Thoughts after session with Hank

Today’s session felt unproductive, and I didn’t get to ask him about housing accommodation paperwork or the communication consent forms. We started the session off with him asking me how I was doing. I said I was doing okay to which he responded by asking if I was really okay. I said sort of, so he asked what was going okay. I didn’t know how to say that everything in my life is going pretty well right now, but mentally, I was not doing well at all. I wanted to tell him about the awful thoughts I’ve been having about overdosing, but I of course didn’t want to say anything that could potentially get me hospitalized or even cause any words relating to hospitalization to be spoken. I told him that things have been going okay academically, but I couldn’t articulate my thoughts well, and at several moments, I wasn’t even able to speak. I also told him that things with theatre have been going well with the play, and I explained my position and the details of the play.

He asked me how I was feeling about meeting together, about the fit, how safe I felt, etc. I told him that I thought it was going well and that the fit was good. I said that meeting with him has been good. I wanted to say that I didn’t feel safe yet there in his office or with him and that I don’t exactly trust him yet, but I couldn’t manage to get that out and relay it to him. I had a really difficult time, more difficult than usual, with talking and explaining things to him. I didn’t like it, and I know Hank doesn’t want me using writing, so I don’t really have that outlet to explain things to him after, and I don’t quite know how say the things I need to say. My mind has been so annoying and frustrating, and I just want it all to stop. Things have been feeling like too much, and I just want to give up on it all.

He asked about the papers I brought so I told him that included in it were the writings I mentioned at the last session about dissociation as well as some writings I have done over the past months concerning my hospitalizations, internal dialogue, and other things. He asked if he could see the ones about dissociation, so I handed them to him. I told him the second one has the better example, so he read that one. As he read it, he clarified who was who as I forgot to tell him that I changed the names of everyone. He jokingly said that he assumed the character, Hank, was Len, and joked that the next time he saw him, he would call him Hank. I didn’t have the courage to tell him that it was actually the name I had given him. If he actually paid attention to the date printed at the top of the page and the part where I mention the student life staff packing, he would have figured out that Len had not yet started working there and that he was actually Hank. After he read this, he pointed out the end where I wrote that I felt like a major failure for not being productive in session. He points out how harsh I am to myself and that when he read it, he wasn’t thinking about how horrible I was at being able to speak. He saw someone who was struggling with something. He asked if I could see it that way instead of being harsh to myself. He also asked if similar experiences have happened before and after, so I told him that it has happened quite a lot before and a lot after that time. He asked if it happened in sessions, so I told him it has. He asked if when this happens it’s like disconnecting from the world and feeling unreal or if it’s that I’m so anxious I’m in a panic attack. I told him from what I have researched and the definitions and descriptions I have read that dissociation is disconnecting from the world and reality and like nothing is real and that that is what I experience. I know that this experience happens as a result of anxiety and panic so it could be panicking, but I’m mostly mentally gone or (what I believe) dissociated when this happens. Hank seemed to confirm my experiences that this was dissociation. (I thought about this later, and I think what I experience of this is actually both maybe. I don’t really know. All I know is that I get so anxious, my mind shuts down, goes completely blank, doesn’t work, criticizes me, and then I feel completely disconnected from the world and nothing feels real.) He then asked what I needed when I get to the point of dissociation. I wasn’t all that sure how to answer. When asked a question and sitting in silence unable to force myself back to reality, I need someone to talk to me, try to catch the majority of my attention so that my mind has a small grasp of reality to hold on to while I try to recenter. Hank mentioned that in the piece he read, I talked about how any movements either large or sudden make it worse. He also talked about how some clients like to feel physically grounded and attached to reality, so they will hold the hand or hands of the therapist. When he talked about that, I could feel my arms and shoulders closing in on me, and I was getting more and more tense as he talked about this. I thought I was going to cringe so much I would become one with the couch, but eventually, he asked me if that physical touch was something I wanted or if it was something that wouldn’t help. I’m sure he could see my gradual cringing and collapsing in on myself, so when I told him I didn’t want to be touched at all, I’m sure he already knew. He seemed to already know my answer as he got to the end of his question. Later, he clarified that when I am dissociated in session that the best way to help me is to stay calm and still, talk softly trying to bring my mind back in the room, not make any sudden or large movements and stay seated and away from me until I come back to reality. He asked if I could tell him when I start dissociating in session, but the thing is that I can’t because I try to think of something to say, but then I get so anxious that I can’t think and because I can’t think I can’t formulate any type of relevant thought so I can’t speak because my mind won’t let me so there’s really no verbal way I can convey that I’m slipping into a black hole. I remember that you suggested doing some kind of hand gesture or something to signal that my mind is leaving but I don’t know if that would be any easier than speaking as my brain is already malfunctioning. I don’t know. It might be something I should bring up. He asked me if I could ever see myself as being able to say when I need help grounding and connecting to the world when my mind tries to draw me in and hold me there.

(He explained something about how with some clients, he will hold their hand to keep them connected and in the room. As he explained this I was internally cringing, and I think also externally tensing up and hugging my limbs in closer. He asked if that was something I was comfortable with, so I told him no. He asked why that was, if it was because of vulnerability or proximity. I had to think for a moment because I wasn’t quite sure, but I finally decided that it was because of proximity. He repeated back to me what he was understanding me saying, confirming that I didn’t want him coming close to me. He mentioned that in the piece he read that even someone moving too quickly or coming close to me would just make it worse. He asked what would help if I get to that point so I told him that if it seemed like I was gone for too long and am unable to pull myself out of it, that it would help if he would say something to help me reconnect to the present moment. He repeated back to me what I said and added to it further explaining what he would say to bring me back. He explained that staying calm and talking to me, guiding my mind back to the room. The three words he chose I think were calm, quiet, and still )

At this point in the session, I wanted to give him the piece where I wrote about my internal dialogue, so he can understand just how critical I am of myself. It’s something I think he needs to know about before we go any farther in therapy because it is one of the major things that needs to be dealt with, but I’m not sure if I’m completely able to speak about it. I know other times I’ve tried I haven’t been able to.

