The problem with dissociative disorders is that one minute things look grim, and the next all has calmed down and the people involved are left perplexed as to how things can do a complete 180 in a matter of hours or days?
On Monday, things looked pretty dire. My therapist was convinced I was in dangerous territory and to the outside, it probably looked like I was decompensating quite badly and hugely vulnerable. And if I’d stayed in that highly dissociated place for weeks at a time, then there would definitely have been an argument for possible hospitalisation. However, I knew from experience that the shock of being taken to hospital would have been enough to make me switch into an apparently adult coping part and I’d have to sit there feeling humiliated under the sceptical eye of some Psychiatric resident as they questioned me. And I would be sent home that same day/night with no further action to be taken, expect maybe to see my GP.
People like me don’t get psychiatric care easily.
So yeah, Monday looked bad. Tuesday wasn’t great either. By Wednesday I was almost back to normal, coming out of that heavily dissociated phase and ready to unpack some of what had happened between Sienna and I. I was still angry with her for forcing my hand with contacting my Dr. And I still felt very confused about why she pushed it so hard, against my will. My husband suggested that Sienna has brought up the issue of letting my Dr know roughly what’s going on with me, several times and I’ve always refused to do it and she’s let it go several times. He thinks this time she felt our relationship was strong enough for her to push more, whereas before I would just have left therapy. Maybe he’s right.
I asked Sienna if I could have a phone session with her at some point over the next few days. She offered for me to come in to the office if I wanted on the Thursday evening. I agreed to go. I was really glad to be going in to see her in person, I felt like such a lot had been going on over the past few weeks that led up to this week’s drama and I wanted to process it with her and also work out with her what the boundaries actually are around self-harm, dissociation etc and where the line is before she decides my Dr should be notified?
In the Thursday session I said to Sienna, “ I think I’m just a bit confused as to why I needed to contact my Dr or why… it doesn’t make sense to me because for me, the dissociation wasn’t out of the ordinary, it wasn’t anything you haven’t seen before and neither’s the self-harm. So… why this time?”
Sienna said “ So the bit I am potentially seeing is that you’re bringing the young parts out into the open and the level of distress was there – and that’s going to get bigger, that’s going to get more as more stuff comes through. And you’re also getting one or two confused parts that are new. The increase of new awareness and new parts means that I want a safety net in there. And it’s just a way of belting and bracing it and keeping both of us safe.”
I nodded, digesting what she was saying and not sure what I feel about it. “ mmmm”
Sienna continued “ And you might never need to use them (the diazepam).”
I felt exasperated! If she’s leaving the choice to me about whether I take them or not, why push me so hard to get them?
I exclaimed “ So what was the point of all that then? Like, how does that make you feel safer because I could choose not to take them!!”
Sienna said “ Because, I’ve done my….
Me : “You’ve done your part…
Sienna interjected “ I’ve done my ethical part…
I spoke over her “ You’ve done your parts, which is what this has all been about!”
I resented that I was caught up in a game of ethics and arse-covering. And I felt like Sienna’s main priority was making sure she couldn’t be sued or seen to be negligent rather than any real worry for my wellbeing.
Sienna raised her tone slightly “ It’s not all its about, it’s also about… I don’t want you full of cut marks. I know you’re not cutting deeply but it shows a level of distress, for one part. And I know when you come out of a period of dissociation you can’t touch base with the level of despair that was going on. And all you need to do is nick an artery and you then have a serious situation….”
I said “ That’s never happened. I don’t have history of that. (cutting that deep or needing hospital)”
I continued “ I’ve never been to hospital for self-harm…”
Sienna said “ and I hope you never will.”
Sienna told me that she hoped I could use the strength of whatever adult parts are in there, and/or when my husband or Sienna say it’s time to take a pill, that I take that advice. In truth, the levels of terror and distress I got to on Monday night are quite rare but if I’d had diazepam in the house, I would gladly have taken it. And I am glad to have the pills, but I’d much rather have gotten than in my own time, off my own volition rather than out of fear of Sienna not working with me. Admittedly Sienna never threatened not to work with me, quite the opposite, yet for me it still felt like it could go that way… if she’s using words like ethically and professionally then she’s considering how to make things “safe” and above board and if she thinks my Dr needs to be involved, and I refuse, well how do we get around that impasse?
Sienna asked what the self-harm does for me? I told her it depended on which part is doing it. Sometimes it’s anger at myself, hate and contempt for myself, the need to destroy myself, sometimes it’s to calm myself and self-regulate.
She said it felt like that part who did it on Monday was despairing and needed to release something.
I revealed to Sienna “ I asked that part why she did it on Monday and she said that it was for comfort.”
Sienna said “ to feel?”
I replied “ It feels the same as a hug. That’s what she said.”
Sienna said quietly “ interesting, isn’t it?”
