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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by mair on May 13, 2003, at 15:33:42
I walked out of a therapy session today seriously wanting to hurt myself or at least wanting to stop going. Periodically we have these sessions where something raises my anxiety level and I go through this brain paralysis where I can't string two consecutive thoughts together so it's impossible for me to communicate in any meaningful way or to be able to answer questions cogently. And of course the longer this goes on the worse my anxiety gets. I start staring at the clock and really can't get out of there fast enough. My therapist can see this happening and she's pretty gentle about just trying to get me to explain what I'm experiencing, but really this whole dynamic just mortifies me. I feel this sense of both embarrassment and shame - embarrassment that this is happening and shame that I can't get a better handle on it. I think I also become afraid that at any point my therapist is going to tell me that there is nothing she can do for me, or I imagine that she's as frustrated as I am and pretty much sitting there trying to work out an exit strategy for herself.
I'd love to know how the rest of you deal with those feelings of mortification. I'd love to skip the next session but I know if I cancel out it'll only draw more attention to my behavior.
Mair
Posted by noa on May 14, 2003, at 2:45:59
In reply to Mortification, posted by mair on May 13, 2003, at 15:33:42
Don't skip!
Say hello to your amygdala.
Really, I know I harp on that, but it sounds so similar to experiences I have had. Like panic and shame and fear that she will abandon you as being unworthy and unloveable because she is getting to know parts of you that are bad and unloveable? Parts that you spend a lot of energy avoiding any contact with?
I found that learning to tolerate this shame-panic in relatively small doses in the therapist's office began to "inocculate" me in a way until I could begin describing it in words. My therapist is good at working with me on the fine line between gentle exploration and needing to not overwhelm me.
It was very hard work, but worth it. I would not have been able to do it if I weren't going twice weekly. But, btw, that didn't mean that I HAD to deal with it directly in the next session. It was totally played by ear.
Maybe you can bring in your post, or any journal writing you do, to help explain to the therapist what you experience, since I know that verbal language during one of these attacks can be so hard to access.
With me, we started exploring the sensations I was feeling, and the frustration at not being able to find my language, and how this relates both to how my brain works and to early experiences of shame before I had words to describe them, and how automatic it is for me, sometimes to go right into that shame panic attack when I feel certain feelings, and how in my family my feelings weren't tolerated, etc. etc.
Over time, it began to be somewhat less toxic. I guess because I started accepting this part of me as well, part of ME. And learning that I could enter this state of mind and still know that I can come out of it, too. Ie, that other layer of panic kind of got separated out.
I think, though, that this hard work also depended upon my depression being adequately addressed medically.
One book that helped me was "Cognitive Therapy for Personality Disorders: A Schema-Focused Approach" Jeffrey E. Young. Ignore the "personality disorder" part of the title!! I did. Most of the book was not so useful (like some of the activities/techniques), but the main idea--that we carry around "schema", or deeply rooted core ideas about ourselves that we constantly work to either maintain or avoid, was helpful, and what was especially helpful was the questionnaire in the back that helps you identify possible core beliefs or schema. But it was hard work reading this and thinking about it, I admit.
Also, "Shame: The Power of Caring
by Gershen Kaufman" also had some ideas I found helpful in thinking about the connection between emotions and shame.
Posted by Dinah on May 14, 2003, at 17:02:12
In reply to Mortification, posted by mair on May 13, 2003, at 15:33:42
Oh, I do know what you mean, Mair. I get mortified in therapy more times than I wish to recall.
I can assure you that your therapist isn't wishing you elsewhere. She knows that it's the material that's coming up that is making it difficult for you to find the words to discuss it. She won't mind that at all. Mair, you should see the annoying therapy clients therapists get (myself included). I'm sure she doesn't consider you one. Of course, I'm sure you know that intellectually.
Have you tried talking about how you can't talk at those times? About how you're worried that she's fed up with you, or wishes you elsewhere? In my experience, talking about that lessens the shame. Oddly, becoming more vulnerable makes me feel less ashamed. And then it can lessen the anxiety enough to ease into the thing you were afraid to discuss.
This actually happened to me yesterday. I was in an emotional state, and could only think of one way to say something. That way wasn't all that coherent, and he was asking me to rephrase it, and I just couldn't. I couldn't think of different words. But because of all the conversations we've had about the process of what happens, and how he feels when it happens, and how I feel, I had the confidence in him to focus and stumble through it, with only a few objections to him over his impatience. And it does take trust and confidence, I think.
