Distraction vs Avoidance

Angry Birds, wii party, reading novels and dare I admit it, Blogging!   All of these can be helpful distractions, and yet, there comes a point when distraction slips into avoidance.

I had the first proper DBT sessions this week.  First the Skills Group, then next day the one to one with Joy.  This is how it is now and every week, twice a week for a whole year.  In fact the person leading the group session said 12-14 months!  Even after all the pre-commitment work it is a daunting prospect.

At the moment we are a small group (just 3).  We were all apprehensive.  I was very aware that both the others seemed a lot further on than me in terms of skills (even though two of us were new).  This was most evident when we looked at diary sheets.  They had both used lots of skills compared to my one.  I was quite ashamed of my comparatively blank sheet so when it was my turn I focussed on a question.

“Is what I have been doing distraction or avoidance?”

We concluded there is a fine line between the two.  When the activity is used as an alternative to unhelpful thoughts or behaviours it is distraction.  When the activity is used to numb the brain and feelings so you don’t have to address or acknowledge unhelpful thoughts, emotions or behaviours, then it is avoidance.  At the moment I think I am functioning at 70% / 30% in favour of avoidance.

So, Angry Birds, you might not be so helpful after all!

Change like the weather!

One of the most distressing aspects of BPD for me is the way my mood and the way I see myself and the world around me can shift between extreme opposites in a very short space of time.

I got up this morning, showered, got Jenny ready for school, had a proper conversation with Jo before he left for work, walked my dog and hung out the washing.  It was a great start to the day!

Then, with nothing I can pin point to trigger it, everything changed.  A bubble descended and settled around me separating me from the rest of the world making everything seem distant and unreal (derealisation in BPD technical jargon).  A sense of pointlessness overwhelmed me – what is the point of shopping, possessions, rushing around doing jobs, going to work.  Everything that keeps society as we know it running is meaningless.  Full of such thoughts I descended into a low mood and all the energy I had for doing anything drained through my feet into nothingness.  For a while (I don’t know how long), I sat like a zombie deep in my unwelcome thoughts. 

Suddenly I was brought back to the here and now by my dog (Jed) barking at something out the window.  I looked out and saw that just as my mood had changed, so had the weather.  Heavy grey clouds filled the sky which not long before had been blue and full of sunshine.This was like smelling salts as two practical thoughts burst the bubble I was trapped in.  The washing was out and the grass was getting long again, and last time I’d had to strim it because it was too long for the mower.  Full of energy I dashed out, rescued the washing and got out the lawn mower before the clouds emptied their heavy load making the grass too wet to cut again.  

Usually I find cutting the grass quite satisfying.  It isn’t complicated, it’s reasonably quick and you see a very good result for your effort.  Not so on this occasion. 

First, despite the grass being a reasonable length and dry, it kept clogging the blades.  This was frustrating me and I was starting to get angry, having urges to kick the mower and give up.  My self-control held out though, and in the end, on a more thorough search I found a twig trapped near the blades.  After removing that all was well – for a few minutes.

The second glitch was quite painful.  Our garden slopes downhill quite steeply making doing the bottom edge quite hard work.  It is easier to work with the mower pointing uphill than downwards or sideways.  As I walked backwards to get as near to the edge as possible I stepped too far, my foot went off the edge into the flower bed. I lost my balance and fell backwards so I was sitting on a rose bush!  Ouch!  Fortunately not with my whole weight as the fence broke my fall and save me needing embarrassing assistance to remove the thorns.

I recovered from that, swearing at myself for being so stupid – but got on with the job as now I could feel the first spots of rain.  I only had a couple of runs to go when the mower started to dig in the ground and not move across the grass easily.  I couldn’t work out why and was becoming frustrated again.  I turned and started to force my way, with an unwilling lawn mower back for the final run.  I had started and I was going to finish before the rain came in earnest.  I was half way back when I saw it.  There, lying on the grass was one of the wheels.  No wonder I was having trouble pushing the blasted thing.  I picked it up, pushed it back on the axle and hoped it would last till I finished.  It did.   

A few more drops were falling by this time so I rushed it back to the shed, losing the wheel again in the process.  It was a relief to have the job done.  I went back inside to have a well-deserved cup of tea.

As I sat with my tea, enjoying the view across to the mountains over the valley, something dawned on me.  The sky was blue and the sun was shining once more.  The dark clouds had passed by – and so had my mood (for the time being at least).

There’s a well-known phrase “change like the weather.”  Well, that’s me, and a big part of BPD.

Angry Birds

Diary sheets! 

Apparently these are an essential part of DBT and I will need to do one every week till the end.  Joy had given me one at the last session saying I may as well get started.  The idea is that as I gain the skills I will learn and apply them more often and the giving in to the self destructive urges will ultimately stop as the urges become less intense and less frequent.

Fair enough!

I’d dutifully recorded my moods and urges to self-harm alongside things I did that helped.  At the next session we looked at what I’d recorded.  I had listed as one of the things that helped when the urge to self-harm was getting intense, 

“playing stupid computer games”

Mistake!  In Joy’s words,

“If it helps it’s not stupid!” 

