tides of December.

It’s been a month since I wrote last, and as usual, much has happened in the past month.

I have another part-time job. This makes three. My boyfriend got the dream full-time job. We have this thing called stability, and that’s weird, because I’m still transitioning from the academic world to the working grind.

I see a lot of clients everyday. It feels like an assembly line of therapy at times, and I’m too new in this field to think that way. But it scares me. Being unable to divvy my full attention to each individual simply because I have so many. Of course, I am still underpaid and overworked. And, of course, mental health is completely underfunded and underrepresented in nearly all sectors of healthcare.

But, I digress.

I know what I do is important, and I know what I do is meaningful. In addition to my children and adolescents, I’m now working with some really difficult clientele right now. The majority of them suffer from chronic pain or traumatic injury. The depression and anxiety is skyrocketed for nearly everyone I see.

I think hopelessness is the hardest symptom of all, and I think that only because I know what it’s like to experience that feeling myself. I know what it’s like to hate hearing anyone else tell you it can be any other way. Because, in your mind, it can only be hopeless. Because, to accept anything other than hopelessness means risking accepting a change you may not like. Hopelessness, in a paradoxical way, feels safer. It is a cushion of certainty, a guarantee that prevents us from the fear of crashing of burning.

The holiday season always arises mixed emotions for me. I am closer to my parents now that I have moved out of their home. Time with them is cherished and appreciated, rather than met with annoyance and angst. Yet, I tend to struggle with body image around this time of year, only because holidays center on food and food and more food.

And, I can use all the positive affirmations and visualizations and deep breathing I want, but there is still the five-hundred pound gorilla in the room that is masquerading as sprinkled cupcakes, and when my attention is on that, it’s hard to focus on anything else.

As I’ve said so many times before, it’s safer to focus on the craziness of the eating disorder rather than the craziness of the unpredictable day-to-day existence we live in. The eating disorder makes sense and it’s in my control. Nothing else is. Nothing else is. Nothing else is.

Nothing is in my control.
Nothing is in your control, either.
And, depending on perspective, that can be petrifying or liberating.

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The “SYSTEM.”

I have issues with most of the standard “theories” relative to eating disorder treatment.

CBT is a decorative bandaid, DBT is hard to find and difficult to buy into, psychoanalysis is too expensive, and group therapy leaves little room for in-depth personal exploration. Family therapy has high efficacy, but typically, it’s geared towards adolescents, and typically, it’s for wealthier and more motivated families.

Oh, that and most non-profit agencies and college campuses REFUSE to treat eating disorders. Which leaves everyone with: private practice.

Which is no small fee.

What’s happening with me is that I’m developing my own.

I’ve been researching. I’ve been writing. I’ve been thinking and talking outside the box. Using my own experience and my own therapy modality to guide me.

Maybe it’ll go somewhere someday. Actually, no. IT WILL GO SOMEWHERE SOMEDAY.

I’m tired of eating disorders being that “lifelong” illness. I’m tired of high relapse rates. I’m tired of the stigmatization, the broken medical model, the in-and-out recovery, the refusal to work eating disordered patients because they are too “high risk,” the utter lack of funding we have for individuals in lower to middle-class income brackets, and, of course, the fallacy that a disorder as complex as these can be solved with a thought record or a positive coping strategy. I’m tired of anorexia being the most fatal illness and the third highest leading cause of death for adolescents. I’m tired of people neglecting bulimia and binge eating as “crisis issues” because it may not be as physically apparent.

We need more. We need so much more.

There is research. Lots and lots of articles and brilliant professors in laboratories researching neurobiology and possible eating disorder treatments. Great. There are clinicians. Lots and lots of clinicians in residential facilities and private practices.

But there is a gap. There is not enough. The theories are weak. The treatment is difficult. The prognoses are poor.

Inspiration struck last week. My diploma arrived yesterday.

Who knows what will happen from here?

But if someone needs to do it, why not me?

the things unsaid in therapy.

I keep having dreams about my therapist. I terminated our work in December, seven months ago, and yet, I think of her constantly. It’s painful to long for someone that is paid to talk to you. Even more son, it’s painful to be a therapist and know all this and yet still hold out hope that she is out there caring for me, wondering about me, thinking about me. It makes me feel pathetic. It really does. And I hate feeling pathetic. 

I don’t nearly think about my own clients as much as I used to think about my therapist. Why would I think she’s even batting an eye thinking about me? Even more, why do I care so much? 

My boyfriend, who is an incredibly gifted therapist, researcher, and theorist summed it up really well this morning after telling him about another strange dream I had. He conceptualizes clients and human behavior from an attachment-based viewpoint (how we feel with our primary caregivers), so some of this may sound like neurological jargon, but it was really mind blowing for me. 

