Wednesday, July 31, 2013

Becoming an Emotional Grown-Up

Emotions are a hard subject when you have spent your life learning to suppress them.  Then comes the big SMACK in the face when you learn that this is counter intuitive.  You can suppress emotions all you like, but they will find other ways to come out.  For years I turned my emotions into self harming actions because as a child  I learned that showing my emotions only brings hurt and pain.

Now I am slowly learning to let those emotions out.  Naming, feeling, showing... all parts of emotion education that I missed.  I find myself wanting to go back to my maladaptive ways.  I have even gone so far as to find NEW maladaptive ways to handle the on pouring of feelings that comes with opening yourself up to a significant other.  My wife has been very supportive in my recovery process.  So much so that it's become a problem.  So part one of taking responsibility for my own emotions was asking her to NOT support me if I engage in a self harming behavior.  I even outlined what that was, what to look out for, and how to not support me.  I asked her to not comfort me, bandage me, or help me recover after an episode of self harm (SH).  Also, I asked that she tell me when she's upset, disappointed, disgusted, etc with my SH.

This started during my outpatient program.  Having a program therapist who understood my need to extinguish, not just lessen, my SH behaviors helped.  I soon learned how to do a behavior chain and then found myself doing many- one for every time I engaged in any form of SH (including self injury, disordered eating, and therapy interfering behaviors).  This helped to stop the latent SH behaviors and to help me start learning to see the patterns building up to urges and behaviors.

A couple of weeks ago I started part two of claiming responsibility for my emotions: making a safety contract. In the fourteen years that I have done therapy I have only ONCE signed a safety contract and that was because that therapist gave me no option.  It was a cover-her-ass move.  It basically said that I had to try to contact her or any help line I could (not that she ever gave me the number) and that I would do everything in my power to not harm myself.  I did everything in my power to never mention self harm to her again.

This time I made my own safety contract.  I held myself to the fact that I would not engage in self harm, disordered eating, and therapy interfering behaviors.  If I unintentionally do engage I have to fill out a behavior chain.  If I intentionally engage in my target behaviors it is at the discretion of my therapist whether or not I continue in therapy with her.  She added some bit about making an appropriate reference, but that's not the point.  The point is when I do these behaviors I now have actual consequences.  No more "are you okay?" and late night post-harming phone sessions.  Now if I engage in behaviors I just have to do a behavior chain and bring it in the next session.

Another thing I have done is changed the format for therapy phone calls.  Instead of being able to call and discuss crisis with my therapist she is now acting as a phone coach.  I have to use at least three skills before I can call, I have to tell her what skills I've used, and I have to be open to any suggestions given.  Five to ten minutes tops.  It's a more effective way of handling crisis and it makes me have to use my skills.

I am finally become an emotional adult.  No longer will I hide behind excuses.  There may be external causes to my behaviors, but ultimately it is my choice to give in or to use the skills I have worked so hard to learn.

Anyone interested in what skill sets I'm talking about, you can find more information here:
An Overview of DBT
Basic DBT Skills Outline
How Therapists Integrate DBT Skills

Thursday, July 4, 2013

How To Be Angry With My Therapist

I have done a lot of thinking since my therapy session on Monday.  I still agree that what is happening with my therapist is good for me, but now I am realizing how angry I am.  Anger is a hard emotion for me.  I often don't let myself feel it.  The past four days I have not only been feeling it, but taking it to that unhealthy place where I ruminate about what I'm going to do with it.  I realize that going into my next session yelling and accusing is not going to be the most beneficial way to deal with it.  I also know that ignoring it and attempting to just "see what happens" is not healthy either.

So here I am caught in my dilemma: do I go in, guns blazing, asking my therapist the various series of questions I have or do I sit back and see what happens?  And if neither of those is truly effective, what's the middle ground?  Before I really dive into my options, let's look at what's bothering me:

Why is my therapist so caught up on my ER visits?

Last session was the third time since the beginning of February that my therapist has asked my opinion of why I was in the ER so often in the beginning of the year.  I get that maybe some of those visits weren't necessary, but I don't get why she is so hung-up on them.  I have trouble asking for help and when I do decide I need help it's normally because I have decided I'm in crisis.  So this is something I need to work on.  I realize now that a lot of the pain I was feeling was from flashbacks of being abused, but acknowledging those flashbacks is hard and being in the moment to realize that the pain is a muscle memory is even harder.  I still don't know what ER visits were for "real" problems and what were for psychosomatic issues.  I'm embarrassed by this self-perceived flaw of mine.  So I'm not thrilled to have it pointed out several times by my therapist.

Why am I suddenly hearing a lot of "what do you think? what do you need?"

