Wednesday, December 8, 2010
Visits to My Psychologist, or The Joys of Tele-Therapy
I wrote an entry not that long ago on my experience of seeing a psychologist after years of not having therapy. I’m still seeing her.
The way Australia’s universal health care system, Medicare, works, it will cost me only about $15 a session until the end of the year. This is because the out-of-pocket expenses I’ve incurred are now over the maximum amount needed for the Medicare ‘safety net’ to kick in. Until the end of the year, whenever I visit my psychologist or any kind of doctor, Medicare pays 80 per cent of my out-of-pocket expenses.
The safety net starts all over again at the beginning of the calendar year, but the 18 Medicare-subsidised psychology visits allowed per year are allocated from the time in the year they began, which in my case was mid-June. This means that, while it would be natural for me to want to ‘blow’ my last six visits before the end of the year because I would pay next to nothing for them, in reality I have to stretch them out till June next year. I’ve decided to have two more visits this year (I’ll need these to cope with pre-Christmas socialising, if I manage any) and then one visit a month till the end of April, leaving a six-week gap until my 18 subsidised visits start again in June, if I decide I need them.
The system is quite limited, with Medicare still favouring psychiatry over psychology – if there are limits to psychiatric visits per year, they’re much higher, and the psychiatrists charge heaps more than the psychologists. But I’m grateful the system is there at all – psychologists have only been subsidised by Medicare at all for the last four years or so.
The very limitations of Medicare’s support for psychological services also indicate the practical orientation of psychology, suggesting that the powers-that-be don’t see these services in traditional psychotherapy terms. As someone who has enthusiastically embraced the therapeutic relationship, I’m still having trouble with the relatively informal nature of my visits to my psychologist, including the fact that they are at differing times of the day, with differing time intervals in between.
I’m finding it difficult to really let go and complain about my parents to my psyche, especially when it comes to discussing my mum. I have been able to talk about my mother with my psyche in ways that are productive, but all the while I’ve somehow feared that she would think I was complaining about her. This is paranoid, I know, but it’s also indicative of the types of therapists I’ve seen in the past, who, if they had inferred this kind of parallel, would have identified it as part of the therapeutic process. Despite my psyche’s easy confidence, I don’t quite trust her to be robust enough to handle the enormity of my angst towards parental figures!
Because the fact remains, as with my relationship with my mum, I’m more analytical than my psychologist (not more intelligent). And when I whinge about my mum being in her own little world, perhaps in some way I’m also complaining about my psyche’s chats at the beginning and end of the session – she often talks about her family during these chats. I know why she does this – she told me once her small talk is meant to put the client at ease – but part of me wants her to myself for the entire session, even during those minutes when you’re getting seated, or getting ready to go.
Anyway, I wrote this post because I wanted to mention two things my psyche has said that have really penetrated my consciousness and made me understand, almost for the first time, that I have much more power over my mind, and the way it operates, than I’d thought.
Since about the age of seven, my mind has sometimes felt like a frightening, uncontrollable place that gave me pain and suffering in unpredictable ways. Even before the more adult kind of social phobia I’ve detailed in this blog, I was subject to a sense of dark dread that would hit me for the most trivial reasons – accidentally taking some small item home with me from my grandparents’, knowing my parents were going out that night and a babysitter was coming over, and, when I was really young, dreading I would go to hell when I died, or that the communists would take over Australia (no need to allocate blame for where the last two fears came from!).
Everything I thought about, including normal adolescent fears, was mediated by that lonely dark dread of the worst happening, the worst being somehow beyond imagining and not able to be faced and dealt with in any way. This overweening, lonely angst was the precursor to the more specific fear I would later develop – the fear of my phobic symptoms manifesting in uncontrollable ways.
Anyway, my psyche said something interesting to me a couple of months ago. She’d mentioned an episode of a comedy-drama series we’d both been watching, Offspring. The heroine of Offspring is Nina, a young, accomplished obstetrician who is nervy, self-obsessed and awkward. She has a crush on Chris, the sexy paediatrician she works with, and her feelings for him only exacerbate her painful self-consciousness.
The main technique used to depict Nina’s angst is to show her walking along the hospital corridor as we hear her innermost thoughts in voiceover while, in sync with these thoughts, various expressions of fear and embarrassment cross her face. This is both funny and painful to watch, and possibly inexplicable to those who don’t suffer from anxiety (a cousin of mine said she couldn’t warm to the character; one female reviewer complained of the Ally-McBeal-style ditziness of the heroine). In fact, watching these scenes has been at times quite a profound, even therapeutic, experience, with the comic angle helping to demystify the anxiety, and diffuse the sense of the viewer being trapped in Nina’s claustrophobic inner world.
Nina is obsessed with what others think about her, dreads specific events in the future, and, when locked in her own thoughts, is disengaged from the world around her. Yet, most of the time at least, she’s not that transparent. When she encounters a frightening or unexpected situation in the real world, she appears to be distracted and sometimes flustered, but her actual thoughts remain unknowable to others. She’s as opaque as the next person. Seeing this has also been therapeutic for me.
