The Secret World of Maya Alexander

Chapter 59

Name : Maya Alexander
Therapist: Emily White
Date of session: 7th  November 2018
Reason for request: miscarriage
Number of session:  Re-referral - session 4

Summary of session
Reflections about the process:
Checked in with Maya about what she remembered about the last session. Maya said that it had been a tough session but that she thought it had helped her begin to accept different ways of thinking about things.
Acknowledged that it had seemed tough, and explored what this meant for Maya.  Maya said it had been hard to talk about her mother and how she felt about needing support because she mostly did not bring these kinds of thoughts to her mind.  She explained it felt as though she was blaming others for her difficulties. She felt she should be responsible for herself.

Clarified the idea of blame: Maya agreed that thinking in terms of blame and guilt was not helpful for her or for the people around her.

Moved on to thinking about parts of the session that had been helpful: Maya felt it had been helpful to begin to think about why she felt like a burden when in her job she accepted and supported individuals who were struggling and did not judge them like she judged herself. It had also made her realise that accepting support was not a sign of weakness and this had helped her to accept some support from her friend Charlie over the last few weeks.

Friendships and sources of support

Thinking about Charlie and how his friendship had been a source of support, discussed whether it would be helpful to explore the idea of friendship. (Maya had mentioned work colleagues and one other friend but friends had not seemed to feature frequently in her dialogue). Maya looked a little uncertain, commenting 'well there is only Charlie really'.

E: 'Well tell me more about your friendship with Charlie.'
M: ' We have been friends a long time. We were at uni together. There were a few of us back then'.
E:' What was that like, having a small group of friends?'
M: (Smiling) 'We had fun. But we were young then. We had angst too, but that's just part of growing up.'
E: 'Did you talk to each other about this 'angst'?'
M: 'Sometimes. It wasn't a big deal'.  (Pausing as though stuck on a thought.)
E: 'What do you mean when you say it wasn't a big deal?'
M: 'Getting upset and overwhelmed sometimes  just seems more okay when you are young. Part of being a student...Though I guess I did struggle a bit more than the others.'
E: 'What makes you think you struggled more?'
M: ' Well  I went a bit off the radar for a while.'
E: 'Tell me what being off the radar meant for you?'
M: ' Oh well, I had to just get away from it all for a while. I just felt like I needed to get away. So I took a break from uni for a while.'
E: 'Did getting away from it all help?'
M: 'I am not sure it did. I think it just made people feel weird around me really. Like I had done something no one could understand but that no one wanted to ask about either.'
E: ' So what helped you through that time?'
M: ' Well Charlie helped me. And  I met Stephen around then too. He was quite ordered and predictable and I think that helped me keep on. When someone helps you with a plan each day. It made things easier.'
E: 'Could you talk to Stephen and Charlie back then, at times when you felt like you needed to get away?'
M; 'Just Charlie. It has always upset Stephen to see me in a state. I guess being with him helped me learn to try and keep  things in a bit. Not to indulge my emotions. To focus on everyday things just like he does.'
E: ' Do you think that helped you? Focussing on everyday things? Holding things in?'
M: ' Well it seemed to for a while. I was okay for a while. I thought I was doing okay.'
E: 'What about your other friends? The ones you said you used to have fun with. The ones who you shared your teenage angst with?'
M: ' Well after the time I went off the radar. Things just seemed to change. I mean they did not disappear. But they did not go out of their way to be around me. And well I guess I was not really in the right place to be bothered about seeking them out. I felt awkward. Like I made them feel awkward.'
E: ' Do you still feel that way? What about with your colleagues? You had mentioned before they were fond of you?'
M: 'Well yes, but you don't really share very personal stuff at work. It is not the thing to do.'
E: 'Do you have colleagues who you would consider friends? Colleagues who share personal stuff with you?'
M: ''Well I guess Helen shares personal stuff.'
E: 'And do you think that is bad?'
M:' No, not at all.'
E: 'So why would it be so bad for you to do the same?'
M; 'I guess my stuff is not normal personal stuff. My stuff is too complicated. My stuff is not the kind of stuff you hear a Psychologist saying.'
E: What is your stuff Maya? How do you know it is too complicated?'
M; 'People's faces. (Pausing.) In the past. Stephen. My friends in school and uni. The teachers at school. My mum. You could see it in their faces. This kind of helpless look. Or disappointed look. Or angry look. Or scared look. Like I had just divulged something that was unnatural or done something weird and they would have rather not known about it.'
E: 'Do you think your 'stuff' is unnatural and weird Maya?'
M: ' I don't know. I guess it is just my stuff and I have learned to keep it in. Stephen is very private too.'
E: 'It sounds to me that you spend a lot of energy on 'keeping'. Keeping things in. Keeping on. It sounds like that could  get lonely sometimes?'
M: (Looking blankly, then beginning to cry.) 'Sometimes I feel alone. But then sometimes, there are quiet moments when no one else is around, when I feel a part of something so much bigger.'
E: 'What do you mean Maya?'
M: (Looking concerned - like she had revealed more than she wanted to?) 'Oh. I just mean like that connected feeling you can get from nature sometimes.'
E: 'That sounds like a nice feeling. Do you ever get that feeling anywhere else?'
M: 'I am not sure I do.'
E: 'Do you think it would help to have that 'connected' feeling in other places? With your friends or family or husband? Maybe even for small moments in our conversations?'
M: 'I guess there are those small moments when I do feel a bit more 'connected'. I just need to make sure I notice them.'
E: 'Can you remember any of those moments in the last week?'
M: 'Maybe with Charlie. Charlie has been such a support really. But it is hard because I feel guilty sometimes because... (Pausing as though she was hesitating to share.) I know that Stephen doesn't like our friendship.'
E: 'What makes you think that?'
M: 'A long time ago. He told me not to see him anymore. That  if I needed to talk I should be talking to him and not Charlie.'
E: 'But you still talk to Charlie. He sounds like your closest friend.'
M: ' Yes I do. But it's a secret and I feel guilty that I keep secrets from my husband. But... I don't know. I'm not sure I can cut Charlie out of my life.'
E: ' It must be hard to have to keep your only friend a secret. It sounds like more 'keeping', keeping things in.'
M: (Sighing.) ' Are we nearly done? I am sorry Emily I am finding this exhausting today. I think it must be the shorter, darker days making me tired!'
E: 'I think we are about done. Don't be hard on yourself Maya. You have seemed really open and honest today. And maybe you have done less 'keeping in' . Lets see how that makes you feel over the next week. After some time and space.'
M: 'Yeah, I'm not sure. I think maybe for me, keeping things in is just easier.'