“She became your idealized mother as you have told me many times. She became a place you can feel safe, someone that on a very primal level felt loved you and saw you for you. She validated every part of your existence as a mother should. she allowed you to also feel safe on a subconscious level. She was changing your attachment patterns but allowing you to feel safe enough to talk about feelings and explore the things your right brain deactivates when stressed. however, she started doing things that made you question her love. She made choices that took her off the pedestal and because she never realized that what she did was wrong she never said anything and that part of your brain that activates danger was activated. When you can no longer trust that she has your best intentions in mind, you no longer have a secure base. Without the base, you go back to your usual response which was to suppress and distance and that’s what you did. you felt threatened on a primal level, you wouldn’t tell her your real reason for leaving (suppression) and you left (distance). Now, she, as a professional, never should have placed you in that position in the first place, but I still think you would greatly benefit by going against your attachment strategy of deactivation (distance and suppression) and let her know how she hurt you (corrective emotional experience). It’s a risk though, and I believe she really hurt you on a level.

I love my mother. I love my father. But I never learned empathy from either of them. I never learned that it was okay to cry and okay to be angry. The actions they perceived as negative were punished and reprimanded. As a mental health professional, I have now learned that this okay…but the parents NEED to validate if they are going to punish (i can see your angry, and that’s okay. I’m so sorry that you’re angry right now because that must be so hard …but we can’t hit other people). I don’t remember receiving that. 

I don’t blame my parents. Few of us know how to validate. It’s not a skill taught in school, and it’s certainly not a skill emphasized in greater society. My first real experience with genuine validation was with this therapist. Me, stepping out of a comfort zone, with fear and hesitance and feelings of utter chaos and failure. Her, metaphorically hugging me, letting me know it was okay to feel, encouraging my worth. Me, trying to suppress my feelings, minimize my pain, laugh instead of cry. Her, drawing out my feelings, maximizing the sensations, noting my incongruity.

I latched onto that so quickly. She became a lifeboat. Every session, I longed for her. I held onto compliments like they were tangible presents. I will never forget the time she called me special or the time she told me she would always be there for me or the time she said she had my back. I will never forget when I began complaining that I was afraid I was letting her down, and she stared at me and said that was impossible. Once, in a very dark eating disorder time, she said, “You are so smart and such a go-getter; I have full faith in you,” and I still cling onto that very basic message when recovery becomes hard. 

The fifty minutes were not enough. I could have sat on that couch for weeks. Whether we talked or not, the content rarely mattered. Being in her presence mattered. Feeling that kind of love and safety mattered. Like a small child, I just needed that comfortable, secure base. I needed to know someone loved me and could care about the dark and painful sides of me. 

She wasn’t the most ethical therapist. She asked me for referrals; she once said she would be willing to supervise me when I start interning as a therapist; she talked about her own life far too much; she probably allowed me to call and text her way too often during the week when I just needed to talk. She asked for a letter of recommendation, and that was the final straw. I’m not her employer; I was her client. That stung. But I never told her. I just told her treatment was over, the goals had been met, and have a good life.

There were so many cracks in this idealized mother, but I wanted to look past them, because underneath her unconventional ways,I knew she cared. She told me she cared, and she showed it. An eating disorder survivor herself, she had the resilience and the willingness to help someone who was struggling the invisible fight so many of us suffer. She knew my pain; in fact, she had already lived much of my story. 

I wanted to be her. She was a therapist in private practice living in a relatively upscale part of Southern California with two children and a husband. She was recovered. And that’s all I wanted then. Recovery, and I mean full-circle recovery, seemed like a distant life from my own. Everyday had been a battle in my mind, a battle of eating and exercising and the scale and how much willpower I thought I had or didn’t have.

She had the life I was waiting for; the life that seemed impossible when I first started this graduate school journey and was “required” to attend my own mandatory psychotherapy. I hadn’t even started seeing clients. I was in an emotionally toxic relationship. My parents and I were fighting regularly. I felt fat and ugly and insecure and lonely and anxious constantly. I was working two jobs, averaging nearly fifty hours a week. Everything was on a routine; I thrived on spontaneity, but I was living a life of rigidity and compulsion. I wore a smile, concealed the pain, and convinced the world my life was perfect. And nobody could call me out on that facade until I met her.

She challenged. That’s the best kind of therapist. One who can challenge you with love. One who can call you out on your bullshit, while also telling you that your bullshit doesn’t make you broken. One who can defy your eating disorder, while understanding its complexity, ferocity, and incongruity. One who understands ups and downs and will stand by your side throughout all of it, with no expectations and no disappointments.

