Psychosis

Psychological, Social and Integrative Approaches

ISSN: 1752-2439 (Print) 1752-2447 (Online) Journal homepage: https://www.tandfonline.com/loi/rpsy20

What stays unsaid in therapeutic relationships

Dolly Sen

To cite this article: Dolly Sen (2017) What stays unsaid in therapeutic relationships, Psychosis,
9:1, 90-94, DOI: 10.1080/17522439.2016.1270988

To link to this article: https://doi.org/10.1080/17522439.2016.1270988

Published online: 19 Jan 2017.

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Psychosis, 2017
VOL. 9, NO. 1, 90–94
http://dx.doi.org/10.1080/17522439.2016.1270988

What stays unsaid in therapeutic relationships

Dolly Sen
University of the Arts London, London, UK

ABSTRACT ARTICLE HISTORY

This piece will explore my experiences accessing psychological therapies, Received 6 December 2016
concentrating on two different psychodynamic therapies and therapists I Accepted 7 December 2016
have had. One was more productive than the other. I will talk about what
KEYWORDS
worked for me, what didn’t work; equality & identity on the “wrong” side Experience of using services;
of the therapeutic relationship; what happens to shame when one person first-person account; hearing
is protected from it and the other isn’t; and finally what happens if your voices; hallucinations;
therapist doesn’t share your ethnicity or sexuality, how can you talk about post traumatic stress
things like racism and homophobia when they don’t “get” where your pain disorder; psychodynamic
is coming from. I will finish the piece on what was the best experience of psychotherapy
therapy I have ever had and why.

I was born in 1970 in London, the oldest of five children. I am from a mixed heritage: my father is Indian
and my mother is Scots-Irish. My childhood was not a happy one: Physical, emotional, mental, sexual
abuse, racism, poverty, neglect, and bullying were daily occurrences. Despite this, I excelled academically
and had very close bonds with my siblings.
There is the argument that psychosis is a biochemical disease. I am not so sure. If the mind has to
endure feeling extreme terror, day in, day out, whilst the brain is growing, or be a child that is sometime
tortured, raped, or left alone for days, where there is not sanctuary internally or externally, what can
the mind do?
Every Sunday the radio would play the UK top 40. I listened to it and taped the songs I liked. In 1984,
when I was 14, all of a sudden the music went quiet and a troll-like voice issued from the radio: “What do
you want, Dolly? How much do you want?” My skin prickled. I shut off the radio in fear. Deep demonic
laughter followed. “Can’t get rid of me. I’m yours for life now.”
“Who are you?”
“I am the universe. I choose whether you live or breathe.” I got up and ran out of the room. I stopped
listening to the radio from then on. As the days passed, I thought maybe I just dreamed it all. The voices
then chose the TV as their medium. I was drowning in a sea of bad ads that I had to read into for cosmic
significance. Soon I stopped watching TV.
One week after hearing voices for the first time, I attempted suicide by taking an overdose. The
suicide attempt, the physical pain of the recovery, and the return to a world of voices and visions was
the loneliest thing.
Stress increased the visions, voices and painful ideas. One time Dad pressed my hand down on the
oven hob; the skin of my hand sizzled and throbbed. Holding my burning hand, I ran into my bedroom.
I had a picture of Jesus on the wall. I looked up at it and begged him to help me. He just stared blankly
down at me, his bleeding palms facing me. Our hands looked similar. I understood then I was being

