The Secret World of Maya Alexander

Chapter 53

Name : Maya Alexander
Therapist: Emily White
Date of session: 24th  October 2018
Reason for request: miscarriage
Number of session:  Re-referral - session 2

Summary of session

Reflections about the process:

Initial checking in about how things had been over the previous week, Maya coped better with general talk about events (such as collecting her niece) than about feelings (hers or others).
Recapped key themes /thoughts from last session -
•Hope to 'get back to normal', and thinking about what 'normal' is to Maya and others. Is this a helpful way to think of things?
•Maya seeming to cope better with focussing on what works rather than difficulties, how does this fit with her need to be 'okay' and 'back to normal'?
•Feeling 'empty'
•Feeling a burden/guilt
•Sources of support

Maya did not seem to show a strong reaction to me 'wondering out loud' and naming these themes and thoughts. Lots of silence and long pauses and possibly seeming keen for me to lead the session. Is she used to letting others take the lead in terms of telling her what she should think or feel? Or is this part of her separating herself from difficult emotions?

Encouraged Maya to tell me her thoughts on one of these ideas:
Did she think exploring one of these ideas would be helpful? Did she think there were other thoughts or themes that would be more helpful?
Limited response (shrugged shoulders).
Suggested thinking about 'sources of support' and Maya went along with this.

Sources of Support
Explored the people Maya had in her life- Maya did not elaborate unless prompted
•Husband - Stephen
•Colleagues in work - Helen/Marge?
•Mum and Sister Alice (live in Lancashire)
•Other family? M: 'Oh, me and my sister Sylvia don't talk much... she's very busy.'
•In laws? - M: 'We don't really have that kind of relationship'/ 'Stephen doesnt like them knowing our business.'
•Friends?  - M: 'I guess some of my colleagues at work are kind of friends'/ 'I've lost touch with a lot of friends' / 'I see my old friend Charlie sometimes.'

Stephen:
Asked an open 'tell me' question about Stephen and their marriage/ how this supports Maya.
Maya tended to give factual information - married just over 7 years, insurance broker, local from the area.
Used more direct questions to elicit information. After a while Maya seemed more open but often seemed deep in reflection as though she was contemplating the questions for the first time.
E: 'Do you talk to Stephen when you are finding things a bit hard, like when you describe 'feeling empty'.'
M: (Long pause as though considering her words) ' Well Stephen doesn't really do emotions... You know what men are like!'
E: 'Tell me what men are like...What do you mean? What is Stephen like?'
M: 'Well I don't mean all men, but some men. Well they think that being unhappy is wallowing, or maybe even being manipulative. Well I don't mean manipulative. Maybe trying to make others feel bad? Oh, I am not sure what I mean...'
E: 'Are you trying to say you find it hard to talk to Stephen about how you are feeling?'
M: 'Maybe, I am sure it is the same for lots of couples. Isn't it?'
E: 'Do you think it is?'
M: 'Well I don't think it is easy to talk to anyone about emotions. It is like you are burdening them.'
E: 'You have mentioned that before, 'being a burden' . What does it mean to you?'
M: 'I don't know. I suppose it means making others feel bad, maybe doing the wrong thing, not being okay, not being good enough.'
E: Do you feel you are any of those things Maya: 'doing the wrong thing', 'not being okay', not being good enough'?'
M: (Laughing) 'Well I wouldn't be here if I didn't, would I?'
E: (Trying to reframe this notion) 'Do you think people who need help and support are 'doing the wrong thing' or 'not being good enough'? What about the people you help in your job Maya? Is that what you think about them?'
M: 'Of course not! Everyone is trying their best. Everyone has tough times.'
E: 'So why would that be different for you?'
M: ' I guess it shouldn't be. It just feels like it is. It feels like everyone expects me to be okay. Like I need to be okay and prove it to everyone all the time.'
E: 'Where do you think this feeling comes from Maya? What is it that makes you feel this way?'
M: 'Well I think I can see the disappointment in people's eyes sometimes. Or an uncomfortable feeling between me and them maybe.'
E: 'Is that what you think you see in Stephen's eyes when you are 'feeling empty'  or struggling a little? Do you think he is disappointed?'
M: 'Oh no, not with Stephen. I usually see that he is hurt or angry.'
E: 'Tell me what you mean Maya. How does he seem hurt or angry?'
M: (Pausing, looking flustered) 'Oh, I just mean it would probably cause an argument. He would feel like I was upset on purpose. Or maybe he gets angry because he feels responsible for my happiness? Oh, I don't know really.'
E: 'It sounds like that must be difficult for you. Feeling Stephen may get angry if your are upset. Has it always been that way, or is this since the miscarriage?'
M: 'Maybe not as much when we first met. But maybe I was happier then? Maybe it is my fault for letting things get too much for me? For not handling my emotions better?'
E: 'It sounds a little like you take responsibility for a lot Maya. Do you think you should control your emotions better? Do you think that is always easy to do?'
M: ' I manage most of the time! I hold it in as much as I can. I mean I go to work and keep a home. I live a pretty normal life really. I think I function pretty well most of the time.'
E: 'You have talked about 'normal' before. What is it like for you to be 'normal'.
M: 'Just being okay I guess. Being content. Not causing any problems for anyone'.
E: 'Last time we met, you talked in your very last session about you and Stephen having a nice time for his birthday. You had not mentioned feeling like a  'problem' or making him angry. What is different now?'
M: 'Oh, I guess things have not gone well since then. I guess I stopped feeling bad for my feelings or thinking I had to make everything okay for him. So I just feel a bit more separate.'
E: 'It sounds to me like you noticed that maybe it was not helpful for you to feel responsible for Stephen's emotions and to have to hold on to yours all the time? What did you do to 'stop feeling bad'? Did it make things feel better?'
M: 'I'm not sure if I have thought about it much. I am just trying to keep on at the moment. We are living quite separate lives.'
E: 'Is that helping?'
M: 'I don't know. Sometimes I feel I don't know what is for the best, so I just do what I can manage.'
E: 'Do you think you are managing?'
M: (Long pause) 'I am not sure' (looked strained, as though maybe she was holding back.)
E: 'Have you talked about these feelings with anyone before?'
M: 'Not really. Maybe a few times with Charlie'
E: 'Charlie, is the friend you talked about. It sounds like maybe you don't feel a burden when talking to Charlie?'
M: 'Maybe, but sometimes I do. But I don't think Charlie would want me to feel like that.'
E: 'How would Charlie want you to feel?'
M: 'Like I can talk to him about how I feel without pretending.'
E: 'Does it feel helpful if you talk to him about how you feel without pretending?'
M: 'Sometimes. But then I worry that once I have let out a thought or feeling, that there is no turning back. And I am not sure what other direction there is.'
E: 'Do you think you have done that today? Let out a thought or feeling so there is no turning back?'
M: 'I think I have been doing it for a while. The trouble is, I am so used to pretending that I am not sure what belongs to me and what belongs to everyone else. I don't know what might become of me when pretending ends. Sometimes that feels like too big of a risk.'

