My therapist has described the nature of my last few sessions, actually the sessions since she has returned from vacation as “optimistic” and that is scaring the shit out of me.
Upon her return, she had the audacity to say that despite a few ups and downs, this appeared to be the best I’ve ever done during one of her extended vacations. I didn’t lose weight, I didn’t cut myself (although thoughts to do both entered my mind); I handled any storms that came my way appropriately – by making an appointment with her covering psychiatrist (is that cheating?), and discussing an incident with a friend and colleague.
“This is progress.” she declares with a hint of a smile. “Does that scare you?”
“Yes.” I replied. “But not as much as it used to.” And then a pause. “And that scares me.”
This month will be five years I’ve been working with Dr. Adena*. She practices a specialized type of therapy called Transference Focused Psychotherapy (TFP)** developed to work with patients diagnosed with borderline personality disorder. Basically, the meaningful relationships from the patient’s past are re-enacted and examined through the transference with the therapist. Before working with Dr. Adena I was in Dialectical Behavior Therapy (DBT)*** for a long time. DBT is more of a here-and-now therapy, focusing on managing the storms, learning how to cope with the self-destructive, acting out behaviors. I’ve asked Dr. Adena if all those years were a waste of time. She has told me repeatedly that was where I needed to be then; I could not have effectively worked within the TFP framework without all those years of DBT.
I see Dr. Adena twice a week; there was even a short time when we increased it to three times a week during a crisis period. To me, improvement, and subsequently recovery means only one thing – abandonment by her. It means that I will no longer be able to have those two forty-five minute hours to talk with her, to ask her questions, to get her feedback and her on-target interpretations. I fantasize that one day she will declare me “cured” and unceremoniously toss me out of her office, never allowing me to contact her again.
In reality, in the logical part of my brain, I know that we still have a great deal of work to do, that we will cut down from two sessions a week to one session before I am declared “cured,” and that in all likelihood, I will be the one who decides when I don’t need therapy any more.
I read a book last year called “The Center Cannot Hold” in which a woman has a last session with her therapist and she clings to a heating pipe in the waiting room, hysterically sobbing, refusing to leave until the therapist and the therapist’s husband threaten to call the police to remove her. Sometimes I picture myself as that pathetic creature at the end of a session, so sensitive are borderlines to the perception of being abandoned. Although when Dr. Adena tells me it is time to leave and I calmly and cooperatively get up from the chair and walk out of the door, I often stop in the bathroom which is down the hall to cry, partly from the intense emotional content of the session, and partly from the fact that it will be some time before I will be able to see her again. But what is different from five years ago, is that I won’t act out between sessions.
Dr. Adena asked me what I think is different these last couple of months. I said I have replaced the acting out behavior with other things like writing and real and virtual (read Open Salon) friends and my passion for my work. I said OS has been a godsend; it appeared at just the right time.
She said to me “It didn’t just appear - you made it happen.”
I considered that for a moment. “You’re right.” I conceded. A friend introduced me to it, but I was the one that took advantage of it and wrote and posted and kept going back.”
We talked about my guest list for my fiftieth birthday party which my brother had requested from me.
“There are twelve adults and two children. I didn’t even know I knew that many people. The last party I had was in 2000 for my graduation from social work school.”
Dr. Adena commented “Quite a different guest list, I imagine.”
I agreed. “The people there were current or former therapists and my counselor from the halfway house, my mother and Heather and my brother. And that was it. Pretty pathetic huh?”
I started to cry and grabbed a couple of tissues from the box on her desk.
“Why are you crying?” she asked.
“I’m lost. “The patient identity has been my identity for so long and part of me is still hanging onto it so fiercely. I’m trying to shed that skin, but I’m fighting myself every step of the way. I’m building a new identity but I’m not there yet. I’m not comfortable in it yet. I’m between identities and I feel naked and exposed. I don’t know what to do and I’m terrified.” I continued to cry.
I continued. “I am so scared of having another breakdown. The more progress I make the more I have to lose, the farther I have to fall.”
She asked, “What makes you think you’ll have another breakdown?”
I practically shouted at her. “It’s in my goddamn genes. I have no control.”
She reminded me gently that every major and minor breakdown I’ve had has been precipitated by a loss or perceived loss of some kind and I am much less vulnerable now, and much more resilient. I looked back and had to admit she was right. My last major breakdown in 2005 was precipitated by the loss of my supervisor at work to whom I was deeply attached; he was replaced by a nasty, unsympathetic alcoholic woman (read; my father in a skirt).
My flow of tears dried up. I remembered something I had read in a textbook on TFP which I brought to Dr. Adena’s attention. She had the book in her office and she pulled it from her massive bookshelves. This particular book is written in a question and answer format and the question I had in mind was “What are the signs of progress in TFP?”
There are six of them. When I bought the book about a year ago, I was wrestling deeply with number three:“The patient can begin to tolerate some awareness of the patient’s hatred, and of the patient’s love.”
Now Dr. Adena hands me the book, saying she didn’t have her glasses on and I find the page and I go immediately to number four:“The patient can tolerate fantasies that represent the development of an internal psychological space where affects can be consciously experienced rather than discharged into action.”
I read it aloud and look questioningly up at Dr. Adena. She nods and says to me, “You are struggling with this one.”
And the session is over. I get up and obediently leave her office. I do not stop in the bathroom.
* Dr. Adena is a pseudonym.
** For more information on TFP go to
***For more information on DBT go toclick on DBT Frequently Asked Questions