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A Recent Experience in Psychotherapy

depression-manThis story was provided by former therapy patient Don.

In this essay I will present my experience in a therapy of about six months, which occurred in the middle of 2014. In order to provide useful background to the reader, I will give a brief history of psychological issues I have dealt with in my adult life, and also some significant events that occurred to me before the start of the recent therapy.

I am a male of about 65 years of age. In my middle twenties I developed panic attacks after a single bad episode of smoking marijuana. They were very severe, with the mental fear being much worse than my concern about the physical symptoms. I had been married for about 3 years, and my wife was supportive and understanding with me, but my progress was very slow with respect to lessening of the panic attacks. Eventually they changed from free-floating panic attacks to panic attacks in response to certain stimuli. At this time I began a therapy which lasted about 12 years, once per week.

In my childhood, adolescence and college life, I had been reserved and quiet but did not have any significant anxiety which interfered with my living. I had always been aware of my lack of emotional connection with my parents and family (I am the youngest of 4, the closest sibling is 9 years older than me) and explored it further in therapy. My mother was both neglecting and intrusive, and I became self-sufficient very early in my life. My father was distant.

I worked for a large company and it was necessary for me to travel by car or plane to various locations for various reasons. This travel caused me severe anxiety and panic attacks at times, and I knew firsthand why people became agoraphobic; although I forced myself to do the travel and it probably helped me eventually with respect to anxiety diminishment.

In 2006 I was offered the opportunity to take an assignment in Milan, Italy for one year (my wife would accompany me). I wanted to do it very much, my father was born in Italy although he was deceased by 2006. My mother was also deceased. I was intrigued by the thought of living and working in Italy. I had stopped my first therapy in the late 1980s (my therapist died) and I had not started another. I had also moved to another part of the US with the same company.

The thought of actually accepting the assignment caused me a lot of anxiety and I started therapy again to help me understand and manage the anxiety, in the six months before I would depart. I had many ups and downs, including intense anxiety (but not panic attacks) during the first month in Milan. I spoke with my therapist a few times by phone from Milan and was helped by it. Once I became more relaxed I enjoyed the experience very much, the physical environment of big city life in Milan, the history of Milan and other parts of Italy, and the warmth of the people both in the office and other encounters. I did not continue therapy when I returned to the US because my therapist had retired.

In 2012 I was offered again the chance to return to the same Milan office for six months. And again I had anticipatory anxiety and went to another therapist before I departed. As during the first time, I enjoyed the experience in Milan. My wife could only stay for the first three months and I was there for the second three months myself. Part of my work on this visit included working with an unmarried young woman in her late thirties on a detailed project. We had a lot of interaction together and traveled by car to the jobsite on occasion. She was very friendly and emotionally expressive, and also shared with me information about her family life. She had a younger sister, with whom she was very close, who was suffering from severe depression. She was worried about her and talked with me about her. I shared a little of my own life and we became close. Her emotional expressiveness, eye contact, and direct communication with me about what she thought and felt touched me very much. I would have tears running down my cheeks while riding the subway back to my apartment when I would think of aspects of our interaction. I have tears running down my cheeks now writing about it.

I knew at the time in Milan that these tears were not just about her, that they were about my longing for connection in general, the missing connections from childhood.My wife has some issues of her own which have interfered with my feeling close to her over the years. And then there is probably the aspect of the woman in Milan being the right person for me at the right time in my life. When I returned to the US though, I couldn’t hide my emotions from my wife and I would cry or have tears at odd times. I eventually told her what happened to me in Milan. She was somewhat understanding but also felt hurt and betrayed that I had these feelings in connection with another woman. I also have a married son and daughter, with whom I am close, but for some reason this experience with the woman outside my family affected me deeply.

I continued to see the same therapist (a man) when I returned to the US in early 2013; and talked and cried a lot about what happened to me in Milan. It was the most tears I have shed in my adult life, even compared to the times of intense panic and anxiety. Panic and anxiety are “bottling up” kinds of emotions but the emotionsexperienced in Milan were freeing. My wife has also been seeing a therapist for years and I asked her if we could both talk in the presence of her therapist about what I experienced in Milan. I thought she might be more open to talking about it in that setting. Her therapist agreed, and we both went to see her therapist (a woman).

