While I know there is a place for medication, it is not my usual default position, so I had little the issue with his ‘threat’.
For some reason, I want to mention here that he had a ‘big corporate job’. That was part of his opening line to me, perhaps his identity. Did he say that so that people might immediately know he had a lot of responsibility? That, however, does not entirely sum up his job and does not sum up the pressure he was under. He supported a huge department, where errors from his camp could and would wreak havoc in many other areas of the business.
He felt the pressure from his job was unsurmountable. He also felt it was the cause of his depression and all other symptoms.
During this phase, he was open, talkative and unrestrained in his storytelling.
After taking his medical history I began listening to his experience of life through the lens of
Early on I tried not to do many interpretations though they were burning and brimming in
The first time he mentioned his migraine he said, ‘it was a cracker’, then laughing as his own pun said, ‘yes it nearly cracked my head open’.
I was surprised at his spontaneous laugh, or more, chuckle, at that moment. I had hardly ever seen him smile. I was mesmerized and wondered if now might be a good time to ask a deeper question. I forged ahead, asking, ‘where do you think the migraine comes from’.
He rolls off a plethora of suggestions that he later tells me really are direct lines plagiarised from his doctors. When I question him further on this day about what he actually thinks it is, he tells me he has no idea. He said he once thought it was caused by his alcohol consumption, but he often had a migraine when he had had little to zero alcohol. He said he monitored the migraines on advice from his doctors around food, but he told me his diet was such (rarely different) that it appeared it was not that. The list of possible causes was endless but without a fit.
This session was likely the only real session we ever did in any depth around his migraines. It stands out for me … for that very reason.
I often checked in with him about his migraine and usually got a ‘Nah, not had one’, or ‘yeah, but I want to talk about something else’.
That was our migraine treatment plan.
We worked deeply on his early family life, him choosing to lay on the couch, a technique I often use. I usually suggest laying off the couch to certain clients ( for some clients it is contraindicated and I, therefore, do not always work that way or make that suggestion) as it usually allows better access to deeper thoughts and feeling as one cannot be stimulated by the room, the surroundings, the psychotherapist’s face, clothes, etc.
In those early days, I often wondered what he got out of his session with me, as there was little forthcoming from me. Not because I was silent or withholding, but because he just talked and talked and talked. However, I also knew that he was finding his intersubjective self. A self that had had no permission to exist with unavailable parents.
As if hearing my thoughts, one day randomly he said, ‘I can’t tell you how good I felt walking back to the office from here last week. It didn’t last long, but wow it felt good’.
It was not long after this comment that he came into session to say that he had read an article about disturbed sleep and that he had been accepted into a sleep study program.