Granted, my therapist has always been the one to push me when I try to delve into hard topics.  Never before have I experienced her using the "what do you think" clichè as a first line of defense.  Normally she'll have a quiet moment of thought then either ask me questions for clarification or explore the topic with me.  Suddenly I find myself bombarded with these questions.  I wonder if on some level she is just so exasperated that it's hard for her to hear the same questions from me over and over again.  I also wonder if she is struggling with the idea of continuing therapy with me.  I know it's hard to hear me say "I want to change" over and over again just to see me end up inpatient or attempting suicide or hurting myself over and over again. It's been almost ten years of this off and on and I'm tired of it, so I can't even imagine how she feels. However, I do feel I have the right to be taken seriously if she has decided to keep me as a client.  It may be hard, it may be exhausting, but I am STILL her client and I STILL deserve to be treated as such.  I'm not the friend who keeps coming back with the same crisis, I'm a patient who is having a very hard time accepting what getting better means and who needs help facing the fact that I deserve to get better.

Why is it that I felt slightly attacked last session?

Perhaps it's my own interpretation.  More than likely it probably is.  But I still felt that during my last session my therapist was definitely frustrated with me and my crisis.  She was trying to make several points and attempting to distance herself from me (or so I feel), but in doing so I felt I was being punished and shamed for what I did.  I know it wasn't right. I know I definitely made several mistakes that must have had a severe impact on her, but she made the choice to keep working with me.

What this all boils down to is a series of things that I have to address with my therapist.  I need to do so in calm manner and express myself, but I can't disconnect the way I normally do when addressing problems with the working relationship we have.  It makes me uncomfortable to confront her, but I know that in order for me to keep making progress I have to do this.  I know my best bet is to be upfront with her as soon as the session starts.  Let her know what I feel about the last session and give her a chance to process with me what happened.  After all, she is human and has feelings too.  On the same note, she's my therapist and I deserve to have therapy cater to my needs.

It is very hard to even acknowledge this anger.  I fret that I feel slighted just because I'm embarrassed.  I fear that I took everything in the wrong manner.  I seriously am afraid I'm making a mountain out of a mole hill.  In the face of all of this, I realize that these might be true but I'm still angry.  And there's the dialectic.  I have every right to feel angry, but I have to choose to be effective with it and not destructive.  It seems the time has come for me to acknowledge, feel, and deal with anger rather than pushing it down like I normally would. This is the first test in bringing my true self into the therapy room: allowing my anger to be there and address it rather than deflecting with something positive that has happened.

Seems that my life is no longer made of baby steps, but long adult strides that must continue at an even pace.

Monday, July 1, 2013

Learning to Forgive Myself

 First time going back to my private therapist after finally finishing my outpatient program.  It took four months, five re-starts, three hospitalizations, and a lot of self-learning to get to where I am. No amount of prepping could have had me ready for tonight, though.  Re-starting therapy can be a wonderful thing, especially after an intensive program like the one I was in. Sometimes it can be like ripping a band aid off a hairy spot on your leg- quick, painful, and leaves a lingering red spot after.

Certainly, things have to change for both my therapist and I.  Nothing can ever be the same after a client walks into a therapy room after having OD'd on meds.  To make matters worse, there is the electronic suicide note I sent out to her.  We discussed some of this during the two week lapse I had in program, but mostly those two sessions were to distinguish that I still wanted to get better and that it was unacceptable to do what I had done. Tonight was different.  She came in prepared and ready to lay down the law. Our dynamic has been forever changed.

No longer will I be allowed to come in with my thinly veiled self and attempt to joke around and deflect.  Suddenly I find myself re-starting completely with my therapist- back to day one- assessing my goals and having boundary lines finely drawn.  This is the consequence of what I have done.  I am not yet sure if I like it, but I know that it had to be done.  I know that therapy couldn't go on forever the way it was.  In January I had started to try to break through my barriers.  I was looking at the way I presented myself in session and what I had been leaving out and not talking about and I was preparing to change.  I didn't know how to.  I got scared, I got hopeless, and I attempted to take myself out of the equation.

Problems never just go away.

I spent a lot of tonight crying over the loss and the fear.  And then I let myself let someone else in.  I told my wife how I felt.  I cried, I yelled, I let myself feel.  And then I understood: sometimes dynamics must shift in order for major change to happen.  It's not just about me and what I need; it's also about others.  However, those others can handle their parts on their own.  I have to take responsibility for myself, my actions, and the consequences. It may seem unfair, but it's not about being fair. It's also no longer about what I want, it's about what I need.  And right now this is what I need.

I may not be responsible for being here, but I am responsible for getting myself out.

I know that I am responsible for some of it- the suicide attempt, the note, the acting-out.  However, some of it was beyond me- the trauma, the façade I had to make to survive, and the maladaptive coping mechanisms I have come to rely on.  Now their time is done and it is time to embrace who I have become in the face of all that.  It is time to take responsibility for all that has happened and to make my life my own.

I started out with the title, "How I Turned My Therapist into a Bitch."  I realize now that I didn't turn her into anything.  Nor was she really a bitch.  I was just embarrassed at all that I had done and shocked to find that I will no longer be enabled. My reaction to tonight's session had nothing to do with my therapist and everything to do with learning to forgive myself.  So tonight I start with accepting the fact that my therapist still wants to work with me.  No need to look for the "why"s and "what if"s.  I'm just going to practice some radical acceptance and be thankful that I have the support. I'm taking one moment at a time and trying to live my life mindfully.