The Love and Trances of Madison and Belladonna

Belladonna is Diagnosed (Epilogue for The Visit)

by Cammie Dawn

Tags: #consensual_kink #dom:female #f/f #romantic #sub:female #asexual_characters #multiple_partners #plurality #polyamory #realistic #transgender_characters

See spoiler tags :

#sub:male

The final part of the special multi-part chapter for Skaetlett's Plurality Jam. Bell talks to Madison after a particularly important therapy session, recounting multiple decades of speaking with social workers, doctors and psychologists.

“I would have traded the world for just a few more minutes, but that selfish desire would have served nothing but to deprive Madison and Saph from the love and life they share as well as keep me from my Family here at The House. Things are as they should be.

I fully understand the tragedy of Orpheus in moments like this. Watching her car drift away I was reminded of all the times I’ve had final goodbyes. Some clumsy little departures at train stations with a simple “I’ll see you soon”, some tearful ends at airports or worse watching a life full of boxes piled into the back seat of a car fade away while my body cannot do anything but watch. The worst are the ones where I didn’t even know it would be the final goodbye.

Madison was right. Knowing when we’ll see one another again makes it easier.

For now, I know she is driving. I know she is safe. I know we will see one another in a couple months. So I write this journal and I hold the memories close to my heart, waiting for the day when I get to add some more.

Won’t be long, I’m sure.”

“What do you think?” Bell asked, “Normally I don’t share my journal with other people because I worry it will impact how I write it if there’s an audience attached and it’s supposed to be for therapy, but I felt it was the best I can do to give you a gift. Package my memories up and show them to you.”

“You know you don’t have to, right?” Madison asked, “I appreciate the trust very much, but never feel like it’s something you have to do. Especially if it’s important for your therapy.”

“It’s fine. I promise. My latest therapist doesn’t even pressure me on it. It was one of the useless ones who got me started on journaling and I kept to the habit because my memory is piss-poor anyway.” Bell said, airily.

“Doesn’t surprise me.” Madison shrugged, “I’m glad you have the journals to fall back on. Though, sympathy for the ‘useless therapists’”

“I know you have experience with them too. It’s okay.” Bell sighed, “I just have a really bad history with bad mental healthcare. I’m hopeful for Clare, but god, I’ve been in and out of therapy since I was a kid and it’s only ever served to make things worse for me.”

NSPCC (Home Visit)

OCTOBER 19 1994

Nancy Moore, case manager, met with Brainerd family at their home on 17/10/94 at 4:15pm in response to report from youngest child Benjamin’s (9 years old) school. Visit was unannounced. Mr. Brainerd was present at home and was asked by writer to not be present during the conducted interview. Home is observed to be in good repair and tidy state. Ben is observed to be malnourished, weighing 28kg at 128cm. Bruising on arms and lower legs. Ben refused request to disclose additional bruising. School reports average academic performance, under performance in PE classes. Report from school notes that Ben is observed to be distant and unresponsive during lessons.

In interview Ben was distracted and distant in affect. The writer asked basic questions about child’s state of care and accommodation. Child advocates no mistreatment and indicates bruises sustained during normal play activities appropriate to age and social dynamics. Child indicates being happy and safe and well fed.

Writer will suggest to school that maintained observation may be required but sees no need for external intervention.

The living room door was shut. Ben had lived in this house his entire life and he had never seen the living room door shut.

He just stared at it. The thick and textured white paint on wood. The frosted glass window. The bulky hinges.

Strangers were talking and he couldn’t follow what was being said. One moment he was in his bedroom and the next these two people in suits had him sit down on the sofa and were asking questions about how Ben was doing at school. How his relationship was with his father and step-mother. Questions ranged from how many meals he got to what bedtime regime was and what forms of punishment and discipline were utilized. They asked whether he was happy and insisted on knowing how he got the bruises on his legs and back.

And the living room door was closed.

The air felt different when the door was closed. It felt heavier somehow. The walls felt more oppressive and tight.

He could feel his father on the other side of the door though. Listening. Pacing. Waiting.

There was always a tension in the house when dad was angry. It was worse when he went to the pub. That was when his breath smelled bad and there was an oppressive air that made everything feel sharper and more terrifying. It was not unlike the tension that had bottled up in the sealed living room, it covered the entire world. When dad’s breath smelled bad it was better to hide. If dad noticed him then…

He just didn’t like when dad was upset or angry or talked with those sloppy drawn out words or had those wet eyes or his breath smelled bad.

That was what the closed off living room and the knowledge of the silhouette in frosted glass felt like. It made him want to hide.

Despite that fear, there was something inside of Ben that told him these people were going to take him away and that would be even more scary. That he would be put in a home. That something terrible would happen if he answered these questions wrong.

And so lies poured from Ben’s mouth.