CONTACT Dolly Sen dollysen70@hotmail.com

© 2017 Informa UK Limited, trading as Taylor & Francis Group

91 D. SEN

persecuted for being Jesus by the demon that was my father. He wanted me to die. He was behind
the voices that told me to jump down a stairwell. When I was on the street, they told me to step into
oncoming traffic.
Because of these frightening experiences, I stopped going to school. Social services got involved; they
arranged for me to see a child psychiatrist. The irony of it all was that I wanted to talk to someone about
what I was feeling and the experiences I had. I wanted to see the psychiatrist. I was quickly dissuaded of
that the second I stepped into the psychiatrist’s office at King’s College Hospital. The psychiatrist coldly
told me to sit, and without making eye contact, said, “So what’s wrong with you?”
She had a checklist of questions and I felt myself shrink smaller and smaller with every question. I
seemed an annoyance to her, that I was wasting her time. She asked me really personal questions, such
as ones about abuse, with such coldness in her voice, it made me want to kill myself there and then. So
she became another person to add to the list of people who didn’t care, who couldn’t protect me, and
another reason not to trust. Just in case I couldn’t get that, she ended the session by saying, “I should
pull up my socks and to stop being silly.” Hard to even entertain that notion when I thought demons
was chasing me. My meeting with her didn’t convince me that hell didn’t exist.
Looking back, I have some anger over that encounter, and wonder how my life might have been
different, if I had met a warm, kind, supportive professional. Maybe my life would have played out the
same, but I know I would have experienced a little less pain.
That first meeting meant I was not able to trust anyone in services, and I spent the next decade or
so highly distressed, in & out of hospital, and a survivor of three suicide attempts.
There have been several turning points in my life, including waking up on my 30th birthday to
decide to either commit suicide or give life everything I had. I decided to give life a go. That simple
decision had profound and beautiful implications. All thanks to that thought and action, I am now an
award-winning writer, artist, performer and filmmaker. I have had over 10 books published, with more
in the pipeline. My art, performance and film have been shown worldwide, and I speak internationally
on mental health, including at the World Health Organisation. If you, like me, have been residing in
psychotic hinterlands for a good few decades, you realise when you rejoin society, you are decades
behind your peers. Your first love, job, career, home, relationships are new things in your 30s and 40s.
People talk of lost youth like a misplaced item. Mine was never there in the first place.
When you stumble with the mistakes in middle age that most people dispensed with in their teens,
it’s humiliating and demeaning, it skins you alive when you have no skin to begin with. Your vulnerability
feels like a coat of petrol in a world of fire. It adds shame to more shame.
Psychiatry and society say I should have shame for hurting because of trauma, shame that I am mad.
I was told to gain a thick skin in a world that gives me nothing to buy them with. I want a culture that
doesn’t produce a suicide every 40 minutes. I want a mind that doesn’t produce a suicidal thought
every 40 minutes.
I had been medicated with over 15 different anti-psychotics. Anti-psychotic meds put me in a passive
smog. A tablet does not cure abuse, isolation, or stigma. But I was sedated, out of society’s hair. They
said the tablets would make me feel better. Please define better when I have lost my soul. Maybe you
don’t need a soul nowadays. One thing I knew, I had to stop hating myself.
So what could I do? My mind is too strange to pay the adequate amount of taxes. My soul is too hurt
to accept society or be accepted. If I do not belong to this world, where is my map?
I needed mental health professionals to help me with my map. I begged for talking therapies but was
told talking therapies were dangerous for psychosis. Painfully, they didn’t think eliciting shame for being
lost was dangerous, or slyly threatening me with discharge or not helping with benefits if I didn’t take
my meds would make me disengage. Sometimes I think services should offer this disclaimer to people:
You do not have the right to say anything without it being used against you. Anything you say can and will be
used against you. You have the right not to use these services. If you do not have these services, you will lose your
benefits & then your home. Do you understand the rights I have just read to you? With these rights in mind, do you
wish to engage in our therapeutic relationship?
However, I was persistent, and finally found a psychiatrist called Dr Stephen McGowan, who was
the only psychiatrist I had who ever listened to me. Sadly, he has since passed away, but he referred
 PSYCHOSIS 92

