After that horrendous therapy session, I went to bed exhausted. But there was no reprieve as I woke up after just 3 hours sleep.
The heavy dissociation had worn off a bit by now and it was only then that I could feel the burning, biting pain of my self-harm scratches. They really hurt! I limped and walked gingerly as I could feel the pain of the skin knitting together as I moved.
I did think to myself how powerful dissociation must be, because I never felt an ounce of pain from them earlier on. I mean, I could feel they were there and it wasn’t a pleasant feeling, but I wouldn’t have described it as pain.
I stayed up all night. And I think for most of it I alternated between fear and terror of Sienna leaving me, terminating me for being too high-risk for private practice. But also, there was confusion and anger about how we got here. I really didn’t feel things in session were any worse than what she’s seen before and I knew myself that this would pass, it always does. This is just a part who came out for the first time, showing their distress. I resented Sienna for blowing my cover, for threatening everything I have constructed to keep my inner world safe and away from others. I’d trusted her and allowed her a glimpse of the chaos and distress and fear and sadness that I hold within me every single day of my life. I’d trusted her with it and she betrayed my trust.
But there was also confusion, because when the people around you start questioning your sanity, you start to wonder if they’re right? Are they all seeing something that I can’t right now? I was certainly very distressed and very vulnerable and very dissociated so maybe I’m not seeing things as they are? But to me at the time, the level of distress was bad but not the worst I’ve ever been.
For me, the trigger to all of this was attachment stuff. Fear of abandonment, not feeling safe, struggling to stay in relationship with Sienna. Parts of my system wanting to defend me against the relationship which in their mind will inevitably end one day and cause me heartbreak. Their way of defending me is to destroy the relationship, detach from the attachment figure, to not need them. But the young parts, the little children who desperately just want a mummy, who just want to be accepted into the safety of a mummy who doesn’t leave, ever…. They were desperately clinging on to Sienna, grasping to find some semblance of safety, some sign that Sienna would never abandon them. Because to them abandonment means death.
So I was left with this internal fight of detach versus stay attached. I felt like, if I could just reach Sienna in a way that my system could feel, that everything else would calm down. I’d spent many weeks feeling dissociated and untethered and like Sienna hadn’t been as attuned as normal that it was obvious to me that once I got that attunement back, I’d be okay.
Just before my check in on Tuesday morning, I felt this protective part move in. And I decided to tell Sienna that I was fine, back to normal. I hoped that if I did that then she’d leave me alone and not still insist in writing to my Doctor. I knew that if I used the right words and sounded coherent enough, she’d probably back down. I felt quite pleased with my plan.
Sure enough, when I spoke to Sienna and she asked how I was I said I was feeling better, almost back to normal.
Sienna asked about my cuts, how were they?
Sienna said “ I was very close last night to telling your husband to take you to A&E. Not so much because of the cuts because you said they were superficial but because of the level of heavy dissociation and that and the increased level of cutting, a mental health assessment might have been what was needed.”
I felt my heart skip a beat, a familiar feeling of dread and panic and fear rising. Adrenaline rushing up. And anger. What the fuck is she talking about?? This is out of hand! There is no need for this amount of drama.
Sienna continued to speak “ We’re very near the edge at that point where it’s dangerous and ethically and professionally I’ve got to be really careful. So that’s one of the reasons why I’ll be drafting up a letter for your Gp, to try and get you some medication to take the edge off that level of distress. But we just need to get more help with this. Because we are getting into some very important work and it’s important that you’re safe but also that we can continue that work. I want you to be in a place where you can be held while we do this work, but do it safely.”
I listened to her. Desperately trying to anticipate what was going to come out her mouth next… is this the termination speech? I felt sick. When a therapist starts using words like “ethically” and “ professionally”…. That in my experience is the lead up to termination. And the fact that she is even talking about having to keep herself practicing safely etc tells me that this is an exercise in arse-covering. This isn’t about me at all. This isn’t care, this is a therapist making sure that if her psycho client hurts herself badly or worse, that she can’t be legally held responsible or proved to be negligent. I felt the rage build.
Sienna mentioned something about if the cuts get infected etc and I interjected angrily and with contempt;
“ They aren’t going to get infected! That’s never happened. Do you really think I got to this age without being able to look after myself???”
Sienna replied “ I appreciate that, but you’ve got to understand that I’m very keen to take you further into the work but in order to do that, we’ve got to watch that the distress you experience doesn’t get worse. Because that’s two quite significant self-harming incidents in a week. And severe dissociation. So it’s not that I’m saying to stop the work, it’s quite the reverse in fact. In order to keep doing the work we’re doing then let’s get extra support in there. It’s not about medicating you every day, it’s about giving you something you can take when the level of distress get too much.”