He didn’t even feel connected to the words he was saying. The fear was driving. Home wasn’t so bad. He knew what home was. Knew how to handle home.

Anything else was too scary. And so the fear drove. The fear spoke for him and told the strangers whatever would make them go away.

Then he would work hard to make sure no one ever questioned his happiness and safety again.

“I was afraid they’d put me in a home.” Bell confessed. The old memory was more of an idea than a recollection. A recycled piece of trivia about her own life that she only remembered through the story being told again and again and again through the decades, “Wasn’t my only brush with social workers, either. But I learned to stick with the devil I knew.”

“Oh love…” Madison sighed, “I get it, though. My parents were never as bad as your dad seemed to have been, but parents should be able to protect and care for their children. I wish yours had been able to do that for you.”

“As I wish yours had for you…” Bell bitterly noted, “God, we’re just unpacking a lot of stuff today, aren’t we?”

“It’s okay. I was expecting today to be one for big conversations. You had mentioned that you were going to be having a rather important session with Clare. If you want to talk about it, then please do. I promise, it’s okay. I care. I want to know.”

“Okay… well. You’re not wrong. Today really was a big conversation and… I’m still processing it, honestly. Mind if I kind of explore my thoughts a little bit?”

“Take your time, Bell.” Madison responded, “I’m here and you don’t have to say everything all at once.”

Bell nodded vaguely, looking off into the middle distance, “I’m still struggling with that urge to just push it all away, you know? Like I said, therapists and I never really had the best history and the first time I went to an actual therapist wasn’t really by design. It just sort of happened…”

NHS ST. GUYS PEDIATRICS WARD

APRIL 24 2001

Patient name: Benjamin Brainerd

Date: 24/4/01

Location: St. Guy's Hosptial

Reason for visit: Psychological screening

Client pulled into screening during routine visit for ongoing treatment for delayed puberty. Screening will determine if client is safe to pursue hormone treatment. Malnourishment noted and history of disruption in home environment. Client is living alone. Client reports caregivers ejected him from family home within the past year.

Client disclosed history and seemed present, interactive and distractible. Client divulged heavy topics but appeared emotionally detached from topics.

No findings support psychological cause for delayed puberty symptoms. Client appears informed and ready to begin medical intervention.

Recommend starting on monthly testosterone shots and continue care with GP.

Client offered further psychological and psychiatric treatment to address troubles caused from childhood trauma. Client declined at this time.

Doctor Phil Maylor

There was a mirror. An honest to god wall length mirror.

It felt like an interrogation room.

Ben hated this. It was bad enough that he needed to be in the children’s wing of the hospital but he didn’t see any reason he needed this psychological evaluation.

He’d been visiting the hospital once every few months for the past year as they gave him blood tests and bone marrow scans. A 16 year old should have started puberty and yet even as his secondary school life had come to a close and he had begun working a call center job to keep himself afloat, he remained trapped in the body of a pre-teen.

He was frustrated with the whole affair. He was an adult. Living alone after being kicked out from his father’s flat. Yet every day he had to field the caution and intolerance of people wondering why there was a kid in the office.

This psychological screening felt like a waste of time. Clearly the issue was in the body, not the mind. Spilling out all of his tragic tales of bullying and beatings and exclusion and rejection wasn’t going to kickstart his body into the natural process.

He just stared at the mirror and let the words pour out. He didn’t seem interested in what he was saying. He just didn’t see the point in being there at all.

The doctor was kind and patient. He supplied soft reassurances of “that must have been tough…” but never offered advice, guidance or summary. It felt like he was just speaking to himself. In a way he was. His eyes never really left the mirror. The reflection did not feel like his own.

A small part of him felt that the lack of reaction implied that nothing he said was really that groundbreaking or surprising at all. He’d always wondered what a psychologist would say when faced with his history, particularly the parts where his caregiver failed suicide attempts or he was briefly homeless. Certainly he thought that breaking all contact with his mother or the story with the regurgitation would have gotten a reaction. He was sure there would be some reaction when he confessed that the NSPCC had visited his home twice in the past and that he had been screamed at and hit with a rod for attracting enough attention to have them try and “break this family apart”.

Nothing.

He just supposed that a mental healthcare professional had heard worse and in the grand scheme of things his little life wasn’t all that shocking.

“In retrospect, my life could have turned out a lot different if I understood myself a little better back then.” Bell joked, shaking her head, “I spend way too much time thinking of how my life would have been on estrogen instead of testosterone shots.”

Madison weighed her reply delicately, there were a number of factors at play but she wanted to show acceptance and sympathy, “We can’t wish for a better history. I’m glad to have known you as you are. I wish you could have had understanding and self-acceptance earlier, though.”