While in her therapist’s office I began to describe my encounter with the woman in Milan. I was describing a text message that she had sent to me after we went for a walk in the park on a weekend. She had thanked me for being available to talk with her and stated that she felt very at ease with me, which made me feel that she just liked being “with” me. I started crying very deeply and evidently went into a trance state for a few minutes. I don’t remember going into the state but I remember coming out, it felt similar to coming out of anesthesia. It was the first time it ever happened to me in my adult life.

My wife had obviously witnessed it and told me more about it later. It was towards the end of the session. The therapist noticed that my eyes looked far away and had asked me if I knew where I was. I said that I did not. She then asked me some other questions which I responded to. She brought me a glass of cold water to hold in my hand. When I came out of the trance I did not remember anything that occurred during it. I was not fearful when I came out of the trance, but I felt emotionally very tired. As I thought about the event in the weeks following, it confirmed for me aspects about my childhood that previously were only conjecture. My conclusion is that I was probably left isolated at times and not responded to, and that I coped with my anxiety by going into a trance state. The encounter with the woman in Milan had activated my emotional memory of the strong desire for attachment that I had previously kept buried.

After experiencing the trance state I researched it and became aware of the concept of complex PTSD, a type of traumatic stress disorder that is based on long term exposure to uncontrollable situations rather than an acute, short term event. It was helpful to me to understand my childhood trauma and its effects according to this concept.

Because my emotional experience and trance state occurred in the presence of my wife’s woman therapist, I discussed with my current male therapist that I was strongly considering switching to a woman therapist; that I had only been to male therapists previously. He was a little unsure of the need for me to do so but he did not object strongly. I initially asked my wife’s therapist if she would consider working with me but she did not want to due to her long history with my wife. I subsequently looked into female therapists on my own and picked someone based on their approach and years of experience. As a side note, I did not experience any strong feelings about leaving my male therapist and had not had any awareness of separation anxiety with any of my previous male therapists, both the one who died and the one who retired.

At the time I thought I must have felt safe with my wife’s woman therapist and that it enabled me to experience emotions that I had not been able to with a man. My simplistic expectation was that I would go to a woman therapist and talk more about what happened to me in Milan, and determine what other emotions or memories would surface.

In the beginning stages with the woman therapist I felt comfortable with her and went through the routine of describing my history in general and then what had happened to me in Milan and the recent trance state. I started to feelattached/connected to her and told her about it. When I was not in the session I had comforting thoughts with respect to her and it seemed to me that she was quickly becoming a good internal object for me.

Soon after this in one of the sessions she sort of abruptly told me that I was “living in the past and you don’t even know me”. She told me that my positive transference would inhibit progress in the therapy. I was aware that my strong positive reactions and attachment were influenced by my past, the same as my feelings when I was in Milan. But my feelings were for her, the real person, in the present time; which I again told her. She typically would not confirm or even acknowledge that my perceptions might have validity, and I felt from this point on that it was not a good thing for me to discuss my positive feelings with her. However, I believe it would have been very beneficial for me to continue to express my positive feelings to her and have them accepted by her. The emotional release that had been triggered by my awareness and desire for connection while in Milan demonstrated this. In retrospect I believe this area could have been a very helpful aspect of my work with her.

I began to feel a little negative from this point on, that I was not worthy as a person from whom to accept affection, and that, according to her, I could not evendistinguish present feelings from transference. In a later session I was feeling rejected and childlike, and I voiced my disappointments with her that I didn’t feel any rapport with her, that I felt she was cold at times, that I was feeling inhibited. I was talking in a monotone, they were “I” statements, I didn’t attack her. She made a statement that I was in a very different place than our last session, told me that I was really beating on her, and told me that I was raging at her. Her emotions went quickly from appearing hurt or indignant to very angry, telling me again that I was living in the past and that my statements really weren’t about her; berating me that I was unable to make this distinction. The unpredictability and intensity of her anger shocked me, including the reality-reversing statement from her that I was raging at her, when in actuality it was vice versa. She then went on to tell me that she didn’t know if she would be able to continue to work with me, that she couldn’t be what Iwanted her to be. I was devastated. I had finally gotten to a place with a therapist where I could voice a little hurt and anger and I was fairly immediately attacked and retaliated against.

