I’ve had a really awful week. The level of dissociation I’ve experienced lately has felt so disorientating. I can’t pinpoint why exactly the dissociation had intensified but it feels like it’s been a reaction to Sienna’s break and also the shock of a younger part telling Sienna what the secret in the envelope was. It may also just be that we are at a deep level of the work and the younger parts are coming forward more and that is putting my entire system into disarray. I have fell into a deep mistrust of Sienna and also of the relationship we have. I haven’t felt able to connect with her in any meaningful way and that’s increased my anxiety and made the dissociation worse.
I had two incidents of self-harm in the past 10 days (just superficial cuts) . Sienna has had a lot of contact with me lately yet nothing is soothing me or bringing me out this dissociation. Our session last week and this week have consisted of me crying dissociatively, not being able to verbalise much and Sienna physically holding me.
On Monday morning, I woke up from a nightmare. In it Sienna had decided to move away and wasn’t going to work with me anymore. I woke up really dissociated and a young part who is new to me self-harmed. She’s 10. I saw her in my mind’s eye, dark shoulder length hair with a white long vest on. We sat on the floor of my bedroom and just cut and cut until it felt better. Until she felt soothed.
She had text Sienna “ I’m going to die.”
Sienna replied “ Why do you think you’re going to die?
I replied “ Bcos I have to.”
Sienna replied that she had a client right now but she wanted me/her to come in tonight.
To be honest I don’t remember anything else about the rest of that day. I’d self-harmed extensively over my body including my hand and arms which is something I avoid doing because it’s harder to hide.
When I got to session on Monday, it was the 10 year old at the front. Sienna began speaking to me immediately.
“Who is about? Who’s here?”
Sienna said slowly “ Okay, you’ve got to know, that no matter how you feel…. I am not going anywhere. Notwithstanding breaks and things, we’ve been consistent, Mondays and the Thursdays. And not matter how disruptive they feel, know that this is grounded. Even when there’s breaks coming up, they are just breaks and we go back to normal after.”
Sienna continued “ Tell me what’s going on about the distress. Do you know?”
I said quietly “ I had a bad dream.”
Sienna asked what it was about. I felt ashamed when I told her.
“ You left me.”
“ I left you” Sienna nodded. “ Okay, well when I leave you to take breaks, know that I am coming back.”
At the time, I felt like Sienna’s voice was loud (it was hurting my ears) and very firm and I felt scared. It felt like she was annoyed with me or something. But as I listen back to the audio of this session, her voice was none of those things. In fact her voice was that of an adult talking to a child and speaking plainly and reassuringly.
I asked tearfully “ Are you giving me into trouble?”
Sienna replied “ nope, not giving you into trouble. Does it feel that way?” I nodded.
Sienna said softly. “No, I’m just trying to reassure you that no matter what you feel, no matter what you dream, this is consistent and we are okay.”
Sienna asked “ Tell me about this younger part. Is she just living in constant fear that another adult is going to leave her?” I nodded.
Sienna sad “ tell me what else is going on with her.”
I said quietly I didn’t know. I couldn’t maintain eye contact, I kept drifting off in my mind to God knows where. I was still aware of being in the room at the same time though.
Sienna said gently “ You know, it’s just going to take time, for you to realise and trust that our relationship can withstand a lot, and that even if I go away, I’m coming back. And you’ll know when I’m coming back because I’ll be telling you. And those little ones who are so scared, I hold hope for them. And belief, not just hope but belief that they are going to feel better over time.”
I felt like I should respond. I mumbled “ Okay.”
Sienna continued speaking. “ You are too important. We are important to each other. You are important to me and you’re important to (husband).”
Sienna speak with the child at this point and I can’t even hear what passes between us. I think I’m really dissociated and just spaced out and constantly crying.
Sienna asks what I need? I literally had no answer to that question.
She asked if I needed a cuddle and I shook my head. She said I think maybe you do at some point today.
Sienna asked if maybe now we are at the point where the anxiety was at the level that we needed in involve the Dr, to maybe get some anxiety meds. I shook my head.
She asked about the self-harm. She asked about why this little one was so distressed. I literally couldn’t speak. I couldn’t give answers. I felt submerged still in this feeling that the dream of Sienna abandoning me, brought up. I felt a complete lack of safety or grounding.
Sienna finally gave up on the questioning and just came over to my sofa. She told me to budge up and pulled me into her arms. She reassured me the dream wasn’t real. She reassured me about the breaks. She talked in soft tones and stroked my hair and my arm and I just listened. She fell silent and I fell silent, tears continually falling. I closed my eyes now and then, needing rest, exhausted from everything and just listened to her steady heartbeat and the birds outside. Safety. Sienna rested her head on the top of mine.
And we stayed like that for about 20 minutes. It didn’t bring me out of the dissociation totally, but it did soothe me.
On the audio, we start speaking but it’s quiet and I don’t know what was said. But I hear myself saying “ I don’t have a safe place. Nothing is safe.”
