Things I’ve been told:
“A therapist is closer to you than a husband.”
“Tell your therapist EVERYTHING. Don’t hold back.”
“A 24/7 number is not about calling it but knowing you can reach someone when you’re in crisis.”
“AA sponsor/sponsee is about knowing you can call any time even though maybe only have to once.”
“Others with trauma don’t want trauma therapy. They’re happy with a bit of EMDR, some hypnosis, and listening only.”
“Controlling your emotions is good but not when you’re with your therapist. Then you have to be open.”
Last Sunday was the first day since my brain injury that I was — at will — able to control my emotions. For almost 15 years, my emotions have done what they liked: not exist, go on a roller coaster bender, show up mildly, disappear into anger, consume me, then finally begin to become stronger in existence as they normalize. But for about ten hours on Sunday, I was in control of them.
It was . . . strange.
Because a different personality was in charge (yes, I said that).
Because my brain was zipping along and I didn’t have to feel a thing.
Hey, I can switch them off, I suddenly realized Sunday morning, a morning I was tired of feeling. After a bit, I thought: Nah, let’s try having emotions back on. Nope, too much — off! On. Off. On. Off. All day.
Then the neuroplasticity that had given me control got a tad tired. Things went back to my normal.
I have to admit it was a relief, for along with the control came hugely increased brain processing speed that, I think, was at my pre-injury rate. Holy f–!!! Way, way too fast for me. It was an onslaught of thoughts. Going back to my current thinking speed: huge sigh of relief.
In the midst of all this, I started to wonder about trauma therapy. It is almost un-endurable. I can see why others are happy with a bit of EMDR and yakking away to a silent, listening therapist. Therapy means more than listening; it means the therapist poking about in the silty bottom of your mind. As he pokes, no matter how gently, silt starts to float up. And before you know it, the whole damn mindstream is filled with silt and muck and floating gunk.
This unsettling process requires a rock for a therapist, requires you to know absolutely your therapist is available to you in a big crisis (there will be so many little ones you deal with on your own or with late night calls to friends, they become a blur), and results in a dynamic, changing relationship with your therapist, one that sometimes hits an impasse.
I felt a year ago that I was deteriorating before others saw it; I felt I needed to get some things in place so that I wouldn’t completely collapse. Because these things are not my neurodoc’s standard operating procedure, we tussled for months and months. He finally acquiesced to seeing me twice a week when his schedule opened up. It may be a couple more months till then. Meanwhile he lengthened our session time enough that my slow-to-express injured brain can think and process properly. I thankfully no longer leave feeling half done, feeling like I’ve been kicked out mid-thought. I still cannot process my emotions in session time, but then no session would be long enough for that, for, like a reluctant rusty wheel, my brain cranks out feelings over days, not seconds or minutes or hours.
One of our continuing sticking points is me trying to reach him with a brain that doesn’t work well with in-crisis decision making and a poor working memory. Unlike most other doctors or therapists I’ve worked with, he has more than one phone number. You have to know what day it is and what time on what day to know what number to call. And then you have to hope the voice mail is not full. And then a couple of times a week, it’s not possible to get a call back for two days, maybe 36 hours at best anyway, because he won’t get the message for that length of time. As a mental health professional told me, for people with only psychological problems, four or five phone numbers is not that difficult to handle, but for someone with brain injury . . . Well, it’s meltdown time EVERY SINGLE TIME you call. Did I call the right number? What day is it? What time is it? Did he move on to the next number yet or is he still at his main one? Should I have called the other number? Maybe I should call the other number, just in case. No, I can’t do that, I don’t want to bug him. But what if I called the wrong number? On and on the rumination wheel squeaks in my head as the hours tick by and the phone doesn’t ring.
It doesn’t matter if you eventually start to get it right for a few weeks in a row when one week once again you receive no call back and find out at your next session that you called the wrong number or rather the right number at the wrong time and he didn’t get my message.