“Well, self-acceptance is a constant struggle, isn’t it? Case in point with today.” Bell sighed, “It’ll take some getting used to. But I think it’s long past the time for me to start accepting it. There have always been signs. But then again, I always wanted to have a clinician pull on those threads, you know? They never really got the jist with my gender stuff while I was struggling with it all.”

“Do you think it was more a case of you just not knowing how you felt about it and so you didn’t talk in sessions about how it was affecting you? Or were they seeing what they expected to see?” Madison propped her chin on her hands watching Bell curiously, her attention fully engaged with the conversation.

“I don’t know. I mean, I was always fairly forthcoming. I guess it’s not something people notice unless they’re looking for it?”

OAK REACH CLINIC

DECEMBER 2 2015

Session: 17

Progress Note #: 2550

Client Name: Benjamin Brainerd

Session Date: 12/2/2015

Time: 12:01 pm to 1:00 pm

Modality: 90837

GT Staff: Louise VanderCook

Rating: Some Progress

Problems

Objectives Identified - Identify cognitive distortions in relationships

Critical? - no

Progress Rating - Some Progress

DSM 5 Diagnosis

F43.12 Post-Traumatic Stress Disorder, Chronic

Symptoms Presented/Reported in Session

Client presented as dissociated and at times tearful. Client reported feeling dysregulated.

Notes

Offered grounding at beginning and end of session as client had reported feeling dissociated and dysregulated. Client reported feeling "better" after grounding exercises. Plan: Continue to explore client's feelings related to safety.

Ben stared at his hands. Watched them open and close over and over again.

Across him, Louise sat behind her desk. Head bobbing between monitor and patient. Ben hated that barrier between them. When he asked her about it she had said it was an attempt to give the patient room so they didn’t feel pressured.

It made him feel abandoned.

He’d started visiting her on the insistence of his wife. He’d resisted mental health treatment for a while, every time the topic came up a surging terror gripped deep within his heart that he couldn’t identify.

The final stone was a car crash that had made it so Ben couldn’t go a few hours within devastating flashbacks, not to mention his already poor sleep had gotten worse.

At first he hated it. But over time he eased into the routine and found some comfort in just speaking his mind. He just wished that his clinician would speak her mind every now and again.

“Some days it feels like I’m still that powerless teenager getting kicked out…” he confessed, his eyes unfocusing and watching the double image of his fists wobble apart, “Like I still feel like that child trying to be an adult, you know? I wasn’t even 18 yet and I was on my own, paying the bills, making a life for myself and I wasn’t fully developed back then. There’s a part of me that feels like I’m too young to be doing what I’m doing now and…”

He stopped and sighed out, his heavy heart unsure where he was even going with this, “There’s a part of me…” he continued, his voice lighter in tone and heavier in content than it had been before, “that will always feel too young to be a married man and trying to manage a store. A part of my brain will always think I’m a child… not like I am a child… more like I’m still a teenager who is trying to find his feet. Scrambling all the time. I don’t… I don’t feel like I worked out my pace. Like I’m a child pretending to be an adult and that’s kind of how I learned how to be an adult and I never stopped pretending.”

She– he wrapped his knuckles on the side of the chair, “I’m not looking as young as I used to. My face is wrinkled and I look tired and old… but it doesn’t look like me. I don’t know. I just. It reminds me of when I got put on monthly testosterone shots and like… sometimes I wonder what would have happened if I was brave enough to ask for estrogen instead. Like, I’m not transgender. I’m not. I just. I have transgender friends and I know that all that could happen if I came out as trans is I’d lose my career, lose my wife, lose the life I have and I don’t really think I’d gain much in return, y’know?”

Louise typed things out and said nothing for a while. She had waited to see if Ben was done.

He always wondered what it was that she wrote during those sessions. He never really knew what she could offer him that he couldn’t get from speaking to close friends or his wife.

“Plus, you have the whole BPD stigma.” Bell clarified, “The moment I got that diagnosis I feel like my whole relationship with therapy set on a darker tone… and I won’t accuse any of my old therapists of misogyny or anything, but I will note that I didn’t get strapped with that label until I started social transition.”

Madison nodded sadly, “Notice Me hug you, love.” she reached to the screen and imitated the motion, wishing she had more than hypnotic suggestions to carry her comfort, “Saph and I have a friend who is fairly outspoken about BPD and the social stigma that follows it. That friend says that though it’s a real thing with severe issues, it can sometimes be used by clinicians to pigeon hole difficult clients without going into the root cause of their conditions.”

“I’d argue that’s what’s happening here, yeah. At least it was, until today.”

“You deserved better care. Especially when you worked so hard to stick with a system that was failing you.”

