The Talking Cure

I had my first therapy appointment in almost a year this morning. For months, I've been thinking of what to say, how to organize my hundred thoughts into simpler categories; and I've been writing journals and letters as if they were preparation for therapy: little exercises in articulation and communication.

A reduction had to occur: my daily, minute-by-minute, reassessment of my self-understanding had to be translated into only one hour of therapy per week. And so I've been stirring my thoughts, hoping the heat (of my need for help) is hot enough to reduce them.

My first appointment was this morning. The therapist, Colleen, had that strange soft-and-sharp look common to women in their sixties: she had a round figure and face, and soft white hair, but the hair was cut short and spiked with gel, and her makeup was overly precise: thinly drawn eyebrows, and a hot pink, almost lipless, geometric, mouth.

She laid out the possible exceptions to therapist-patient confidentiality: child abuse, abuse of a dependent, suicidal thoughts or the possibility of self-harm. And I made sure to nod and smile in a way that indicated I wasn't abusing children, and wasn't (this week, at least) suicidal. She talked slowly, with a rolling sing-song, but her voice seemed nervous rather than calm; I didn't allow myself these kinds of thoughts at first -- I was optimistic and proud of myself for finally having made an appointment -- but, looking back, I think I'm right in my description. She had the demeanor of a substitute elementary school teacher, anxious but trying to appear certain, and dependent on the lesson plan to a degree that seemed almost religious (as if it were a bible, and any lack of veneration on the students' part was expressed as mortifying).

Colleen didn't know anything about me, though I'd been told by the staff psychiatrist that the results from my diagnostic tests would be passed along to her. So, I mentioned the psychiatrist's assessment and tried to explain my problems. I talked about my irresponsibility -- from brushing my teeth to paying my bills to attending class -- and, similarly, my disorganization and my ever-changing sleep schedule. I tried to describe the trouble I have transitioning from one activity to the other -- going to bed, or going outside, or even going offline. I described that once I'd made the transition, I often enjoyed or got used to the new activity, and yet, despite knowing that, my fear of switching activities persisted.

She said, "So you have a problem with change?"

"Change" isn't a word I'd use, because I love some types of change: moving to new apartments or states or countries. But it was easier to say, "Yes, I think so."

"So, on a scale of 1 to 100," she said, and opened her arms to show the range, "how much do you want to change? Really want to."

The question felt wrong, but I tried to answer. "Intellectually," I said, immediately embarrassed by the word, though pretension mostly occurs when I'm struggling, "I think change is required. I've thought, so many times, that I don't want to go on living like this. But, on the other hand, my anxiety and disorganization is what I'm used to, and I've wondered if I've sometimes feared that, if I felt less anxious, I wouldn't recognize my life -- it wouldn't feel familiar, if that makes sense."

She nodded. "So: anxious," she said, and wrote it down.

We continued talking, her repeating words I said and then asking me questions I found bewildering. I tried to answer in a way that felt honest, but it seemed she only heard words with pop psychology resonance.

I explained again my inability to get anything done, and how I've been missing my classes.

"Well, what would your ideal program be, then?" she said.

"The thing is, there's no right program for me. It feels like I can't get anything done -- the problem is me, really, not my program."

"So, you feel out of place?"

"I guess I'm saying, I don't think the place matters. I mean, even if I tried to create the ideal program, a program just for me, I'd start it and wouldn't be able to follow through."

"So you have a problem with follow through." She wrote that down. "Let me ask you a different question," she said. "Are you a perfectionist?"

What the hell? I thought. But I answered: "When I was younger, I think my perfectionism went along with being artistic -- sorry if that sounds vain, or --wanting to do something creative. Anything artistic, if you want it to be good, at least, requires an attention to details. But, nowadays, I place more trust in the revision process, not expecting myself to get things right the first time. I'm more realistic now, … But, going back" --here, I let myself frown because I'm under the impression that frowns look confused rather than frustrated --"I didn't mean 'follow through' in the way that it's used when talking about perfectionism or ADD. I meant, like, getting out of bed everyday at time where I can make it to class. I meant, organization, too, and …" I paused, and then thought, why not tell her what I'm really thinking?

