Tag Archives: DBT

The fill-in therapist is nice. 

Talking to Dr C’s fill-in today was helpful. I brought up my continued issue with taking responsibility for things (specifically my student loans). She gave me some tools to help ease the automatic tapes that scream at me every time I think about my inability to repay the loans… I’m not sure her suggestions helped as much as her repeating a new grounding mantra a few times (something about being an adult, away from my past, and not wanting to allow myself to continue the abuse)… her approach is different from Dr C’s a bit, but it’s helpful in the moment. Dr C is good for getting at the root of all this stuff and dealing with the past. Fill-in therapist’s approach is more cbt/reality and good for handling things in the moment (while also still accepting that I’ve lived with the abusive tapes since I was little, so it makes sense that they would have been adopted as my own)…

She’s a good fill-in therapist. I’m glad Dr C ended up finding her (she was the third choice, as choices 1 and 2 didn’t work out). I’m not sure I could work with her as a primary therapist (cbt/dbt tends to trigger failure tapes), but it was really helpful today. 

I’m still shaking from having called the student loan people, and kinda dissociated, but the tapes it usually triggers are much quieter. 

Only 2 more weeks and Dr C is back. Well, she’ll be back in the county in just under 2 weeks, and we’ll have group that week that she returns, but individual doesn’t start up again till the following week. 

I need to get in gear now and make some sample journal pages for the two things I want to demonstrate in tonight’s workshop. I think only 2 people are coming, but I still need demo pieces. 

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More connecting of the dots (or, the elegance of the avoidance dance)

When you’re “allergic” to dbt, you and your therapist have to get creative about integrating ideas from it into therapy.

Yesterday, I was having trouble identifying what was causing my rollercoaster emotions. Dr C and I came up with a chart to help figure it out… she used the dbt diary card and the behavior chain as a jumping off point. We had events, people around/involved, emotions, sensations, and thoughts as the first level. Then another two levels of emotions, sensations, and thoughts, and finally a level of just emotions and sensations. I could fill it out haphazardly and incompletely, then she helped fill in some of the blanks & connect some of the dots… at the root of everything behind the emotional ups and downs is terror (and the avoidance of it)… it’s weird, because the word doesn’t do justice to the overwhelming and crushing nature of the feeling, but it’s the closest word for it.

I’ve been trying to keep up with filling out the chart more often, but I’m finding that it becomes pretty triggering to look at the things I’m trying to avoid (duh!). At least in therapy, it was safe to open up that can of worms. Dr C kept talking with me about it, and that prevented me from getting too lost in the bottom layers. I’m kinda worried/scared that looking at it at home wouldn’t give me the same ability to pull out of what is stirred up. Yeah, it’s probably a cop-out to avoid addressing it, but I need to keep functioning this weekend. There’s work and social stuff happening. I can’t be a wreck… so I keep avoiding.

There’s a fear behind the avoidance: what if it overwhelms me? What if I can’t regain control over the impulsive thoughts? What if I fall back into a cycle of hospitalizations?

Sure, I could reach out to Dr C for support, but how much can she really help if the panicked child and the angry teenage are both triggered and overwhelmed at the same time, and I lose my connection to my adult, competent understanding of things? I know I’ve come a long way since the last cycle of hospitalizations, but the potential of it coming back scares the crap out of me.


Back to emdr

During Monday’s session, I talked about feeling like I was running from something; something terrifying. I had no real concept of what it was, just that I’ve been running from it for the past several weeks. She asked if I wanted to do emdr around it.

Sure. It’s helped before, why not?

Only this time, it was an amorphous, looming feeling I was working on, not any tangible or comprehensive memory.

It took me a while to get started on it. I wasn’t totally sure I wanted to “go there”. I didn’t really know where “there” was, only that it terrified me and made me want to run away crying.

She was good about it though. She gave me permission to back off and do a lighter session instead. I fought with myself for what felt like an eternity. We ended up going through with it.