Please don't skip. Go and talk about it. I find that those times I don't want to go are generally my most productive sessions, if I'm willing to be honest about why I didn't want to be there.
Posted by noa on May 14, 2003, at 19:53:18
In reply to Mortification, posted by mair on May 13, 2003, at 15:33:42
Mair, how are you today?
Posted by judy1 on May 15, 2003, at 12:00:13
In reply to Mortification, posted by mair on May 13, 2003, at 15:33:42
Obviously you are not alone with the type of feelings you are having, and I think noa and Dinah gave you great advice. I've found that starting the next session by stating how I felt in the last really helps my therapist. She usually tones things down so I feel calmer, basically because she knows if she doesn't I tend to disappear for a while. I think of it as a dance, going forward when you are strong and going back when you're anxious. Most therapists are very familiar with it. take care-judy
Posted by mair on May 15, 2003, at 21:14:03
In reply to Re: Mortification » mair, posted by judy1 on May 15, 2003, at 12:00:13
Thanks everyone
Cancelling appointments is not a very realistic option no matter how much I might like to skip. If I left a message on my therapist's machine, I know she would track me down to persuade me to come in even if to talk about why I don't want to be there. She's been pretty clear that she thinks it would be a very bad idea for me to terminate or even cut back on therapy and that she would be proactive in making sure I didn't do that. I know she'd probably convince me to come so if that's the end result, why put her to the trouble of having to persuade me? I'm also too polite to just not show, so what happens is that I ruminate alot about whether I should cancel until it's too late to do anything but show up.
I went back there today with some trepidation. The first thing she asked me was how I felt being there. She could read me well enough from the time before to know that I probably wasn't going to feel great about how things had gone, but i think she was surprised that I was upset enough to want to hurt myself. Of course it doesn't take much to trigger those impulses anyway.
We went through things pretty carefully about what causes the paralysis that seems to overtake me sometimes mid-session. We've worked this through before so it probably shouldn't bother me as much as it does when it happens.
Without going into great boring detail, suffice it to say that I know that all of the difficulties I have opening up to her arise from the reasons I'm still in therapy to begin with; she's pretty well convinced that alot of this is transference and I'm playing out with her numerous barely remembered encounters with my father. I tend to think that transference is a convenient explanation. I think, although I can't really say it well, or even at all, that I'm pretty uncomfortable with the fact that I'm starting to care too much about what she thinks about me. Feeliing totally disconnected from her was an easier place for me to be.
I so much appreciated the thoughtful responses I got from you, my most excellent sages. I think this is just something I'll have to keep plugging away at with varying degrees of distress. I felt not as traumatized leaving my session today, but I am emotionally on edge and pretty well spent. I hate this low grade persistent state of anxiety I'm in now - maybe I just need to step back and go at things in therapy more slowly.
BTW Noa, I'm so impressed with those of you (Dinah too) who are able to show things you've written to your therapist. I'm not quite sure what I'm trying to hide, but I really can't see doing that at all.
Fondly,
Mair
Posted by noa on May 21, 2003, at 18:37:54
In reply to Re: Mortification, posted by mair on May 15, 2003, at 21:14:03
Hey, Mair. Glad the next session was less awful. Hang in there. Sometimes, I thought of the difficult work in therapy as kind of inocculations. If I could survive dealing with some stuff head on despite how uncomfortable I felt, maybe it helped me build up better tolerance.
Don't bother comparing yourself to anyone else (this time it was regarding showing therapists posts from babble). Comparing self to others usually ends up with the same, negative, self-critical conclusions. My experience for myself, anyway. My first therapist taught me that. He was right.
Hope you're doing better this week. Keep us posted.
Posted by shar on May 27, 2003, at 1:38:29
In reply to Mortification, posted by mair on May 13, 2003, at 15:33:42
Mortification and shame are the very basis of SO many of our real world problems in every day life that they are rich ground for exploration.
They don't feel good, the feeling (especially shame) sucks big time, but...you might be amazed at how much shame you feel *outside* your therapist's office. Thus, the office can become a place where you can experiment and experience what shame is, how it affects you, and where it comes from (the latter probably is obvious to you...mine is, of course, family of origin).