She told me that she was “setting limits”. I understood the concept but it seemed so unnecessary given what I had actually done and said. The bar was set so low. I told her after this episode that I was afraid of her and that it was very destructive to the therapy. I said that in addition to retaliating in anger, she had triggered my worst fear, that of abandonment, by threatening to not work with me if I didn’t “behave”. I was crying by the end of the session, from her anger and from her threat. Also,though, I was crying because I actually felt compassion for her, that I truly had hurt her.

My discussion of this event went on for quite a few sessions but she would never respond meaningfully, would not even acknowledge how destructive this was for someone with my history. I also described to her that I had cried partly out of compassion for her, but she didn’t respond with any validation of being hurt (I still am not sure if she was hurt or if it was a feeling on her part of an untrue attack). So now, in addition to not feeling comfortable to offer my positive feelings to her, I was also afraid to voice any anger or disappointment to her. No area was safe. I felt like she was rejecting me because of my illness, because of who I was.

The week that she became very angry with me I saw her two more times in addition to my normal session, because I was feeling very anxious and upset after her angry outburst. On the upcoming weekend I was flying to the city of my daughter, who was getting married at the end of the following week. I was concerned that I might continue to feel very anxious and I asked her if I could contact her and possibly talk with her by phone during that week if I needed to, because I wanted to be able to enjoy my daughter’s wedding. She told me that from what she knew of my emotional state that I should be fine, and if I felt really bad I could always call 911. She would not agree to consider talking with me. This added to my feeling of not being cared about by her, either personally or professionally. I very rarely make special requests of people, including during my other therapies, and it reinforced my long-held feeling that it was no use to ask for help because it would not be given.

I seriously considered terminating at this time and went through the process in my mind. But the reality of leaving triggered even more severe anxiety. I was now aware of how attached I had become to her even though she was causing me at times severe distress. I told her of my consideration but decided to stay, mainly because I felt I couldn’t leave. But my anxiety between sessions continued to escalate, sleep was difficult, and my ability to focus on routine tasks was diminished. She countered by offering to see me more than once per week, but she didn’t take my insurance and I was paying on my own. In addition, I didn’t believe that more frequent visitswas the solution. To me, I was in a double bind – I wanted and needed a connection with her but she was the source of my fear as well. I also talked with her about this aspect, but again she would not respond meaningfully.

At this time I was feeling very attached to her but in the double bind – which I couldn’t solve. I would wake in the middle of the night with pounding heart and anxiety, and ruminate about the relationship with her and how I could repair it. It reminded me of what I had read in Winnicott about a “mind psyche”, that the child becomes dependent on his intellect/mind very early if his environment is dangerous or unsupportive. Some weeks I would request another session and when she would return my call I would have tremendous relief and tears. Also, with her, compared to my other therapists who had given me cell phone numbers or email addresses, she only communicated through phone messages. I think it added to the feeling that I had to wait and hope for support and contact, similar to childhood.

I made a concentrated effort in one session to repair the relationship and voice my concerns again, along with published information I had brought with me to reinforce my own views. In my opinion she was dismissive and flippant, and asked me if this was all a big game to me and asked if I wanted her to solve my fear for me. I felt after this session that I should endure the separation anxiety and terminate. I told her at the next session it was my last. She did not genuinely ask how I was doing, did not ask if I needed more sessions even if I wanted to leave, and did not ask if I needed a referral.

I was feeling very anxious. I went back to my previous male therapist for support. He helped me to feel better over the next month. When I described the events that happened with the woman therapist, one of the first things he said was “reenactment”, meaning reenactment of the original trauma. That it could happen between client and therapist, the therapist had to be very aware and careful – because of her own issues and countertransference. The episode with her of unexpected intense anger and the threat of abandonment was a very traumatic event for me. And in my opinion, she would not participate in the discussion of it, to acknowledge her overreaction and that she was aware of the destructive effect it had on me.

But it wasn’t the same with him, not the highs and not the lows. I didn’t have the attachment. I wanted to try to work with her again. I called and left her a message that I wanted to return. She agreed. I said in my next session with her that I felt ithad been good for me to determine that I could leave her/my mother and survive. I think that is partially true. She viewed it as something that I “had” to do, some repetition, that she didn’t play a part in it.