It was different this time. Not having a cognitive memory to go with made it both more difficult and a bit easier at the same time. I found myself putting more effort into the few sentences I was able to mutter to her during the process. I was more open to admitting that I wanted to destroy my body because of what I was feeling. It alternated with intensified body memories… and all of that went back to feeling like I shouldn’t be lying…

This session didn’t make as huge of a difference immediately, especially compared to say, the spider phobia session, but the terrified feeling isn’t as strong. It’s certainly brought up more stuff to process (well, more emotions that I have not felt since the move), but it has also maybe had a dampening effect on the intensity of it all…

Group was right after the emdr session, and I’m glad there was more time to just sit in a safe place for a while longer…

I’m not sure how I feel tonight. Body memories are back and constant for the first time since the move, but they also don’t bother me as much. We specifically worked on my desire to destroy my body in an effort to stop feeling them, so the desire to cut and smash my body to pieces isn’t as compelling tonight despite the intensity of the body memories…

Long story short: emdr can totally be worth it (easily more helpful for all of this than dbt. While it’s triggering in its own right, I find I can handle the triggering after emdr way better than after dbt)…

Tonight I’m just left with a weight in my chest and a nagging desire (but inability) to cry. At least I don’t feel like i’m a constant fuck-up like dbt had me feeling.


do I go or do I stay?

I got a call this morning from a clinician at De’s former office. I had planned to ask her a bunch of questions and talk a bit about my hesitancy in returning there, but as usual, my head went blank as soon as I answered the phone. I had originally written my concerns/questions down but it was on my phone and I couldn’t look at it while talking to her. I became so flustered that I simply set up an appointment with her for early next week. I will make sure to print out what I had written and take it with me to the meeting. She had said we won’t go over all the information I did the first time with De, but it will still take an hour to an hour and a half. She had mentioned doing some of the assessments again. I’m trying to remember the ones I did the first time around, but the only ones I remember are the BECK Depression Inventory and the Trauma Symptom Inventory – 2 (TSI-II) (funny enough, I did quite a bit of research on the original scale when it was being tested… It’s changed over the years. I wish I could remember my research. It was SO long ago… like seriously, almost 18 years. I feel really old now). The way she said it though made it sound like there were more than 2 assessments. I guess I checked-out for it. Hopefully this go-around will be more memorable, lol.

Anyway, I’m still pretty hesitant about going back there. There is still part of me that feels like this is special treatment (it is), and that makes me uncomfortable. I know the people around me are telling me to go for it if it will help, but how do I get over the balking reaction when I think about it all? I know I’m really looking forward to being able to tackle this piece of the trauma, but I also know I need some other supports that I can’t really look to this new therapist for. There’s a “no duplication of services” clause with most any treatment providers. I’m not sure I know how to handle some of the daily stresses without the added support. Yeah, the trauma is a HUGE factor in most of my struggles, but there are other aspects to it, not just the sexual abuse. I know that was a large barrier to my success with DBT (lots of stuff was brought up, but I wasn’t able to process it because I was expected to focus on the skills development and emotion regulation). I’m hoping this go-around for trauma processing will go smoother. I guess that is something I will have to bring up with this therapist…

I heard back from one of the EMDR therapists I had emailed. His office does not accept my insurance at this time. The other two, I have not heard from. I guess if I get a weird feeling from this therapist, or we can’t assuage my anxieties, I will check back with TL’s agency and with D’s agency. I have options for support, I just need to settle on a course of action.


Happy Tofurkey Day!

1897012_10152868130329892_2569156459545851216_nHappy Thanksgiving to all my US readers. Happy Thursday to everyone else 😉

I’m trying to not break down in tears. I pushed myself to hang with friends this morning for “Friendsgiving”, which was good. I was able to laugh and be social. I was very ready to head home after about 3 hours however… The best part though (aside of hanging with friends), was that they set out colored pencils with a paper table-cloth so we could doodle. They are big into the Wicked Queen from Snow White, so I drew them an apple… I figured it went with the theme of the day, and with their decor.

Now mom and I made some of our own dinner, so there’s take 2 on food for the day (I swear this is more food than I eat in a week, all crammed into 1 day. Gotta love the tradition of gluttony with the excuse of it being a holiday). Just have to wait for the last of it to be cooked and I sit down for another round of stuffing myself…

___________________________

It’s just after 9pm, and I find myself cruising Netflix and hulu+ for movies that might trigger tears. The feeling of needing to cry has not left, and now I just want to get it over with. I want the tears to flow and the relief to come. I know even with the growing depression, at least some pressure would be released by crying, but it’s not happening. I can’t seem to let my defenses down long enough or fully enough to let the tears escape (though they threaten at every turn). I really need the relief. I need the break in the intensity of the emotion.

