So I saw E the other day, for the first time in nearly a year. Okay, for the first time in ten and a half months. As I wrote the other day, I wasn’t sure if it was a good idea, and as it turns out, it wasn’t. But it wasn’t terrible either.
I had a 5pm appointment, and we met in the garden behind her office. I appreciate this because it’s in-person and without a mask. I suppose in an ideal world, I’d rather meet in her office, which of course I haven’t seen since early March 2020, but clearly we don’t live in an ideal world.
I arrived a couple of minutes early, and E was in her kitchenette, making tea. She must have seen me through the window, because she came right out and greeted me in a warm voice, “Q! It’s so good to see you again!” She opened her arms up for a big hug, then paused a moment to check, “You are COVID-free, right?”
“Yes, of course, otherwise I wouldn’t be here,” I said.
Then she came closer gave me a welcoming embrace. That felt nice. “Let me just finish making my tea,” she said, “I’ll be right out.”
So I settled myself at the table, looking around her garden. Nothing had changed much, same garden furniture, same plants and trees, and E herself looked about the same. She came out smiling and full of questions. She wanted to know how my family was, how my work was going, what kind of a relationship am I developing with Patty (my son’s pregnant girlfriend). I gave her brief responses, conscious all the time that we both needed a bit of catch-up, but that I didn’t want to use my session just for that.
After about ten minutes, she asked me how I would like to use the time. I’d emailed her when I asked for the appointment, saying that I was experiencing a lot of withdrawal symptoms from lowering my dose of Cymbalta (duloxetine) and could use some support.
I summarized my symptoms to her: the buzzing, tingling sensation under my skin, the difficulty focusing, the sensation of being behind a glass wall, or a bubble maybe, that separated me from the rest of the world. Last week, I’d had flashbacks (?) or at any rate, sudden in-my-face memories of being assaulted, but those have faded. Negative thoughts about myself and the urge to self-harm continued, however.
“I’m not acting on them,” I told her. “But I’m aware of them. I try not to give them a lot of energy. I try to let them rise up and then fade away.” That is true, I do try. Sometimes it works, and sometimes it’s rough, but I don’t go into that. It’s not what I need help with right now.
“Anyway,” I go on, “one of the thoughts I keep having is, I’m so alone with this. And I suppose I’m trying to combat that, in part by coming here.”
She nodded, telling me again that it’s a good thing to reach for support. “Are you getting medical support through this withdrawal?”
Nope. I explained to her that I can’t go back to see Tabitha and am searching for a replacement. There is no way I’ll find a psychiatrist (big shortage of them where I live, except for child psychiatrists, isn’t that strange?), but I’m hoping to find an experienced psychiatric nurse practitioner, a PNP, whose practice isn’t already overflowing.
“But it’s not like I am just doing this for no reason, out of the blue,” I told her. “I mean, Tabitha and I talked about it at our last session, and I’m following the slow reduction she recommended. It’s just harder than we expected it would be. And so yes, even though I feel unfocused and unmotivated, I’m making a lot of efforts to find someone new.”
“Why do you want to go off it anyway?” she asked.
I sighed. So many people ask me that, and I don’t think I have articulated my reasoning in a clear way. “I guess I feel so ANGRY about psych meds,” I told her. “I have been on them several different times in my life, each time for a couple of years, and this last time for probably 10-12 years. I won’t say they didn’t do me any good, but a lot of the time I was taking them, I was not doing well at all. And to be honest, I attribute feeling better now to all the emotional work I have done, not to my medication. Or maybe there is some of both mixed in there.”
“The thing is, each time I have agreed to go on meds, I have been encouraged by some doctor telling me some version of, just go on for a while, so it can lift you up a bit from the floor, so you are in a better position to make the changes in your life that make you feel better. They make it sound like it will be a matter of six months or something. In fact, I think the first time I went on meds, the doctor said to try for about six months. But it’s never six months, it’s never straightforward. I have always ended up layering on other meds and feeling sick, often feeling worse. I have only ever felt suicidal when I’ve been on medication.”
“And while on the one hand I’m taking multiple medications for YEARS, I am acutely aware that most studies of the efficacy of psych meds are only run for three months. There are very few studies of long-term use and very few studies of what it is like coming off meds. I don’t think the medical establishment can necessarily even tell the difference between ‘relapse’ and ‘withdrawal.’ So I feel like I have been sucked into something where I am promised a simple medication for a short period of time and instead go through all sorts of psych med cocktails for up to a dozen years. It’s like and bait and switch, which makes me feel like stupid for falling for it.”
