Monday, 30 April 2012

Impermanence - Finding the Dialectic of Emotion

Nothing is permanent. The goodness in life passes in the same way the bad periods slithers by or sticks to our awareness. Positive emotions and experiences leaves a good taste long lingering in my mouth, but it can be rudely interrupted and all too quickly be contaminated by the next onslaught of pessimism. 

I swing widely between the poles of ‘good’ and ‘bad’ judgement, rarely receiving the respite which a balanced, middle ground provides. Take for example the last 24 hours. This time yesterday I was curled up in bed, steeped in self pity. I felt so ashamed and selfish wasting a whole day doing nothing to help make me feel better. I knew I needed to do the housework, go food shopping, have a shower, go for a walk, meet some friends, go to mass, send emails ….. the list went on and on. I was feeding my negative emotion and allowing it to gain nourishment from each moment spent lying in that bed. I was down in the depths of my emotional rating, and I honestly thought that I was the biggest failure on the planet that I should just give up on life and that nobody would care if I was gone. 

Then I wake up today, still feeling the hangover of negativity surround my aura. I dragged myself to an interview for some potential writing experience with a local newsletter. It took every morsel of energy to find the motivation. It was raining, ‘typical’ I thought. I missed the Bus; I was convinced it was a sign. I didn’t have the full address; I should just give up, it’s not going to work out anyway. It really was a miracle I got there in the end. I hadn’t even researched the organisation, certain that it would be a waste of time as I would never get the job. 

If I look back and evaluate the emotion I was experiencing, I was really nervous. Fear wanted me to run home and hide away, to avoid, sabotaging any chance at a life worth living. But being the suborn mule that I can be sometimes, and because I had told some people about the interview, I felt I must go, even if to say I went. 

I actually found the place with relative ease, and was greeted by two lovely ladies who seemed interested in me and appreciative of what I could potentially bring to the organisation. We brainstormed ideas and I felt excitement build up in my tummy. The more I talked to the two lovely ladies there, the more confident I felt in my abilities. I could really do this. They really do like my ideas. To my delight, they asked me to contribute to the June issue and gave me a deadline for submission next week. 

Walking towards the bus stop I felt elated with happiness. I felt like I had overcome the fear which stops me from doing so much in my life, like I had climbed a personal mountain. I was propelled into a heightened state of positive emotion, a world away from the foul mood I had been in only hours before. I grinned childless to the bus driver and sent a barrage of texts and emails to friends and family bombarding them with my good news. 

Now that the initial exhilaration of this morning’s achievement had subsided slightly, and I am not so ruled by my emotional instability, I can see how exhausting this yo-yoing of emotion is to my emotional stamina. If I try hard to be dialectical in my thinking about today’s events, taking into account the importance of living in the moment, I guess the middle ground might be as follows; 

I spent the day resting in bed yesterday, even though I had a lot to do. By doing this I was reminded that staying in bed all day negatively affects my mood. I do need to lie in sometimes, but next time I might only rest for the morning, and get some tasks done in the afternoon. I allowed my bad mood to continue into today. Each day is a new page in my life. I can start afresh if I do not hold onto the past. It was a great achievement to obtain the job this morning. Congratulate yourself. Now move on to concentrating on the rest of today’s tasks. 

I aim for this balanced way of thinking in all my endeavours. When I read it back I don’t feel any overwhelming emotion either positive or negative. I just want to move onto this afternoon. I have a focus group to attend which has nothing to do with the newsletter. 

Have you ever had a similar experience? How do you stay centred?

Friday, 27 April 2012

Upgraded Armour. Reflection on The Center for Living


I abilities feel stronger, robust even. My suit of armour has been fixed and polished. Inside the suit I am vulnerable, full of emotions and open to triggers, but now that all the chinks and dents have been smoothed out, I am prepared for the onslaught of emotion, armed and ready with more skills. I feel humbled and so glad that the Centre for Living proved me wrong. It’s not easy for me to say that. I like to be right, but I was really mistaken about the programmes ability to help me evolve in my understanding of DBT.

The most valuable morsel of information I am leaving with today is that my life is never all-or-nothing. Just because I had a bad morning, say I eat more than I planned, it does not mean that I need to discredit all the other good things I achieved that day.

One particular therapist was really wonderful. It’s not that she thought me anything new; in fact at first I found it hard to participate in her sessions as I thought I had heard it all before! But the longer I sat there, the more everything just ‘fell’ into place. It’s about using the DBT skills together, in tangent with each other, it’s about weaving the mindfulness skills into everything I do, not just sitting quietly observing my thoughts for 10 minutes a day. It’s about noticing the grumbles of anxiety before the fear takes over and I loss control. It’s about catching the little niggles of frustration and quenching it with self soothing skills, so that intense anger stays at bay. It’s not about the food, or the behaviours. I need to be mindful long before I get to that stage. It’s always about the emotions. This therapist clawed me back to WISE MIND and is a perfect example of the therapy really working, of it making sense.