I suddenly don’t know how to cope with all this. I don’t know how to lessen the emotional experiencing right now. The more I think about the implications of some of the BPD diagnosis, the scarier it gets. I keep being reminded that individuals with BPD experience things much more intensely. I keep being reminded that it’s never a matter of lessening the emotional impact of things, but more so learning to deal with it. The prospect of that is terrifying. If I have to keep going through life feeling things this intensely, I don’t want to do it. I don’t want to just learn to ride the crazy waves of emotion. I want to lessen the whole experience.

I’m not sure I can explain the intensity of the emotion. It’s more than just really sad, it’s debilitating. When anger hits hard, it’s more than just anger, it’s blow-out rage. When it’s really happy, it’s really incredibly happy. Yes, there are times when it’s not incredibly intense, but when it crosses that line, it leaps over the line and the next 10 lines after that. It’s like the difference between getting a paper cut and eviscerating yourself… Strong emotions for me are on the self-evisceration end of the spectrum, only I have no idea how to anesthetize myself for it. I know how to turn off the emotions completely, to block feeling them. I know how to put up walls and keep them at bay, but if they start to gush, I have no idea how to lessen the hurt. I have the theories and the intellectual skills, but it doesn’t help the emotions. All the learning in the world makes no sense to my emotional brain, the one that feels every emotion with the intensity of a burn victim. I know DBT and CBT are supposed to help with it all, but it doesn’t translate to the emotional side. It also doesn’t translate well to the kid inside who interprets everything as not doing good enough, not being good enough.

I’ve noticed the old “failure” tape has gotten louder and more insistent of late. It screams over everything. I’ve noticed that I need to apologize to TL when I write to her. I need to find a way to make up for being “less than”. I’ve noticed that I cannot bring myself to easily tell her that I need the weekly appointments even though I really feel like I need them. I feel this need to “be good” and muddle through the two weeks between sessions. I need to do this because I don’t want to disappoint TL. I need to manage within her boundaries, even if they are just my interpretations of her boundaries. I’m aware that a lot of this is a reflection of the transference I feel around her, only I’m not sure if I can or should try to talk to her about it. We have only about 3 sessions left at this point. If I wasn’t about to terminate with her, I might consider addressing all this, but I’m confused about the value of it if we are ending. I guess there would be value in talking about it at least in so much that then I could more easily talk to the new therapist about it (or it may be more easy to spot if I tell her about it? and easier to help navigate it?). I don’t know. I guess I should talk to TL about this. It’s really difficult though. It’s the battle between the old learning (the child inside) and the new learning. I struggle to quiet the child and make her feel safe so I can implement the new learning. It’s most certainly a struggle.

I’m realizing again that TL managed to afford me a measure of balance that I hadn’t found before. I can’t seem to allow myself to attribute the balance to any changes within myself, so I have to call it something with our interactions or how she relates to me… I don’t have enough faith in myself to believe I could accomplish something like that myself, it has to be the other person…


There’s freedom in telling

This is something I have been thinking about on and off for years. I have been of the belief that, for myself, I need to be able to tell my trauma in a safe environment. I need to be able to speak about it, to share it, to not carry it alone anymore.
Recovery from traumatic events is a very individual and personal experience. I understand the drive to have empirically based evidence that suggests a particular treatment works (especially if it’s expensive), but I also understand that recovery is not the same for everyone. Some people need to talk about it, some people benefit from the behavioral interventions, some people need to focus simply on the future.  I think when we limit the options for treatment, we limit the chance of recovery. There was a recent article on cbs.com about the VA system and how it continues to fail soldiers. They cited a lack of empirical evidence on best practices as one of the major problems. I think a greater issue is the lack of client-centered treatment.
When we try to fit all consumers into one tidy little recovery box, we miss a lot. I have tried dbt seven times.  I have failed it with catastrophic results all seven times. No matter how I protest the concept of that particular treatment for myself, clinicians and treatment providers always fall back to it saying that I “just wasn’t in the right mind-set for it”. If I were to approach them with a similar history of failed treatment that was not the “popular” one, I would be reprimanded for stubbornly trying something that has clearly not worked. Not only had it clearly not worked, but it has threatened my life every time. So why is it ok for clinicians to keep suggesting it to me? Because this is the accepted treatment modality for many of my symptoms. They no longer think outside the box of what is dictated by insurance. We are losing the creative approaches to meeting the client where they are at, and that is ending very badly for a lot of people.
My ideal situation would be trauma treatment (or any treatment) that is catered to the individual.  If things work for the person, great, let’s keep doing it.  If things don’t work, let’s wreak our brains trying to find something that does. There is no reason so many people should be failed by the system. We have research, we have experience, and we have smart people out there who can figure out how to make things work. Sadly, money talks, and it’s rarely open to backing “unproven” or unconventional methods. I’d be screwed if I had an addictions problem because so much of it is based on AA. That would be incredibly triggering and unwelcoming to me and I would fail. They would blame it on resistance, and label me impossible… they’d never once look at the fact that I react strongly and negatively to any talk of a god or higher power. They would simply say I don’t care enough about my recovery. We need to change the way we look at recovery on all fronts if we are going to be able to be successful in healing the hurt in so many people.