me to the then new PICUP Clinic (Psychological Interventions Clinic for Outpatients with Psychosis)
within South London and Maudsley Trust, which offered CBT for psychosis. This therapy helped me see
that psychosis is quite a logical process and that I had a definite road to psychotic crisis, and I listened
because the therapist was warm and non-pathologising in her language. She talked about lessening
distress and never talked about fixing a disorder or dealing with maladaptive coping strategies. Where
it was helpful is that I could see the steps towards more pain, so I understood the need to take up a
different dance. I have not been in hospital since that therapy, because I have learned to put a spanner
in the wheel of the cycle of psychosis. I functioned better, but my mental and emotional distress made
life a razor tightrope I had to balance with so much weight on my shoulders. CBT for psychosis taught
me to swim the turbulent waters of psychosis, but I was still being pushed into the waters. Constantly
having to swim against the tide is exhausting. My pain & trauma still made me actively suffer, still gave
my voices and unusual ideas enough ghosts to haunt me. I asked for extra therapy that gave me a
chance to talk about my past and resolve the issues from then.
The same Dr McGowan listened and referred me to St Thomas’ Psychotherapy department for psy-
chodynamic therapy. The therapist I saw there was the complete opposite in character to the CBT
therapist: she was cold, distant, and critical. She also spent more time digging for more painful expe-
riences when the ones I could remember were already overwhelming. For example, because my mum
is deaf, she asked me if I thought my mum not picking me up when I cried as a baby was a reason I was
unconsciously angry at her. The therapist was digging for more shit when I couldn’t deal with the shit
I already had. During this time I was experiencing abuse from an ex-partner, which ultimately made
me homeless. She had no understanding or care about that situation, always bringing it back to lack
of trust in relationships, because of early life difficulties, as the root of my personal problems. I knew I
had difficulty with trust then, but the therapist did not inspire trust, and localised all that was wrong
with my life within me, discarding external causes as if they were minor and annoying things getting in
the way of therapy. I needed a caring human being at that point but didn’t get one. I’m sorry if caring
gets in the way of theoretical explanations of mental distress, but I decided to leave after one year of
my two year therapy. She wrote to me soon after about how the end of my therapy was affecting her.
She made me feel bad, made me feel shame. I wrote a poem about this underlying shame that is the
indelicate but precarious glue that keeps psychiatry and patient together.
Tell us your shame
Tell me your most shameful secrets
You are not going to tell me?
Then you must be sick.
You need treatment.
You need my expertise.
My expertise means I can have no shame
I can hide it
But you must always tell me yours when you see me.
Must I restrain you to protect me from myself?
Here, have more shame to drown you.
You must engage.
You must engage in your shaming.
I don’t know why you are not getting any better.
Which brings us to another poetic response, this time about dignity:
Being labelled, pathologised and medicated,
I cannot claim my mind for myself
I cannot claim my life for myself
So how can I even have dignity?
93 D. SEN

Medicine does not heal

But seals the scream
Is that dignity?
Dignity are never in the side effects.
Weight gain – my arse is getting bigger than my dreams.
Too tired to reach for the day, let alone the sun.
Try having sex without coming – dignity?
Love with a lot of going – dignity?
A journey of a thousand miles starts with a single step, but try it with a largactil shuffle.
Constipation does not feel like dignity
How can I sing the song of dignity, drooling?
I would walk away with my head held high, but am too tired, too alone, too despised.
But let’s put aside the pills for a moment.
Is dignity in the waiting room?
Is it in the set of eyes that sees you as a sickness?
How much does dignity cost exactly? It’s not in our budget this year. It’s not in the economic case.
Dignity is not in the control and restraint, face down, begging to breath.
It was not in the staggered silence of my “community care”.
It is not in the “burden of care” phrase.
I am still waiting for my appointment with dignity.
 ignity means not begging for my identity, my dreams, it means not begging to be heard, to be
D
cared for.
Dignity means honouring the person, but not being hated will do.
Dignity cannot be taken 4 times a day.
And shouldn’t be bitter pills to swallow …
Recovery is swallowing bitter pills and being quiet about it. Recovery, in part, is re-entering the world
of sharks, without there being a recovery model for this world of sharks.
I could function slightly better, but my PTSD which is at the basis of my psychosis, the carrot it chases
but cannot digest, kept getting triggered. It made me highly anxious and suicidal at times. When I
asked for help again, the best I was offered was 6 weeks of CBT, which didn’t – and couldn’t – touch
what was going on. I was asked to pick one small thing to be less anxious about. How humiliating and
insulting. One anxiety was speaking on the phone, so that became the focus of therapy. It didn’t work;
one session of EMDR from a private therapist did that. Nothing had changed except increasing distrust
and anger, with pain raw and untouched.
All these experiences have made me question the inequality of identity of being on the “wrong”
side of this so-called therapeutic relationship. My previous experiences have shown me you can be
on the wrong side to it. I think it is partly due to this disregard and blindness about shame; when one
person is protected from it and the other forced to have it. There is no “Therapeutic Relationship for
Dummies Book for Patients”. You are not told what to do with your identity in this relationship, or how
to be confident and safe with that identity. I even wonder if it is a relationship when we are being ana-
lysed, objectified, controlled, our story told in demeaning words, and the other person is being paid
to “care” for us. They also work within a system that has wounded us previously and have stayed silent
about it. If this were a lonely-hearts ad, I would give it a wide berth. But because I needed the mental
health system to have benefits to eat, I stayed in this relationship and make the right noises, but my
heart stayed closed.
The therapeutic relationship also does little to acknowledge the political/social context of the world
it inhabits. It seems less and less about having a reduction in distress and more about being less of an
 PSYCHOSIS 94