I found such great validation in the other service users I met over the last 2 weeks. We were all at different stages of our recovery journey. Most were at the beginning of treatment, just becoming accustomed to the structure of DBT, and still exploring the diagnosis. Some had accepted it, others were still fighting it. Some simply didn’t understand it and hence couldn’t make an informed decision either way! We were all sitting in that room because of a common link. We all in some shape or form lacked the ability and skills to deal with our emotions. I found comfort in being reminded that I was not alone, that there are other people out there going through this hell. 

Wednesday, 25 April 2012

Distraction. ACCEPTS, Distress Tolerance


Everyone loves progression right? Well I know I do in any case. Today in group we finally moved onto the next module: DISTRESS TOERANCE. Again, this is a nice inoffensive, non triggering topic. This time round anyway. Last time I found it hard to accept that these skills won’t solve all my problems straight away, as in right now! But rather they are designed to help you to bear pain skilfully without making the situation any worse. (Marsha Linehan 1993)

This set of skills is for when in the throes of an emotional crisis. When the problem can’t be solved, or if it can, maybe it is simply not the right time to solve it in that moment. It may not be the right environment to try to solve the problem either; for example, I am not skilled enough yet to stay emotionally regulated around my family during disagreements, so for now, using the DISTRESS TOLERANCE skills is the best solution for me. When I am in a food crisis, where I am trying really hard not to binge or purge, then being at home or around food is most defiantly the worst environment to be in, so some skills might not be as effective. And parallel to that, sometimes I can’t get away from situations involving food; this is when I find DISTRESS TOLERANCE skills really help. I like to think that my cue to use the distress tolerance is when I reach my complex skill breakdown point. It is also a way for me to find wise mind and calm the moment so I can try a solution focused skill like OPPOSITE ACTION, because it’s really important to not spend all my time self soothing or distracting! I would never get anything done!

What I picked up from today’s group is that PREPERATION is the key for these skills to REALLY work, and to allow myself to gain maximum benefit from them. We are always being told to practise the skills in less emotionally intensive situations so as we are familiar with them when we really need them when deregulated. So that is the aim of this post. To put together a list of distraction ideas based on the skill WISE MIND ACCEPTS.

DISTRACTION for CRISES SURVIAL is not the same as ‘zoning off’ when a problem CAN be solved, like staying in bed watching Disney films and avoiding the real world for days on end. That will just make it worse! WISE MIND ACCEPTS is for when you have to tolerate the situation in a way that is not harmful to yourself or others.

WISE MIND ACCEPTS stands for:
A – Activities
C – Contributing
C – Comparisons
E – Emotions
P – Push Away
S – Sensations

These are some of my own ideas; things which I know will help me during a crisis. Again, it is a work in progress and as always I would love to hear all your suggestions.

Activities Throw self into the moment.
·         Reading books – Silly novels, short stories about unimportant topics, Sci-Fi, Harry Potter. NO non-fiction. Magazines, trashy or glossy! Read recovery Blogs, Karyn Hall, Audio Books
·         Exercise - Get active, something intensive which demands focus and attention. Zumba class, Yoga.
·         Hobbies – Music, learn a new song on the guitar. Art and crafts. Writing, blogging. 
·         Mental activities – Memrise.com. Word games, scrabble on phone, Memorize a poem or prayer. Write a poem or short story.
·         Cleaning – Bedroom, Kitchen, Bathroom, Make-up, Wardrobe, Cooking, Washing
·         Events – Go see a movie, a play, a show, a lecture. The Silent Room, Meditation class. Google entertainment.ie, Hospital lectures.
·         Friends – Meet up, text, call, chat, email….. But DO NOT talk about crisis.
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Contributing - Focus on something/someone other than yourself.
·         Volunteer time, Hospital, Church,
·         Do something nice for another person. Bake, cook, send letter/card
·         Surprise someone, pay for coffee, buy something
·         Send nice text, Email, facebook
·          Smile at shop assistant, people on the street.
·         Give money to charity, buy food for homeless person
·         Visit Nana, Granny, Someone who is sick
·         Say prayers for the well – being of others

Comparison – Remember, it could always be worse
·         Compare myself to myself this time last year, a few months ago, even a few weeks ago!
·         Compare myself to others in my situations who are coping worse than me.
·         Compare myself to the rest of my family who have the same condition who are not accepting and coping with the disorder.
·         Be thankful for what I have

Emotions – Create opposite emotions to the one you are experiencing.
·         Music – create ‘happy’ playlist, ‘upbeat’ playlist, ‘relaxing’ playlist
·         Movies – Disney, Comedies, Period Dramas, Scary films
·         Comedy show
·         Read romantic books, thrillers
·         Read inspirational stories or poems

Push Away – Allow yourself a break from the emotion/thought
·         Mentally leave the situation, go to another ‘room’ in your mind
·         Give it to God box
·         Do a guided visualisation on Youtube

Thoughts – Focus mind on thoughts, Take a mental ‘Time-Out’
·         Count to ten
·         Count your breath
·         Visualise STOP! Sign
·         Look around, observe the things around you, and name them.
·         Say the same thing over and over in your mind. Breathe in WISE breathe out MIND. Over and over

Sensations – Interrupt physiological action urges with something intense which will not harm
·         Have a very hot or cold shower. Alternate between the two
·         Hold ice, eat frozen fruit
·         Go swimming, use the steam room
·         Suck on a lemon/lime
·         Snap a rubber band on your wrist

I cannot stress the importance of being prepared ahead of a crisis, and also it’s so important to find what works for you. It took me a really long time to figure out that these things work for me.