We continued to work together a little better for a while, although none of the old issues were addressed or resolved. Before one of the sessions I had the thought to sit in another chair in her office, on the same side of the room instead of opposite. I don’t know what all it represented to me but I did it at the next session. She was obviously disapproving of it and accused me of trying to manipulate the setting.Anything I speculated about my desire to sit there she disagreed with. I shortly went back to my usual chair but felt rejected again. I couldn’t hide my sadness during the session and at the end she offered another of her typical statements that “she had failed me again”. This, in my opinion, was not offered sympathetically to me but rather in the tone of exasperation at my unjustified sensitivity.

In the following session I was feeling upset over her unacceptance of the chair issueand other issues of disregard from the past. I started to describe various things that she had done and said to me which were very hurtful. She did not respond at all about the content of what I said but reached the point where she blurted out that “either you are paranoid or I am psychotic”. I smiled a little and she assured me she was not joking. She elaborated that I/people like me live in this distorted world in which we think that our perceptions are correct but they are not. So, after having interacted with me for many months and never mentioning the word paranoia, I wasnow a full-fledged paranoid who lived in a fantasy world. She then told me that if I didn’t work on my “fucking” paranoia (her adjective) that I would never get better. I responded that none of my therapists, work managers, colleagues, friends, or family had ever said that about me. As usual, she did not respond to the content of my comment.

She was very angry during this session. It was not hard to sense. I felt like she attacked me and was trying to control or destroy me both with her anger andpathologizing (in effect telling me I was paranoid/crazy and both my perceptions and facts were suspect). I believe that she couldn’t accept the reality of my repeating back to her the behavior and comments that she had done in the past. I may nothave been 100% accurate in my recollection of the things I described to her but I think I was very close. I am a good listener and I pay attention to detail. And people with my background are vigilant and on guard for what people say and do. Even though I felt confident about my own perception of myself, it was again a shocking thing to have the therapist, on whom you are dependent and attached, make such an extreme statement. I knew when I walked out the door that day that my working with her was over.

I went back to my male therapist again because again I was feeling very anxious. Both at this time and the previous time I felt that he was my advocate, he understood me, and he believed me about what had happened with the female therapist. But even with his support the failure with her felt very bad to me, I truly felt that it was my fault, and that I had been unable to fix the relationship. Her rejection and non-responsiveness to my need and hurt left me isolated and alone. Most of the times when I had brought up painful issues and events that had occurred between us she only took it as criticism, became defensive, or didn’t respond at all; I rarely felt that she had empathy for me. I think she could have empathy for me when my pain and disappointment did not involve her, but not if it did involve her.

I was also upset that my working with her and our relationship had ended on such a bad note – she was angry with me, she had cursed at me and called me paranoid; basically an argument for a last session. I also felt that I had been abused by her at times during our working together, and certainly during the last session. I was considering requesting another session from her to have a better ending and I did so; and she accepted. My current therapist cautioned me but I wanted to do it. I wanted to do it for various reasons – to conclude our relationship on at least a cordial note; to voice again some of my hurt and disappointments from working with her, sort of confronting my abuser; and, if I’m honest with myself, hoping that she would miraculously see things differently, take responsibility for her part of the difficulties, and have a renewed commitment between us that we could go forward in a better way.

But the good things I hoped for didn’t happen. I was a little surprised that she had agreed to do another session. I thought she must have known that one of my reasons for coming back was to voice my complaints after the previous session. Maybe she was hoping I would continue, maybe the money from a paying client was the most important thing to her, or maybe she truly had some concern for me. I started off the session by thanking her for accepting my request to meet again, that she must know I had some negative things to say. She acknowledged this.

I then talked about a book that she had recommended to me early in our working together Schizoid Phenomena, Object Relations and the Self, by Harry Guntrip. I was already familiar with Guntrip and Winnicott but I did not have this particular book. Many times in our interaction when I would focus on her, either positively or negatively, she would say “it’s not about me, it’s not about me”. To me, by this she was saying that all my feelings towards her were really transference; she seemed to want to minimize or ignore completely the real relationship in our work. I told her that Guntrip’s view was that the earlier the deprivation or maltreatment occurred in the child’s life, the more important was the real relationship to the adult client. As usual she did not respond to this. I talked further about Guntrip’s and object relations theory that the adult is helped by having the therapist become the good internal object, to replace and overcome the original bad internal objects. She didn’t say anything. I talked more about other hurtful actions and statements by her during the therapy, including not supporting me before my daughter’s wedding.