He then asked how my relationships and friendships have been going, so I told him that I have been isolating lately. He asked if that was something new or recent that has been happening or if it has been ongoing. I told him that it started at the end of October up to the present.

He asked about what I was doing for spring break and I told him I was just going home. He asked about how it was to go home, and I said it was both tiring and enjoyable though I didn’t know if enjoyable was the right word to use. I really wanted to tell him that I have a piece of writing explaining what going home is kind of like, but I felt that I shouldn’t say that because I’m supposed to be speaking more. He asked why it was tiring so I said that when I go home I have to pretend that I’m okay. He asked why I felt like I needed to do that, so I explained that one, I don’t want my mother asking me about it and trying to fix everything and two, because I don’t want my younger siblings to know because they don’t quite understand. He asked about and validated my reasoning and thoughts about the things I need from my mother. He also asked if I didn’t want my siblings to know because they may worry, and I told him that that was part of it. I should have explained more about that because that’s been something I’ve been concerned about.

None of my siblings know why I was in the hospital, and for some reason, I can’t let myself talk about it with my sister at all. The other day I was sitting in on my sister’s home school class which is made up of her, my mom, and one other student who is very close friends with my family. Towards the end of the day, my sister and the other student were looking at the stickers on my laptop and talking about them and asking about the ones they didn’t understand. My sister asked me what the semicolon one meant to me, and I responded saying that it has a lot of different meanings. She said “yeah, I know; what does it mean to you,” and I of course said I don’t know and was barely able to formulate any type of coherent language. My mom intervened and said “that’s her way of saying she doesn’t want to talk about it.” I was thankful for that but also felt so awkward because that was a reminder that my mother still remembers that I don’t want to be alive.

He asked what it would look like if I explained everything without having to worry about anyone trying to fix anything or judge and if I could just be free to explain what I was feeling. I tried to think about how I could verbalize this, but then I told him that I had actually done that exact thing last year when I wrote that letter thing for my mom, so I could explain everything to her. I was still trying to figure out how to briefly describe what I experience and feel and since my anxiety was continuing to rise my mind of course wasn’t working properly or quickly. I wanted to explain everything aloud, but once I stopped speaking to figure out what else I was going to say, Hank responded with something about how I wasn’t going to get off that easy and how he could read and all that and learn about a person, but he wanted to hear directly from them what things they were struggling with over the past few months. I agreed, and I was trying to get myself to speak so I said that I didn’t know how to briefly explain it. He said that he didn’t care if it was brief or not, so I tried to explain that December and January went pretty well for me mentally and how I wasn’t feeling depressed, and the thoughts weren’t bothering me. He asked why I thought those months were better, so I told him that because I changed dosages with meds, I was doing better. He asked which one I thought made a difference, so I said that I thought the Wellbutrin improved my mood while the lithium took away those thoughts. I then tried to describe how things haven’t been the best over the past two weeks, but I didn’t really know when it started. I think he thought that I was trying to get out of verbally explaining things but I wasn’t; I kind of guess I just got excited that I had an already fully written and completed answer to what he was asking and I guess I sort of got distracted by wanting to share that that I forgot to keep talking and explain things. I wasn’t trying to get out of talking, actually just the opposite. I wanted to talk about what I’d say if I didn’t have to worry about anything, but I guess I wasn’t exactly able or maybe even letting myself continue speaking. I don’t know. I was feeling really anxious and I couldn’t think straight.

As I write this now, I realize things started going downhill when I triggered myself that one morning. Hank asked if when I started feeling badly if the suicidal thoughts start and then the depressed mood or if I feel depressed and then the suicidal thoughts start. I have never thought about this, so I told that I didn’t really know. He said to pay attention to it next time and see which one starts first.

At the end of our session, Hank asked me that if there is one document I would pick for him to read before the next session, which one would it be. I went back and forth between the writing I brought, but I finally decided on the writing I wrote directed toward my mom. I chose this one because I feel like that would be the best one to start him off with so that he has the general idea of what I struggle with. I really wanted to share the piece that includes my internal dialogue, but I might share that one after

I meant to ask him about filling out the housing accommodation form for me, so I can live in a single room next year and not pay the extra two thousand dollars, but by the time I was about to mention it, I guess it was the end of the session even though I thought we still had about ten more minutes left. I wanted to ask him if he would be willing to fill out the part a clinician must complete and explain to him what happened with my former roommate or just give him the writing I did about that. I also wanted to ask him about a communication consent form so that you two could communicate, but I wasn’t able to ask that either. It kind of felt like I was rushed out of the session, but there was no one else after my session. I don’t know. Since we finished early, I had to wait outside the building for my ride to get there and about a minute after I left, he came out the back door near where I was. I completely hated seeing him outside of the office. I don’t know why, but it was so uncomfortable.

After that session, I felt like a complete failure because I couldn’t verbalize anything I needed to. I didn’t feel like we made any progress on anything, and I didn’t feel that anything we talked about was important or deep enough, like we were just talking about the surface of things and not addressing any important issues in depth like my isolation or late, persistent suicidal dreams and thoughts. As soon as I got outside, my mind began screaming at me, and I was thinking that I didn’t want to meet with Hank any longer.

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