Monday, 23 April 2012

Hot Cross Bun (CBT) Model of Thinking/Feeling/Behaving


Today we were asked in group to write down how an emotional crisis looks like and feels like to ‘us’. The worksheet was based on the well known CBT (Cognitive Behaviour Therapy) ‘Hot Cross Bun’ Model. Even though I have seen it a million and one times before, it really helped to revise it, and use it in relation to DBT skills. This is the model in a picture format.

I find retrospective thinking hard to do, as I find it difficult to sense any emotion other than the one I am experiencing at any one particular time, no doubt it’s a BPD thing. None-the-less I tried hard to imagine a scenario where I was overwhelmed by an unpleasant emotion. Here is some of the dialogue which helped me to complete the worksheet. I really found this particular therapist very helpful today, I guess it’s nice to have a change in health professionals every now and again to gain new perspective
.
My Reflection of Myself in a Crisis

Example: Getting letter to say that a course I have been waiting to attend for many months has lost its funding and has been cancelled.

·         How do I feel?
Me; “I feel as if everything is overwhelming.”
Therapist (T);”Can you identify the emotion behind this statement?”
Me; “Well, it’s like I become paralyzed by fear and anxiety or worry.”
T; “So, is it fair to say that anxiety related emotions would be your initial or strongest feeling?”
Me; “Yes, anxiety, fear and worry.”

·         What bodily sensations do you notice
Me; “My body can become very tense; I fold my arms and cross my legs and clench my jaw”
T; “Is this when you would notice you are in an emotional crisis?”
Me; “No, probably not to be honest, it’s more when I feel like I can’t catch my breath, am shaking or have a migraine. Sometimes I become very tearful.”
T; “Ok, it’s really skilful that you can realize that. It gives you scope to work at leaning to catch the anxiety at the earlier stages, rather than it escalating to a higher intensity.”

·         What Thoughts Come to your Mind?
Me; “This feeling will never go away.” “I can’t manage.” “I should be able to manage/cope better” “I need to do something to change/stop how I am feeling RIGHT now”
T; “Well done on identifying these thoughts. The way to help change them is to weigh up the evidence for and against them and challenge them by asking; ‘Are these thoughts rational?’ Can you come up with a fairer, more tangible thought which will be more solution focused?"

·         How Do You Act?
Me; “Well because I can’t think straight, I tend to resort to behaviours which, when in wise mind, I know are harmful in the long run”
T; “What kind of things?”
Me; “I have a list!, I will avoid any situation which feels overwhelming, even if I know it needs to be dealt with and will even avoid doing things I enjoy. I stay in bed, and isolate myself by not contacting anyone. This time I didn’t open any other letters, couldn’t respond to emails or texts.”
T; “That makes perfect sense to me, but as you said, it doesn’t really help solve the crisis at hand.
Me; “No it doesn’t help, even makes it worse. I become very emotionally deregulated and resort to old destructive behaviours such as binge eating/drinking, which leads to secondary emotions of shame and guilt  and then I feel I must punish myself by self-harming to make up for it. Then it basically starts the whole cycle off again doesn’t it!
T; “Exactly! Here is where you can intersect the cycle to change the emotional and behavioural outcome by noticing initial bodily sensations before the thoughts and behaviours take over.

We then went on to cover all the ACCPECTS and SELF SOOTHE skills which can be useful to change the intense emotion. I will be making a separate post about the ACCEPTS skills as I am still putting together what works for me.

I guess I just wanted to go over this exercise, and always find that here, on my blog, is a great way to reflect. The biggest lesson I learned today is that I can always learn something new, even if I think I know it all! It feels good to have bashed this out again. I hope it helped you to read it too.

I would love to hear if this model has ever helped you.




Thursday, 19 April 2012

The Raging River of Emotion


My intricate network of defective nerves carrying the equally faulty transmitters must have decided to jolt its self back into action today. I sat for a while in the chilly spring sunshine before my weekly ‘me-time’. It really is such a delight to have a whole hour where I can simply talk about me, and I know that my therapist will give me her full, exclusive attention. That sounds conceited, I know, but I don’t care. I have spent too long neglecting my own turbulent mind.  I thought about how privileged I really am while I sat on an ugly and uncomfortable plastic bench outside the treatment centre. ‘I have someone who gives me time to talk and helps me to become a better person; I have a confidant, a sounding board.’ Then it struck me; ‘I have never given myself so freely and truthfully to anyone before and I have never felt such empathy from another human being in my life.’ It feels peculiar, both excellent and shocking at the same time, for I feel extraordinarily exposed and vulnerable having another person on this earth know my secrets, yet relieved that I don’t have to bear the weight of them alone anymore.