It is amazing to me how often we do feel shame at relatively innocuous occurrences...we make a mistake, we do something that nobody but us notices is 'horrible,' etc.
I would encourage you to pay good attention to when you feel shame, and to talk about it nonstop with your therapist (even though it might not feel good) until you move on to something else. The interesting thing about the human psyche is that we do, so often, move on to other things. Doesn't mean one thing won't come back (such as shame which is so deeply ingrained), but that there are so many other things we do.
Good luck to you, and I hope you and your therapist can play with that some. My T and I often refer to our time together and in group as a 'lab setting' where we get to try things out in a safe environment. I encourage you to move into trying things out, talking openly about things if you trust your therapist. It could make an interesting difference.
shar
Posted by mair on May 28, 2003, at 13:24:56
In reply to Re: Mortification » mair, posted by shar on May 27, 2003, at 1:38:29
I had a therapy session yesterday. I got to one of those places I frequent where she asks me a quesion; because of the content of the question I feel this oppressive rush of anxiety - then I freeze up and can't can't say much either because I don't want to say what I'm thinking or because my mind starts racing and I can't hold onto any one thought long enough to verbalize it. The thing that was different this time was that while I was sitting there trying to distill what I was thinking, I started thinking of you guys. Particularly I was thinking of Shar and what she wrote about shame, because shame was part of what was holding me back. I had just read shar's post before I left for my appointment. It was as if all of you guys were there cheering me on and telling me to take the plunge.
If my therapy was a Hollywood production (and a very boring one at that) I would have knocked down this impenetrable wall and answered her question in a way which made her understand what I was thinking and the emotions associated with those thoughts. Alas, old habits die hard and I eventually told her that I couldn't keep going with that thread of discussion. We switched to the somewhat safer topic of what she should do when my anxiety level sky rockets mid-session. As she pointed out, it puts her in the bind of deciding to lay off, knowing that whatever I'm thinking about is important or push forward some with the hope that I don't leave, as I have before, thinking that I should never go back. This is of course my bind also - I can be very self-critical about not forcing myself over this invisible hump because I know I can't get very far unless I start opening up to her more than I seem to be willing.
Anyway, I have no happy ending to report, but I did want to thank you guys for joining me in my session and offering me your unique brand of support. I'm hopeful if I can conjure up more images of you while I'm doing one of my mental tap dances, maybe just maybe I'll get to where I need to go a bit faster.
Mair
Posted by Dinah on May 28, 2003, at 14:26:43
In reply to Thanks for coming - Shar and others, posted by mair on May 28, 2003, at 13:24:56
Mair, Don't underestimate what you did do. Those Hollywood moments in therapy only happen in Hollywood productions. In real therapy there has to be lots of small moments of developing relationship and trust. Today was one of those moments. You were both able to discuss your feelings of being in a bind and how that made you feel and what you might be able to do about it. Maybe next time you can move a bit further. And in lots and lots of very non-Hollywood moments, you can make some steady progress.
Posted by noa on May 28, 2003, at 17:05:11
In reply to Thanks for coming - Shar and others, posted by mair on May 28, 2003, at 13:24:56
That is fantastic!!
Posted by shar on June 1, 2003, at 11:42:33
In reply to Re: Thanks for coming - Shar and others » mair, posted by noa on May 28, 2003, at 17:05:11
Dinah and Noa are right on!
What you did, while not of epic proportions, was a step onto a new path because you were aware of what was happening with the question, the anxiety, paralysis, etc. That would be a safe thing to talk about at some future therapy appointment--because looking back at something is not as taxing as when it originally happens.
So, it would be possible to talk about the incident and focus on what you felt when that occurred. That is one way of getting a grip on some of these powerful emotions and thoughts. It has taken me a long time to get to the point of saying "I feel a lot of shame that I am this way" or because of someone else (like feeling envious of someone in group because they have a lot of $$ leads me to feeling ashamed and worthless about where I am, or rather who I am). So, now I can sometimes say it out loud when it occurs, but that sure didn't happen overnight! And, probably, it shouldn't. I sort of believe we learn and grow as we can, we do as much as we can handle and that's good; more would just overwhelm us and we'd probably not be able to hold onto the message.
Keeping on is what it's all about, I think. Plodding, skipping, walking, strutting, staggering, crawling, running...all of those are what we do to keep going.
Thanks for taking us with you to your session!!
Shar
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