(We interrupt this blog entry for a brief TV review: unfortunately the series subsequently disappointed, as Nina didn't really develop at all; rather than gaining a greater sense of herself, she was just as people-pleasing, insecure and trapped in her thoughts in the last episode as she was at the beginning, and the plotting, so strong initially, gradually deteriorated as the series progressed.)
Anyway, at one session soon after a particularly apt episode, my psyche brought up the topic of Nina, and I gleefully told her I’d been watching the show.
‘Nina is very attached to her thoughts’, my psyche said. ‘Most people have different kinds of thoughts but they don’t pay much attention to them. There are some people, though, who get very attached to frightening thoughts. This is what you do’.
The combination of my psyche saying this, and me having recently watched the process being played out on screen, was quite powerful. Through my understanding of mindfulness I’d already been aware that thoughts were separate from the self, that they were random mental events rather than the basis of my very identity. But this dramatisation of an attachment to fearful thoughts, and my psyche so clearly pointing out that attachment, somehow made me understand in a much more practical way not only that my thoughts are not me, but that my attachment to fearful thoughts is something that I have some control over. If I’m attached to my thoughts, then there is a possibility that I can detach from them, at least partially.
I’m not saying for a minute that this will stop me getting fearful, especially when I’m dreading, for example, an upcoming summer barbecue full of groovy people who I know just well enough for them to invoke terror. What it means is that I have an extra tool in my arsenal when faced with scary thoughts. I had already been able to respond to these thoughts by telling myself: ‘these are just thoughts, they are not the truth’. But now I can add to that, and say: ‘these are just thoughts, and I can see how I cling to them as if they were the truth’. I can see for the first time that there is some security in these thoughts for me, that they represent a kind of ‘home’, and that it doesn’t have to be that way.
Talk about good timing.
As I’m writing this, I’m also wondering if the attachment to thoughts has got something to do with my feelings towards my mum. Do thoughts become a security blanket when there is no one to cling to? Are insecurity and fear a form of security seeking? In being so attached to my thoughts am I somehow refusing to separate from my mother? Am I metaphorically burying my face in her absent shoulder?
That’s not the only example of my psyche saying something relatively straightforward that has really resonated with me. As the copywriting aspect of my business has expanded while the editing aspect has diminished, I am starting to deal with clients over the phone more frequently. This is downright terrifying, and I’m currently facing imaginary scenarios of being in constant, crippling fear of clients calling if the business should seriously take off.
I’m even more fearful of people in the context of work than I am in the rest of life – I have a terror of success, a compulsion to display my fear combined with a deep need to please superiors (in this case, clients) and demonstrate my talents. These contradictory aims make dealing with clients in a functional way challenging to say the least, and I’ve avoided writing about this because it’s such a difficult and seemingly insurmountable area. The anticipatory fear that I sometimes experience in these situations is akin to the feelings of dread that originated in my childhood.
Recently, my psyche said of my ‘scary’ clients: ‘you give them so much power’. In the context she meant I was giving them the power to produce my symptoms, as well as power over how good or bad I felt about myself. I was using them as judges of whether or not I was an okay person.
This isn’t the first time a therapist has pointed out something to this effect. One very insightful psychiatrist once stated that in my fear of making a fool of myself socially, I turned other people into objects whose existence was only relevant in relation to me – that I corralled others for the purposes of giving me negative attention. At the time this certainly chimed, but it was an abstract idea, one I couldn’t really do much with. A problem was identified, but no concrete solution was suggested or implied.
With what I understand now about thinking, I was able to read my present psyche’s remark more usefully than I could have in the past. She was actually saying to me: ‘You give your clients so much power in your thoughts’. In other words, it was the way I was rehearsing encounters with these people in my head, or simply the feeling that I adopted automatically when I thought about them, that was the issue. I was giving them power in and through my cognition, through the exercise of my mental faculties, at specific moments in time. These specific moments occurred every time I conceptualised them, not simply during my actual dealings with them.
In the past I’ve simply assumed they had the power I was attributing to them. After all, they are my clients, the people who hold the purse strings. But are they really the arbiters of my self-worth? In reality, they are simply people who want a service from me. If I sound awkward or frightened on the phone, they have the choice of whether or not to deal with me in the future. Their personal judgments of me, whether positive, negative or somewhere in between, are not really all that relevant. They are not sitting on some pedestal miles above me, dictating how I should feel about myself.
Now, when the usual dread descends, I tell myself that I am giving these people unnecessary power. I’m using them to make myself feel scared. In reality, they are marginal to my life. This thought process doesn’t banish the dread of course, but there is a real reduction – its hold on me weakens. The ‘judges’ start to descend to earth, devolving to their actual status as fallible human beings with their own agendas.
One thing I’ve been doing ever since I started to see my psyche is write down the most salient points she makes, sometimes during the session. I then type them up on my ‘therapy’ file (obsessive? me? never!) This has been a good thing to do, and occasionally I’ll read through the file. Because my thinking constantly seeks to go back to its old habits, and drag me back into the dread – that confusingly comfortable, familiar place of pain, humiliation and discomfort.