Counselling did and didn’t work

I started counselling sessions maybe three months ago with the same counsellor I saw a few times a about two years ago. I chose this because, from the few sessions we had back then, I really thought we could work well together. They’re on holiday now and I have to say, I’m actually doing better while I do my own thing.

The feelings I sought counselling for are still the same for the most part. I encounter things that trigger memories of the suicide attempts and hospital stays, which leads to anxiety and just lots of feelings, and sometimes (luckily not often) panic attacks. Things that trigger memories of medical trauma from a few years before that. And good old gender dysphoria and the feelings of shame, worthlessness, and distorted body image that come with it.

Their approach is all very focused on the concept of an inner child, and on not trying to rationalise anything because (to oversimplify things) that’s just the critic parent or the super-ego taking control. I am encouraged to listen to what the inner child is feeling and saying, conveying it as merely a messenger, without analysing it at all or relating it to its context. I get this and I see how it can be helpful to many people, including myself on some occasions, but most of the time it’s just irrelevant to me.

I’m very much logic driven. I want to know why and how things happen so that I can troubleshoot and problem solve. I know feelings and emotions don’t necessarily work in a way that makes this approach effective, but at the same time, feelings and emotions do happen for a reason. They don’t come out of literally nowhere. And knowing the reason is what makes me feel better, and what often allows for the strong maladaptive emotional reactions that arise from some situations to eventually be replaced by healthier reactions. I can’t always easily identify a reason, and it’s ok to not have an answer for everything, but why would I not look into it when I know I can actually unearth the reason and do something about it?

Sometimes the reason feelings happen is just that I have a mental illness, and depression and hypomania do happen. It certainly felt like they happened for no reason before I was diagnosed, but once I had a diagnosis it’s easy to see which feelings are a response to a particular thing or arising from a pattern from past experiences, and which feelings are just my illness driving me towards one end or the other of the mood spectrum.

Anyway, I think it’s important to make a distinction between asking why as in “why the hell am I reacting this way, this makes no logical sense, I shouldn’t feel this way and I need to stop feeling this way,” and asking why as in “I wonder where this is coming from, it’s ok that I’m feeling it, but I can also see it’s not a rational response and I wonder why.” What I mean is the latter. I’m not beating myself up over having certain feelings and emotions anymore.

I don’t think I’m being the authoritative parent figure shutting down the child’s emotions. I think I’m the parent saying “hey, I’m here, what you’re feeling is ok and I’m listening,” but who also wants to know why afterwards. Not interrogating the child as if it was their own doing, just gently looking into the issue with an open mind. Because a child crying every time they see X normal thing is not healthy, and ultimately that’s what I would want to address. Not because I find the crying child unpleasant, but because I want the child to not feel like crap if it’s possible to start changing the way they perceive and react to X.

In fact, I would argue that consistently being there for the child validating their emotions but neveer looking any further into it despite it happening all the time, would constitute neglect too. I was emotionally neglected to a significant extent growing up. I was ignored, I was told I was faking things, I was told I was lying, etc. And the way I treat myself sometimes definitely mimics that, and I do listen to the inner child in those instances. But there were also a few times, maybe 3-4 times, where I would be crying and someone would sit with me through it without judgement, which is good, but then once it was over, it was over and forgotten. And I don’t want to do that to myself either, I don’t want to just listen to my feelings and validate them and then move on and not think about them.

I want to feel my feelings without judgement, but I also want to examine them critically. Not critically as in disapprovingly, but critically as in inquisitively.

So I’m confident I’m not ignoring the concept of the inner child, but it’s also not all there is to me. Especially when it comes to things like triggers related to medical trauma that happened when I was 20 or suicide attempts when I was 25 and 26.

The way I feel about certain things may be related to how I felt about similar things when I was a child, and I will acknowledge that. But I will also be blunt and say I don’t care how the inner child feels or what he has to say when, for example, someone mentions being intubated unconscious and I immediately feel the things I felt the two times I’ve woken up intubated, unable to open my eyes, not knowing where I am, shouting with no sound coming out, seemingly no one there to help me, completely confused and terrified with nothing but an innate primitive survival instinct in me.

And yes, my inner child will have feelings that relate to that because there are parallels between that and the experience of growing up mentally ill and unknowingly dysphoric with my suffering unseen and unable to get help. But I’m not here analysing a piece of literature and finding the recurring themes, the symbolism, or what a metaphor alludes to. It’s not about the parallel. They’re not feelings arising from my wounded and abandoned inner child that I need to nurture. It’s very much coming from my present adult self reacting to a trigger related to an event from my adult life. The reaction is not arising from an inner child.