economic burden. The aspiration seems to be a life of quiet desperation. The external world that can
break a person is not allowed in the therapeutic session, with the disclaimer that “you can’t change the
world, but you can change the way you respond to it”. Easy to say if you are a white, straight, middle class
person without a psychiatric diagnosis. No matter how caring a person is, if they haven’t experienced or
looked into the experience deeply, they wont “get” the trauma, and trauma it is, of having a less than,
demonised status. The racism and homophobia I have experienced have feed into the negative voices
I hear. The voices I hear that have stemmed from childhood trauma and neglect, such as, “You are dirty
and not worth anything”, “No-one cares about you” and “People want to hurt you” are compounded by
the messages that come from racism and homophobia, which are along the lines of “You are not one of
us”, “You deserve violence” and “You are unworthy”. It is a big part of the picture but goes unaddressed
in most therapy. If you have the misfortune of experiencing racism, sanism, or homophobia from some-
one who has forced you to be in a therapeutic relationship with them, what can you do? You can fight
it, but that will be seen as aggression, maladjustment, or lack of insight; if you surrender and become
passive, you lack motivation or are apathetic. Those who don’t share a downgraded status need to ask
themselves: how can I help the person maintain dignity, how can I help them be neither passive nor
aggressive in a world that looks down on them? How can I help them explore racism, homophobia, etc.,
in safe and meaningful way? Or how can I change institutional discrimination, seeing as that institution
pays my salary? Difficult questions, yes. But as we keep getting told by therapists, change is painful.
For all those reasons, I do like therapists who know the failings of the theory and practice of their
professions and are open to having frank discussions. I was lucky to have someone like this recently.
She was authentic and honest, she shared her vulnerability with me too but didn’t spill it. She was
non-judgmental to the nth degree, could laugh at herself, the world and me; she understood the political
& social context of the world we live in. When Trump won the US election, we were both as upset. She
fought my corner with regards to housing and benefits. She thought pathologising language, such as
“defect”, “maladaptive” and “deficit” had no place in our connection; she understood mental distress
is more to do with a broken heart rather than a broken brain. She gently and warmly individualised
the therapy to be meaningful to me. I love all animals, but sheep especially, so she turned my schema
therapy for psychosis therapy into “find my inner sheep” therapy, turning dissociation into a lost sheep;
my sense of being evil into a black sheep, so I could relate to it better; and for me to learn to be a kinder
shepherd to my broken heart. She was more of co-conspirator than a medical professional, and I forever
grateful for her input to my life.
I am now discharged from her and all mental health services. I am still a lost sheep, but now I am
sure one day I will find my way home. Whether it is because of therapy or just a human being being
human, who can tell?
www.dollysentraining.com
www.dollysen.com

Disclosure statement
No potential conflict of interest was reported by the author.