“I didn’t really have a choice in the end. I needed to have a therapist to sponsor my transition and now I need one to okay my surgery.” Bell’s face turned sour, her nose scrunched up at the idea of having to continue proving herself worthy of medical care, “WPATH guidelines even say it’s unwise to allow someone with my condition to proceed with treatment. I’m terrified someone will just decide to take it away, though Clare says that won’t happen.”

“Clare seems to be trying her hardest to take care of you and see you and hear you. You said that she insisted on you not hanging on to the BPD label, didn’t you?”

Bell nodded, eyes anywhere but the screen, “She did. She says that a diagnosis that does not serve me only works to make me more vulnerable. If I wanted to identify with BPD, that’s okay, but she didn’t want me to be stuck in a box so to speak… which kind of helps with…” she stopped herself short and shook her head.

“Clare sounds like she’s quite conscientious in how what she puts on your file will impact you and she is advocating for your surgery. I really don’t think she’d do anything to harm or hinder the process for you.” Madison said, tactfully.

“I don’t either.” she closed her eyes and let that sink in, she believed it, “I think the hardest part about that time in social transition was that I couldn’t be as open as I would have been otherwise. Like they needed to make sure I was of sound mind and making a decision that would impact every aspect of my life and it didn’t serve me well to let myself seem mentally ill.”

On her side of the screen, Madison bristled with protective indignation, “They shouldn’t have made you jump through hoops anyway. I have opinions!”

“Yeah, so do I.” Bell grumbled, “But I jumped the hoops and did my best to hide my—” she looked down at her hand and closed her eyes with a slow breath, “hide our…” she shook her head violently, pushing away the notion, “Nope, nope, can’t do it. Not yet…. I’m sorry.”

“Love… it’s okay. Please. Take your time. You don’t need to force yourself for my sake.”

GREAT LAKES COUNSELING CENTER

APRIL 21 2019

Diagnosis

F43.12 Post-Traumatic Stress Disorder, Chronic

F33.0 Major Depressive Disorder, Recurrent episode, Mild

F60.3 Borderline Personality Disorder

F64.0 Gender Dysphoria in Adolescents and Adults (Transsexualism)

Has struggled with chronic depression since adolescence which have been leading to chronic suicidal ideation without plan or intent. Client is able to function as necessary, symptoms put strain on ability to see positives about self and maintain healthy relationships. Has identified as transgender and struggled with dysphoria since adolescence, recently decided to start the physical transition process to lessen dysphoria and have a higher quality of life

Patient Presentation

Cognitive Functioning: Oriented / Alert

Mood: Anxious

Functional Status: Intact

Affect: Appropriate

Interpersonal: Interactive

Relevant Content

Client noted feeling depressed due to struggles of her transition and having been misgendering/deadnamed a lot this week. Client stated she was brought down earlier this week when someone from our billing team deadnamed her. We discussed how she places a lot of stock in other's perception of her (her voice and presentation in particular), and how her dysphoria is so much worse when she is mistakenly misgendered. We explored her negative thoughts and ways of challenging this, such as being more aware that everyone has their own perception and their perception of her matters so much less than her perception of herself.

Signed - Samantha Lane, LPCC, MS

4/21/2019 - 12:32pm

Belladonna looked at herself in the Zoom window.

She liked the fact that she could just call into sessions now and not disrupt her entire day to drive out to a clinic but she hated the reminder of her physical form. She could shrink the thumbnail but her eyes always drifted back to that tiny reflection of a masculine face that never truly seemed like her own.

She hoped that issue would soon be solved. She knew that it would not be long until Samantha was ready to sign off on her HRT.

It ached at her heart that it took a single hour almost two decades ago to get signed up for testosterone but it took a full year of social transitioning and psychological supervision before she could be approved for estrogen. The transphobia of the sentiment burned.

The hard part about talking to Samantha was that it felt like a femininity exam. That for these pressurized windows where she needed to perform her role as an ideal transwoman. Her voice needed to be kept high, even at cost of her throat’s comfort. Each time she spoke with this latest therapist it felt like she needed to squeeze her windpipes in order to sound convincing enough.

She needed to get a good grade in woman, something which was both normal to want and possible to achieve. It was the only way to get approved for medicine.

“Sometimes it’s easy…” she said carefully, trying to get her voice just right, “I don’t need to think about it. I just perform and it feels natural and normal. But most of the time it’s like I’m swimming upstream, having to focus on how I sound every single sentence.”

She paused for a moment and took stock of how she wanted to word things before continuing “I’m going to invest in voice lessons at some point. I keep trying these online tutorials but they’re all from the perspective of singers and musicians and I just don’t know what an R2 register is. I don’t even know what 'glassy' sound means.”

Samantha always looked impassive on these calls. Even if Belladonna’s eyes were not always drawn to her reflection, she didn’t think she would be able to read what was happening inside the clinician’s head. Even if she could, there was a deeply seeded belief that therapists weren’t emotionally invested in these conversations. To them this was just as forgettable as an hour at the office. Another hour at work to endure.