We have an idiosyncratic relationship, in so far as I would never choose to disclose such prized and feared confidences to this woman if I knew her casually. To be honest I don’t know if before DBT I would have been able to tolerate her mannerisms. She is quirky and a bit disorganized. Actually she reminds me of my mother; extremely caring yet frustratingly scatty. I got the feeling that I also annoyed her (but of course that could be BPD thinking!). She seemed to resent how little progress I was making despite how well read up I was on the DBT material.

Before we had even met last summer, I had read Marsha’s Training Manual, and shimmed her major body of work: Cognitive-Behavioral Treatment of Borderline Personality Disorder. 1993. I am an intelligent woman when I want to be, and I like to be primed and set to tackle a problem when I feel able. I am always able to read. So for the year between getting my diagnosis and accessing the right treatment to treat it, I read everything I could get my arduous little eyes on. I spent hours scouring the internet for reliable sources of information and weaving together the best comprehension I could grasp outside of a Clinical Psychology Doctorate. Luckily I still had my University student library admittance which afforded me full access online to both the British and American Medical Journals. I also had a good grounding in mental health from my years studying Occupational Therapy.

Now all that stood before me was to somehow turn my culvert of knowledge into tangible skills. And annoyingly, I couldn’t do it alone. She was the bridge I needed (but didn’t want to have to rely on) to pass over the violent river safely. Battling the raging currents of emotion alone was not working anymore, but I couldn’t see that. I fought for weeks not only against my emotions, but against this woman who said she knew a better way across and wanted to help me get there. I didn’t believe her. She couldn’t understand my internal conflict, no-one could.

At first I thought she came across patronizing, one of the many things which annoy me about her. Yet, as the weeks wore on, I realized she was merely reciting little Marsha-isims. “How can you create a life worth living, if you are not willing to participate in the therapy?” And every time I would be self critical or chastise myself for my transgressions, she would pipe up and bluntly cut across me; “That’s a judgment!!!” So for a while I stopped talking, I stopped telling her anything and I continued down my white watered river of destruction!

Now that I am a few months down the watercourse, the rapids are less frequent and some tributaries of support have joined my journey towards the sea of recovery. The emotions are still there as is the water in the river, but I have more energy to swim back and survey the journey as the intensity of the emotions have subsided and the volume of support has grown.

Even though we still don’t always see eye to eye, I am now at peace with my therapist and the service as a whole. I can see how far I have come, and how far I still have to go, but like the river, it only really flows in one direction… towards the sea. I guess my route has simply taken a small meander along that path. 

Monday, 16 April 2012

Distress Tolerance SELF SOOTHE Ideas

Distress.  It is impossible to avoid, no matter how charmed your life may be.  Emotional pain and distress are an inevitable part of life. Yeah, I was annoyed when I heard that first too. But even the Duchess of Cambridge has crap to deal with!  The inability to learn how to effectively cope with intense emotion and distress only leads to increased suffering. I found that using my senses to soothe my distress really helped me to tolerate the emotions which were troubling me, without having to use other people as that crutch to stabilize me.

The goal with self-soothing skills is to comfort yourself emotionally by doing things that are sensually pleasant and, most especially, not harmful. At the same time, focusing your full attention on sensory inputs — on what you are physically experiencing in the moment (mindfulness) usually will get people outside of their own heads (and away from troubling thoughts, feelings, and impulses).
Learning to relax and self-soothe is crucial to healthy emotional functioning.  When you are relaxed, your body is not in a constant state of “emergency,” preparing to fight or run away at any given moment.  Most importantly, your brain is much more capable of coming up with healthy ways of coping with distress when physically relaxed.

I find that having a self-soothe ‘box’ is my saving grace, having it ready and stocked with all the things that I know work for me. What works for me also changes depending on the emotion, for example when I am upset, hugging a teddy is a fantastic, yet when I am angry, having a long hot shower nearly always helps me calm down.

Recently I was brainstorming some new ideas for my box, I asked some wonderful friends in a DBT support group on facebook, and found that it was the best thing I could ever have done! Between us we came up with a list which can be used as a reference when trying to think of something to RELAX AND SELF SOOTHE when undergoing extreme distress.

The skills and techniques listed below are a starting point only. Everyone has to find what works for them, and it may even be things that are not on this list at all, but if you are stuck, try some and see if they work. A good way to orientate yourself to self soothe is to really and mindfully focus on your senses while using these. Not all these things fit into my 'box' but that's why I am writing this post, so I can look at it when I am in distress.