In a way, it feels almost infantilising when I say “I had a panic attack with flashbacks to my suicide attempt two years ago and very graphic, violent, intrusive thoughts” and I’m told “let’s check in with your inner child.”

I had a few rough days some weeks ago because I had to do something different at work that kept reminding me of the medical trauma from a few years ago. I brought this up and my counsellor said it was interesting I hadn’t felt the need to check in with my inner child, given how bad the week had been. And again, I just don’t care what the inner child has to say because it’s not the wounded child having feelings, it’s my grown self having feelings. Feelings about an event that most people would agree it’s normal to experience as traumatic, and that I experienced as an adult.

So it’s not the wounded child having child feelings that don’t align with my adult feelings. It’s my adult self having feelings based on a past event that don’t align with the current event by emotionally and physically reacting to something innocuous as if it was a threat. And those are the things I want to look at critically, and slowly teach myself that there is no threat and that I’m not back where I was, so that with time the emotional reactions to those triggers become more and more neutral.

Which is indeed what I’m very slowly achieving by sitting with the feeling, letting it be without reacting to it, and reassuring myself that whatever is happening right now is not what was happening when this or that happened, and that these are not helpful feelings to act on but just conditioned feelings from previous experiences. There’s not much going on in terms of an inner child there.

As for the feelings related to gender dysphoria… There’s just a lot of internalised transphobia to unpack there. I’m ok with who I am as a person, and I’m ok with my physical self when I’m not relating it to others, even if I am dysphoric about it (so the dysphoria is there, but I don’t feel “less than” because of what’s causing the dysphoria). But when I think of myself as physically existing amongst others, I feel ashamed, wrong, disgusted, out of place, unworthy. There is little input I need from the inner child when it comes to this, and as well intentioned as they might be, there’s very little I can get from someone who doesn’t really grasp these issues to their full extent and who only has the most basic understanding about what being this way means. It’s more complex than “I wasn’t accepted as an equal growing up because I didn’t conform to the expectations for the gender I was supposed to be, and now I have no confidence.” It’s not just whatever my child self went through, but also teenager me and adult me living in a society where transphobia is quite prominent, and where I have often found myself having to justify my existence to others.

Anyway, that whole thing is a topic for its own post some other day.

In short, because this was very long-winded, I’m just not clicking with this counsellor because that approach just doesn’t do anything for me in the way it’s been presented. But I don’t regret the time, effort, and money that I’ve invested in it because it has also allowed me to explore what does and doesn’t work. I am genuinely glad to be acknowledging the part of me that would be considered the inner child, listening to it and validating it when it’s appropriate and called for. It’s just not at the centre of everything I experience and I have found no benefit in trying to make it be.

I’m happy with how things are going, and I think the sessions I’ve had have allowed me to fine tune my skills even if the approach itself didn’t quite do it for me. I’m not looking for someone else at the moment because I don’t think the whole “I’m ashamed to exist as a physical being because of my transition history” is something many counsellors/therapists can easily address (from the ones available to me). And I’m not in desperate need of help with that anyway. The hassle of shopping around to find the right one isn’t worth it at present.

At the end of the day, I’d say leaving counselling feeling like I don’t need any more counselling is a good outcome!

Flashbacks and intrusive thoughts

Content warning: self-harm and suicide mentions

I started the day with anxiety feeling like a hole in my chest, and disgusted by this body of mine and the person I am. But I had things to do and a train to catch, so I got out of bed to get on with the day.

I felt the anxiety, the self loathing and self hate, the frustration and anger of rationally knowing those feelings don’t necessarily represent reality while still feeling them, and then the fear that maybe this is all there is.

I spent an hour or so first thing in the morning afraid of myself and sobbing uncontrollably. Irrelevant detail, but this caught me while sitting on the toilet doing my business. Mental illness is anything but pretty and cinematic and I want to acknowledge that, embarrassing as it may be.

I first had flashbacks of the day I tried to kill myself. The desperation, the guilt, the anxiety, the pain… All the feelings as fresh as if I was right back there sitting on my bed on that day swallowing handful after handful of tablets. Then the other intrusive thoughts. Graphic images that I don’t want to see and urges I don’t want to act on, but they show up and even with my eyes open I just see those realistic images playing in my head. Some are things that haven’t even happened at all, or have happened but to a much lesser extent. Most involve self-harming in various ways where the result would range from needing some medical attention to straight up lethal, but no need to go into specific graphic details here.

