Therapy musts.

From this new vantage point I look back over the 20 some odd years spent in therapy and wander over what I have gleaned. Therapy is truly an art form. So many variables come into play to make it work. I won’t say good work vs. bad work, because that implies judgement and believe me judgement doesn’t do much but hinder the process. I have been there many times, often when frustrated that I found myself judging the therapist, the process, life. All of it. I didn’t get it. It felt like I was being force-fed some awful ration, one I wanted none of, even if it would save my life. I saw therapy as the enemy. I didn’t want to lay myself bare. Those secrets were mine to keep, even if they hurt me. Therapy was beyond difficult in those early years. For every 50 minutes, probably 2/3 were spent angry and silent. I did still have manners, so part of those minutes included “hello”, “how are you?” and “see you next time”. The rest, one word answers or a nod. Virgil slogged ahead, thought it wasn’t pretty and really wasn’t all that great. As the weeks and months passed we found some middle ground, but it still doesn’t come close to where I am today. I was never much of a talker. Yeah, I know. A true handicap when it comes to therapy. Over the years I have learned a lot, made plenty of mistakes, and found new skills.

1. It takes two.
For the process to work you both have to be committed and engaged. There will always be times when one or the other isn’t quite there. Somewhere in my life the ability to read people became a survival skill. I do it everyday, all the time. Just as my therapists can read me, from the first minute, I too can read them. Though I may not know why, I do know there are times when it is difficult for them to focus, and work. it may be illness, or family stuff, or whatever else is going on outside that office. They are humans. It is too easy, in the process, to hoist them up on some shining pedestal. To expect 110% every time, every minute. It is so critical to see them as just another person. They are no better, and no worse than I am. The sooner we figure that out, the better. If they are left up there in superhero land it is far too easy to think they are all-knowing, and all-seeing. That they will get everything on the first go. That they will magically fill in the blanks, and put the puzzle together without reference. Not a good way to think of them. Without my words, my truths, and my admissions the picture is incomplete. I cannot expect them to read my mind. If I am struggling, sliding, and losing my footing, I need to let them know that. Sure, after all this time they usually see it, but I can’t just take that for granted. In that same vein, they will make mistakes, just as I do. They aren’t going to say the right thing every time. They might push too hard, might press the wrong button wrapping us once again in stony silence. It isn’t always a smooth ride. Without the errors we all wouldn’t know what is doable or not. What is too close, or triggers too much. I am pretty blessed to have some very skilled therapists. I have sat in front of others that make me cringe in their heavy-handed, unskilled, unthinking approach. So much harm can come of that. But even the most astute have moments when it just wasn’t a good day. They see the errors just as I do. Sometimes they can be fixed in that session, sometimes not. But the constant is there, they will be fixed, and we will move on together. They are amazing that way. I know so many people who are not that lucky. Those that suffer manipulation and harm at the hands of therapists.