RELAX and SELF SOOTHE ideas! (Please feel free to add ideas in the comments, this list is a work in progress!)
  • Try something little to begin with, such as using a nice moisturizer on your hands and face after you wash them, also face and hair masks are bliss. I've been trying to do this for the past few weeks and not only does it help me to feel as if I am WORTH looking after, it has also dramatically improved my skin tone etc... (Life worth living!)
  • Curl up with a blanket wrapped around you and a teddy bear. This is great for when I'm feeling little and afraid or upset and tearful. I like lavender filled wheat bags, heated in the microwave and placed on my neck.... I do this regularly when I write! 
  • Watch a favorite movie (that way you can zone out and don't have to concentrate) Something mindless or funny is even better! My personal choices are; Pride and Prejudice, Shrek, Beauty and the Best, Emma, Actually..... any of the period dramas! I love the dresses!
  • When was the last time you took a moment to gaze at the ocean and just watch and listen to the waves hit the shore?  It can be a wonderfully mesmerizing and stress relieving experience.  How about watching an exquisite sunset, or the leaves on a tree blowing in the wind?  These experiences are natural stress relievers and can provide wonderful moments of tranquility.
  • Do you have a favorite piece of clothing to wear, something you instantly feel safe and comforted when you put it on? I have a pair of old baggy battered velvet purple pajama bottoms. They are so old and raggity, but I can't get rid of them! And I like to wash them in a nice smelling washing powder that my Mom used to use.
  • Candles are relaxing and scented candles are truly a plus.  Most people enjoy the soothing benefits of soft candle light combined with the pleasing scents that aromatherapy candles can provide. I personally love Yankee candles as they are strong and are inexpensive. I have a fireplace in my room which cannot be lit anymore, but I fill it with candles and have a little meditation session when I am stressed, always works a treat!
  • The best way to self sooth myself, I find during extremely intense emotional experiences is to retreat to my bedroom, and put on a tried and trusted self compassion relaxation. It was introduced to me by the wonderful Amanda Smith from Hope for DBT.  Here is the link for the 15 min meditation; 
  • I find that art and crafts has a very soothing effect on me, and while I was inpatient I learned about mandalas, which are a form of meditative art, although they have a spiritual aspect to them, I find simply coloring in the patterns so relaxing and creative. Here is a link to a site where you can download and print out some to have ready for when you need them.
Website for Mandalas
  • Photography forces me into the present, I have to be mindful to my surroundings and almost get a sense of external perspective through the camera lens. So if I feel the urge to binge.... I grab my ready packed camera pack and head outside and snap away! Even looking at happy memories through old pictures helps me too, like of the time I went traveling, or my 21st party.
  • As I suffer from an eating disorder, using my sense of taste can be hard, but I have bought some lollipops to suck when I am angry as for some reason they help! I also find going out for a hot milky drink soothing, I have hot chocolate since I gave up caffeine last month, especially from Starbucks!
  • Music is my lifeline, always has been ever since I realized that I can use my voice to express my emotions when words fail me. I love to sing and play guitar. Classical music are art to me, so I have few pieces which always help me calm down, especially during exam stress or when I was grieving a loss. I have made a playlist on youtube, which I am not going to post on here because everyone has different tastes, but I will post a song, which I feel describes how important it is to validate your emotion.

  • Finally, a good old fashioned hot bath or long hot shower will always bring me back to the present, relax my body and calm my mind

For a very good alternative explanation of SELF SOOTH go to dbtselfhelp.com , This site is my online bible!


Saturday, 14 April 2012

Personal Responsibility and Action Plans


For a week filled with extreme emotions and tear stained streaks down my cheeks, I am feeling lighter. Clich├ęd as it may sound, I feel like a weight has been lifted off my mind, well actually, it’s been yanked off my mind by harsh but powerful words and my own realization that I am the only person who can ‘fix’ me.

If I was to summarize my experience of this last week of intense treatment, it would be in two simple words ‘PERSONAL RESPONSIBILITY’. I have been jolted back into reality being on this programme. No-one is going to do the work for me, no matter how much I want it; it simply is not going to happen. No prince is going to ride in on a shining white horse and save me from the BPD monster, but I can get on my own horse, learn how to ride it and trot away into the sunset myself.  Personal responsibility in my recovery involves taking action and doing what needs to be done to get well and stay well. It involves problem solving, making goals and sticking to them. It involves making promises to myself, not my family, not my team and not my friends. It involves taking ownership of my life and my future. I must remember that am an expert on myself and gain back control of my life.

I have been given a wonderful sense of empowerment, while still validating my emotions. I am so afraid of what my life will bring now that my future is so uncertain. I feel it in the pit of my stomach; I have noticed the inability to catch my breath and the hot sweats I break out in when thinking about what I will do. Yet although these emotions wash over me, and I feel them, they are not going to change or improve my situation.

I have been really trying to use the core skill OPPOSITE ACTION in response to the anxiety. My action urge is to avoid, not thinking about options, not to get advice and not to apply for opportunities. That way I can’t be disappointed again, I can’t be rejected. Yet I am also not helping the problem, I am not giving myself a chance at a LIFE WORTH LIVING, and am pilling more misery on top of misery. More fear on top of more fear.

To go ALL THE WAY with this skill, I have to stop procrastinating and ‘just do it’ as the Nike ad tells us. One of therapists always tells me that ACTIVATION PRECEEDS MOTIVATION, so even if I don’t feel like applying for the internships, jobs, courses or voluntary work I just have to do it, then I will feel the benefits of my labour after.