Honesty in treatment

I’m a believer (most of the time) that honesty in treatment is the key to making any progress.  I say “most of the time” because sometimes my fear gets the better of me and I want to hide the ugly or scary parts of myself.

In an attempt to “just breathe” and get through the weekend, I tried to take a step back from myself for a moment.  I opened up my journal and started to write a list of what I get from my behaviors and actions.  I wanted to be as brutally honest as I could be with myself, so I resolved not to show it to anyone.  I wrote all the contributing factors down no matter how shameful or embarrassing they may be.  I was originally going to make it a cbt/dbt-style exercise with pros & cons, and some challenges to the reasons, but I eventually decided to stick to simply listing the reasons.  I am not necessarily in a place to objectively challenge any of those thoughts or beliefs, so I didn’t want to torture myself further by trying (honesty can be scary, especially with all the judgements flying around in my head).  I came up with a pretty comprehensive list.  I think I covered everything I get from my behaviors. I even managed to cover some stuff I do not like to admit to myself that I get, but I wrote them down in an attempt to be brutally honest with myself.  I find myself very stuck in therapy partly because I cannot get past the shame and embarrassment of a lot of things.  I’ve made some progress with De on some of the shameful stuff, but there’s heaps more back there still.

My problem comes now in the sense of urgency I feel at needing to talk about this stuff.  I’m afraid that if I don’t talk about it right now, in the moment, and to someone who can follow-up with me on it, I will lose my drive.  I will find ways to talk myself out of the reasons.  The thick walls of shame will fly back up in a flash, and I’ll be stuck again.  My hope is to be able to talk to De about all this, but there are boundaries in place over extra contact (boundaries that I desperately need right now).  I have to wait until Tuesday to talk about it.  Intellectually (and from a professional perspective), I totally get this and know I should wait.  The little kid in me is having an emotional shit-fit however.  She’s stomping her feet and dying to beg for a chance to address this in the moment.  I’m trying to calm her down.  I know I cringe at admitting most of the list to De (a professional I have grown to trust), let alone anyone else I may not know or that may not have the professional perspective.  I know this needs to wait to be addressed in an emotionally safe environment, but damn I wish it was now.  I am trying to compromise with the emotional side of myself.  I wrote it out where De will be able to see it and know it exists, but I have asked her not to read it.  I am trying to commit to myself to leave it up where she can see it, and to trust that she will not read it before Tuesday (I have no reason to believe she would not do as I ask).  I know I need to address this stuff to be able to move past it, but I also know shame can cripple me in it.

On one hand, it’s really good that I have the freedom to show or hide from De whatever entry I need to.  It helps me censor myself and practice self-containment.  On the other hand, it allows me to hide things I may need to address but am too ashamed of  admitting.  My ability to communicate is ever-evolving.  I am still learning balance.  I’m hoping the blog helps with that.  I know if it were something I could not edit (like an email after it is sent), I would drive her and myself nuts more than I already do. I think honesty is incredibly important in treatment, but so is self-control on my behalf.  With the blog I am learning that I can be more honest when writing, but I am also learning that there are some things I need to learn to reign in.  I am able to spill a lot to her, but also go back and hide things or reveal things after the initial emotional spillage.  As L reminded me this morning, sometimes things need to “marinate” before being addressed. I’m grateful De puts up with me and my alternating emotional explosions and implosions (sometimes she gets way too much info, other times I am unable to give her anything at all).  I’m learning the balance with honesty also.  Right now, I am at the stage of needing to be able to tell her everything and be taught what needs immediate addressing vs. what can wait… I hope she doesn’t hate me for this learning process. She only has to put up with me for another 2.5 weeks anyway (I know, not an excuse to completely lose my shit right now)…

::deep breath:: the process of learning things as an adult that I never learned as a kid is incredibly trying and painful… and way more difficult because as a kid, it was expected that I didn’t know this stuff.  As an adult, I should know better by now and be past these little hissy-fits.