The Secret World of Maya Alexander

Chapter 62

Name : Maya Alexander
Therapist: Emily White
Date of session: 14th  November 2018
Reason for request: miscarriage
Number of session:  Re-referral - session 5

Summary of session
Reflections about the process:
Maya's presentation was markedly different today. She seemed restless and distant. Also looked a little shaken perhaps?
Tried to check in about the week and Maya gave very non-specific responses (shrugged her shoulders, 'oh fine').
Talked about Maya saying she had found the last session exhausting. How had this felt afterwards ('oh it was fine').
Acknowledged friendships with Charlie and connection with nature as seeming to be good sources of support. Had Maya thought about this?
M:'Not really, I've just been getting on with things, did not see much point dwelling.'
Spent a moment acknowledging that Maya seemed a little restless and distant today and asked we should spend some time thinking about this.
M: 'Well we could try I guess. Whatever you think.'

Sense of distance and restlessness

It was very difficult to engage Maya in any sustained conversation today. She seemed to revisit different thoughts which were possibly difficult for her but would then move on again very quickly or minimise the thought with comments such as: 'oh but it is fine really', 'oh it was long ago', 'well it is not a big deal really is it?'

E: 'We have talked a lot about you keeping on and trying to appear fine Maya and it feels a bit like you are telling me you're fine and just getting on with things, but today you seem more restless. What do you think I am noticing?'
M: ' Oh I don't know. The weather is pretty wild out there isn't it? Maybe it is that?' (Pause, quieter, tearful.) 'Oh but I guess things have been a bit tricky.'
E: 'What has been tricky Maya?'
M: 'Oh nothing much.'
E: ' Nothing much?'
M: ' Well everything is always like this. It always has been. Nothing goes well. Nothing works out. Sometimes I think I might be cursed.'
E: 'What makes you think you might be cursed Maya?'
M: ' Oh no I am being silly. Of course I'm not cursed. It's just bad luck. Or maybe not bad luck. Maybe I am just not very good at things. At understanding things. Oh I don't know. Maybe I am like my dad after all!'
E: 'What was your dad like Maya?'
M: 'Sometimes he was very very happy. And sometimes he was very very sad. But I guess I can't ever remember being very very happy, so no I'm not like him. At least he was happy some of the time. I don't know why he was so sad. Maybe I should have made him happier?'
E: 'Do you really think that?'
M: 'No not really. It was a long time ago. I'm over all that now. I don't even know why I mentioned it.'
E: 'Why do you think you mentioned it?'
M: 'Oh, maybe it is just because it is a rainy day.'
E: 'A rainy day?'
M: 'Yes. It is wild out there isnt it. I love the rain sometimes but sometimes I hate it.'
E: 'I am not sure I understand what you mean.'
M: (As though talking to herself.) 'Stephen used to say it was ridiculous to want to walk in the rain. I guess he was right. And what kind of mother would take herself to walk in the rain? Losing the baby was probably my fault. I think I might have walked in the rain when I was pregnant. Maybe that is why he hates me. But he didn't even want the baby did he? Maybe that's why I hate him. I don't hate him though. Maybe I made my dad sad, walking in the rain. It makes my mum sad. I can tell. And well it makes my elder sister just want me to disappear. I am a misfit. A bit of a freak.' (Gazing blankly out of the window.)
E: 'Maya, there seems to be a lot of things that you have mentioned today,  which we have not really spoken about before. But what I am hearing from you is a sense that there are a lot of thoughts in your head. And that maybe you are being very hard on yourself?'
M: 'Oh, I am sorry. Ignore me. It is the rain. It is wild out there isn't it? I am fine. It is just silly thoughts because maybe I am not sleeping.'
E: 'It sounds like it could be important for you to give yourself some time and space for these thoughts. Maybe to look through them and see how much evidence there is for them? You know you are not to blame for your father's death or losing your baby don't you?'
M: 'Yes, of course, but how can we ever really know anything. How do we know things are true and real? Maybe I am not even really here.'
E: 'What do you mean maybe you are not even really here?'
M: ' Oh you know! I used to get all in a fuzz about philosophy when I was younger.'
E: 'What kind of fuzz?'
M: 'Oh about pointlessness and vastness and stuff. I think that is why I feel so alone sometimes. No one else seems to notice the pointlessness or the vastness.'
E: 'Do you notice it all the time?'
M: 'Oh no, not usually. I'm fine. The rain was wild today, wasn't it? It's probably made me a bit weird. I am sorry Emily. Don't pay any attention to me.'
E: 'Maybe it is important to pay attention to these thoughts and feelings to try and make some sense of them?'
M: 'What do you mean? It was just a random thing I said. I don't even know why I said it. I am fine.'
E: 'How do you know you are fine?'
M: ' Well I am here, I am going to work, I am fine.'
E: 'Is fine a good feeling Maya?'
M: 'It is a fine feeling. (Checking clock). Are we nearly done.? It is getting dark and I hate driving in the dark and the rain. The rain was wild today.'

Closing and reflections on the session
Tried to encourage Maya to notice signs that she may be processing a lot of things, but Maya minimised this as having a bad day and tried to shift the conversation to one of offering me reassurance that she had just had a 'wobbly' moment.
I reiterated  sources of crisis support to Maya should she be struggling between now and the next session. Maya dismissed this saying, 'Honestly I am fine'.
Ended the session by not challenging Maya's conclusion that her feelings may have been brought on by the 'wild' weather as she seemed to really need some reassurance that she was okay.

General Presentation/Engagement

Maya presented as very unsettled today and struggled to organise her thoughts in a coherent way. She talked about lots of different parts of her life and seemed to be having a lot of self negating thoughts, which she would then quickly minimise by saying she was 'fine'.
Sense that perhaps Maya was less guarded than usual and that there is another part of Maya which she was less able to keep contained today? What was the trigger for this? Was there one?

Themes/Reflections
•Negative self-perceptions
•More disconnected
•Less aware of needing to keep contained than usual
•Guilt/shame/blame
•Possible signs of low mood (pointlessness)?•Avoidance of difficult thoughts and feelings. •What is the impact of this upon well-being and relationships?

Close current involvement? Y/N

Reason:
Maya seemed to struggle more today than previously observed. Was this triggered by an external factor? She mentioned the 'wild rain' several times and I wondered what this may represent for her. Also possible that the process of therapy has brought to her attention the difficult thoughts and feelings she has contained for a long time and triggered a decline.
Need to help Maya process and explore these thoughts and feelings in a way that could be more helpful.

Name : Maya Alexander
Therapist: Emily White
Date of session: 21st  November 2018
Reason for request: miscarriage
Number of session:  Re-referral - DNA

Summary of session
N/A DNA
Phoned and left a message

Close current involvement? Y/N

Reason:
Need to follow up as struggled in last session.

Name : Maya Alexander
Therapist: Emily White
Date of session: 28th November 2018
Reason for request: miscarriage
Number of session:  Re-referral - DNA #2

Summary of session
N/A DNA
Phoned and left a message

Close current involvement? Y/N

Reason:
Need to follow up as struggled in last session. Spoke to supervisor. Second session not attended. Close after 3?

Name : Maya Alexander
Therapist: Emily White
Date of session: 5th December 2018
Reason for request: miscarriage
Number of session:  Re-referral - DNA #3

Summary of session
N/A DNA
Phoned and left a message

Close current involvement? Y/N

Reason:
Spoke to supervisor. Case closed due to three missed appointments and case being a self-referral. Concerns about mental health would not meet thresholds to break confidentiality and refer on. Message left to encourage Maya to seek re-referral