“It seems important to you to be recognized. In the way you dress, in the way you speak…” she finally said.

“Of course it is!” Belladonna all but cried out, her voice slipping back into her developmental tone, “Some of my friends have been assaulted on the street for not passing perfectly. Like this isn’t just some ‘in my head’ shit. This is a matter of survival. I need to be able to fly under the radar or I am in literal danger. I don’t have the luxury of doing this half-assed!”

The momentum of Belladonna’s anger was cut off as she was assaulted by inner-discipline that told her that she needed to be a model woman who is worthy of HRT and it wasn’t good to get angry like this or make it look like transitioning would endanger her.

She closed her eyes and breathed in. Her voice reset to a gentle tone, “Sorry. Sorry. I just mean it’s important to me. I wanna get it right, y’know? I know practice and dedication will help. It will.” she gave a broad smile. Her voice was on point now. Surely Samantha would see that and give her the good grade that she so desperately sought.

Even still, behind her eyes there was a cynicism that was growing deeper and darker towards this cis-woman who had the power to grant her freedom from that which she considered a ‘birth defect’. This professional had neither the knowledge, curiosity nor the care to understand even a fraction of what was going on inside of her mind.

But that’s how therapists were, Bell supposed; neurotypical people acting as arbiters of mental health and sanity.

Bell hated that fact with a burning passion.

Donna opened her eyes and stretched. Bell had retreated entirely. “Notice Me pull you into a firm embrace, my love. I appreciate your understanding, truly. This is not easy for us.”

“We can change the topic if you prefer?” Madison noted, detecting the shift between facets. “If you’re not ready to talk about it, we don’t have to.”

“It shall be on our mind regardless.” Donna said, stressing a syllable for impact, “It would be best to discuss.”

Madison was always sensitive to word choices and the subtle emotions that played across the features of her love, regardless of which facet was presenting, “Bell started to say ‘our’ a moment ago and now you’re saying it too. Can I ask why?”

“Well…” Donna sighed, “We’d mentioned that we’d been going through a number of tests recently and Clare’s been leading us slowly to something Bell really doesn’t want to hear.”

“I was worried it would be something like that, honestly.” Madison dryly admitted, “How did it go?”

Donna opened her mouth and found the sound cut off. Her eye flickered in the telltale manner that indicated an IM window had fired off from inside.

“Is Bell okay?” Madison asked, stressing concern, “Does she not want you talking about it?” Madison was ready to honor the unspoken ‘Red’ that Bell was flashing. “She retreated rather suddenly and if this is more than she can handle, we should probably stop pushing. I promise, we can talk about it more later.”

“Bell’s going to take her time on this one. She had a pretty bad reaction when we got the BPD label too but in time it became something she identified with, found community with and learned to handle some of the stuff that makes life tough for us. Clare said we were using it as a crutch, but it was one that helped us when we weren’t getting good treatment.”

Madison nodded, “You’d all mentioned stuff to that effect, yeah.”

“Honestly, I think Bell getting angry and quitting on our previous therapist was one of the best things to ever happen to us. I feel we may have made more progress in understanding our condition if we had not been spending all of our time trying to perform our gender and be on our best behavior. It’s hard to get proper treatment for mental illness when our transition relies on us hiding the fact we have one.”

MAYBERRY, WELLES & ASSOCIATES

JULY 20 2021

7/20/2021 Sarah P Archer, LPCC, MS- Clinical Progress Note

Assessment (Axis I & II)

Assessed

Major depressive disorder, recurrent episode, severe (296.33) (F33.2)

Generalized anxiety disorder with panic attacks (300.02,300.01) (F41.1,F41.0)

PTSD (post-traumatic stress disorder) (309.81) (F43.10)

Borderline personality disorder (301.83) (F60.3)

Start Time: 7:58 am End Time: 8:59 am

Change: No Change

Suicide Assessment: Belladonna denies suicidal ideation, does not have an organized suicide plan, no lethal means available, no intention to act on plan and no command verbal hallucinations.

PHQ-9/GAD-7

Mental Status Exam

Sensorium: Oriented and Distractible

Mood: Normal, Anxious

Affect: Appropriate/Normal and Inappropriate

Safety: No Safety Issue

INFORMATION

Client identifies as a transgender female and prefers pronouns of she/her, which will be reflected in this note. Client shared about past interventions that were and were not helpful during her time in therapy. She shared about three different presentations she has, including: Work mode, where she is mature, calm and focused; Soft mode, where she is emotional and compassionate; and Strong mode, which she describes as her idealized self. Client shared about her experience with HRT. Target Goals and Objectives were addressed during session.