Sienna asked if I felt I’d stabilised over the past 48 hours. I told her more in the last 24 hours I’ve felt back to baseline, but it still feels like I’ve been through something big, but I just don’t have the memory of it, it feels foggy and far away and dream-like almost. In fact, on the Tues or Wednesday or maybe both I’m not sure, my whole body was in pain. I felt like a car had steam-rolled over me.
Sienna said “ This is one of the points I’m making; when you’re in that place and we are seeing how distressed you are then actually taking that down a notch (with the pills) would be good.”
I replied “ I feel that there was that level of distress because you took it out of my hands on Monday and then what you were saying on the phones one of the days was scaring me.”
Sienna replied “ Like?”
I thought but couldn’t recall what it was that had scared me so much. We both laughed slightly because I couldn’t remember.
I continued “ Like, you were just being insistent that you were going to speak to my Dr. That I was to get these pills and you were talking about being in a service or that I should be with a service… and all these words were being used that I’ve heard before with other therapists and then I got terminated.”
Sienna said “ yes, you connected with that quite a lot. And all I was saying was that If I don’t do the steps that I’m supposed to do then….”
I interrupted, annoyed and I raised my voice “ But that was never agreed as a boundary that if you see self-harm marks on me then I’m going to insist in speaking to your dr.”
Sienna said to me that “there’s a part of the original contract that says it’s within my right to contact your G.P if things get to a level where I think he/she needs to be involved.”
And I said “ Yeah, IF I’m unable to make good decisions for myself, if I’m not making good decisions for myself…”
Sienna said in a tone that meant (uh… yeah and that’s where we were at, duh!) Yeah! Exactly, Yes! Hello??
“ But that wasn’t where we were at, Sienna. That self-harm is a regulation thing, it’s not something new….”
Sienna said “ Do you know what I have noticed though, whether it was in panic or anything else, you then took it into your own hands and phoned the Dr yourself.”
I said to her incredulously “ Hell yeah I took it into my own hands, of course I did, because I needed the control back. And that’s the only reason I did it. But that’s….. that’s damaging our relationship. That’s damaging the trust.”
I looked at her. Did she understand the impact of what she did?
Sienna replied “ Well it’s a sort of parent… it did feel very parent-y having to stand my ground and say you can kick and scream as much as you like ( but this is happening)…. Because you’re not aware of how distressed you were, but your husband and I were and it had been going on a long time and you were exhausted. And that’s my point about this as well…. When it goes on for so long it ends up spiralling and you end up so exhausted. And also the fact that you self-harmed twice in one week…”
I said “ Was it twice in one week though?”
Sienna said “ Yes it was. It was 5 days between it. So that’s all, it came from a place of caring, if you can see it that way. It’s not about being persecutory or bully tactics.”
I said huffily “ Well it felt persecutory.”
Sienna conceded “ I know it did. I know it did…”
We sat in brief silence, letting those words hang in the air.
Sienna said “ I don’t know if you can remember, but I did say to you at the time that it’s really important that we can carry this work on and if that work leads to that level of distress, then I need to know there’s options there. That if you need a diazepam you can take one. And I do know with all this new stuff coming out and with breaks coming up, then I want a back-up in there.”
UGH, fucking breaks. Again. I couldn’t even say anything. My stomach plummeted at the mere contemplation of yet another break.
Sienna continued “ So I am sorry if it felt like bully tactics but it’s coming from a good place. I know some parts really hate it and some will understand.”
Sienna asked me remind her about how this week’s situation reminded me off previous terminations. I talked of painful endings with therapists who really fucked me over.
Therapists who’d wanted me to be medicated when things got scary in therapy. And I spoke of how angry that makes me when people suggest medication because there’s nothing wrong with my brain. People in my life made me this way, so why am I to medicate my brain? To make other people feel better??
I said to Sienna “ There’s nothing wrong with my brain chemistry. I have trauma, there’s a difference. People made me this way and now I am suffering from the effects of that.”
Sienna said “ that’s why I wanted diazepam and not an anti-depressant that numbs you or anything like that, I want you here but if it gets to the point where you’re exhausted because the distress has gone on so long, and you’re self-harming to that level..”
I interjected “ It wasn’t to that level though. It was frequent but it didn’t increase, it wasn’t getting worse.”
Sienna said “ Well, it was to me. I hear what you’re saying though, that to you, you feel and live with that intensity inside all the time so it doesn’t feel to you like anything was getting worse.”
“ I do. But now it feels like I can’t tell you about it because you can decide that…” I trailed off.
Sienna said decisively “ Well, I know some parts are really angry, the young adults or older who have a right to make their own decisions… but when the youngsters were about, they didn’t have supportive boundaried parenting, to know that they were safe and that someone was looking out for them. But By God- I promise you this; I will be.”
I smiled at Sienna’s tenacity and resolute stubbornness and also her dedication to me, that she wasn’t going to be cowed by Sofia’s anger. Even though parts of me hate that she can’t be intimidated or coerced into doing what I want rather than what I need, there’s a warm feeling that comes from her promising me containment and doing what’s right by me.