Sienna broaches the subject of getting help from my dr. I shake my head.
She says “ I know you don’t want to. But this isn’t good for your health. And with the lack of sleep and dissociation compounding everything…. It isn’t good.”
I was refusing. I didn’t want the Dr’s involved and I didn’t want medication. I have no trust in doctors. I felt panic as Sienna pushed me on this.
She asked to speak with my husband and said that this place I’m in in my head with the self-harming and level of dissociation isn’t a good place to leave me. That given the level of work we’re doing it’s not unreasonable to ask the Dr for some help with medication, just something I can take as and when needed.
“ This isn’t a good place (mentally) for you to be, and we need to be able to support you better.”
I was feeling trapped and panicked because Sienna wasn’t letting this go. I was sobbing so hard.
I whispered “ Why are you saying this to me?”
Sienna replied “ Because I need you to let me write a letter to your Dr. I’m not keeping you safe by letting this go on, we’ve talked about writing a letter before and she doesn’t need to know everything, just that we are at a deep part of the therapy work and that you get anxious and need something for that just to help you feel calmer and not so despairing. Have you felt suicidal?”
I shook my head no.
Sienna continued “ Why do you think you and I can handle this on our own? Do you think it will pass?” Sheer panic gripped me and I thought to myself “ oh, here we go… she’s freaking out, this is where I get passed back to the NHS for help that doesn’t exist and terminated by her.”
I said to her “ It always passes.”
She replied “ It does always pass, you’re right. But it’s pretty shit when you’re going through it.”
I said to her “ So just don’t work with me then.”
Sienna said “ No. It’s not about not working with you.”
I said angrily “ It IS. It is about that… that’s what you’re saying.”
Sienna said firmly “ No, it’s not what I’m saying. I’m saying that actually I’m not enough when you’re like this, not when you’re.. not 95% of the time, or 98% of the time. But there’s the odd time when you’re really distressed that maybe we need some medical help too. It’s not that black and white. I’m not stopping working with you… it’s about doing the best thing to keep you safe.”
It all sounded like bullshit to me. It all sounded like lies. This was the end of the road, I’d finally become too much for Sienna. She was freaking out and wanting out of this.
I said to her “ This ALWAYS happens.”
Sienna said “ Maybe because it gets to this level. I don’t know what’s happened in the past. But someone’s really distressed in there, Sirena.”
I replied “ I don’t feel it.”
I didn’t feel like this “distress” was any worse than any other time that she hasn’t threatened me with Dr’s. The self-harm wasn’t any worse than any other time. I didn’t know what the sudden bg deal was.
Sienna said “ What don’t you feel? You feel lost, your distress is to the extent that you’re self-harming that’s the level it’s at.”
I said belligerently and rather childishly “ So? Everyone self-harms.” LOL that kind of makes me laugh now at the stupidity of that comment.
Sienna said semi-firmly and in a tone that was calling me on that bullshit statement, “ no, everybody doesn’t. A neither do you, you don’t self-harm either unless you’re in a really distressed place.”
I couldn’t even defend my comment. She’s right. Not everyone self-harms. But she’s wrong about the self-harm being an indicator of the level of distress. I have self-harmed when far less upset.
Sienna continued “ Wouldn’t it be awful if we are missing something here, something that could be stabilised easily or make you feel better? “
I thought she was talking about another mental health issue perhaps undiagnosed…. This felt like a nightmare, a speeding freight train that I was not in control of. I hated this conversation.
“ You’re scaring me!” I said in panic.
Sienna replied “ I know. I know I am. I don’t want you to be scared. What I’m scared of is that we are doing as much as we can do and right now it’s not enough help you get better. That doesn’t mean passing you on to someone else. I’m talking about getting some medication to help support our work. Nothing else.”
I heard her but I didn’t believe her.
She asked me to get rid of my razors. “ I don’t want you hurting yourself.”
I felt so defeated. The magnitude of what was going on overwhelmed me as I felt like this was familiar territory where she washes her hands of me. I felt like this huge burden and I knew she was scared of this state I was in. The echoes of past therapists talking about me needing to be in a service that offers 24/7 care, were loud in my head. Was Sienna feeling that? She is only one person in private therapy, there’s no reprieve for her, that is a lot to put on someone.
I said to her “ Maybe it’s not fair to ask you to work with me.”
Sienna said “ No, it’s not fair to ask yourself to do this level of work, to a point where you’re self-harming because it’s so distressing. And all I’m saying is that you might just need some medication to ease the distress.”
She continued “ Sometimes we need to do something we don’t want in order to get a better outcome.”
I felt nauseous, exhausted and terrified. I sighed “ I feel sick.” And began crying again.
Sienna said “ Yep, I know. It’s the anxiety. Scare and fear….”
I sobbed “ I just feel really out of control, I can’t….”
Sienna said “ I know. I would quite like for (husband) to take you to A&E tonight.”
I shouted a panicked “ Noooooo!!!! WHY are you saying these things to me?????”
