I was inspired to write this by a piece published by The Mighty, specifically related to the difficulties of being told you are doing well in Eating Disorder recovery.
Although Eating Disorder is one of my diagnoses, it certainly isn’t the primary one, and I feel that this issue of hating being told you are doing well is more pervasive amongst mental health patients than therapists might realise.
So here are my thoughts on the topic.
My therapist wasn’t allowed to say I was doing well for about the first 10 months of my (weekly) therapy, and I had to ask him to intervene with the group leader on my behalf because I was getting too much praise in group.
I tolerate it a bit better now, but to me “you are doing well” means both “and I expect you to do this well and better each and every time I see you and you are never allowed to show you are struggling” or “I am about to discharge you because I think you are better unless you do something to demonstrate you are not” (cue crisis or relapse or behavioural demonstration of how I am NOT doing well)… and it took those first months of therapy for me to trust him enough to even explain to him why I shut down or got worse or argued whenever he said I was doing well. He didn’t know why I reacted so badly to praise. And I didn’t know that he didn’t know.
But it was because I was scared. Scared that he thought I was better when I wasn’t. Scared he didn’t realise how hard things were on a daily basis. Scared that he was going to stop seeing me because he thought I was doing so well. When I wasn’t, or not in the way I thought he thought I was.
I was trying really really hard, but I was struggling, and fighting, and each day felt like I was drowning. And I didn’t understand that it was that effort that he was as praising. It was how hard I was working, and the fact that my hard work was beginning to pay off. And he could see that. I didn’t know that at all.
And so those words felt like an imminent threat hanging over my head. A threat of losing all the support I needed so badly. And so those words felt almost invalidating. I’m not sure what I would have preferred to hear instead, but I guess I must have needed to know that he understood that things were still hard for me, and that he wasn’t going to end my therapy because I had had one good week. Unfortunately when you think the way I think, this unlikely possibility feels like an every day reality. Being dropped, abandoned and left to fend for myself was what I expected. I did not expect what I got and am still getting, which was stable and nourishing support as I continued to heal.
I am now over 18 months in (still on weekly sessions) and he is allowed to tell me I am doing well, but only in a certain way that we have agreed means “you are progressing at the rate that is normal for someone like you and I am not at all devaluing your struggle or assuming you are better or assuming things aren’t still hard for you”. But that trust took a long time to build. And can still be shaken by deeper core beliefs that I will be abandoned eventually, or that I am undeserving of help. To the point where even the prospect of a brief hiatus in my treatment due to him moving from one clinic to another (and promising to take me with him) can still send me into spirals of terror that he won’t keep his promise, or that something will go wrong and I will never see him again.
And so maybe it’s an important thing for us mental health advocates to remember to feed back to therapists. That when in mental health recovery, hearing you are doing “well” can in fact be very frightening rather than reassuring.
Perhaps this is something to do with living with a brain wired towards fear of abandonment / rejection or primed for emotional invalidation, or even just highly perfectionistic (or all of the above and more).
What I do know is that from my own experience, sharing this information with my therapist was crucial to getting me out of a rolling cycle of crisis management in which I became trapped by these three little words “you’re doing well”.
And it was only once we had broached that topic and understood the miscommunication that was happinging that we could begin to move beyond this stage and I felt safe enough to share my successes instead of just my failures (although it’s still not easy).