All of this accompanied by the feeling that I’m just so unworthy of everything, that I’m a burden, that I’m not good enough or just no good at all. My brain forever dysfunctional and my body forever incomplete. Feeling ashamed of these things I have gone through and still go through, while also getting frustrated because rationally I know there’s no shame in having a mental illness and having specific difficulties or needs because of it.

It’s difficult to sit with the feelings by kindly welcoming them, reminding myself it makes sense that they would surface sometimes and that it’s ok and it doesn’t mean I’m going right back to square one. It’s difficult not to judge myself or beat myself up for having them. The dissonance between what I’m feeling and what I think I know to be real only creates more distress. I get angry at myself for still having such feelings and thoughts because I know they’re not true, and then I doubt myself and think what if I should actually listen to them? I get even angrier at myself for daring to question whether those negative thoughts are representative of reality.

And then I thought what I needed was to have a drink, or perhaps take a couple more painkillers than I need, just enough to take the edge off and numb things down. But I didn’t because I know better.

I just stayed where I was and I kept crying, hoping my mind would eventually calm down and stop the intrusive thoughts trying to get me to hurt myself and to convince me that all I am and all there is to my life is being ill. I find that with this as well as with panic attacks, it helps to just let it run its course gently guiding myself out of it rather than forcing myself. I wouldn’t say “just stop” to someone going through the same thing, so I try to be kind, understanding and patient with myself as I would with someone else.

I try to regulate my breathing slowly instead of trying to jump into a 7-11 rythm immediately (that’s 7 seconds breathing in, 11 seconds breathing out). Physical ways of grounding myself are also helpful, and the unhealthy methods I used in the past were self-harming and punching walls until my hand was all swollen. The healthy ways I then found are mainly using a weighted blanket by folding it as many times as possible to concentrate all the weight on my chest as I lie on the floor or in bed (don’t do this for too long!), or by sitting against a wall and pushing against it as hard as I can (if I have something I can push against with my legs that’s even better). I have tried other things suggested to me such as shocking myself by splashing cold water on my face or biting into a lemon, and those don’t really work for me.

What most professionals I’ve seen in my life failed to address was the importance of aftercare. You don’t just pull yourself out of it and get on with the day as if nothing happened. Sometimes I do have to carry on as soon as I can, for example if I’m at work, but it’s still important for me to make some time later in the day to at least check in with myself. Again, if this was someone else I would still keep supporting them after the worst of it is over. I’m getting used to always asking myself how would I treat someone if it was them and not me going through whatever I’m going through.

Today this meant that instead of rushing to get showered, pack my back and run to catch a train, I rescheduled for a later one. I got ready without rushing, left early enough to not have to walk really fast, and found myself a quiet spot on the train. I allowed myself to acknowledge the sadness and frustration instead of immediately trying to distract myself with something else. Over time I’ve learned to recognise when it’s safe for me to engage with some of the thoughts and feelings that arise, and when I actually need to find a distraction before acknowleding them so as to avoid triggering myself back into the same state. Then I got to my destination where I had planned to do certain things, but instead I rested at the hotel for a bit and then went on a quiet walk.

I can’t always drop everything to do some self-care and self-soothing, and more often than not I have to carry on with what I was doing without much of a break. But it’s always possible for me to re-think what is and isn’t essential in that moment, and to re-adjust things things to the extent that I can in order to make life a bit easier for myself. I still feel selfish doing this, even when those adjustments don’t really affect anyone else.

If I really don’t have the time for anything right away, I still find a few moments at some point to just see how I’m doing, think about what’s happened and whether anything triggered it, see how I feel about it now and leave space for those feelings, see what worked and didn’t work in the moment, and see whether there’s anything I can do for myself that would help now.

It’s a learning curve and I always remind myself that no matter how helpless I feel in the moment, it will always pass and I just have to ride it out as best as I can. But this isn’t always easy and I don’t always believe it.

And going back to the fear I mentioned at the beginning of the post that maybe this is all there is… Where does my unaltered self end and my mental illness begin? I don’t think they’re separate. My self is mentally ill. There’s no “before” where I wasn’t affected by mental illness or a weirdly wired brain in one way or another. There’s no future where I will be free of it. It makes me have a lot of gratitude for every day I get through where I’m stable and content, but deep down it also just terrifies me feeling like there’s this ticking bomb inside me and one day I won’t be able to extend the timer any longer. I’m confident in my coping skills at present and my medication is working really well, but there’s no guarantee that will never change. What if the stability of these last two years has been just a fluke? I know episodes will still happen at some point to some extent, and with medication and the right support network I will be able to get through them… But what if I can’t? That terrifies me.