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!

What stability looks like so far (1 year on meds)

I started my medication in mid 2020 after my diagnosis, and I reached the full dose I’m currently on in August 2020. Thought I’d show what my mood has been like since then, and reflect a bit on the past year.

I have been tracking my mood using the Bipolar UK mood scale and my own spreadsheet (template here).


Mood graphs

Ongoing since July 2020
Last 12 months
Last 3 months

Some reflections in no particular order

Ups and downs still happen. I have relatively long periods of a consistent neutral mood, but I still have low days (and some high ones) here and there. But they became less frequent, less severe, less long-lasting (a couple days of feeling low as opposed to a couple months), and way more manageable.

Meds take time to kick in. Although I was in a much better place when I left the hospital after a few weeks titrating meds, it took me another six months or so to reach a point where my mood was stable and where I felt in control and confident in my ability to manage it.

The first few months are scary. Coming out of a mixed episode while inpatient after a suicide attempt was scary. Wanting to be alive for the first time is scary. Every slight mood change had me worried I was about to spiral out of control again.

Intrusive suicidal thoughts took a while to go away. I still have them sometimes, but rarely. They were more common at the beginning. I didn’t want to die, but after being suicidal for over a decade, it was just my brain’s go-to thought.

It took time to know myself. I didn’t instinctively know what my healthy range of emotion is. I had to re-learn what normal sadness and normal joy looks like for me, what’s a normal reaction and what’s a warning sign of oncoming depression or hypomania.

It’s not always the bipolar disorder. I have frequent migraines (not chronic, but close) and part of the prodrome for me is a depressed mood with increased anxiety. Many of the lows in my chart are migraine-related, which is something that took me a few months to identify.

It’s not just medication. I wouldn’t be alive without medication, let alone function without it. But meds alone don’t do all the work. When my mood goes up or down, it’s a lot less severe and more manageable than it would be without meds, but it’s up to me to use coping skills to get it under control and get back up (or back down) to something neutral.

My baseline leans more towards the low side. I’m more likely to have low than high moods when I deviate from neutral. This might be the nature of my bipolar, or it might just be the nature of my life circumstances (a crappy job atmosphere, migraines, some dysphoria as I sit on a long waiting list for surgery). But it’s completely manageable.

I haven’t fully come to terms with it yet. I fact-check and research most information I come across. I’ve read about migraines, about gender dysphoria, about why bright sunlight makes me sneeze, about so many things in my life big and small. I still haven’t read much about bipolar besides self-management strategies because I’m not ready to fact-check how much of a progressive illness it might be, or how likely it may or may not be that my meds will stop being effective or that I will have another episode. But I don’t like living in ignorance, so I’m working on it.

I don’t take stability for granted. I know I’m not cured or fixed. I know I’ll live with this for the rest of my life, and I have a few decades of life ahead of me if nothing gets in the way. I track my mood, I’m self-aware of my thoughts and emotions, I take my meds, and I avoid any known triggers to the best of my ability. I know stability is not forever guaranteed, so I’m grateful for it and I try my best to maintain it.


It will be interesting to see how things go as the years go by. They might get worse at some point, but I’m confident in my ability to handle them better than I was able to in the past.