Other reasons I want to taper off meds, at least as much as possible:
- They cost money, both for the prescriptions and for the psychiatric appointments to keep the prescriptions refilled.
- They may have negative effects on metabolism and cholesterol.
- I have to pay so much attention to them. If I miss a day, I don’t feel well, two days and I am very sick. This means before trips I have to make a lot of effort to ensure I will have enough for the entire time I am traveling.
- I’m not sure, but my sense is that I have more trouble tolerating other medications when I am also on psych meds.
But I’ve lost my train of thought here. I was telling you about having a session with E. The point was not that we talked about why I might want to reduce or stop my medication. I think the main point was that I wanted to see E so I could feel seen, heard, understood. She was a witness to my three-and-a-half-year struggle to get off Effexor (venlafaxine). I hoped to feel some kind of empathy, a warm place of safety.
And although in many ways she certainly was warm, I did not get what I want. I told her I felt alone and came to her because I wanted to be seen.
“It feels good to be seen, doesn’t it?” she said. But then, she did not go on to indicate that she saw me, or to explore my experience with me. Instead, she moved to problem-solving:
- What professional support did I need for the withdrawal? (the conversation I already outlined above)
- Was I being sufficiently clear to my husband? To my sisters/
- Who in my friendship network could support me?
- What activities or places bring me some sense of peace?
- What messages / affirmations can I give myself when I’m not well?
These are not unreasonable questions. My husband is a good support to me, and yes, he sometimes needs to be told more than once before he fully gets it. I’ve already realized that, and in fact I’ve already made the effort to over-communicate (well, in my mind that’s what it is) so he does know I’m not having the easiest time.
My friendship network is not in the best shape right at the moment. There are just a number of extenuating circumstances that make several of my closest women friends less available than I might wish. E wanted to problem-solve that as well, have me reach out more, also maybe re-join her women’s group that I quit a few years back.
Then we listed out the things that I find soothing: art projects, swimming, walking in nature…
I won’t claim there is no value to going through these questions. It made me think about some strategies I might use for self-care. I am a believer in self-care, that’s for sure.
The thing is, E didn’t see my need for some tenderness from her. Or perhaps she saw it but refused to meet that need. I never did figure out for sure, during those years I struggled with her, longing for a connection and closeness that was only sometimes there, if she couldn’t or didn’t want to provide that. She’s a very independent person herself, and I think she envisions emotional health and independence to be tightly intertwined. So she encourages me to find and develop strategies I can use separately from my time with her to heal myself.
No wonder I felt so frustrated so much of the time!
I saw a post on Instagram today, with quite a bit of text about complex trauma. The part that caught my eye was this; “Complex trauma is a consistent experience of not having our needs met–especially our relational needs for emotional closeness. This deficit of emotional closeness is intricately connected to the way we develop the defense mechanisms, insecurities, flawed belief systems, etc., that cause us issues in the present.” I think E never understood that emotional closeness with her was what helped me the most. The times she pulled back, pushed me to reduce therapy sooner, revoked texting privileges or otherwise curtailed closeness–even if she did it thinking she was helping me learn to care better for myself and not be dependent–she was actually replicating some of the harm I experienced both at home and in my first marriage.
E is warm, kind and patient, in many ways. she gave me a lot of extra time and attention. She taught me many valuable skills. She convinced me that “parts” were real and deserved attention. She taught me to value self-care. Thank you, E, for that. However, she was trained in the 1970s and 1980s. She has not kept up with current research on trauma. And what she didn’t know limited her ability to help me sometimes.
This used to hurt me so much. I often worried there was something wrong with me, as a client or as a person, that caused her to vary in her connection to me. She wasn’t mean or cold or judgmental, but she wasn’t always close or connected. And I feel like this session helped me see that disconnection often came from her choice of what to pursue in a session.
After all, I explicitly told her I was there because she knew me and my previous withdrawal experience, and I wanted to feel seen. And still, she repeatedly turned to problem-solving.
That’s why I say going to see her was not really a good idea, in the sense that it did not meet my need for deep connection. But it wasn’t a terrible thing either, because I think the processing I have done the past few days has brought me a greater sense of clarity.
It may also have reduced my longing for her. Sometimes, over the past ten and a half months, I have thought of her and so wanted to tell her things. I have even indulged in my old fantasy of resting my head in her lap and having her stroke my hair (something she would NEVER do). I can’t swear I will never do that again, but right now, I find it harder to imagine wanting that. There’s been a bit of a shift inside of me, a realization that, oh, she’s nice and all, but maybe she’s not quite what I once thought she was. We’ll see if that shift endures, but tonight, at least, it feels rather freeing.