It’s so hard in real life though, so the way I have tackled it is by making small little steps. The number one reason we put off improving our lives is because big changes feel so scary and unattainable. Which is why breaking goals down into small steps is the secret of success. There’s less fear when you’re just concentrating on what you need to do that day, and as you stick to your good intentions, you’ll be motivated to carry on until your new habits become a way of life. I was told to write your goal down on several pieces of paper.  Hang them up everywhere.  This is my first step to focusing on my commitment. Then make lots of smaller easier to achieve goals for each step of the bigger goal.

 So here it goes; I want to get back to university. I want to do a health science related degree. I either want to study occupational therapy or midwifery. It’s been my dream since I was a teenager, and I was two years into my OT degree when I had to drop out due to BPD.

Step 1: Find out what I need to achieve to get onto course and what university I can study in.
·         I need to have the skills to stay in university for 4 years,
·         Be able to endure 8 hour days of lectures/study.
·         I need to have communication skills to be able to interact with other students.
·         I need to be able to manage stress and have good time management.
·         I need to have the finances in place to support myself for the four years.
·         I need to be physically healthy and emotionally fit.


Step 2: Finish DBT and fully engage in therapy to learn new skills.
·         Attend DBT skills group and individual therapy every week.
·         Complete all homework and be willing to learn new behaviour patterns.
·         Adhere to DBT contract to create a life worth living

Step 3: Attend a less intense course/internship/voluntary work in order to build up skills and confidence.
·         Research opportunities online with voluntary organisations and apply for any that interest me.
·         Talk to and ask others about different opportunities.
·         Update CV and write cover letters.
·         Follow up on all leads and correspondence.

Step 4: Get finances in order
·         Talk to social welfare office
·         Find out about financial aid for going back to university.
·         Continue to babysit and pick up small manageable jobs
·         Set up credit union account.
·         Try to save when I can.

Step 5: Work on personal relationships
·         Stay in touch with friends, and be appreciative of their love and support.
·         Reach out to family; be considerate and patient as they are also learning new skills.
·         Make efforts to create new friendships.
·         End destructive relationships.
·         Be honest

Step 6: Foster and develop creative talents and interests
·         Make regular time to write/attend writing classes
·         Listen to music daily, sing.
·         Keep art supplies stocked and ready to use
·         Make cards/collages/draw/paint
·         Learn new things as often as possible.

This is all I can think of right now, but I know that more steps and action plans will emerge from these rudimentary goals. It feels good to have a plan, something to work towards. i don't feel so empty ans lost. 

Monday, 9 April 2012

Objective Self Compassion

So, after spending time in the south of Ireland with my sister (and the baby bump!) and brother-in-law, where my Mother lives with her new husband and his daughter, I am pleasantly relived. I was really worried about spending so much time with my family, as previous comparable experiences have resulted in vexing squabbles and quarrels. I understand now that my sensitive and highly emotive character can be very vulnerable to the criticisms and teasing which occurs within my family unit. Simply OBSERVING this helped me to muddle through the weekend. It also helped me to take a NON JUDGMENTAL STANCE towards myself, something which, until recently I have found incredibly difficult to do. Self compassion just was not something that I was able to accomplish before. A constant record was stuck on self hate in my mind. I believed that I was not deserving of compassion and was not allowed to give it to myself. One of the greatest lessons I am learning in therapy is the gift of self compassion. I am starting to treat myself as I would like to be treated by others, and also how I treat those around me, as I have a great ability to be compassionate to others, but am terrible when it comes to being kind to myself. 

I had so much time to think between the car journeys and early nights with little to do in the countryside. I astounded myself with a realization of how far I have really come in the last year. It hit me that it has been a year since I last attempted to end my life. Which when compared to the year before, is really an achievement. The reason I say this is because the accomplishment lays not just in the absence of suicidal actions, but the ability to now deal with and manage the same feelings and urges (which are still at the same intensity as before) with new, healthier coping mechanisms. I can truly say that I am proud of myself. 

This last week has been a real eye opener for me. I have had huge swings of intense emotions along with some really dangerous action urges. Instead of carrying though with the urge to end my life, I reached out for help, and most importantly; accepted the help I received. Of course it took a while for me to get my head around the acceptance part of this process, as you can tell from the posts on this blog from earlier in the week!!! 

I have an open mind about the upcoming admission. I really think it will help me figure out some of my current problems. I will hopefully have a good team of people around me to keep me regulated. And I also have this wonderful outlet, my own form of personal form of therapy. My blog is another gift I received this past year. Writing is the best way for me to find objectivity during difficult situations, where due to my intense emotions my judgement is often compromised. 

I am so grateful for all my readers too, as you always offer such sound feedback, and often make suggestions which have helped me to act in more efficient ways with more successful outcomes.

Saturday, 7 April 2012

WILLINGNESS to get over this bump and OPPOSITE ACTION TO ENVY



Although I would like to think I am calm, rational and a judicious person when it comes to taking an objective standpoint about transgressions in my own life, simply put, these skills is severely lacking from my toolbox. I find it very hard to push aside the judgements which paralyse me and turn my thoughts into narrow, dichotomous lines which only have two end points.