All through the session she sat in a stone faced fashion. At the end of the session I said that I would like to at least end with a warm handshake. She couldn’t control herself any longer and said that “everything from you is a demand”. As we both stood up, we were very close to each other and I had the desire to just touch her on her shoulder as a mild hug. As I started to reach out she reacted strongly and said “no!!. In effect, “get away from me”. I know that there can be legal issues with respect to touching but it still felt very bad to me. We didn’t shake hands either. I handed her my check and walked out.

As I thought more about her comment of being demanding, I recalled that very early in our sessions she told me that she felt coerced by me. It was in connection with my desire to have connection with her, to have the real part of the relationship with her. I probably was needy, I wanted it very much, but I was willing to accept the non-reciprocity of the therapeutic relationship. I think she felt pressure to reciprocate because my need for her was so great. I think my need was a demand to her, as when I asked for support before my daughter’s wedding. My neediness provoked in her a reaction of refusing to be needed that much. But a need is not a demand, and I think that the question was more appropriate to her – “Why do you feel that my specific needs, and my general need of emotional help, are a demand? After all, you are in a helping profession”.

As can be seen by my descriptions, she was at times a very emotional person with me, a very real person. But the intense emotion was only negative although I could also sense her emotional nature in general. I wanted to continue our connection and have it be even better (or repaired) and this aspect kept drawing me back to her. I wanted to get through to her, overcome her analyst defenses, and have her be real to me at least some of the time. Admit her vulnerabilities, talk about what behavior on my part she was sensitive to. One of the times I said to her: “You’re an emotionalperson, it’s not hard for me to sense how you feel”. I think it was in the session that she called me paranoid, I think my comment made her uncomfortable. During one session she wore a shirt that had “passion” printed all over it in different lettering; I don’t think I was telling her something that she didn’t already know. It was maddening for me to have her be so emotional and then not talk further about it, both from her side and the good or bad effect that it had on me. It was the elephant in the room.

She had some good personal and therapist qualities. She could be insightful and understanding. I liked being in her presence and having eye contact with her. I miss her, I still do. She talked more in general than the men therapists and gave more feedback, although feedback on issues that did not have anything to do with her or our client/therapist relationship and the difficulties. I kept thinking I could find a way to have her see “me”, to see me in our areas of conflict.

I discussed with her more psychology literature than with my other therapists. After a while I think she viewed it as a putdown, that I was telling her how to do her job. But it was another way I was using to try to have her understand me. If she would dismiss or ignore some concept that was important to me I would cite it in literature. In the beginning of our working together I think she liked the fact that I was knowledgeable, maybe she wanted my approval. At times I did say some critical things about her and possibly that caused a change in her view and experience of me.

I have not said anything yet about her other general personal characteristics. She is about 10 years younger than me and is an attractive woman to me. I did not choose her for that reason. When I was looking for information on the internet with respect to choosing a woman therapist I wanted someone with fairly long experience and a psychoanalytical approach. I also came across a published article she had written in which she discussed Winnicott, a psychologist I am familiar with, have read some of his books and articles, and agree with many of his views. Her picture was shown on some websites and I thought she looked pleasant.

In person she was more attractive to me. I think it contributed to the development of my attachment feelings in the beginning. Just as with the woman in Milan, who appealed to me partly because of her personality and eyes, I think we are attracted to and develop an attachment to the real person in the present time. And that attachment can be accentuated because of our past.

Returning to the last session, it was probably a combination of good and bad things for me. I did confront her and I did have the content of the session be my choosing. She didn’t become more responsive and communicative, and she could not get herself out of the picture enough even in this last session to do something for me, for my sake. To me, she at times used the “process” or “rules” of psychotherapy to preclude normal human kindness, behavior that I would expect from someone who was not a therapist.

