Rupture in the therapeutic relationship: where do I go from here?

It’s been a week since my last post where I talked (cried, moaned, wailed!) about the rupture between myself and my therapist that came about after the exchange of a couple of text messages last Wednesday (I do see how very dramatic that seems!).

For those of you not familiar with the context, I had been really struggling with the therapy break (that old chestnut) and had worked myself up to a point of high anxiety where I was barely able to function….that is how it was and so I won’t downplay it. After three days of intense emotional struggle, not eating, and almost self harming, I decided to reach out to my therapist to ask her reassure me that she was still there and that the relationship was still ‘ok’ via text message…

And then it all went to shit! Like huge amounts of gushing diarrhoea shit! Ugh! I still can’t believe that I didn’t see it coming.

I know that it sounds bonkers that a 34 year old woman can’t maintain a sense of connection to a therapist that she’s seen for three years, but then I struggle with object constancy and it’s all part and parcel of disorganised attachment. The feeling of anxiety and all-consuming panic that floods my system, and worrying that I have been left is enormous. It’s excruciating, actually.

These feelings don’t come from nowhere. They feel enormous now but they were also enormous when I was 10 months old and my mum left my dad (and the country) without telling him or anyone else (you know, as you do!). I have a very clear image of myself at two years old standing on the back porch, looking at the snow, wearing a red snowsuit saying ‘where’s my daddy?’ – I don’t know if it’s a genuine memory but it came to me in therapy one session when I had been particularly dissociated.

So where was daddy? Not there then, and certainly not here now. He left me unexpectedly when abroad on holiday. He didn’t mean to. He had a sudden heart attack three days into a diving holiday. So daddy is gone gone. Little girl doesn’t understand and adult me never saw a body or had a funeral so can’t really understand that daddy is dead now. Part of me thinks he’s still on holiday.

We returned home to the UK when I was 3.5 years old. My mum got back together with my dad. Happy times right? No. Next thing to happen was for my mum to disappear on me 5 days a week from the age of four to go away to study. That makes sense to my adult but the little girl part of me still feels that intense confusion and fear that mummy has gone. I was always left wondering when she might return because one day, two days, three or even four doesn’t mean anything to kids – their concept of time isn’t like ours. Mum wasn’t there so maybe she was never coming back.

What I am clumsily trying to say is that the anxiety I feel on therapy breaks or in between therapy sessions does not belong to my adult. Sure the grown up part of me would like to see more of my therapist, but the dread and fear I feel it is that of a little girl that has had no emotional stability or consistently safe caregiver for her whole life. It makes sense to my adult that being away from the new attachment figure would stir up all kinds of chaos for the young ones.

Anyway, back to the text debacle. In fairness to my therapist, she did respond to me, she didn’t leave me hanging- unfortunately, though, the messages she sent did little to reassure the little girl who was absolutely beside herself and the messages felt cold and misattuned to those needs. Little girl had a meltdown!

Lots of readers commented on the post and could see why I would feel devastated by the perceived tone of the messages I received. It felt comforting, on Thursday, that at least some people could see how upset I might feel and that I wasn’t completely unjustified in feeling utterly bereft.

By Thursday evening I felt quite overwhelmed by the comments on my post because they seemed to be confirming what I was feeling was understandable and justified. I didn’t want to be right, though. Because if my feeling were justifiable….then that meant my therapist had cocked up and missed the point…and I didn’t want that to be the case. It’s much easier to take things on myself than see fault in others. I can change me but I can’t change somebody else. I didn’t want for it to be the case that maybe she didn’t care. That felt too devastating.

I’d felt completely abandoned and rejected by my therapist on Wednesday and I can see now that a lot of my reaction to her messages was about my coming from a very triggered place. Perhaps my reading of her words was not quite as they were meant – she said as much on Monday. Unfortunately, though, my therapist’s messages felt rejecting regardless of her intention and that is what I need to work through.