As I mentioned in the last few posts, my emotions have been amplified to way out of manageable levels this past week.  All this lead to me equating many of these emotions as facts; hence I felt had to act on the emotion. The feelings almost felt like they have a mind of their own, and that I was a vessel for them to carry out their action urges. At the time I felt I had no control, but I am not trying to evade responsibility for how I treated my therapist, as I know I could have been more skilful. I could have used OPPOSITE action to my anger, or even HALF SMILE. In reflection, I see that it could have been a perfect week to also practise DISSTRESS TOLERANCE and RADICAL ACCEPTANCE.

Yesterday morning I received a letter stating that a course I had been waiting to get onto for many months had been cancelled due to lack of funding. When I first saw the letter I was super excited, as I thought it was a start date. I had been advised to hold off going to university by my team for another year until I finished DBT and instead attend this collage as it operates under recovery ethics. It seemed a perfect transitory step for me. I decided to do something creative and less academic, so picked a photography course. I really was looking forward to it. 

Now I am so disappointed that my heart literally hurts. I am so afraid; I feel I have nothing really left to look forward to now.

I went to check in with the community nurse a few hours after getting this terrible news. And I am really so very grateful and abashed to admit that he was not the invalidating type I was expecting. In truth, he sat with me for about 45 mins and listened intently to what I had to say. We came up with a plan in order to help problem solve the solution, and jointly agreed that the best outcome would be for me to attend a crisis resolution based therapy group for 8 – 10 days. It came with a warning that I would have to be willing to work at finding solutions to my problems and not to abandon self responsibility. It seems fair, if like a lot of hard work, but I am up for the challenge. I really am so appreciative for how great that nurse was. I really needed his objectivity in that moment. 

I felt calmer and more in control after the meeting, and was much more willing to stay with my family for the night, I tried not to see it as a suicide watch, but as an opportunity to spend quality time with them. I went to see my sister and her husband who are expecting a baby and are in full blown 'nesting' mode. They are buying my family home off my mother, and have done a beautiful job of renovating it and putting their own stamp on the house. I noticed that I had been avoiding seeing the house as I felt great envy towards my elder sister, who has such a perfect life and gets to have everything I want and more, and on top of that gets to have the house I grew up in, the only place I called home. I am afraid I might never fall pregnant again, so am also reluctant to talk to her about the baby and envious of her ability to carry a child. I (quite skilfully in my opinion) figured out that I was experiencing ENVY which really did not fit the facts of the situation

I put on my DBT SKILLS hat and tried to use OPPOSITE ACTION. I knew that the prompting event to the ENVY was that I was being reminded about all the things I really want but can't have. A stable home, a family, nice things.....

My HOT thoughts where:
  • 'I will never have what my sister has'
  • 'I am such a failure'
  • My sister is more successful than I will ever be'
  • 'I am inferior to my sister'
  • 'My parents think she is the better sibling'
  • 'life has treated my so unfairly
The biological changes and bodily experiences I felt with the envy was a slight pain in the pit of my stomach and I was extremely anxious and noticed I was feeling resentment towards my sister and her husband   I began to ruminate about how unfair I felt the situation was and how much of a failure I felt I was. My attention was very narrow and I could barely even talk to them. I OBSERVED how much I had avoided seeing my sister and the house, which had undergone so much renovation that I nearly didn't recognize it! I hadn't even offered to help with painting or decorating because I had been festering in my envy.

Although it is ok to feel envy when others have what you want, the problem here lies with the intensity of which I felt the emotion. I had checked the facts and become conscious that I had not been there to help my sister due to an out of control emotion.

I mindfully asked myself what my assumptions, belies and thoughts were about my sister buying the house and having a baby. I then tried to challenge the hot thoughts which popped up. Here is how I tried to turn the judgments into facts;
  • ‘My sister is 7 years older than me, is married and in a good position to raise a child’
  •   My sister and her husband have worked very hard to get everything they have and deserve it all
  •    I also have many very wonderfully things. I live in a fantastic location and have so many beautiful things. Someday, with hard work, I will also have a house to live in, but for now, recover and health are my greatest assets.
  • It is a very good solution to the present economic recession as my sister would not have been able to buy a house like this without help from the family
  •   My sister’s children will get to grow up in the same wonderful house and we did
  • I am not a failure because I am not the same as my sister, I have other attributes which make me a successful and competent person

My goal is to have a positive and functioning relationship with my sister and brother-in-law, I love them and love the bump too! So my anger and resentment to them was making me avoid them and not nurture and develop a healthy bond with them. That is the main reason that the envy needed to be challenged.

In the moment I made sure to count all my blessings and avoided exaggerating my deprivations, Marsha states that to go ALL THE WAY I must imagine that it makes sense for my sister to have all this, as she has worked hard and deserved it all.

Finally I changed my emotions by changing by behaviors and posture. I unclenched my hands and relaxed my stomach and used HALF SMILE.