I am the therapist I am today because of the therapist she was for me. Again, much of what she said didn’t matter; only a few interpretations and interventions really stand out. It was the safety, the presence, and the feeling of being understood. I cannot emphasize that enough. I grew through the relationship. Yes, she hurt me. I can own that now. But the process, the messy and complicated and joyful process of psychotherapy, was exactly what I needed. She was what I needed. 

Maybe one day I will get to the place where I can call or write to her and tell her exactly how I feel and assert myself. I can get the closure we both know that we never really had. Termination was too abrupt, and my boyfriend was right. When the going got tough, I escaped. This is my pattern in relationships. This is how I’ve learned to protect myself. Cut people off–then I feel guilty–then I want to reach out, but it seems too late.

I know she would accept it lovingly. i know she would be proud of me for standing on my own feet, as this is something she knew I struggled with. Right now, that seems way too scary. But one day, I’ll get there.

I Feel Off Right Now

And maybe it’s because I just ate two enormous cookies that I keep telling myself I shouldn’t have eaten. I was so hungry when I got to my parents’ house and I was pissed that they didn’t have my “safe foods” at home. Yes, I still cling onto those. Especially when my stomach is growling. They were delicious. They were SUCH damn good cookies.

But all my mind keeps registering is…calories, calories, calories, sugar, sugar, fat, fat, fat…WEIGHT GAIN. As if two cookies have the power to stack five pounds on my frame. As if two cookies ruin my life. 

I have to be okay with the gray. I keep telling myself that. I didn’t do anything wrong. I’m not a bad person. I’m just human, and I have a spectrum of emotions and experiences. Live in the gray. It’s a good place to be.

Clients move in patterns, it seems. Or maybe life just moves in patterns. Now they appear to all be regressing. Couples want divorces; my kids are acting out; depression and anxiety are on the increase. And they get so upset, as if they are right back at square one. And I want to hold their hand and tell them, no, you’re not. You’re never back at square one. Even when we relapse, even when life is worse than it’s ever felt, and even when we hit the bottom of all bottoms and then sink a bit lower than that, we are never back at square one. Because every experience, every moment really, stretches our horizons and expands our wisdom. We are always growing. Perceived failure is an opportunity to learn.

I say this, and I don’t always believe it. I’m hard on myself. I felt like an idiot in yoga today when the instructor kept “nicely” moving my poses and adjusting my body. I felt awkward visiting my psychiatrist (for the first time in six months) and talking to him about my eating disorder and life (he has about a 2 on a scale from 1-10 on rapport-building). One of my “frenemies” just got engaged, and I don’t want to see her in class tomorrow and look at her flashy ring. Oh yeah. And I wish I had another cookie. 

And I had to talk to a client on the phone a few hours ago…and she’s actively suicidal and has severe Borderline Personality Disorder, complete financial despair, and zero relationships…I want to help her, but I feel so incompetent…I never feel like my empathy and consideration and unwavering kindness is enough. She hates life and keeps telling me she wants to never wake up. And I don’t have the magic wand to make her world better. I don’t. I’m a therapist, but I’m not a magician, and that can be both depressing and empowering, depending which way we choose to look at it.

Even though it’s the Internet and this my blog, I realize how much I hate complaining. I feel like an entitled bitch. And yes, I can spew out how my feelings are perfectly valid, but I still play the comparison game. And my problems never seem as bad as anyone else’s. And then I just feel guilty. 

Whatevss. Sleeping it off. Self-care. 

 

treat yo selves.

Dear Bee, 

On Thursday, I treated myself. As in, I went on a date. With myself. Hokey-dokey, new-age, love-thyself pseudoscience aside, it was amazing.

Yesterday, I had a seven hour comprehensive exam that basically determines whether or not I graduate from my program. I’ve spent a semester studying for this test, hours and hours of writing papers and treatment plans and memorizing that little book we call the DSM. I think I did well, but I won’t know my results for a few weeks.

The day before, rather than cram my life away, I just did self-care. Took the entire day off. Cannot remember the last time I did that. 

Here’s what happened: Woke up, did a twenty-minute guided meditation, did about 40 minutes of flow yoga, went to the wetlands by the beach and went on a wonderful, mindful walk under the California sun, bought myself lunch and ate it outside, and then got myself a massage. Whole day cost approximately $30. And I was worth every single dollar. 

I was just so touch with my inner body. The meditation, the yoga, the feeling of the warm skies beating down my back, the firm hands rubbing and caressing my body. I could just feel the stress escaping from my pores. And I was FUCKING STRESSED.

Everyone deserves a day like this. And it doesn’t have to cost much, if anything. It’s not about having the time- it’s about having the priority. 