2. Trust
Trust is a small world with so much power. I’d say the most powerful of all when it comes to therapy. It is the foundation, the cornerstone of all that happens in treatment. It took a long time for me to trust. I have been hurt by so many people in my life. People that were looking out for my best interests. People that were supposed to protect and love me. I learned, at a pretty young age, to be the most fearful and distrustful of those that tell you they are there for you. Those that promise to make it better. Whether I wanted to or not, I couldn’t open up to Virgil. My mind had created some hardcore defenses. All someone needed to say is “I’m here for you” to send those defenses clear off the charts in intensity. It was that way for years. I forced her to prove her worth, time and again. Later the same, though less intense, process happened with Beatrice. I would not budge, not an inch till I was 2178943758906% positive they were not going to harm me. The best therapy seems to come from an open vulnerable place. One that I wasn’t willing to visit. It did not matter what they said, or tried. I wasn’t willing to go there. As I wrote about yesterday, that is changing. Trust enables that. I have allowed myself to trust them completely. To accept that they can deal with whatever it is that sits gnawing at my core year after year. That they have the skill to put it back together once we tease it all apart. It is all about trust. For me it is the most critical piece. To trust them I needed to know them. In the years of treatment I have found both to be open. Far more so than most therapists. It was a key to me figuring it all out. It let me see them as people, just like me. With lives and families and struggles. No, I didn’t need the details. I just needed to see them as people. There is so much debate in the fields of psychiatry/ psychology/ social work about disclosure. For me it made a world of difference. I could not work with someone who never shared anything. I could not deal with that “blank slate” staring back at me. I’ve sat across from a few. No, doesn’t work for me. This past December, I held a loaded gun to my head. Lost, disoriented, unable to grasp how everything fell apart in less than two weeks. I sat in the dwindling blue light alone, except for a lethal piece of steel. A few days later I sat on Beatrice’s couch sharing the moments that made up that horrifying evening. I watched as she changed right there in front of me. I was looking at someone I did not know. She tried hard to stay and even harder to make it appear nothing was different, but I saw it. From the first flicker of her eyes looking away, to the squaring of her shoulders. I was so lost in my own head and my suicidal impulses I didn’t quite know what to think. was it me? was she disgusted? afraid? angry? I couldn’t get my head to concentrate. In the next moment she made a choice. One that I think altered our work together. It was that last piece to the puzzle I needed to make our relationship complete. Trust. Complete and utter trust. She didn’t have to share with me. Most therapists would not have. But she did. In that moment, I was able to ground my racing mind long enough to see the sheer magnitude of the truth. She became all I needed her to be and then some. I understood somewhere deep in those hard to access places that we could do this together. It was a pivotal moment for me, one that allowed me to see the opposite side of the mess in my head. The ramifications of a decision lit on far too quickly and easily. She showed me her pain, and in that moment vulnerability. It isn’t something one often sees in their therapist. It did not make me see her as weak, if anything I saw a different kind of strength in her. She showed me trust, and in return I trust her more now then I ever did. It took me a while, but I know now where I can go with her. I am okay in that uncomfortable place that we work from. It all comes down to trust. Without it there is no therapy. I see clearly the relationships that have been forged over years of work. I see the trustworthy, responsible and loving people who are my therapists.

3. Love
Most people probably think love has nothing to do with therapy. It does. I’m not talking about foot of the Eiffel Tower with a rose kind of love. I am speaking of a deep respect and care. To love a person and care about them and their future. Not being just another name in the patient roster. A time slot filled in a burgeoning schedule. I have long seen it within Virgil and Beatrice. It goes both ways. I do think you need to have love to make it work. For me, love and trust are wrapped together in a complicated knot. For me they come as a package, and I am fine with that, because at the end of the day, I know they care as much about me as I do about them. I’m not just a number. One of the easiest ways to shut me down and turn me off is to treat me like just another patient. I know what it feels like after far too many hospital visits. It is a terrible empty feeling. To become just another cog in the wheel of the mental health system. I will never forget the single time it happened with Virgil. Years back as we transitioned from her acting as my primary therapist, to her doing mainly meds. I remember sitting there watching the session unfolded and hating every minute of it. I didn’t understand it then, but I see now that distance had to be made eventually. I was just over reacting to the miniscule shift, and it was slight, but in my mind it was huge. There had to come a day when I did not depend on Virgil. She had become everything to me, all wrapped up in a single package. She was at once my therapist, doctor, parent, confidante. But that was not what she was to be forever. I had parents, even if they had enormous shortcomings. I had a partner, that loved me deeply to share my secrets with. Virgil did not need to fill those shoes. But even as the relationship shifted I loved her just as I had years ago when she was the only real thing I had. I don’t think I would have done the work all those years had I not loved and respected her. As I moved away from her and toward Beatrice, I took that model of love and respect I learned from Virgil and laid it down as a blue print for the path forward. I applied it and let myself trust. Saw the love and respect mirrored back to me when I looked at Beatrice. I knew I would be okay with her. We have moved forward and our work has grown strong and complex, unattainable without the years spent with Virgil, learning.

