Depression, Anger, and Processing Emotions in Therapy

When I was last in any sort of sustained individual treatment, I worked with Dr. Lev*, a psychiatrist who specialized in borderline personality disorder. She utilized a treatment called transference-focused psychotherapy (TFP).

We worked together for 11 years and terminated in 2016. I credit our work together with saving my life and giving me a life worth living.

Severe depressive episodes

She also treated my comorbid severe depressive episodes. When I first started with her in 2005, I was in the midst of one, and she psychiatrically hospitalized me 6 times in 18 months due to my detailed plans to kill myself.

I also had a course of electroconvulsant therapy (ECT) which held me for about a month, then I fell back down into the abyss. The ECT permanently obliterated my short-term memory.

Grief and depression

In 2013 my father passed away. I plummeted into a severe depression. Not out of grief, but out of rage and resentment.

I spent my life chasing him, waiting to hear the words "you are good enough" escape his lips along with the ever-present cigarette smoke. The anger I never expressed to him in 52 years imploded and in early 2014, I attempted suicide.

Transference-focused therapy

After a week in a psychiatric hospital, I resumed sessions with Dr. Lev. My depression slowly resolved as I worked with her to articulate my anger — at my father, at myself, and with difficulty, at Dr. Lev.

I told her I loved her, and that I hated her. It felt terrifying to tell her I hated her. And even more terrifying to tell her I loved her. She'd never laughed at me or rejected me in all the time we worked together, but still I felt as though I was stripping myself bare.

Relationships

Love and hate were emotions that frightened me. I'd never been in a relationship, never experienced emotional or physical intimacy with a man. My father was an alcoholic.

Fathers are supposed to be role models for their daughters for relationships with men. My role model was a drunk, an emotionally and verbally abusive bully, a pathetic excuse for a man.

Expressing anger helped with my depression

Expressing my anger felt freeing and the depression gradually lifted, like I imagine walking out of quicksand might feel. The pressure eases up little by little, until you realize your whole body is free from the weight that had been suffocating you for so long.

Emerging from a severe depression is daunting because at first you don't know what to do with yourself. All the energy you spent just keeping yourself alive can now be redirected to other endeavors — but to what?

Writing about my mental health

I was able to start writing again, a passion I'd neglected for almost a year. Initially I questioned myself, wondering if the depression might have somehow altered my brain and whether I still had my voice.

When an essay I wrote about my suicide attempt was accepted by a literary journal, I knew I'd found my way back.

Borderline personality disorder and TFP

I'm in the process of searching for a therapist due to what I believe is a high-functioning depression. I'm overwhelmed and dealing with some potentially serious medical issues. I need someone to talk to.

One provider already rejected me, I believe, when I revealed my history of borderline personality disorder, even though I told her it was resolved.

I can't return to therapy with Dr. Lev, although she continues to manage my medication. While I was working with her, she generously lowered her fee to well below her typical rate so we could continue to see each other. The protocol for transference-focused psychotherapy is twice-a-week sessions. Her fee is now aligned with that of most psychiatrists, and she doesn't accept insurance.

Therapeutic relief

I did go see her yesterday. This visit was the first time in over a year. The moment I saw her I cried. It was good to see her, and a wave of relief washed over my body. We hugged each other and sat down.

She knows me intimately and as we spoke about the suicidal ideation I experienced this past summer we talked about why I went from 100 to zero so quickly. I told her how much I still missed my mom as two of my clients' fathers passed away and 2 of my supervisees' clients are dealing with pancreatic cancer. My mom died from pancreatic cancer. I started crying and admitted to doom scrolling Instagram and listening to sad songs.

Tears without boundaries

Dr. Lev recalled her own father's passing and told me how she remembers the joyful times with her him and asked me why I can’t do the same with my mother. She became tearful as well.

She laughed as she said, "All the boundaries that are being crossed here. Hugs and now I'm crying with you." We went past her usual 50-minute hour. When it was time to leave, she said "I want to give you another hug."

”I want another hug,” I told her.

Preparing for my first appointment

I'm seeing a new therapist tomorrow. I must admit any new therapist I see starts at a deficit because Dr. Lev literally put me back together. She integrated the disparate pieces of my psyche. I wish I could give this new therapist the grace to start with a blank slate. Grace under pressure.

*names have been changed