I went into that test feeling rested and prepared. And even though it was draining and challenging and a complete toll on both my mental and probably physical health, I did the best I absolutely could.

Can’t believe my grad program is almost over. The ending of one journey is just the starting line of another one 🙂 

 

 

to acknowledge relapse

I work with a young woman who identifies herself as a “problem drinker.” Very long story short and for the sake of confidentiality purposes, she experienced a highly-traumatic childhood and lives with a mentally-unstable mother. Alcoholism runs through her family, as it frequently does with addictive disorders. She drinks to self-medicate; she drinks to avoid feeling; to avoid the constant reminders of her broken past.

She’s been sober since I began working with her several months ago. We’ve worked on depression, anxiety, exploration of childhood pain, recent relationships. She’s a motivated client, and we have built very strong rapport (which I consider the single most important therapeutic skill).

Recently, she relapsed. I astutely observed as she told me this in session. The cowardly look. Eyes gazed down at the ground. Embarrassment. Shame. Lowered voice. I’ve started drinking again.

If shame had an emoji, it would have been the expression on her face. At one point, it would have been mine too.

It’s a painful truth to admit, and I know how much shame arises in just telling your therapist you’ve, in your opinion, fucked up. I hated doing it with my own therapist. So much transference occurs: so much fear of letting your therapist down, so much resentment and pain at letting yourself down. All people with addiction struggle in recovery, but it is far more important to examine how they acknowledge relapse.

I know this is true for me. Every time my therapist told me relapse is part of recovery with that smiling, you-can’t-possibly-disappoint-me expression, I wanted to knock that grin right off her face and yell at her for instilling doubt rather than hope. I obviously understand her intentions now, but back then…hell no. I thought I was the only one screwing up; I thought I was the terrible client; I thought I was somehow responsible for wasting her time and ruining all her hard work. I wanted to always be the exception; I wanted recovery. Perfect, black-and-white recovery…clean, concise, and predictable.

A good therapist, however, never works harder than his or her clients. Thus, when the therapist keeps that mentality in check, it is impossible to be disappointed by any content the individual can bring into the room. Am I concerned about my client’s relapse? Yes, absolutely. But…I recognize this is part of her process. She’s not a bad person for using a “bad” behavior. She made a mistake, as all of us humans do. Alcoholism is a mufti-facted, complex disease that isn’t as easy as stone-cold sobriety. I understand that.

I’m so fucking proud of her for being able to tell me. For being able to own up to that shitty part of herself that she hates, that she believes nobody can accept. Because…I can accept it. I can hold it. I can give her the love and validation she deserves to give herself, but, for obvious reasons, cannot do right now.

My therapist used to do that for me. And it felt good. It is something I always promised I would give to my clients, and it’s something I try and transcend in every single session with every single session. Validation. Support. Constant hope and reassurance that things can and will get better, that they are good enough regardless of what they do or do not do.

Some people never get told that by anyone. My aim is to tell that to anyone who needs to hear it.

good morning.

Dear Bee,

After feeling really dejected the other day about my future and what I had in store for me, yesterday again showed me that I am on the right path and reinforced my avid belief that everything comes to me at the perfect time.

My supervisor, while I was discussing a complex client case in our meeting, praised my “phenomenal work” and told me, “You’re not afraid to push your clients towards the light. And that’s a big strength.” That made me feel so good. And she’s right. Most of my clients are in some kind of pit of darkness or at least are familiar with feelings of the hopelessness that drive them to therapy in the first place, and I do believe it is my job to instill hope where there may be none and provide a light at the end of the tunnel.

Later that afternoon, I was talking with a colleague who is leaving my agency to continue her private practice endeavors. When she was asking me “what’s next?” regarding my own future plans, I told her I wasn’t sure, but I didn’t think I was ready for the private practice route for awhile. She asked why, and I said I didn’t think I was adequate and competent enough for such work. She looked at me in disbelief and said, “Really? You’re incredibly knowledgeable. I have no doubt you’d succeed.” That also made me feel good, given that this woman is twice my age and far more experienced. 

So. Yesterday was a good day 🙂

And today is going to be just as wonderful because I am deeming it to be wonderful.

I am so glad I spent the last year working on myself. I can’t imagine where I would be physically and mentally had I decided to remain stagnant and unwilling to change. I would have probably just continue with my compulsive, rigid way of existence: through food, through work, through relationships. I would have sunk deeper into denial and avoidance. There is little that is more important than the relationship one has with oneself. Thus, to harm yourself is a cry for help and a signal that many primitive needs are not getting met. If you want to harm yourself in anyway, LISTEN to that voice. It’s telling you something, whether you want to hear it or not.