I said to Sienna “ I don’t understand this. If you hadn’t seen the cuts or asked about them, then all you’d have seen is the level of dissociation and I’ve been to that level before and you haven’t felt the need to involve me dr, so why now? The self-harm isn’t bad, it’s superficial. I am telling you now that I am in control of my behaviour, what I’m doing, I am in control of that and I’m taking responsibility for my health, which I always do and my husband knows about the self-harm and how I’m feeling and I’m not suicidal….”
Sienna agreed, and she said she’d checked that out with me in session so she knew I wasn’t suicidal.
So I said to her “ So what’s the difference then? I’ve sat in your office before with those level of cuts and you haven’t known or if you have you haven’t been worried.”
Sienna tried to explain that the difference was the level of dissociation coupled with the 2 episodes of cutting and the fact that the work was at a deeper level informed her decision about needing medical intervention. And that she had to make sure the work was safe and that both her and I were safe. She said that if I was cutting to the same amount every day or every week, my body would be in shreds.
I laughed. So fucking what? I said to her “ I don’t know what it is about self-harm that makes people go off the deep end, they see it and they freak out. “
Sienna insisted “Sirena. I am not going off the deep end, I know that you self-harm on and off. I am not panicking about it.”
I interrupted “ YOU ARE. Because see when you start talking about “ethically” and “professionally” that’s hiding behind language.” My tone was sarcastic.
Sienna argued “ No, it’s not hiding behind language…”
I said “ It IS!!”
Sienna said “ …No, it’s being open and honest and….”
Again I interrupted “ I’ve told you’ve self-harmed before and when you don’t see it, you don’t bother. But because you’ve seen it you suddenly feel like you need to do something.”
Sienna began speaking and I wouldn’t let her speak. “ Well, why didn’t you care any other time?”
I could tell Sienna was trying to stay non-defensive or non-argumentative in the face of me spitting accusations at her.
She explained super calmly and slowly that she felt like other times the work wasn’t at the same level and therefore didn’t feel worried about the odd self-harm incident. I could tell she was having to think on her feet as I fired accusations and questions at her. It felt like she wasn’t sure herself why this time was different, I didn’t feel like I got a satisfactory answer to why this time I was more in need of medication and safety nets and Dr’s interventions that any other times. It seemed arbitrary to me.
I knew I was firing anger at her. I knew I was trying to make her back down by using reason and logic and forceful argument and that my anger was my protective defence, my tried and tested method of getting people to back the fuck off. Generally, it works and usually with Sienna that’s how I’ve gotten her to lay off the Dr idea in the past.
Sienna just kept saying that she wanted to ask my Dr for medication to take the edge of the distress.
Again I said to her “ Sienna, If I take medication it’s for you, not for me. I don’t want it. I don’t need it. The level of dissociation and the level of upset you are seeing, I carry with me every single fucking day. Every day. It’s in there all the time, just because you don’t always see it doesn’t mean it’s not always there.” I felt like that was a good argument and proof that I do cope without medication, I don’t need extra intervention.
Sienna replied firmly.
“ Well, Sirena, there’s a line here, right. I AM going to draft up a letter for you to see and I am not going to let this go. Because sometimes you don’t see it when you’re in it, and I appreciate what you’re saying, but I also know that we’ve had this discussion before (about letter to dr) and I’ve let it go, and I’ve not been terribly happy about letting it go. And as I’ve explained to you before, in private practice it’s just you and me. And for the level you dissociate at, there’s an argument to say that you might be better served in a service…”
I interjected in pure fear and rage “ So fucking let me go then.” At this point I felt like in was inevitable that she’d terminate me. If she thinks I need to be in a mental health service. Which personally I think is total bullshit.
Sienna said “ Well, it’s your choice if you want to go. You can leave any time you like. But what I’m trying to say to you is that I know you don’t want to be in a service that can give you 24/7 support…”
I interrupted again “ There isn’t a service available, are you fucking kidding me? There isn’t anything available otherwise I’d already be in it.”
Sienna said “ I appreciate that. Now will you listen to me? What I’m trying to say is that the work we are doing is important and it’s important that we continue, I want a safety net in there for you. For both of us. And that safety net is not about blue flashing lights and hospitals and detainment, it’s simply a letter to your GP making her aware of what’s going on and to see if she can prescribe something to take the edge of the distress when it gets to this level.”
I said tearfully “ I don’t like the language you’re using. This is different, when you do this. And see to be honest, if you think I need to be in a service that doesn’t even exist for me, then let’s just fucking stop now. We may as well Stop right now.”
Sienna replied “ Well I’m not going to let you do that, because that’s a knee-jerk reaction in panic of something you don’t know or don’t want.”
“No, I’m scared of what you’re saying, that I’m not going to be in control of….. the words that you’re using is scaring me!”
