nine years

She was not happy today. Really, she hasn't been happy for a long time, which is why she is in therapy. She has been in therapy for nine years; the last two with me.

She is great to have as a patient. She is expressive, articulate, insightful and understanding. She makes connections and comes up with causal connections. But she really hasn't changed much, and today she was upset about it.

She had struggled for years before she first sought therapy. She had always been independent, obstinate really. She had been defiant as a child and didn't want anyone telling her what to as an adult. But when she ended up in the ER having her stomach pumped she realized she had better get some help.

Now, five psychiatrists, four therapists, two hospitalizations and a day program later, how is her life going? Not that well.

She is out of work and on SSDI. She wants to work but she doesn't feel at all ready to meet the demands. She has stopped drinking fairly recently. Drinking had been her first attempt to deal with all the terrible feelings. In a way it had been successful. It helped her through the day. But before she stopped drinking she was having alcoholic rages and black-outs.

She has tried at least a dozen different medications. Of the three she takes now she feels that two are really helping to stabilize her moods. She hopes that their effects will last for a while.

She isn't suicidal anymore. Her self-destructive behaviors and thoughts have greatly diminished. But she still is anxious most of the time. She often feels overwhelmed, and is plagued with self-doubt. She cries most evenings. She has a great deal of trouble sleeping, and the knot in her chest never goes away.

At times like these I feel almost powerless. She is a really fine, caring, intelligent person whose while life is a struggle. Her difficulties are a clear interaction between the highly reactive temperament she was born with, and never having anyone who could comfort her and help her modulate her own moods. Instead, from an early age, she was screamed at, bullied and demeaned.

Working with her now, at forty-five, we can only undo and redo things inch by painful inch. I would love to get into the mechanism and reset the dials and give the works a good tune-up. But all I can do is talk to her.