Sienna continued “ And I know that raises a conflict with the older ones. But the older ones aren’t doing the looking after of the younger ones. So until the older ones actually see that they are actually abandoning the younger ones…”
I spoke over her. “ But it felt like the shock of having to contact my dr, it feels like my power gets taken away from me. Everything that I am trying so hard to keep together is then being taken off me and someone else is making the decisions…”
Sienna interjected “ But that’s what has to happen with children, but in a supportive way and a good way, not in the way power was taken off you in your family so often. But in a way that, yeah, you don’t like it but actually it’s a boundary and another option.”
I told Sienna how I’d always managed to use my anger to get people to back off, even people who were trying to help me. As a teenager I successfully got my mum to back off from taking me to the Dr’s when I had an eating disorder. And that felt more comfortable to me, to know I could do that. Boundaries always induced terror in me for some reason.
I admitted that Sienna not being intimidated and holding her ground this week made me angry and scared but there was tiny part of me that felt secretly impressed that she didn’t back off and I also felt cared for and contained. But mostly I felt that afterwards, not during the power struggle.
“ Everyone was scared to hold their ground with me (as a teenager) and I know that you didn’t back down and it felt parental and it felt sort of….. part of me felt a bit safe that… that if I’m not seeing straight, that someone is going to stand up to me and give me….. what’s the word I’m looking for? I don’t know… like…”
Sienna helped me out “ Do the right thing, take care of you. Even if you’re kicking and screaming.”
Sienna said “ and of course that’s one of the big problems with mental health problems is that when you’re in it, you don’t see it as bad as what other people are telling you it is.”
I said to her that I am so used to living with that level of distress and intensity that it’s normal to me, I don’t see self-harming or the dissociation as that big a deal because it’s my normal. I’ve lived with it for so long that I just think it’s a bad day or few days and I’ll survive it. I don’t get why people get so worried.
Sienna replied “ And when you’re in that part that self-harms doesn’t care about anyone else so you lose touch with the impact you have on (Husband) and the people around you. And you can’t hear that we care and that we don’t want to see you doing that to yourself. And I understand that it gives you a release of some sort and it’s a coping mechanism. But at the end of the day, I would never not hold my ground on something like that, that I felt was important.”
I reflected that actually I have some parts who get very triggered by people caring about me. I don’t like it. It doesn’t feel safe. I don’t trust people to know how to look after me.
I told Sienna how everything that’s been happening lately has been attachment based for me. I emphasised how deep that attachment terror is, that it can send me to the depths of distress that she’s seen this week. I explained to her that there’s different parts of my system wanting and needing different things and I feel pulled in both directions. The young parts desperately needing constant attention and proximity to Sienna, their attachment figure and when that isn’t always possible (like when Sienna is busy or on holiday) then the teen parts jump in and get all angry and immediately want to detach from the relationship, they devalue it, they mistrust Sienna’s intentions and as they move away from Sienna by creating conflict with her, being deliberately inflammatory the younger ones panic and scramble to find the attachment once more. It creates a lot of chaos.
Sienna said she noticed that the older parts needed a break sometimes (from therapy) but the children are terrified of it. She spoke about aiming to get the older parts to look after the distressed children, eventually. But it’s just not happening right now.
I feel like Sienna doesn’t get just how separated these parts are. None of them are aware of any other part. It’s not sheer belligerence that stops the older parts not taking more responsibility. It’s not a refusal to do it. It’s just that right now there’s no communication between them. And I have no control over what parts are out.
I hate when it feels like she’s suggesting that communication between them is a choice I’m not making. That some-how I have control over this. And I feel sad and frustrated and I feel like saying “ give me a fucking break, I literally only discovered some of these parts in the last year, I literally only realised I had parts in the past 12-18 months. Before that I had no idea they were there. I’ve only just started learning about them. Give me time please to catch a breath.”
Sienna said sort of as a conclusion “ One thing I want to consistently reassure you about is that no matter what happens with us, if you fall out with me because I’m bossy or whatever you perceive it as, I’ll be here. 6 o’clock on a Monday night unless it’s a planned break.”
I asked “ How do I know though?”
Sienna replied “ Because I’m telling you.”
I love how people without attachment trauma think that’s so simple to believe. That just because they say it means it’s true and trustable.
I don’t know how to believe that just because Sienna says she’ll be there, means she will, not matter what. I believe and expect her to be there when there hasn’t been any argument. But if there has been an argument or a text that Sienna hasn’t replied to (which is what happened 2 Friday’s ago) then I don’t know what her non-response means. I don’t know unless she explicitly tells me that she’ll be there, whether I should go or not. And the uncertainty makes me spiral.
I am going to write a 2nd post for what transpired in the last few minutes of my session as it’s super important.