Sienna said “ Well you know, I could say that I wanted to tell your Dr the whole story and she would probably say that you need 3rd mental health services…”
I interjected “ I fucking DON’T!!!!!!” I was so angry with Sienna.
Sienna said “ I know you don’t. I’m just saying your Dr might see it that way and I am not suggesting telling her everything about the dissociation, just that you sometimes need help with the anxiety.”
“Sienna, how can I ever trust that I can tell you what’s going on for me when you do this?”
Sienna sounded annoyed or impatient as she said “ What am I doing Sirena? What Am I doing? I am not going behind your back and calling your dr. I’m being open and honest with you and saying in my professional opinion that it’s a really good practice idea just to get you some medication to keep at home that you can take when you’re very anxious, distressed or heavily dissociated.”
We went round in circles, her talking about safety nets and bringing the younger ones forward more and needing to be safe in that work etc.
I felt defeated and I felt like Sienna was very wrong in all of this.
I said quietly “ I can’t do this. I just can’t do this anymore.” I wanted to just quit there and then.
Sienna paused and said “ Well I want you to go away and think about it. I know you’re scared and scared and upset and you’re not liking what you’re hearing. But I really care about our work, I really care about you and I want to keep you safe – and I want to keep me safe too.”
I exploded “ Why ARE YOU NOT safe? What am I doing to make you not safe!!!!”
Sienna said “ Well if I’m thinking you might not be safe or the work isn’t safe, and I don’t do something about that, and I don’t contact a health professional if I am worried for your safety, then I’m being unethical to you, I’m not keeping our practice together safe. And you can shout all you like and say all you like, but the bottom line is I need to keep this safe.”
I angrily spat out “ See, this triggers me. These words you’re using… do you not think I’ve heard them a million times before from other therapists who then dump me. This happens all the time… I can’t be honest about how I really feel because I get fucked over and dumped.”
Sienna said “ I’m not dumping you Sirena. If you leave, that will be your choice, but I’m not dumping you because I want this work to continue but it’s got to be done in a safe manner.”
“But I’ve basically to medicate myself, that’s the conditions of it. I actually have to take poison into my body…”
Sienna interrupted me “ No, Sirena… when you say that that makes it sound like I want you to take a drug every-day to numb everything down. That’s not what I’m wanting. I don’t want you numbed down that much, what I do want is that when we see the little ones become so distressed that you are self-harming twice a week… then I want to see if a bit of anxiety medication will help so that we can continue the work. And maybe then instead of self-harming we can find other ways for you to manage your distress.”
I said to her, feeling so much anger “ I genuinely couldn’t give two fucks about the self-harming. I genuinely could not fucking care!!!!”
“ Well, Sirena, I do. I do care….”
“WHYYYYYYYY????? Why do you care about this??????”
Sienna just kept repeating the same stuff over and over. We were getting no where.
I couldn’t believe that she wasn’t backing down on this.
Before the check in call, I thought the worst was over, that I was feeling better. But this call just threw me back into the state I was in the night before. I felt out of control, I felt terror, I felt positive that Sienna was going to terminate me. That people were telling me I’m more acutely ill than I actually am. None of this made sense to me.
It felt like things were running out of my control, that Dr’s were going to be getting involved, and Sienna’s supervisors were going to be consulted… it all felt impossible and huge and scary. It felt like the world was suddenly knocking down my well constructed walls.
There is a weird thing that happens when I feel like things are taken out of my control…. I actually am put more in danger by people taking my control away because I start feeling very suicidal. There’s this panic that sets it, that “people are coming to get me”. And I start wanting to do the worst damage to myself before I am stopped. I’m not sure I understand it.
I sat on my bed feeling intensely psychologically unwell and for the first time, in danger. I phoned my Dr and spoke with her. It was an underwhelming conversation to be honest as I suspected it would be, because they don’t care. She suggested anti-depressants which I told her I didn’t want. And reluctantly, she gave me a low dose of Valium. I gave her Sienna’s details and asked her to call Sienna.
I was done with fighting. I just want to go to sleep. Let them sort it out amongst themselves. They can prescribe me meds that I won’t take and everyone will be happy they did their bureaucratic red tape job so that they won’t get sued if I decide to jump off a building. Fuck them all.
Sienna told me she was really proud of me for contacting my Dr. We exchanged a few texts and a phone check in the next morning. (Wednesday).
Part of me was still angry and mistrustful. But there was a tiny part of me that was secretly impressed that Sienna had withstood my anger, that she hadn’t backed down. And another small part felt safe. I don’t know if I agree with Sienna’s decision…. I don’t think I do, even now. Yet I could see that she genuinely thought there was a need to keep me safe and she wasn’t going to allow my defences push her away and that feels containing.
It felt very parental. But a caring parent, one who fights for their child and does what it takes to keep them safe. I’ve never had that before. It doesn’t feel good exactly… I feel battle-weary. But it feel containing and safe.