Needless to say, when he would call days after my message, I’d be on the phone — isn’t it always that way, you’re only ever on the phone the one time of day your doctor calls back? He does redial a few times. But sometimes when he was tired after dealing with several patients in crisis, he wouldn’t try as hard to reach me (what was I?, chopped cheese who could stay out of the maw of traumatic memories on my own?). I finally couldn’t take the stress anymore. He offered to call me at pre-set times. Now even when tired from other crises, he’ll still make an effort to reach me, and I know when he’ll call. Certainty, routine, structure keep a person with an injured brain calm.
Still, me being unable to reach out to him when a terrible flashback hits is terrifying (I’ve had three of these kinds, one just before I began to see him, and two after, fortunately when with or near him; most flashbacks I’ve had including body memories are not at that level of terror). I now know how to handle the usual ones (I say to myself: it’s 2014, not whatever year my brain is telling me it is). But the all-consuming terrifying ones . . . I need to have that foundation, that rock of knowing I have a way to reach him in that situation even if I never use that protocol. Apparently, people but maybe not health care professionals understand the power of having a 24/7 phone number without ever having to use it. Knowing you can call your therapist or neurodoc gives you that little extra strength to endure or manage a crisis without having to actually call. And then when you are in serious trouble, you can get real, effective help, not the useless, traumatizing help of an ER. When it’s taken my neurodoc years to understand the intersection of brain injury, a rapidly healing brain, and PTSD, and is still working out how best to treat, how can an ER doc or distress centre understand it well enough to treat in a crisis?
Anyway, there is no protocol for me to reach him 24/7 or even to let him know serious shit is going down. My neurodoc has the idea that anyone will do in a crisis. And maybe for some situations with the “simpler” kind of relatively well-known problems like depression it would; but most health care professionals don’t understand brain injury, never mind it concurrent with PTSD, never mind it concurrent with PTSD and a rapidly healing brain that is now experimenting with different personalities. (Did I mention that strange new thing of shifting personalities? No? Another blog post then!) So if I was to go to emerg, it would be like hitting my head against the implacable certainty of ignorance. I’ve done that once already. Ugh. And calling 911, they’d probably whisk me to the wrong hospital. Our hospitals are specialized, meaning if you go to a heart centre, they won’t know much about what to do with your brain. I’ve seen what it takes to argue with the paramedics. No way I could do that.
I now have others in my team I can talk to about family issues or friendships or some brain injury stuff. But for trauma-related stuff, processing the memories and emotions that terrify, there’s only him.
He’s not the only therapist without a 24/7 crisis protocol — or rather a protocol that includes themselves. It seems to be the standard is to call 911. Call me old-fashioned, but I don’t think this is OK. Yes, it’s hard, I know, having lived with a father who took calls anytime day or night, but with modern mobile technology, a health care professional can offer that or close to that without being overwhelmed. 24/7 doesn’t necessarily mean answering a voice call immediately, but maybe within a known number of hours or with a text message, escalating up to a later call if needed. The payoff is a patient who heals faster and is less likely to regress.
People in AA may not understand the details of each other’s lives, but they totally get their shared disease and so can support each other. Veterans with PTSD now have something similar. These groups have a substitute 24/7 system when their therapist doesn’t. But for us civilians who don’t have addiction problems . . . nothing. A friend can help, yes, but in certain crises, you need more. I wonder how the suicide stats would be affected if the old medical attitude of a doctor being available to his patients 24/7 still held? And I wonder how those stats would drop if Medicare funded enough mental health professionals for the need?
Now I understand why others with trauma aren’t interested in trauma therapy per se, only EMDR, meds, and listening. Without that 24/7 crisis certainty with the one person who would know exactly what the problem is, who you can trust to share the hardest things to talk about, who doesn’t need hours of explaining before he can treat, who knows which methods work best to calm and soothe you, who can treat you in minutes not hours or not at all, it’s far, far too impossible.
So now that I know my ability to control my emotions is returning, I’m afraid I will use that to protect myself, to not tell my therapist the most traumatic stuff, and join the legions of trauma-therapy refusers and say just give me EMDR and listen as I limp through the rest of my life.