Reflections on the session
Maya seemed to become overwhelmed when I tried to explore what she meant by pretending and 'not knowing what might become of me when pretending ends'.

M: 'Oh I don't know'./ 'I confuse myself sometimes.'/ 'Sometimes it is easier not to think'.

I reflected back that I wondered if it showed a shift in her beginning to acknowledge difficult parts of her life but that changing long standing thinking patterns can be hard.  Maya did not respond but seemed to nod in agreement.
I asked Maya if she thought that being open about her feelings might feel less difficult in time. Maya shrugged and seemed to show discomfort.
It was difficult to gauge how much strain the session had put on Maya. It seemed that she had rarely spoken or acknowledged the difficulties within her marriage and sense of being a burden outside of  the session. Had it been difficult to 'let out' these thoughts and feelings?

Tried to shift from 'difficult' thoughts and end on a positive by reflecting  that Maya was beginning to use the safe space within counselling to explore her feelings more openly. Maya eventually agreed that it could be useful to explore her worries about being honest and open about her feelings.

It was difficult to assess whether this was a form of disguised compliance. Was this her genuine belief? Or did Maya need to make me feel okay about the session and relinquish a burden she may have felt she placed upon me by agreeing with what I had noticed?

General Presentation/Engagement

Fluctuating engagement. Initially struggled to engage and needed a lot of scaffolding and direct questions. However became much more open in her responses once she relaxed/ let go of worries about feeling a burden. It was difficult to try and end the session positively for Maya. Maybe it was also important to acknowledge that it is okay not to feel okay? She did however seem more distant and possibly overwhelmed by the end. She seemed to take on the responsibility to repair this at the end of the session.
M: 'I am sure I will be okay! Nothing a cup of tea and chocolate biscuits won't solve!'

Was this Maya's way of minimising and avoiding the feelings she had allowed herself to acknowledge during the session, or a helpful strategy for regulating her mood so che could keep on?

Themes/Thoughts

•Marriage - possibly a source of unease since before the miscarriage
•Feeling a burden. Is this a real sense for Maya or her own construct? Why does she feel the need to make sure everyone thinks she is okay?
•Pretending/ No turning back. Why is  this a risk for Maya?

Close current involvement? Y/N

Reason:
There has been a shift in Maya's openness by focussing on identified themes rather than the previous focus on solutions and strengths. However Maya seemed to become overwhelmed, as though she  was not used to opening up and acknowledging these thoughts and feelings.
Need to support her to continue to consider if acknowledging her feelings could be helpful/less of a risk.
Need to explore what ''not pretending' might look like and whether this might be okay some of the time.