I had shared what had happened with a friend on Wednesday. I was utterly distraught. She could see how I felt and also felt that the messages felt cold. She recommended a therapist in my area and suggested that perhaps it might be good to get another perspective on things. I agreed this would be a good idea, not just because of this rupture but for some of the other things that have been niggling away at me in the therapeutic relationship.

I emailed the therapist to see if she could offer me any sessions to help me work through the rupture with my therapist. Essentially, I wanted her to help me see if I could find a way of working through the issues I have in my current therapy or whether it might be time to look for a new kind of therapy.

The therapist responded quickly and the reply I got was really warm and empathic even though all I had said was that I had had a rupture with my therapist – I hadn’t given any detail. It was a world away from anything my therapist has ever sent which was both refreshing and painful. How can someone who doesn’t even know me be so open and warm and yet someone who knows me intimately be so business-like? I know. I know. Two different people with two differing approaches…but ouch.

The therapist had spoken with her supervisor following my email and agreed that we could do up to four sessions to work on this stuff and that she had some availability for the next two Tuesdays. I jumped at the chance to get additional input and support because the situation felt/feels utterly horrendous.

Part of seeking out additional therapeutic support was that I wanted to know if my responses to some of the things that have happened are over the top or actually justified (I know she wouldn’t use those words, and actually my feelings are my feelings – rational or not they are real to me), and also to better understand things from a therapist’s perspective.

I know the new therapist is not ‘my therapist’ but she would objectively be able to look at the situation and maybe signpost things for me on how to get through this or at least help me clarify what it is that I need to say to move forward. So that was positive. I felt too, that having this space on Tuesday would mean I would have a sounding board for whatever happened on Monday…and that in itself allowed me to consider going in to face things.

By Friday morning I had begun to settle down a bit, or detach, or perhaps I was a bit desperate… I am not sure what was going on, really. It’s weird. Different parts were doing and feeling different things. Looking back I can see that even though there was a huge part of me that was hurting and angry there was another part that couldn’t bear the thought of not seeing my therapist. The attached child part longed to see my therapist and to try and make the situation feel better and wanted to believe that she cared.

The last message I had sent to my therapist on Wednesday was that it was unlikely I’d be coming to session but that I’d let her know on Friday because she needs 48 hours notice of cancellation. On Friday morning I text her asking her to read the blog post I had written because I needed her to understand how I felt in the moment, even if it was reactive, and even though I might feel a bit less wounded now:

‘I’m still at a loss about Wednesday but I think where I have got to is that you don’t ever deliberately do things to hurt me and I have to trust that you know what you are doing – and so I guess we need to talk on Monday even though part of me just can’t face it. I’d really appreciate it if you can find time to read the linked post before session because I really think you need to know this stuff but equally we’ll need all the session to talk. If you let me know on Monday how long it took to read then I’ll just add the extra to the payment. Have a good weekend.’

 She replied almost immediately:

Ok, I’ll read it. See you on Monday’.

This message was short and to the point but it didn’t feel rejecting…which made me wonder a bit about how I reacted to the first message on Wednesday which was clearly longer and addressed more of the content of my request. Why was my reaction so different then?

I guess what I would say is that the point at which I was reaching out for reassurance my adult was not online AT ALL. I was fully caught up in a trauma response to feeling abandoned in the break and so the part that needed reassurance needed a very simple, caring message. I needed the kind of thing that you might say to a very distressed child: ‘it’s ok, I am here, I know you feel scared, but I will be there on Monday and we can talk about this’…or something along those lines. 

I think this is one of the pitfalls of working with clients who have fragmented parts. It’s not always easy for the therapist to see which part is communicating a need (especially through a text or email) and so it’s hard to know what to say or how to adequately respond- which is why my therapist will not usually reply to texts. She says that when she can’t see me she can’t get a true sense of what I am feeling and she may hone in on completely the wrong thing and leave me feeling unseen and unheard because she misses something that is massive to me….doesn’t stop me wanting to reach out though!