INTERPRETATION

Client appeared open to sharing and honest about struggles. She reports drastic mood fluctuations when she is on her menstrual cycle, due to being on HRT for two years, but describes her puberty as validating and affirming.

INTERVENTION

The following therapeutic approaches and techniques were used: psychoeducation, communication skills, normalization, active listening, developed coping skills, validation and relaxation techniques. The following DBT skills/tools were incorporated into today's session: core mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness. Interventions/techniques utilized in session were effective. Belladonna was instructed to return for the next appointment in 2 week(s)

Bell scowled at Sarah.

She hated this woman. She rarely used the word hate but this disaffected, disinterested and distracted person was actively a detriment to her mental health. She’d already long confirmed the ideas that therapists did not know or care what happened in her life and that the contents of her life were not dramatic enough to require more than base level attention, but somehow this was less than even her lowest expectations.

This apathy pushed Bell to test her on a weekly basis to see if she could even remember the names of her loved ones or the content of her stories. It felt disrespectful to come week after week and share intimate life details to someone who barely seemed to be listening at all.

When she had complained in a BPD support group people just told her that the therapist just wasn’t a ‘good fit’, as if such a thing were possible.

She would have taken that advice and switched clinicians again but her chances for surgery depended on sponsorship from a mental health professional who had a longstanding relationship with the patient. It seemed easier to deal with an annoyance than to lose another year rolling the dice on someone whose role amounted to ‘check a box for insurance’.

“I don’t even know if we’re communicating in the same language! Are we even on the same page here?! I have no way of knowing if you’re even hearing the things I’m telling you!” Bell exclaimed, at the end of her rope.

“Yeah… no… umm… checking in is really helpful. Yeah.” the clinician droned on, the fry of her voice grating on Bell’s nerves, “You’re totally right about that. And… ummm… based on what I’m hearing. I do have kind of an understanding of… umm… what is happening for you. Like. The things that you are mentioning. And if there’s something I’m not mentioning then it’s good that you’re asking questions and… uh… yeah. Yeah. It’s really helpful when you share your experiences. So. Yeah. I think I’m having an understanding.”

Bell just watched as the therapist wriggled her way through that nothing salad of words. Maintaining her medication and placating the chosen family members who said that she needed therapy were the only things that kept her from logging off there and then, “...Okay, well that’s a really broad statement. Could you be more specific? What exactly are you understanding?”

“Right, right… it is.” she chewed on her thoughts a moment, humming and hahing “So, you know, you mentioned defensiveness. A worry that you may be judged or that people may have these thoughts about you and I see that you’re able to name these feelings that you’re having. We had talked about that. These ‘I feel’ statements. So. Yeah. There are a lot of things.”

Bell stared incredulously at this woman and tried to soothe her mind of thoughts about how useless she was or how this was costing $150 an hour. Getting angry wasn’t going to help anything and so she just sighed and gave in.

“Okay… I understand.” she sighed, defeated.

She wasn’t sure how long she could keep doing this.

“Okay…” Donna said, breathing in slowly, “I may as well just say it. It doesn’t make good to keep dancing around the fact. Clare sat us down today with the results from both the DES and MID diagnostic tests and talked to us about treating us for Dissociative Identity Disorder.”

Madison listened calmly and patiently. Donna seemed to have been expecting a stronger reaction than the one that crossed her face, “Not OSDD, then?”

Donna blinked in surprise. Given how much both she and Bell had been building this revelation up, it was a disarming response.

“I’d been reading up since you told me you were taking the tests.” Madison clarified, “I am surprised it was DID that she went with. I read there were amnesia barriers between parts in DID but OSDD lacked either the distinct alter or amnesia criteria.”

Donna shrugged and allowed herself to smile openly, “Apparently it doesn’t work the same way it’s shown in TV shows and movies?” Donna said, a little uncertain herself, “Clare said my results were more in line with DID than OSDD and that amnesia doesn’t often present as blackouts but general forgetfulness or emotional disconnection from memories. Plus she’s pretty certain we have ‘blocked out’ bits of our past, though I can not say with confidence that I know what I do not know, you know?”

Madison laughed brightly, “Point taken. I will have to do some more reading, then.”

“And for my–” she cut herself off, “For our part, we will keep you updated.”

“Again with the use of ‘our’ language.” Madison noted, “Is that something Clare asked you to do?”

“Not overtly. She said she wanted us to consider that how we act, how we present and how we treat ourselves has an impact. She wanted me to be more careful about how the things I said impact Bell and I want to be intentional about who I mean. It shall take getting used to, but I am certain you would enjoy seeing us less at one another’s throats.”

“I don’t like it when you’re mean to yourself - well, I guess, each other." Madison agreed, “So are there any changes which I should know about or is this going to be more of a gradual thing?”

