which all was up for discussion; I never had to suppress the flood or bury the beast, the dreamy or the dismal. It was a safe space for me in a huge amount of turmoil; it was somewhere I always knew was there with someone I trusted.
As a schizoaffective with depression constituting the ‘affective’ part, a history of anxiety and – when very ill – self destructive behaviours, this was invaluable. I learnt how to cope, learning healthy behaviours and skills to deal with these situations in the every day, and have simple support. Well, not simple, but major. I am not here to gush, rhapsodise, or attempt to write some appreciative poetry, but provide an image of the work that was done in this therapeutic relationship.
Sitting in the therapy chair
I have no idea how to sum up these years. It is not always about the dramatic peaks and troughs. The biggest long-term project we had was for me to graduate from university. My degree at Queen Mary took up five of these six years and last December it happened. I finally walked across that stage. My therapist and I had cake in our session that week. Cake and coffee. We ate cake when I submitted my dissertation, too. We had coffee a lot. Therapy was an outlet for many things, including Aussie Coffee Snobbery, a condition that I thoroughly condone.
After six years you would think we would run out of things to talk about, but there was rarely any kind of pause. That might be because with these long-term mental health issues, particularly in the realm of Cognitive Behavioural Therapy (CBT), every day is different; there is rarely a one-size-fits-all coping strategy. This is perhaps why my blood boils with every, ‘You’re fine,’ from others, because although I now have a lot of new skills to move forward I still need help applying them, and knowing what strategies are the best for individual situations.
My therapist could often see where I was mentally simply by looking at my face. I remember after one event I walked in, sat down, and after a single glance he stated, ‘You’re not well.’ There was a time I was distraught after a particular hurt – nothing too sinister – and he suggested I write a letter to the hurtful person and not send it. I wrote two. The first one said,
“Dear [insert name here]
You’re a [insert strong word here]
Sincerely,
Isabel xxx”
I have truly perfected the art of being a histrionic and bottomless well of drama. I am a pain in my own neck, a condition which unfortunately cannot be medicated.
Thankfully for everyone involved, the second letter was calm, collected and went into detail about why I was hurt by this, how I was feeling, my side of the story, and the consequences of this person’s actions. It was everything I wanted to say, on the page.
I read these aloud and we talked about them. I left that day feeling lighter. My therapist knew how to take a simple exercise and make it a turning point. It was the first step out of the pit and he made it look effortless. Sometimes I would not see this until I reflected upon it later. These were not random conversations but techniques that helped me cope and move forward.
When things were tough I often heard, ‘Don’t get stuck here.’ I would sometimes, if I was in a mood, snap back with, ‘It’s not that easy.’ But the discussion never ended there. He continued to do his job, even when I put up walls, and as a result I always broke through. I was not always the easiest patient, and I should say that this assessment is coming from me, not from my therapist. I suppose this was part of the point of the therapeutic space; words were unfiltered and raw, because these words and emotions were up for discussion, not to be shut down, but understood. My speech can be quite erratic so this was often a ride; I can confidently say that I was never a boring patient.
Before my dear dog, Archie, passed away in 2019 – he is still getting an obituary, by the way – he often accompanied me to therapy. Not always comfortable in social situations, it was sweet how comfortable he was in this space, either wandering around the room as we talked, sitting on the couch next to me, or jumping up on my therapist, of whom he was a big fan. This said a lot to me, as Archie was a very discerning judge of character, who did not hide his disdain for those he felt were not worthy people. So those therapy sessions were some of the best I ever had, as my best friend was in the room for that important treatment and time of personal growth, forever by my side.
I raise my coffee cup to you, Arch, the world’s greatest dog. Your loving heart, loyalty, and ability to sniff out the duds will go down in history.
It was not a perpetual recline, however. My therapist was unafraid to take action. In 2016 I was in an appointment, not realising how desperately sick I was, and fifteen minutes later I was in a cab to the hospital. Lo and behold I was immediately admitted as an inpatient and my second spell in the psychiatric hospital began. I had Vaseline over my eyes, I was in darkness, and had not realised what a danger I was to myself. My therapist saw it straight away and protected me as the professional he was. I was safe.
Why am I talking about him in the past tense like he is dead?
He is not dead, but continues to work, treating his patients. It is me who is in the past, our therapy that does not exist anymore, a six-year space now separate from myself on this day. I admit to a wistful sadness at this fact. Those yellow chairs were very comfortable.
It is a huge change. At one of our final appointments we talked about our work ending. The next thing I knew there was mascara on my chin, flooding from wet, squeezed eyes. Very little else got done. I did receive an important piece of advice:
‘You’re the boss. You’re in charge of where this goes.’
I have since purchased waterproof mascara in a bid to never look so much like a clown in a storm again.
“Voice recorded journal:
I only cry about twice a year but it was usually in therapy after, well, I’m not going to say what kinds of things but something sort of silly I would sit there and cry and my therapist wouldn’t interrupt me I could just be emotional not have to justify myself or explain why something had got to me but just talk just be upset and let it happen not try and stifle it not try and edit it but just to express
It’s a healthy way and goodness knows I have tried to express pain in many unhealthy ways the simplicity of just sitting and crying is a luxury for me ”
No, I do not schedule crying. It has just become, on average, two, maybe three times a year. Is it a trauma thing? Maybe. There was a time when life felt like a burning pyre, and I wept so much every day that a time came when I could not do it anymore.
