The Secret World of Maya Alexander

Chapter 36

Name : Maya Alexander
Date of session: 17th  October 2018
Reason for request: miscarriage?
Number of session:  Re-referral - session 1

Summary of session
Reflections about the process:
We talked about the last cycle of counselling and what Maya had found helpful .
I asked Maya if she had any hopes in mind in terms of the counselling.
M: 'Just to get back to normal' (see below for exploration of 'normal').
I reflected that last time we had spent a lot of time thinking about moving forward and helpful exceptions and wondered whether we had spent enough time giving Maya space to connect with some of the things which may stop her from being able to get 'back to normal'.
E: 'Do you think that might be helpful this time?'
M: Looked distant but nodded ' Well, we can see.'

'Getting back to normal':
Explored what this meant for Maya.
M: ''Being able to get on with everyday things/Getting on with other people/ Feeling okay'
E: 'When did you last feel like things were feeling 'normal' for you?'
M: 'Oh I am okay most days. Work is okay.'
E: ' What about getting on with other people? You mentioned that too. How does that feel?'
M: 'I have always liked my own company really. I mean, I get on with people but I can worry a bit about it all sometimes. I think maybe I am realising that it is okay to want to have time on my own sometimes.'
(I wondered if this was a helpful way of thinking for Maya or whether it was a 'safe' way of avoiding difficult feelings/interactions)
E: 'You talked about giving yourself time and space to feel okay last time we met. Is this working for you?'
M: 'I think so'
E: 'What other things help you when you feel you are struggling to get back to normal?'
M: ' I don't know at the moment. I started getting my niece from school. That felt good'

Niece
Recently started to collect from school. Enjoys being with her. Playful. Sense of fun.

E: 'What stops you feeling like you are getting back to normal?'
Maya talked about worrying what people think of her sometimes/ does not want to bother people with her problems/ be a 'burden'.
Explored who she goes to for support/ are there people who she does not 'worry what they think'.
Maya seemed to struggle with this idea, she talked instead about her problems not being so big and after a bit of 'time to myself'  usually feels 'okay'.
She did not answer the question of 'who'  she can talk to.
(Does she feel she has people she can talk to? Does she feel able to talk to others? Does she want to?)

Miscarriage:
Mentioned initial referral and encouraged Maya to talk about how she was feeling about the loss of her baby.
M: 'Sad/Empty sometimes. Like most people would feel. I think? That is how other people would feel isn't it?'
(Seemed uncertain of the validity of her feelings and a need to check how she should feel. Does this get in the way of Maya connecting with difficult feelings?)
E: ' I am sure that is how many people would feel.' (Validated emotions to encourage Maya to connect with her feelings.)
E: ' Have you talked about this 'sad/empty' feeling with anyone? Your husband Stephen? Your mum?'
M: 'Oh no. I don't think they would understand it.'
E: ' What makes you think they would not understand?' (Exploring M's rationalisation.)
M:  After a long pause. 'You know, just like in this job, I am sure you find there are some people who you just don't feel comfortable talking about feelings.'
E: 'Do you ever feel like that?'
M: 'Well I am here talking to you aren't I ? Not everyone would do that.'
E: ' But would you talk to anyone in your 'everyday life? After you lost the baby did you talk to family or friends?'
M : ' I just dealt with it on my own. It felt easier.'
Spent time exploring Maya's experiences of dealing with it 'on her own'.

Maya seemed quite flat but gave a narrative of what had happened without any prompting. She did not really seem to be directing her words towards me. At times it seemed as though she had difficulty retrieving the memory of what had happened as she would go blank or pause for a long time.

Recount:
Baby died  a couple of weeks before the scan, 'my body didn't even notice' (Possible sense of guilt, not being a good enough mother?)
Alone during procedure
Possible induction procedure - could not really remember details?
Did not see baby/ 'scared' (Separating self from reality of loss?)
No certificate
Taxi home and went to bed
Husband away, returned next day
Mum, Jackie, sister, Alice and Mother in Law, June visited for a few days
'Relieved' when they left
Going back to work helped things 'get back to normal'
This was the first time she had spoken the details out loud or tried to remember them
I acknowledged that it must have been a hard thing to do, if she had not spoken all this time

Feelings after talking
M: 'Still sad, still empty...' paused as though she was contemplating a difficult thought.
E: 'I think it sounds like a really difficult thing to go through Maya. Especially on your own' (offered acknowledgement). 'I wonder if it was hard for you to share this today?'
Maya became very still at this moment and unresponsive to further questions. (Was it too much? Had it helped her to recount what had happened?)

Thinking about now/Reflections on the session
Maya seemed very low and distant after being encouraged to focus on difficult times and sources of support.
Moved on to 'now' and hope to try and reconnect before ending the session.
E: 'Do you think that because you were able to talk to me about the miscarriage in detail for the first time, that it could be a sign that you are stronger and ready to 'work on feeling okay again?'
M: ' Maybe. Do people ever feel okay again? Do people ever move on? Or do they just accept that something horrible will always be a part of them?'
E: 'What do you think Maya? Do you think people can 'move on' or 'accept' and still 'move on?'
M: 'I think that is what I am trying to work out.'
E: ' Do you think these sessions might help you to work it out?'
M: Suddenly seeming more present and looking towards me. 'Well I have surprised myself today saying all of that, so maybe it will help,'

General Presentation/Engagement
Maya looked distant throughout most of the session and particularly 'disconnected' as she spoke about the loss of her baby. She often appeared as though she was talking towards the window and gave very little eye contact.
Generally more distant than in the sessions before. Is this because Maya is being more open/honest/ not 'acting' like she is 'okay?' Or a sign of a decline in her well-being?

Themes/Thought
Does focussing on difficulties help or make things more difficult?
More connected when we shifted back to feelings of hope?
Sources of support/ lack of? How did Maya come to form her ideas about being a burden/ people not understanding? Has she experienced this in the past?
Guilt: Loss of baby? In relationships with others? Being a 'burden'?
Idea of being 'okay'/ 'getting back to normal' . Does this aid or hinder Maya connecting with and accepting her feelings? Is it necessary for her to keep her feelings in check in order to 'be okay?

Close current involvement? Y/N

Reason:
First session. Maya has seemed to present differently than in previous sessions. Less connected with me as a therapist but possibly more honest about her thoughts and feelings, Maya agreed it would be helpful to think about exploring how 'acceptance' of her feelings and experiences might be a helpful first step in 'moving on'  as part of our future sessions