I now feel my envy is more in proportion to the situation. I’m not going to lie, it’s still there, but now I feel motivated to work as hard as my sister so I can have what she has. That means I can’t just throw my hands up in the air and moan about how unfair life is, I have to get off my ass and go get it for myself!

I’m really sorry this is so long and thank you so much for taking the time to read this. 

 

Thursday, 5 April 2012

Anger gets you no-where except a referral to the lunny bin.

I need to expel all the overwhelming lunacy that perpetrated my day onto something objective, so I turned to here, to my blog, to the only healthy coping strategy I seem to possess. I don't even know if I will post this, or keep it as a draft, just an arbitrary exercise to rid my big BPD head of the emotions which churn and mangle my thoughts.

I had my INDIVIDUAL session with my DBT therapist this afternoon. It was only when I was waiting for her in the lounge of  the clinic that I noticed how grumpy I was. I was frowning and gritting my teeth and really quite narky. I didn't have enough time to figure out what the route cause for my agitation was as I was minutes away from therapy so I just tried (read FAILED) to push it away as I didn't want to waste a session on  what I felt to be an unnecessary topic. Well, boy was I mistaken for thinking I could just will it away that easily.



Within minutes of the session the elephant in the room was not only noticed but pulled out by the tusks and made to take center stage. T:"whats going on right now?"All I wanted to do was scream at her. Me: "what do you mean?" now  I was screaming at her, well in my head anyway. "SHUT UP AND LEAVE ME THE F*^% ALONE!" I can only imagine that I looked like an cartoon character, you know the one where where they turn red and steam starts coming out their ears.....

It was clear I was in no mood for therapy, and thank God she realized this and moved swiftly on to discussing what the DBT process calls THERAPY INTERFERING BEHAVIORS. I call it being stubborn and headstrong. Its the ultimate no-no in DBT. She asked me about the plans I had to end my life I had mentioned in an Email, and I point blank refused to talk to her. I picked a point on the carpet and simply stared at it praying that she would just give in and ask me something else. I knew I was being childish, but it was the only thing I could do to stop me from storming out of the stuffy office in a huff and making a holy show of myself.

We sat in silence for a while longer until she pointed out that I had agreed to at least give DBT a shot, and that not saying anything was not participating. I was shaking all over now, gone beyond the point where I might cry and was just plain mad. I didn't care anymore. I told her I wished I had never said anything to her about suicide, and that I felt like I couldn't be honest with her anymore if this was how she was going to react. (and I wonder why BPD has such a bad name....) I was being a bitch.

I do get her point. I mean I can't expect the skills to work if I ain't willing to give them a shot first. This includes staying alive long enough to learn them. So after the fickle silence, we agreed that my lack of structure and routine is not helping my mental health at the moment. Which is very true. Then she landed the shocker on me....

She was referring me to the hospital and wanted me to do the 'center for living' program. This is ultimately a babysitting service for the emotionally challenged, run by possibly the most invalidating health care workers known to this planet. I mean the nurses are straight out of the old Victorian asylum era, where they think that shoving drugs down your throat to keep you quite and throwing patronizing advise about sleep and diet at you will cure you enough to get you back out the door for another few months. They expect to see you again at some stage. Recovery is simply not in there limited vocabulary. 

I have no choice in the matter, so for the next few days until they can organize themselves, I am a 'danger to myself' and must check in with the nurse on call every morning. So much for a life worth living......

Psychiatrist.*****Warning; Full blown BPD RANT

I saw my Consultant Psychiatrist this morning, bright and early at 9am, well I was there at 9am. She was late. REALLY late. So I was not only grumpy from being up at silly o'clock, I was also extra grumpy at her her inability to prioritize her patients. I went into the appointment feeling unimportant and like I was a hassle to her. 

She started out asking about how I was tolerating the increase to 60mg of Prozac (Fluoxetine). I haven't had any major side effects comparable to the nausea and increased anxiety I experienced when I first started. We then moved on to talking about whether it has had an effect on the frequency of bingeing  episodes. This is where I hung my head in shame and admitted that for it to have worked I would have had to let it stay in my stomach for long enough to enter my blood system. I explained that I had been getting sick after breakfast recently.

I was expecting a full on lecture, and even though I could sense her frustration, she very gently recommended that I try the liquid formulation of the drug. She explained that it is less easy to get rid off and will absorb quicker into my system. I will give it a go, and see how I get on! Fingers crossed it doesn't taste revolting!

I also moaned about my sleep issues (once again!) to which she suggested laying off the caffeine and that I should concentrate on practicing  sleep hygiene,  which, now, in retrospect, was the right thing to have said, as sleepers and me do not have a good history, especially if there is even a small niggle of suicidal thoughts going on.

I don't really know what I was expecting from the visit. Maybe I wanted her to just 'fix' me and for me not to have to put any work into my recovery. I think I also wanted her to read my mind and understand just how scared and terribly depressed I feel. Which, of course, is simply stupid.

Anyhoo.... she doesn't want to see me for another FOUR MONTHS! So either I didn't get across to her how shit I  am doing, she doesn't think she can help me, or she feels that I am doing just fine and dandy for the moment!

Ok rant OVER