The Secret World of Maya Alexander

Chapter 56

Name : Maya Alexander
Therapist: Emily White
Date of session: 31st  October 2018
Reason for request: miscarriage
Number of session:  Re-referral - session 3

Summary of session
Reflections about the process:
Initial checking in about whether Maya feels the sessions are useful. Maya seemed to struggle with this question. She said she felt she had been able to say things in the session which she did not usually talk or think about. I asked if she thought it had been helpful to talk about these things. Maya mentioned that she worried that getting them out made them more real and sometimes thinking about hard things gets in the way of 'getting on'. I acknowledged that Maya had talked a lot about 'getting on' and 'getting back to normal' and maybe we could think about where these feelings came from. Maya seemed a little reluctant. 'I think that is just normal. It is just what everyone does.'

Recapped last session -
•Sources of support
•Husband, relationships and feeling a burden
•Reflected about whether Maya felt a burden in these sessions ('Not really, I know it is your job'.)

Seeming Unsettled?
Possible sense of agitation? As though Maya was possibly unhappy that some of these things had been shared?
Named this: 'How has your week been Maya? Do you think you have found it any easier to 'keep on' or 'get back to normal? Has talking been helpful or has it felt like a 'burden'?'

Maya looked unsettled as though she was worried that I may ask something she did not want to share. She paused then responded M: 'I think I did have a bit of a wobble after the session last week. But I thought about who I had to support me, like we had talked about and I got in touch with my old friend, Charlie.'
E: 'You mentioned Charlie last week. You said you thought he was one person you could talk to . How did that go? '
M: 'It was good. It was nice'
E: 'What was nice and good about it?'
M: Long silence (possibly not ready to recollect/share?)
E: 'Last week you talked about feeling like a 'burden' to your husband Stephen. It seemed like this meant you tried to hold all your feelings in. Is this different with your friend Charlie?'
M: Long pause (discomfort?) 'Yes it's different, he's a good friend.'
E: 'It sounds like having Charlie as a friend is good for you...?

Maya was reluctant to respond to my open and leading questions about her friendship. Was she keeping this part separate?  What made her feel reluctant to talk about this friendship?  Was there a need for her to keep this separate?

Sources of Support: Mother/childhood

Acknowledged that it seemed a step forward that Maya had a friend she could confide in but provided the opportunity to move on as this topic seemed to be unsettling and might potentially disengage Maya.

E: 'You have talked about living far from your family before. How do you feel about talking to them? Are they supportive?'
M: (Exhaled, as though relieved for the subject of conversation to be moving on.) 'I talk to my mum and my little sister Alice on the phone at least once a week. I don't hear from my big sister Sylvia much, as she is very busy with her two young children... And well we never really had very much in common anyway I suppose'.
E: (Focussing on possible sources of support.) 'Do you feel you can talk openly to your mum and little sister? Do you enjoy the telephone conversations?'
M: ' Well we just talk about everyday stuff really. Alice asks how I am feeling sometimes.'
E: 'Do you find it easy to talk about how you feel with Alice?'
M: 'To be honest, I try not to dwell on things. And I usually feel okay in the moment. I'm distracted from my thoughts by the phone call really.'
E: 'What about when you speak to your mum?'
M: 'Mum prefers to stick to practical stuff. Things that can be solved or sorted.'
E: 'How do you feel about that? Is that what you need?'
M: ' I guess it is just how it has always been. That is how lots of people cope.'
E: ''What about you Maya? Does being distracted and focussing on practical things help you to cope?'
M: (Lengthy pause) 'Sometimes.'
E: 'Tell me about these times'.
M: (Longer pause.) 'Well I guess if I am able to get on with the everyday things of life that is a sign I am coping okay isn't it?'
E: 'Do you think not being able to get on with everyday things is a sign of not coping then?'
M: 'I think that is what most people think.'
E: 'Do you think your mum thinks that?'
M: 'Well yes I suppose so... you see she gets this really worried look when things are not as they should be... and she looks like she just does not know what to do. Like she feels helpless I guess. And then I get this awful feeling for making my mum feel like that. Because she has had enough to deal with in her life. Losing my dad, working so hard. And I didn't help things when I was younger...' (Paused.)
E: 'It sounds like you worry a lot about your mum. What were you thinking about when you said you didn't help things when you were younger?'
M: ' Oh, after my dad died. I didn't just get on with things like Sylvia and mum did. I got lost in my thoughts. Overwhelmed sometimes. I could not sleep and the school would call my mum even though she was trying to work to keep the house.'
E: ' It sounds to me like you were grieving. Did you get any help with that?'
M: 'I had a teacher who was kind at school, and sometimes Alice would talk to me in the night.'
E: 'Did Alice get on with life like your mum and Sylvia were able to?'
M: 'Oh, I think her school arranged some counselling. I think that was why she was so good at listening to me. She was okay though I think.'
E: 'What do you think helped her to be okay Maya?'
M: ' Oh maybe the counselling I guess.  Or the fact that she could see that I felt the same. Maybe even being able to help someone else.'
E: 'So it sounds like you're saying receiving support, feeling connected and helping others are other ways of being okay?  It sounds like for Alice it wasn't about keeping on with practical things. It was about the people around her and how she was relating to them.'
M: ' Yes of course I know that! I mean that is my job too!'
E: ' I just wondered if you felt that, because you often talk about feeling a burden, or needing to hold it all in and just get on with things. Particularly for the closest people in your life. Like you mum and your husband?'
M: (Nodding, looking almost tearful.) ' When I was very little, my dad would sometimes just seem to know when I needed a hug. And everything was okay for a moment. I mean when he was well he did anyway. Then as I got older he seemed to just find things harder and it was more like me knowing when he needed a hug. When he died, there were no hugs for a while. I used to think I wished my mum could give me a hug and tell me it would be okay. Then when I got married I used to think that my husband might hold me and tell me everything would be okay. But it seemed like all I did was hurt those two people by my sadness. So yes, I suppose I do feel like a burden to them and like I owe it to them to be okay. But that is just how things are and I don't see how I can change that.'
E: ' That sounds like it is hard for you Maya. It sounds like that might be hard to accept sometimes.'
M: 'I guess that is what I have always done. Accepted what other people needed me to be.'
E: 'How does that make you feel?'
M: 'It feels necessary. It would be worse if I did not.'
E: 'Have you tried telling your husband or mum how you feel?'
M: ' Sometimes, and like I said it has just made me feel worse'.
E: 'Maya, it sounds to me like you are saying that there is a part of yourself that you cannot let out around two of the closest people in your life. Like you feel that you have to be okay for them?'
M: ' We are all acting aren't we? All the time we are different. We shape ourselves to each situation we are confronted with. It is just how life is.'
E: 'Well it sounds like it is a way of being you feel you must accept. You mentioned, when you were younger that feeling of being held and told everything would be okay. Do you miss that?'
M: 'Sometimes I wonder if I made that feeling up. I mean it doesn't even match with the memories my mum and sister have of my dad. And I was so young. Maybe I just wanted it so badly that I made it up in my head.'
E: 'Do you still want it so badly?'
M: (Staring into the window as though she was examining her own face and was unhappy with the reflection.) 'I'm okay.'
E: ' Do you believe that Maya?'
M: (Laughing suddenly as though to change the feelings in the room/within herself?) 'Hey, aren't you supposed to just validate my thoughts and not challenge them too much!?'
E: ' What do you think I am supposed to do?'
M: ' Help me to feel okay?'
E: ' And what is the best way to do that?'
M: ' I guess you think I should know that being a Psychologist?'
E: ' Do you think I should just 'validate' everything you say like you mentioned? Would that help?'
M: ' Sometimes it helps.'
E: ' You talked about needing to be told 'everything is okay' but what about when everything is not okay?'
M: 'Maybe I meant I needed to be told that I am okay and my feelings are okay?'
E: 'Well I think your feelings are okay. As for yourself as a person, do you think it is me who needs to tell you that you are okay, or the people you care most about? Or maybe even yourself?'
M: 'I think it is all of those! I want the world to tell me I am okay!' (Said almost like an emphatic declaration.)
E: ' I wonder if it might start with you though Maya? And maybe when I ask you if you believe it when you tell me that you are okay, it is because you have spent so much time telling me that you tell everyone you are okay, even when you don't feel okay at all.'
M: 'Do you think I will be okay Emily?' (Becoming tearful.)
E: ' I think you have it in you to be okay Maya. What do you think?'
M: 'I hope so.'