Having said all that, on the occasions where my therapist has responded to me or sent a prearranged message at a particular time she seems hell bent on keeping the adult front and centre in her communications. So often it feels like our exchanges seem to miss the mark because she only talks to the adult part. She doesn’t acknowledge the child parts outside session. It’s different in session, thank god.

Through her messages I think she wants to bring the adult part back online (and that makes sense) but actually all that happens is that my young child parts feel rejected, unseen, and abandoned, when she sends messages aimed at the adult. It takes a lot for me to show any level of vulnerability and need and so to have it almost ignored feels absolutely crushing to the little parts. And that’s exactly how it felt last week. I felt like I had been annihilated and struggled to get my adult self back online.

I don’t know what the right thing to do in this situation is. I know that how what she does makes me feel awful but perhaps there is some kind of therapeutic rationale behind the way she communicates that I just don’t understand. For me, I feel that if she at least acknowledged the child parts, then it’d settle them a bit and allow adult to come back online. Ignoring the young ones just agitates them even more. The attach parts are set to scream until they get a response from the attachment figure, after all so ignoring them doesn’t shut them up.

Anyway, Friday went by steadily. The feelings of pain, rejection, and abandonment from Wednesday were still swirling around and distressing the child parts; the inner critic was doing a smashing job of attacking my body – I only ate twice between Tuesday and Friday. The teen part was feeling very much ‘fuck her and fuck this’. I could feel an additional cloud move in as Friday progressed. I sunk into a really very bad place. I’m not just talking depressed and lethargic. I was bordering on suicidal and I don’t mean that in a flippant way. I literally wanted to die. I haven’t felt like that since my breakdown in 2009. I really felt desperately unwell in my mind.

I text a friend and tried to dig my way out of my hole before having early night. I had bad dreams about therapy and then woke up feeling anxious but not like I wanted to die. Thank goodness. It was crap still, but not end of the world crap. When it gets bad I have to try and remind myself how quickly these feelings can move in and out.

I think what I am beginning to understand now, is that perhaps I am not a massively changeable, volatile, and, unstable person, but actually instead there are many parts of me and they have lots of different feelings. I need to become more aware of who’s running the show at any given moment.

Who is the ‘holding it together’ one and who is it that wants to die? Who wants to attach and who feels left and wants to run away? And so on. Because whilst I know they are all part of me, they are exactly that, fragmented parts. That’s why it is so unnerving to feel so conflicted so much of the time, there are so many voices from so many different times competing for attention. Sometimes some are silent and sometimes they are screaming. It really just depends on the moment and what triggers there are.

For example, this week I have really been aware of Eleven (my eleven year old self) being close to the surface. I don’t see a lot of her but this week I have felt her pain and that pain runs deep. I feel how sad she is about having tried to tell an adult how bad things have felt for her and what it is like to be shutdown for it and to not have her feelings acknowledged. She longs for someone to listen to how scary things are for her and validate those feelings but no one ever does. And because she copes so well (on the surface at least) no one ever looks beyond what they see.

By the time it got to Monday I was in a really bad way physically. I think not eating properly (bearing in mind I am always teetering on the edge of normal eating anyway) had really started to mess with my body. I mean you just can’t live on 400 calories a day when you already have a BMI of 16. There are no reserves to draw on. I was shaky and lightheaded but that numb feeling gave at least some part of me a relief.

I didn’t think it was all that noticeable to anyone else but I have just been to get blood taken for next week’s haematology/cancer follow up and the lovely nurse took one look at me and said, ‘you’re looking really pale, are you ok?’ and then as I got up to leave, ‘you’re looking very slim, are you eating ok?’ I said I was fine and that I’ve just been fighting a virus which meant I’d lost some weight…we get good at making eye contact and lying like it’s the truth don’t we?

So to Monday…As I drove to my session I was physically shaking- from nerves more than low blood sugar I think. My mind had shut off, I felt numb, but my body was clearly sending up distress signals.