"I have to be honest. I'm supposed to be as honest as possible, right?" I looked up from my hands to her face, and she was nodding. I continued, "I feel like communication between us is very one-way right now. I've read enough psychology books that I understand your vocabulary, but the way I'm using words is probably more personal, idiosyncratic. And so I feel like I'm doing elaborate translations rather than just talking, communicating. I mean, I mean -- I think, sometimes, you hear me use a word that has a strict meaning in psychology, and you don't take into account its context, the sentence I'm using it in. I feel like you're reacting to familiar words, rather than ideas."

"Oh," she said. "Well, I've never heard that before. That's interesting." Then: "Nat(h)alie, I'd like to ask, do you know what schemas are?"

"Um," I said. I was annoyed because, no, I'd never read books on CBT, but if I said I didn't know the word, which sounded very CBT, would she think I'd been dishonest in saying I'd read so many psychology books? But CBT: gross. So I said, "I know how the word's defined in the dictionary."

"Well, schemas are ways we think about the world. Interesting, huh? And we all have schemas, or ideas. Sometimes, our schemas help us in childhood, but not when we're adults. Perfectionism, for example, can be helpful when we're little, because children are still learning things. But, you know, it's not very helpful in adulthood. So, that's why I asked about perfectionism. Schemas are important, and what we'll be doing in our therapy together is figuring out your schemas. Does that sound good?"

No. I said nothing. No. I realized she talked like a grade school teacher not to be condescending, but because she liked clarity, and when she made her ideas clear, they were too simple and short for a normal adult tone. She didn't mean to talk down to her patients; she reduced my ideas for her own benefit. (I had spent so long reducing my ideas in preparation for this appointment, but, for her, reduction was measured in degrees of similarity between my ideas and the ideas she'd learned. And perhaps that explains a grade school teacher's singular and memorable voice: it sounds maternal and flexible, to compromise for how inflexible the speech-content is.) So, No. And again: No. "This is hard for me," I said, "but I'm not feeling very comfortable. I think we may not be a good match, and I wonder if you could recommend other therapists at Psychiatric Affiliates I could…"

"Well," she said. She was crossing and uncrossing her ankles quickly. "Okay?"

"Obviously, this is hard for me to say, even though I know the dynamics here are different than they are in the outside world" -- I still struggled to be as tactful, polite, as possible.

"What you may not know" she said, "is that, as therapists, we're trained not to take things personally."

I thought what I'd just said indicated that I knew that. Nodding: "Oh, I kno--"

"But," she said, "I usually encourage my patients to have a couple more appointments with me before they make that kind of decision."

"I just, I just really need to start the process as quickly as possible, because I won't have health insurance soon. So, I'd prefer if you could recommend someone else."

"Well, there's other options. We can have another appointment, too. What would you prefer?"

"I'd prefer to try another therapist here, and, compare, and you know --"

"Okay," she said. "I don't take that personally. Our appointment's over, so why don't we go walk over to the desk and schedule you an appointment with someone else, and we'll see, well, if you come back. Like I said, it's your choice."

"Thank you," I said. "Thank you for your help."

"It's my job," she smiled.

"Oh, but," I trailed off.

At the desk, she announced her presence with a fake cough. "Pam, we need to schedule an appointment for Natalie. An appointment with Shelly, ok?" And she said Shelly very loudly, with raised eyebrows. I wondered, was I misreading the situation? She really did seem offended.

"Well, thank you again," I said, and smiled, and we shook hands. Her hand was limp and she recalled it quickly.

A client had just cancelled her 2 pm appointment with Shelly, so I signed up for the empty slot, walked home, and three hours later, walked back. The appointment went well: Kelly was in her 70s, with a calm, reserved, way of speaking. She asked questions that made sense to me, and was patient with my answers. I didn't, for a moment, regret my honesty with Colleen. All my life, I've felt so unassertive as to be sub-human: spineless, collapsible. More helpful than all the thinking I can do about myself is the realization that I can, very simply, say what I think.

Posted by nchicha at April 14, 2004 12:38 PM