Closing and reflections on the session

Spent time acknowledging that the session had been an emotive one and that it had seemed difficult for Maya at times. Checked in how Maya felt about the session. What had she meant about my role being to validate her? She had seemed keen to reassure me that she had been joking. (Was this just Maya's need to repair as she seems to do in most relationships in her life?).
Reflected back that counselling can sometimes be a challenge as we need to try to change our patterns of thinking and feeling to help us. Maya shared with me a quote from a tutor at university: 'If you keep doing what you have always done, then you will keep getting what you have always got.' I asked her if that was her way of saying that she understood why I sometimes checked out the statements that she made. Tuning into psychological processes in a more explicit way seemed to engage Maya a little more and lift her mood.

Summarised to Maya that during the sessions I had heard that she tries hard to be okay but that I wondered if she does this to make other people feel better rather than herself. Acknowledged that it sounded as though the people who are closest might struggle to give her what she needs and even though she may not be able to change this, accepting how this makes her feel and holding in mind people who may be more available for support, like Alice of Charlie, might be helpful. Maya agreed to try to spend some time thinking about this, but then very honestly acknowledged that it is easy to say these things when you are in a room far away from everything but that it can be harder to act out in real life. I said that hopefully these sessions mean we can keep checking in on these things so that she can hold herself in mind more in real life too.

Maya seemed calm upon leaving and as though she was working through her own thoughts and feelings.

General Presentation/Engagement

An emotive session where Maya fluctuated between laughter, tears and at times subtle hostility. A change from her often flat and contained presentation. Does this mean that Maya is able to feel more comfortable with allowing her emotions to be present and share them?
By the end of the session, Maya seemed to accept that challenging her thoughts and feelings was a necessary part of the process, however it is difficult to know whether Maya's need for things to 'be okay'  takes over so that she tends to agree with suggestions, particularly at the end of a session, in order to fulfil this need.
There are times when Maya seems very open (talking about her childhood) but this is interspersed with times when she seems to hold back or drift away with thoughts which she does not say out loud.
(Maybe I need to acknowledge these moments more in the sessions and see how she responds?)

Themes/ Reflections

•Holding on to emotions/ 'being okay' at the cost of being able to be herself?
•A need for others to tell her she is okay? External validation/ Importance of how others perceive her?
•Experiences as a child? Sense of security/ Caregivers making things okay/Nurture?
•Recognising the value of those in her life who can give her emotional support and accepting her need for this?

Close current involvement? Y/N

Reason:
Maya has been able to show more emotions but continues to seem to struggle to accept her emotions in 'real life' and her need to show others that she is 'okay' seems to come at the cost of recognising her own needs.

Need to help Maya focus on accepting her own needs in a way which does not challenge her personal constructs so far that it might risk disengagement or overwhelm her.

Continued sense that Maya keeps parts of herself separate, even within therapy sessions