Saturday, April 21, 2012

An End, Maybe

I hesitate to write about this because I'm still processing it and don't really have an articulate summary thought out yet. Sorry if this isn't coherent, but it's weighing on my mind and I had to say something. In a nutshell, I think I'm getting fired from therapy. My appointment with R yesterday was...rough, to say the least. It was a weird, awkward mixture of him asking whether I found therapy helpful, and me trying to answer honestly without offending him, while also not exactly being sure what my answer even was. We talked about how my eating habits, my thinking regarding food and weight, and my rigidity remain almost entirely unchanged. That makes it seem like therapy has had zero effect on me whatsoever. Except that maybe I'd be a lot worse off without it, who knows?

Staying in treatment was a condition of my parents letting me come back to school this year, so it was never really my choice to begin with. But now that it's pretty clear I'm not improving, I'm mad and frustrated with myself for failing.

A major issue, according to R, is that we fundamentally disagree on the weight thing. Not about gain in general - I know that I should gain weight. But his goal is significantly higher than anything I deem remotely reasonable. He also flat-out doesn't think I can get there outpatient. History is on his side, considering I haven't put on any significant weight in eight months, but I flat-out refuse to go IP. There might be people who disagree with my position on that one, but it's nonnegotiable. I'm not giving up my life again, no matter how stubborn and dumb that may sound. I've been in semi-decline since getting sick over vacation, but I'm not in dire straits medically, and I don't think it's fair for him to force me into a higher level of care.

And okay, deep breath, this is the part I'm still working out: the shame. Just being in therapy gives me this deep-seated sense of inadequacy that I carry around constantly. Outside my immediate family, I think only two or three of my friends actually even know that I see a therapist, but it still feels like I have a neon sign over my head announcing to the world that I'm a wreck who can't keep her shit together without professional help. (I don't think this about other people in therapy. It's a purely self-conscious issue.) I walk around every day with this profound sense of failure, like I'm flawed and diseased, like something is fundamentally wrong with me. And I hate that. Sometimes it feels like therapy has destroyed my self-esteem. I worry that I can't function without it because I've been told over and over again that I need it.

I'm stuck somewhere between not believing there's any valid reason for me to be in treatment (because I'm not skinny, I'm not sick, and I'm perfectly functional in everyday life) and not believing that I'll be okay without a professional support system, simply because I've become convinced that I won't make it on my own.

Our conversation yesterday left me feeling really negative and defeated. R was sympathetic, but his position is that unless I agree to IP, or at least IOP, as per his official recommendation, there's not much else we can accomplish together. I should have seen it coming, considering how difficult I've been all year, so I don't really have any right to be upset. But still, it's hard to hear how messed up you are for eight months, and then get turned out on your own. I should make clear: he didn't officially fire me, but definitely addressed the possibility of us not working together anymore. We left things up in the air for now. I'm going to see him next week, the last time before a stretch where we're both out of town a few weeks in a row, and we'll make a decision then.


  1. I'm so sorry it's a difficult time. It sounds like a few weeks' break between you and R might be helpful to gain a little more perspective on the situation. Could it be that you and R just don't "click?" It's super important to have a counselor/therapist who you feel is not only helpful in moving forward, but also that you really make a connection with. I'm sorry to hear about the shame that you're feeling. That's a really tough emotion to deal with. The thing is, it speaks more about your good character and willingness to get healthy to be trying to work things out with a professional, than if you were ignoring your struggles and not getting help. Asking for help from someone who is highly trained in a particular area is smart and insightful. If you had a broken arm, you would see a doctor, right? It's very similar, and it's something that is a positive step, not one that means there's something wrong with you. I'm not sure if that makes sense, and I certainly don't mean to sound like I'm preaching.

    The weight issue is a tough one. Similarly, my counselor wants my weight to be higher than what the dietish has set for the goal. I'm not sure how exactly professionals decide on numbers. I also struggle with my feelings about weight, not knowing if my resistance is a product of the disease or just something I don't agree with. Have you voiced your concerns over the number? Does he have certain evidence that suggests why he has chosen that specific number? Or has another professional (like a medical doctor) also discussed it with you?

    Could you guys compromise on the level-of-care issue by trying IOP? Did you have a bad experience with that at one point? Or is that something you'd be willing to try on a temporary basis to continue seeing R?

    Sorry my comment got so long, oops! Take care!

  2. Yikes, that had to be an awkward session. I'm really sorry you're having such a hard time. Lack of progress in treatment is a sticky issue with all sorts of causes. Have you thought about trying to find a new therapist? Sometimes people just don't mesh right, it happens. What is a good approach for one client might not work for another, and some therapists have broader repertoires than others.

    Honestly I'm a little surprised he's so involved with your weight and food plans, when you also have a dietician. In my treatment, it's pretty much always been that the dietician deals with specifics of numbers and such and the therapist deals with issues and stresses and behaviors. I'm not a professional and can't recommend the best way to do things, of course,

    I do understand your reasons for not wanting IP. I've had that pressed on me by many people in the past and although I know it saves lives, I never felt like it was for me. So anyway, I absolutely hear you on that one, and maybe avoiding IP can be incentive to do more intense OP work. I don't think going to therapy really carries that much stigma anymore, though, a lot of I know have seen a therapist at some point, including every therapist I've ever had (first world problems, right?). I totally recognize it can *feel* that way though and am sorry you've been carrying shame about it. Honestly I think going to therapy to address a problem is a major sign of strength, and you should be incredibly proud of the progress you've made. Just don't let yourself settle, your life is worth more than that.

    I hope that you and R can work something out that lets you get the support you need with someone that you feel listens to and understands you. Hate that you're having this kind of trouble right now, hang in there chica. You are an amazing person and even though the road can be rough, I know you'll make it.

  3. I don't have a really insightful comment here but I do know that when I was seeing the therapist who ended up helping me get my life back, she told me that I HAD to be making progress to get to the weight that she wanted or I couldn't see her. I actually really liked that. I felt like our time together was very goal driven and that the physical and emotional goals were tied together. She managed the meal plan (in consultation with a dietitian) and I liked that...I only had to work with one person, couldn't play them off each other, and didn't feel as sick just going to one person a week as I would have if I had to go to multiple places across town. These are all just my personal experiences but maybe you could look for a butt kicking therapist who is willing to manage both aspects of your care. It was nice for me to be responsible to only one person (who I really respected and wanted to please.) I feel like I'm rambling here so I'll stop but like C said, hang in there. You're an awesome person and you will make it through this, whatever ends up happening.