“Because I don’t think you realise how bad things have got…”
I interrupted “ No, I’m not going. No.”
By this point I was literally sobbing my hear out and feeling like a trapped animal.
Sienna asked if she could give my husband her number. That seemed like a lesser evil. If she’d be satisfied with that then hell… take his number!
I said in this young voice “ You’re making me so scared.”
Sienna said gently “ I know you’re scared….. I know you’re scared. But I’m scared for you.”
I said quietly “ I’m not bad.”
Sienna said “ Sirena….. you have self-harmed twice in the one week. You haven’t done that for years. Not to this extent. You are very very dissociated and lost.”
I got angry, so angry with myself for ever letting the young ones out. For ever having shown Sienna the level of distress. It fucks me over everytime.
I said bitterly “ This is why I’m supposed to keep them all in, this is why!!!!”
Sienna disagreed “ No it’s not.”
“ It IS!!!” I said.
Sienna said “ It’s not. They don’t need to stay in, what we are trying to do is measure the amount of distress they’re in, allow them to come out into the world but they’re just completely all over the place because they don’t know how to handle it. And they’re not connecting yet. And they will in time.”
I cried “ I’m sorry…”
Sienna said “ No, what I don’t want to do is have you suffer to this extent while we go through this process…”
I interjected “ This isn’t new. I survive it.”
Sienna said “ This life isn’t about surviving, you’ve survived all these years we want to get you to a point where you’re living… not surviving. You know in some ways this is really good, that the young ones are coming out, but they are just really distressed.”
I sighed. “ I don’t want to scare you. I’m sorry.”
Sienna said “ you’re not scaring me in that way. But as a practitioner and as a therapist I can’t not say to you that….”
I interrupted her “ because this is where you say to stop (working with me).
Sienna said “ No, this is not where I say stop. This absolutely not where I stop. This is hwere I say to you, right we are getting into some nitty gritty stuff and we need to get you support for the anxiety. And we need to involve your Dr. We don’t need to tell her about the the dissociation but we do need to tell her about the self-harming.”
I felt really irritated. “ It’s scratches, it’s not a big deal.”
Sienna paused and then said “ It doesn’t really matter what level it’s at, it’s still happening.”
I said “ I don’t care, leave me alone.” And I meant it, I wanted her to leave me alone, to stop badgering me about Dr’s and medication and making a big deal out of fucking scratches.
Sienna not being put off said “ I care. I care a lot. “
“You’re going to be okay Sirena. And I know this is really frightening.”
I said “ This is why I’m on my own.”
Sienna said “ Why you’re on your own? You’re not on your own though. You’ve got me and (husband). You’re not getting rid of us in a hurry either!”
Sienna said she was going to go downstairs to speak to my husband who was waiting in the Foyer. I panicked and asked her what she was going to say. I felt like my whole private inner world was going to be laid bare for the world to see and judge and comment on. I felt stripped of any dignity or control over anything.
Sienna said “ So, I’m going to speak to him about your levels of distress, I am going to swap numbers with him so that he can contact me if he needs to. That I am quite concerned. That I’m going to write a letter to your GP. But this isn’t good, this had gone on too long, we need to be able to work…..”
I interjected not wanting to hear anymore “ Stop.”
Sienna insisted “ No, we need to be able to work with the little ones, and their just a little bit too distressed.”
She went downstairs to talk to my husband and I just burst into tears. Everything felt so out of my control and I hate every bit of it. I felt ashamed, burning shame for how weak I was, how stupid this all was, how I should have kept better control of things. I felt threatened and I felt angry and cornered. I just needed to be left alone to come out of this myself. I couldn’t see why this was all such a big deal, why did Sienna think things were bad enough?
I did feel a bit unsure of reality because inside I felt like things weren’t bad enough for what Sienna was putting in place, I didn’t feel in danger, I didn’t feel like this time was any different from the other bad times I’ve had. Yet clearly Sienna was feeling like she needed to act.
Sienna came back in. “ you’re going to be okay. I’ve told your husband that I’m going to contact my supervisor (who happens to also be a mental health nurse practitioner) to get advice on what you could take, what we could propose to your DR. I’m going to write a letter to your Dr and get you some medication. Okay?”
I said to her quietly “ you’re taking my power away.”
Sienna said “ Temporarily. Temporarily. If I was your child doing this, what would you do? Sometimes when you’re in it, you can’t see how bad it’s getting and we are getting to a deep vulnerable part of the work. It’s going to be okay, you’ll be alright, you’ve got to know that.”
She walked me downstairs to my husband. Talk about a walk of shame. Sienna scheduled a time on Tuesday morning for me to call her.
When I got home I cried so hard and was convinced that no matter what Sienna said, she was going to terminate me. That she’d get through this rough patch and then terminate me. I couldn’t hear any reason, I couldn’t believe that there was any other outcome and I felt devastated. I felt sick to my core. And I stayed in this dissociated terror until I passed out form exhaustion.
So yeah, bad times.