4.Attachment
Ah, this might get a “uh oh”, or two. But It has its place in the therapeutic relationship. It is indeed part of the journey. To greater or lesser degrees it is essential. Some might disagree with me. My family has beaten this drum from the beginning. The therapist/ patient relationship presented a threat. They saw it as something dangerous, and bad for me. There is a point when it is too much. For me it was a relationship that I needed, and to some degree still do. I needed, more than anything to have someone I could cling to. I desperately needed a role model that would not run, no matter how terrible life became. No matter how much I decompensated, or how suicidal I was. As terrified, and impulsive as I became it never wavered. It was a life line. It was a steady constant tether I could always tug on if I felt my world tip. That hasn’t changed. I do not think that is a bad thing. As the years have passed I feel less dependent on Virgil. Less like my world would end should she suddenly vanish. I have found strength in my years of steady attachment to her. Just as I should have. She stood fast and modeled for me a strong steady relationship. I learned that not EVERYONE would hurt me. Not EVERYONE would abandon me. I could hold that line she offered when things were so raw and painful. Even as my family harmed me time and again she was right there. Yes, I was completely attached to her. It was that attachment that allowed me to venture out into the world. To return to school, though terrified I would fail. It was her constant presence that allowed me to slowly grow and develop into the person I am today. It was that dependence that allowed me the platform, the foundation upon which to grow. I hate when people speak of dependence and attachment as a vice, or an issue within the therapeutic relationship. That it will somehow challenge boundaries and blur the lines between patient and therapist. I can honestly say I wouldn’t be where I am today without it. The decision on Virgil’s part, so early on, to foster it. To carefully tend it, and let it grow. The risk was great, and it was uncharted territory for me. It could have back fired, it could have weakened me, rather than strengthened me. But in the final analysis, I think it will all be right. The length of our work together, the bond we have formed and the ground we have covered all evidence that this attachment is not pathological, it is the very opposite. I know where I end and she begins. I am fully cognizant of my being an individual. I do not need Virgil to exist in this world. She is a partner in this journey of discovery, hope, and yes, healing. We stand as equals in this journey. It was the bond, and the positive modeling she offered, and mirrored for me that allowed me to see that, and now live it. In my early ragged days when I didn’t see where I ended and she began, she showed me boundaries and taught me about consequences. She taught me that my behaviors impacted everyone around me and that I held the keys to living a better life, if I worked to control the impulsivity. I was not abandoned or harmed in the process, despite being 100% convinced I would be. It was the steadfast, unwavering attachment that cast light on this doubt. There is nothing wrong with attachment, it is vital, especially since my childhood development and experiences left me so shaken and fearful of close relationships. At its most base level therapy is a relationship. The therapist a stand in for those who have harmed and failed us. We play back and re experience a relationship, but with far different results. Our therapists model healthy and safe partners so that we can live and breathe a very different outcome than those we have suffered through our whole lives. We can explore the hurts and the defenses within the safe confines of a relationship that is at once nurturing and educational. Without some degree of attachment that relationship would not feel honest and complete. It is vital. There is nothing wrong with attachment when used in that manner.

Therapy is indeed a journey. A long and often rambling journey where learning and adapting become the hallmarks. Within the confines of an office we find the ability to free ourselves from a lifetime of pain, all too often of our own doing as we repeat well-worn behaviors. Our emotions controlling and dominating our lives. Therapy gives us the safe space in which to look at these patterns and why we engage in them. Look deep and find the roots while finding ways to explore new paths. It can truly be a path to enlightenment and freedom. Least I know that to be true for me. So much possibility lies out on the horizon that could never have even been visible had I not chosen to believe in this work and trust my therapists.

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