Closing reflections on the session
Positive  - Acknowledged that Maya had talked and shared parts of herself which she may have found tough and that might have been exhausting and new for her.
Reflected that this was a shift and maybe she would have some feelings about the session afterwards and we could think about these next week.
Acknowledged Maya feeling connected with nature and that many people gain a sense of spirituality from nature and that it can provide them a sense of peace and be an important  part of life. Maya seemed to feel as though this was something that others might think strange and so sought to reframe this positively, like seeing it as being mindful/ like mindfulness.

General Presentation/Engagement
Moments when Maya seemed as though she was processing thoughts she had been 'keeping in', yet a sense that she was still guarded and filtering what was shared? Possible sense that she feels ashamed about her emotions and thoughts and how they impact on others, even within a therapeutic relationship.
Sense of positivity and hope at the beginning of the session not sustained. (Idea that she is tougher on herself than she would be on her clients/family/friends.) Difficult to revisit this at the end as Maya seemed flat and keen to end the session.

Themes/Reflections
•Beginning to recognise she is hard on herself but unable to move on from the idea of needing to 'keep things in'?
•Although there appears to be a lot of people in her life - a possible sense of being alone because she is worried about sharing parts of herself others may make others uncomfortable
•One friendship but conflicted about this due to guilt for maintaining the friendship
•Nature and spiritual connection - is this a protective and helpful factor for Maya?
•Going 'off the radar' - what did this mean for Maya? She seemed vague in her responses
'Personal stuff', 'unnatural', 'weird' - is Maya being hard on herself here? What personal stuff makes her feel unnatural or weird?

Close current involvement? Y/N

Reason:
Maya has begun to recognise that she is hard on herself with the expectations she has placed upon her ability to cope on her own. She continues to adopt a narrative of the need to 'keep things in' and this seems to relate to her perceptions of how people have responded to her in the past. She struggles to hold in mind people who make her feel less alone and seems conflicted by at least one of these relationships. Maya seemed to find it 'exhausting' to open up, as though it was taking her out of her comfort zone. Possible need to reflect on this next session.