I can remember after traumas, feeling tender on the inside but blank on the outside. I do not feel them less, but my body has fitted itself armour in an attempt to be impenetrable from the sharp edges, forgetting that the most searing burns of the past are infecting my insides. What is bruised skin? What are tears, when you think you are responsible for the destruction of your life at the hands of others? Where is God? That one I know, in my heart, in my soul, in every molecule the human eye can and cannot see.
Sometimes I still have physiological reactions, an anvil on the chest, stomach muscles tensed up in stress, the treachery of the panic attack. I am not an automaton; it betrays my sadness. But the tears simply will not come. My therapist pointed out that my medication made me so emotionally regulated that this was unsurprising, but more importantly, this meant that when they did come, they were genuine.
I have to resist the urge to overthink it. My tendency to ruminate is another part of the depressed territory that has taken a lot of work but is an example of something that is ongoing, a constant thing to keep at bay, when reflection becomes overpowering, an incessant blaze. Some days I can bat it away, others are a struggle, hands to my temples, leave, leave my head.
After our discussions in therapy I have learnt that one answer to this conundrum lies in creativity; it involves activities that preoccupy the mind in a way that other kinds of information do not. Perhaps this is because I do not feel simple distraction, but passion; I am not neutralising the bilge with cotton wool, but making something new from it.
Over time it went past pure CBT to general support. In the hospital we would fill out CBT worksheets and questionnaires that would identify the feelings and the issues to be dealt with, and the ways to find solutions. The actual sheets were a lot more technical, but that is the gist. It works when one is in the blinding thickness and very depths of mental and emotional obscurity; it requires the pen and paper, objective approach that can be seen and felt, even in that state of mind.
In my out-patient therapy there were no worksheets; objectivity came with pin-pointed talking and listening. It was not simply expression and then advice, in fact, the answers usually came from me, guided by his questions. It prevented any kind of dependence; those prompts gave me the confidence to trust myself. Of course there were exceptions. Sometimes I felt so lost, or could not comprehend something, and pleaded for answers. He always knew what to say and I have never underestimated how difficult his job is. My situation is complicated and I do not envy any professional who has to wade through it.
Even now, as I write this, I find it difficult to collect myself. Writing about six years of therapy leaves a lot to cover, but unfortunately I am only human and my words are not infinite. I have even experienced something of a writer’s block, a self-doubt. I vacillate between self-doubt about my abilities and a cautious confidence. The former often plays into my tendency to be unkind to myself, to give myself a hard time and sometimes see failure where it does not exist. I struggle to see straight. It is uncanny how I can look in the mirror one day and simply see my face, and then look into the same mirror at the same face the following day, and see nothing but my demons.
This issue was not just highlighted in therapy but by friends too, and I have been working hard to lessen its grip upon my mind. I believe that slowly but surely, through our work, I am making progress.
Our work in therapy was consistent; my various tendencies were not dropped from the conversation after they happened once, but were canvassed as long as they needed to be. Sometimes this progress felt stagnant but that was usually an illusion; it could feel like I was falling into the same traps, but there was always progress, even when I did not always see it. In group therapy at the hospital there was a line oft-repeated when we were unkind to ourselves:
“‘Would you say this to your best friend?’
‘No…’
‘Then why say it to yourself?’”
It is hard to argue with that, even when one is in an irrational state, when logic is just, frankly, annoying. Is it the depression talking? Anxiety? Personality complications? It actually did not matter in therapy what my diagnosis was. I have heard more than one therapist say that they do not pay much attention to diagnoses; that is the business of the consultant psychiatrist. In my therapy we have discussed how I feel about and relate to a diagnosis, but the diagnosis itself is not the point.
I figure out how to manage the symptoms, to express the fears and frustrations, find healthy ways to cope, and much more. My therapist impressed upon me that I am not my diagnoses; they do not define me, and are subjective to begin with.
Outside of this space I do appreciate diagnoses. When I see it on the page I feel like less of a confused creature with no medical parameters. I remember when I was diagnosed with depression in 2011 I was relieved, it’s a real thing, I’m not making it up. Ironically, being told I was mentally ill made me feel less crazy. In therapy, however, there are no labels.
My therapist never made me feel crazy. The ‘I’m a lunatic’ narrative never once came into the equation, even when I felt that way. I am a normal person with an illness. I needed reminding of this sometimes. My therapist was continually patient despite some of my infuriating behaviour, or when my memory issues meant I forgot things over and over, when I needed to learn the same things again or took time to break negative patterns; his patience with me did not falter.
“Voice recorded journal:
I come away feeling peaceful or more peaceful some things can’t be solved in a single session some things are for life other things are softened understood I can move and breathe again”
There is so much more to the work that I did with my therapist of six years but there is only so much space in my mind and ways to express it all.
A close friend made a good point, that it is good to go through a healthy goodbye, with no anger, hurt or regret, but a positive set of emotions in the conclusion of a wonderful thing. This is a good point, and it hurts, but because our work was a positive experience, and not because I felt wounded by something or someone.
I will always be grateful to my therapist and the work we did together from 2014 to 2020. I have a suspicion that without this therapeutic work and relationship I would not be here today. I think we did an excellent job at the task that was me, from the highs to the lows, through three hospitalisations and their aftermaths, through both trauma and true happiness. This support, as well as the kindness and empathy with which it was provided, was a gift to me that I will never not appreciate. I am a stronger person, a more able person, and on my way to greater strength with every day and every session we have had.
I am on to the next chapter now with a new, specific type of therapy that will help me in my current situation. When I think about it the real question that echoes in my mind now is, ‘So, Isabel, how does that make you feel?’