“Gradual…” Donna replied, “Though we clung tight to the use of facet as a term because it was a middle ground. A way of admitting we had a condition without accepting it. I would rather we not use that any longer.”

“Did Clare have a suggestion for what to use instead?”

“She uses ‘parts’, I wish to try that on for a while and see if it fits.”

“I’ll do my best to remind you if I catch you slipping, then.” Madison assured, “I just want to support you through this.”

“It is appreciated, beloved.”

FOCUS CLINIC

NOVEMBER 11 2022

Progress Note (11/05/2022)

Type: Telehealth

CPT Code: 90837 - Individual Psychotherapy, 53+ mins

Place Of Service: Clinic

ICD10 Primary: F43.12 - Post-Traumatic Stress Disorder, Chronic

Start Time: 17:15:00

End Time: 18:15:00

Change In Meds: no

Subjective:

Client who presented as "Bell" addressed how she was adapting with the thought that their other moods were real. Writer and client spent session considering if all the moods were consenting to sharing their trauma's in session. "I just feel like if I acknowledge it then it means that I would need to disappear because I am not wanted. People like Bella and Donna, not me". Writer and Bell talked about how she is an important part of themselves that had make sure they survived. Writer and Bell address their main believe that they are not enough or worthy. Client then changed to "Donna" who remained for the rest of session. "I didn't realize that we (facets) have to come to a agreement on things and that we don't know if its Borderline Personality disorder". Client and writer practiced and confirmed the consent agreement sent via email stating that all the facets consent with being in therapy. "When you are not sure if a story we share needs everyone's consent you can ask the facet to check". Client's present facet in session was Donna who doesn't carry the traumatic events the others do. Client stated that they informed their partners about the possibility of DID diagnose and felt accepted by their partners. "I wasn’t sure of how they would react and didn't get any push back". Discussed her worry of how the general public rejects those with DID diagnosis. Writer and Donna spent the remaining session exploring how the possible diagnosis would support or challenge the client.

Objective: Client came into session present and prepared. Writer utilized narrative therapy and psychoeducation. Assessment: Client is a 38 year old Transwoman who presents symptoms of Post-Traumatic Stress Disorder Chronic due to multiple life events the client has experienced that has caused them significant distress.

Plan: - Weekly Therapy - Explore DID communities and resources online.

Donna’s ears were ringing. It was like a flashbang had gone off inside of her head.

The ringing came with it a certain sensation in her mind that made thinking feel slow and laborious. Normally she could get a read on the other facets via their emotional pangs. Bell was rejecting everything that was happening. Bella was frozen in fear. She couldn’t even feel Ben or Sis.

“...I’m wondering what you think about that?”

Clare sat across from Donna and watched her carefully. Donna always liked how calm and approachable Clare was. This was their 9th therapist in 25 years and it finally felt like they had found someone they could trust. Someone they could approach.

Someone who actually remembered the things she painstakingly poured out week after week and seemed to take little hints as invitations to make space to talk about things.

After a few months of sessions, Bella had felt comfortable enough to talk about the “facets”. It had felt important to give that context if they were going to openly share how big of a part Madison had been playing in her life.

They’d tried to open up to the other therapists. But they never could manage to muster the courage to say something. And then their relationship with Madison flipped the script. It was no longer about not being able to talk about something that existed only in their heads.It was a matter of justifying to themselves why they wouldn’t talk about a real and evidenced aspect of their relationship.

It was only a matter of time before it became a topic of exploration.

“I…” she stuttered, “I cannot say it’s not crossed my mind before…”

Weeks of testing and going back and forth had ended with Clare stating that which Donna had assumed weeks ago and Bell was still deep in denial of.

Dissociative Identity Disorder.

Clare had told them that a diagnosis would not change anything that was true about themselves but it could offer them options for support and community as well as self-acceptance and understanding. She had noted that the BPD diagnosis had become a crutch and only served to keep the divide ‘between parts’, fueling further emotional and mental breakdowns.

“We can try and work within this space for a little while and just see where it goes, okay? If it doesn’t work out then it doesn’t work out. You don’t need to have it on your insurance. You don’t need to tell anyone. We can just see how it fits, okay? And if you want to go the way of treatment and still not have the official diagnosis then that’s okay too.”

“...will I lose my driver’s license?” Donna asked, her voice uncharacteristically vulnerable.

Clare broke out into an unguarded chuckle. “What? No! Who told you that?! No! No. You don’t have to tell anyone and we won’t report it and I’m pretty sure DID isn’t something that can take away your license.”

“And this will not impact my surgery letter, will it? I read a book once that said…”

“Donna, Donna…” Clare soothed, carefully, “You’re a woman through and through. That’s obvious to anyone who meets you. Nothing is going to get in the way of you getting that surgery if it’s what you truly want. I would like to invite Ben to open up about his feelings on it, but it’s clear this is something you have all wanted for a very long time now. It would be cruel to stop you this far along in your transition anyway.”