The first thing I said when I sat down on the couch was ‘I’ve been shaking in the car’. I had no idea how the session was going to go but I didn’t feel especially hopeful. Something felt off. My therapist’s tone and body language felt all wrong. I know I am sensitive to these things because I have always had to be. I’ve always been in a necessary state of hypervigilance because I never knew when the next attack was coming. I needed to be alert to the warning signs.

I might have been projecting negative feelings onto my therapist and maybe she didn’t feel cross or annoyed with me, but something was telling me that things weren’t ok.

The session was stilted and difficult. I found it really hard to talk and I felt like my therapist didn’t really try and draw me out. Sometimes I listen back to sessions and I can hear how hard she is working with me, trying hard to connect with me, trying to make me feel safe. There was none of that on Monday. There was no warm voice or understanding non-verbal gestures. It felt like she didn’t want to be there. It felt like she thought I was criticising her.

I felt as though she didn’t really understand that although I now saw that the response to her messages was quite extreme, that the feelings of abandonment we real to me in the moment. She didn’t acknowledge how feeling ignored and uncared for felt. She said that she had responded to me and that that showed that she was there. I get what she was saying but it felt like we were at crossed-purposes. She wanted me to see that because she had text me that she had proven she was there; and I wanted her to see that she felt impersonal and distant.

On paper there was nothing wrong with what was said in session. Technically everything was correct in terms of theory….but that’s the problem. There’s more going on here than applying theory to a struggling human being. Knowing your stuff can still lead to empathic failure.

Being told that the time for my ‘young infantile needs to be met has passed’ is all well and good (hell don’t I know this, I’ve written about it enough!) but I needed some empathy too. i.e ‘you know the time for your young needs for holding to be met has passed. I know the little girl part of you wants me to hold her and make her feel safe, and I understand how painful it must be for me not to do that for her. I know that she feels rejected, but I am not rejecting her.’ – you know? Something that expresses the theory but also shows how it feels to me with her in our relationship despite the theory. She did acknowledge it was painful – I guess I’m splitting hairs.

I left the session feeling a bit hopeless. I had hoped to go in and repair the rupture and to find some common ground and reconnect but instead I left feeling like I was alone with all these feelings. I mean, the huge issue has long been feeling disconnected between sessions and then struggling, yet this time I felt disconnected in session…and so it’s not great now. Usually my leaky bucket takes a couple of days to dispense with the warm connected feelings. This time I left session with an empty bucket.

Fortunately the session I had with the other therapist on Tuesday was positive. It was a completely different experience to what I am used to and quickly allowed me to tap into emotions. I was staggered that I felt the urge to cry – usually those feelings are on lock down. I felt heard and understood. Bonus!

I have come away feeling positive about moving forward either with my therapist or, if not, someone else. My feelings were validated and I feel as though there are potentially other ways of working that may help me better if I can’t resolve things with my therapist or find a way to meet in the middle. Ultimately my goal is to try and sort things out with my therapist. I love her and really value her. I just need to find a way of expressing my needs and hopefully getting a few more of them met so that I don’t repeatedly find myself drowning in disaster therapy breaks.

Right, this is enormous and so I am going to go…don’t really feel like I have said much!

p.s Thanks to everyone that commented last week and supported me.

img_2363

Author: rubberbandsandchewinggum

Mid-thirties. Mum of two. Procrastinator. Therapy and mental health blogger.

5 thoughts on “Rupture in the therapeutic relationship: where do I go from here?”

  1. Sounds like it was a difficult one. I’m glad you sought out the opinion of another therapist, and I hope that maybe it will mean success in repairing the relationship with your current therapist. Definitely continue to keep us updated!

    Liked by 1 person

  2. I am so full of admiration at how you’ve handled this. What you’re dealing with is enormous and you’ve made some brave decisions and faced the tough stuff when you could’ve just quit. In a totally non patronising way – bloody well done! X

    Liked by 1 person

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s