Or maybe it was mostly counter transference on her part. Many times in our working together she had very strong reactions to me, all negative. But she would never talk about them directly. She let me talk, but that was not enough. Her behavior caused impasses and empathic breaks for me and it takes two people, a dialogue, to mend the breaks. As I have read in some other clients’ accounts of harmful therapies, it’s as if the therapist is sometimes playing hide and seek. They choose whether to make themselves visible or not, by responding or not responding, or they respond in a vague fashion. A misunderstanding or miscommunication that would easily be fixed if one of the two people were not a therapist becomes more complicated, more confused, and more drawn out. Accountability is also important to me. At one time I stated that I wanted her to be accountable for her intentions, emotions, statements, and actions – that if I asked she would disclose and validate them. She said that she wouldn’t do that, and that her responses would be based on her 20 years of experience as a therapist. And I said, “OK, at least I know that’s your position”. I believe this approach by the therapist, probably followed to greater or lesser extent by all therapists, can be the source of the greatest problems in the therapy process.It gives the therapist tremendous power and tremendous responsibility – for help or harm.

My view on transference has changed over the years based on my thinking, reading, and experience. At this time I don’t like the term in general because I think it is misleading and untrue. Nothing is “transferred”, not our emotions and no one in the present is a “stand in” for someone in the past. Our emotions and responses in the present are a combination of past conditioning and unmet basic needs (plus the true-to-the-present part); basic needs which, because they were unmet in the past, exist as an even larger deficit in the present. This might be too simplistic a classification, but I think all negative “transference” is conditioning and that positive “transference” is either conditioning or unmet basic needs.

The following is a quote from a book by P. Lomas: “What are transferred to the analyst are primarily those urges of the self that have been denied experience, and the authentic self is concerned not merely with past frustrations but with present and future possibilities of relationship”. Another from T. Szasz: “The concept of transference serves two separate analytic purposes; it is a crucial part of the patient’s therapeutic experience, and a successful defensive measure to protect the analyst from too intense affective and real-life involvement with the patient. For the idea of transference implies denial and repudiation of the patient’s experience qua experience; in its place is substituted the more manageable experience of a transference experience. Thus, if the patient loves or hates the analyst, and if the analyst can view these attitudes as transference, then, in effect, the analyst has convinced himself that the patient does not have those feelings and disposition towards him. The patient does not really love or hate the analyst, but someone else. This is why so-called transference interpretations are so easily and so often misused; they provide a ready-made opportunity for putting the patient at arm’s length”.

I think my female therapist wanted to keep me at “arm’s length”, both with respect to my positive feelings to her and my reactions to the real, and hurtful, things that she did to me in the present. I wanted a real relationship as part of therapy, and either she did not think it was necessary as part of treatment for any client or she did not want to, or was not capable of it, with me. It activated a very deep pain in me though, to be “excluded”, and I continue to deal with it with my present therapist.

As I look back on this traumatic therapy experience I have a revised view of the potential benefits and harm of therapy as “standardly” practiced; especially for people with deep seated issues. In a book by Ann France describing her therapy experience (Consuming Psychotherapy) she makes the following statements: “I am now not at all sure that vulnerable people should be exposed to psychotherapy. This implies that … most of those who need it may not be sufficiently resilient to benefit from it, given the strain it actually causes … psychotherapy … can be harmful, without there being any very clear way of knowing in advance whether this will happen … It can merely be the replay of past traumata … which leads to nothing … The dangers in such a perilous undertaking … provided the genesis of this book … it works best with the healthy”.

In my previous therapy experiences, during which I did not develop significant transference/attachment, the method of client-therapist interaction was not a factor. I felt comfortable, that we were working on my issues which were “out there”, both of us working together to help me. But when strong attachment comes into play the method of client-therapist interaction becomes crucially important. Even with a therapist who does not do anything “wrong”, the typical interaction of filtered and non-responses can duplicate the lack of connection in traumatic childhoods. True reciprocal emotional contact is not given. Validation of the client’s perceptions may or may not be given. A “real” relationship is the most important factor to a person with impaired childhood attachment issues.

I want to conclude with a quote from Carl Jung that I came across shortly after I returned from Milan and my encounter with the young woman – “Through Eros one knows the truth”. In this quote I am sure he is referring to Eros in the more correct, broad sense – life giving, desire, yearning, union with others. After all of my years of therapy, and thinking, and reading; all of these “head level” activities; through Eros, feelings and the heart, even factual truth was revealed to me. The factual truth that I was so alone and isolated as a child and that more than anything I wanted to have connection with people.

 
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