Donna just sat with it for a moment. She was able to visualize Ben as his own person, Bell had even told Madison about him during her recent visit, but the idea of him not being a consenting member of their transition stung in a way that Donna couldn’t quite put language to. It made her want to push away the idea and not allow the moral implications to set in. Clearly at some point in the past few years there had been an internal line drawn within her, within all of them, between the concept of ‘facets’ and ‘parts’. Donna was hardly ready to define what that difference was and how it impacted consent but the thought had occurred to her somewhere within the weeks since taking the DES-II and MID. While it was a hypothetical scenario it never truly felt like something she needed to internalize.

“This is going to take a lot of processing…” she sighed.

Clare broke into a laugh, “I bet it will!” she exclaimed, warmly, “But hopefully this opens up the room to being able to discuss it and accept it.”

The laughter was levity. Donna just sagged and let the gravity of the diagnosis start to settle in. Bell’s silence was starting to worry her. “But why DID? I don’t have blackouts.”

Clare’s expression was diplomatic as she spoke, “Amnesia between parts doesn’t need to be a permanent and always thing.” she stated firmly, “You’ve all displayed individuality and your attachment to even shared memories is specific. You, Donna, can talk about your family of origin without it troubling you, like when you told me about the thing with the beans on toast? Bell can’t do that, she can’t even say the name of your step-mother. You’re not emotionally impacted because those events didn’t happen to you. Does that make sense? Dissociative amnesia isn’t just about recollection, if you remember something but it doesn’t feel like it happened to you, that’s still in line with DID.”

“Emotional amnesia…” Donna said to herself, “The BPD support groups brought it up as the reason why we tend to doubt people care about us when they’re not present.”

“Hey, hey, hey. Let’s not get too far ahead of ourselves, okay? I know that’s how you are, right, you want to just dive in the deep end and grapple it and understand it, but there’s a lot you’ll need to learn and unlearn and I’ll be here and I’ll give you some books and new support groups so you can just try it on, okay? If it doesn’t fit then we can double back and see what does fit. It’s not all-or-nothing, okay?”

Donna nodded. She liked that. Failure as an option and leading from a perspective that subjectivity was at play.

“And don’t rush.” she said firmly, “You don’t want to commit and then find out that, uh-oh, Bell doesn’t agree with what you’re doing and she over-corrects and it’s one step forward and two backwards.”

The clinician paused and took stock of Donna’s stunned expression at being predicted so accurately, “But look, look, look. It’s okay to go along with this and be wrong in the end. We don’t need all the answers right away. You can take some time. Digest it. Really let yourself… all of yourselves… think about this and we’ll revisit it again. This doesn’t have to be a be-all-end-all thing, okay?”

Donna couldn’t help but chuckle darkly in response, “It’s such a relief to hear you say that. They never really gave us an option when the others tarred and feathered us with the BPD diagnosis.”

“Yeah well, I’m not like the others now, am I?” Clare boasted.

It’s true. She wasn’t. She was so much better.

“In the coming weeks we’re going to start doing some communication work. That will be our goal. Get you all talking to one another. The way it sounds, you get good mediation from Madison. She doesn't let you all get away with being hostile towards one another.”

Donna smirked, thinking of how Madison looked at her and told her to ‘Be nice’ when she said mean things about Bell’s controlling nature or helped ensure Bell didn’t interfere with their passionate moments during her recent visit.

“So, we’ll be doing homework soon. Right now we just want you all to have a place you can sit down and communicate. Like a conference table. We’ll work on picturing that in your head. So if you can, you might want to try out some visualization or meditation. Do you know anything about self-hypnosis?”

Donna burst out into unguarded laughter.

“Oh, yes. I think I know a thing or two about hypnosis.”

She was glad that therapy tended to be on the same night that she called Madison. She’d have a lot to talk about after this session.

“Whatever comes of this, I am glad you’re with me– with us for the journey, my love.” Donna lowered her head, “I never wish for you to feel like you are taken for granted.”

“I don’t feel that way, Donna, I promise. I would let you know if I started, okay?” Madison responded, firmly.

“I trust you.”

“I know.”

“Notice us hold you tightly and just appreciate you.” Donna said, staring at the webcam with intent.

Madison heard the ‘us’ in the trigger and allowed herself to feel it. The warmth of Bella, the conviction of Bell, the passion of Donna and even echoes of her budding connection with Sis and Ben.

“Oh…” she whispered.

“We love you.”

“I love you too. All of you.”

Thank you for reading! As always comments and feedback appreciated. Follow me on Twitter @Camden_Dawn or Tumblr at MissCammieDawn for future updates and info.

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