I can see what she’s saying.  If faffing with a game prevents me from acting on powerful urges to self-harm, the game has a useful purpose.  What was a silly, pointless, frustrating, time-wasting game of “Angry Birds” became a helpful, even therapeutic Angry Birds.   

What a great investment that 69p app for my i-phone was!

S.C.I.D. Danger

Well my DBT pre-commitment sessions are drawing to a close.  One more to go and then I start the programme properly.

In this penultimate session Joy explained that we’d pretty much covered all the pre-commitment work and there was one more baseline assessment to do.  This time not a multi choice questionnaire but a s.c.i.d.  This immediately made me think of dirty pants but Joy went on to explain it was a diagnostic tool for Borderline Personality Disorder.  

S.c.i.d. is an acronym for Structured Clinical Interview  for DSM disorders (DSM being an acronym for a diagnostic manual of some sort).  Confused by acute ‘acronymitus’, I preferred to revert to my own understanding of ‘skid’ – “a dirty stain on clothes or fabric caused by a pooey bottom.”  It turned out this wasn’t such a bad interpretation.

The interview took the form of a series of questions covering a range of the BPD diagnostic criteria.  These were asked by Joy who was able to ask me to explain further or clarify any of my answers.  It also meant when I said, “No, I don’t do or experience that!” she was able to ask about it in a different way to make sure.  

I’m not quite sure why we did it.  I had to have a BPD diagnosis to be referred to do the DBT in the first place – though she did say that if I put the work in I could expect not to meet the criteria anymore at the end, which is a very appealing thought.  The actuality of the interview however was as unpleasant as any huge skid you can imagine.  It forced me to think about all the things about me and that I do that really are horrible smears in my life.  By the end I felt pretty crap (excuse the pun).

Role on the end of DBT!

Oh Joy!

1.    A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

I guess from a medical perspective todays blog might relate to the above diagnostic criteria for BPD (called splitting).  I’m not sure though.  I accept that I do have a tendency when an important or professionally influential relationship has a more intense moment, to polarise my opinions about the person to either good or bad.

For example, in my work I (my company) took on a fairly large project.  It was working in partnership with another organisation and a project steering group was established to keep the project in line with the aims and objectives agreed with the funder.  One person on this steering group was a “Maverick” or a “loose canon” or in terms of meeting funding requirements, “a total nightmare!”  As the person who was responsible to the funder, and for the running of the whole project it was my job to deal with her.  She did not respond well to any form of training / support / being told politely to come in line.  In the end I saw her as completely cancerous to work with (i.e. malignant and needing to be removed), I became ill and had to recruit a new director for the project.  She is still causing problems for the project now, and I still see her as 100% impossible to trust or work with.  The person who took over for me is nothing less than a saint.

Now you could say that fits with the diagnostic criteria shown above, and if it does, so be it.  The bottom line is, my opinion of her as a colleague and team member is totally right.  End of!

So, back to DBT.  I thought things were developing OK with Joy.  I didn’t 100% trust her, but then it’s early days.  I’ve only seen her seven times.

The last session didn’t start off particularly well.  I had completed a worksheet as homework and we set about discussing it.  There was one bit where she wanted me to see something differently.  I didn’t agree.  The question on the sheet asked for one thing and I answered it.  She thought I should have a different answer and set about trying to make me agree with her.  There wasn’t much radical acceptance going on here and I wasn’t feeling like a doormat either.  In the end I realised she wasn’t as good at disagreeing with me as other CPNs I have known.  For example, John can put forward an alternative point of view without it feeling like a confrontation – and he can even tell me I’ve got something completely wrong without making me feel useless.  He can also acknowledge when things have got a bit tricky and communicate he is still ok with me.

Having realised I was winning the argument I went and quoted the sheet to her and the logical nature of my response.  She gave up at that point and now I’m not sure she is able to help me. 

 At the end of the session she told me she had received the occupational health report request relating to my recent job offer.  She said she had dictated it the day before, it would be typed up that day and sent out the day after.  I let five days pass from the day it should have arrived and then phoned occupational health to see where things were up to.  The report had not arrived.   

I phoned Joy to see what had happened.  She said it was in her tray for checking, and then she would send it later on in the day.  I protested that she had said it would be sent the Thursday before.  She denied saying that it would be dealt with the week before.  It would’ve been ok if she’d said, “sorry, I didn’t manage to get it done then, but it will go today!”  That would’ve been disappointing but no harm done.  However, in denying what she did say to me she has broken trust.  She is unreliable and not honest.  This is not an example of “good / bad” relationships or splitting.  It is just a fact.

It gives me a dilemma regarding DBT.  

• ·         If I sack her as my therapist I lose the opportunity to do DBT and I really need and want to do it. 
• ·         If I challenge her formally it will be her word against mine and hers will be the winning voice because her team will back her up and I’m just a “Bolshy Borderliner” anyway. 
• ·         If I do nothing I will not get the benefit of the therapy because I don’t trust her.
• ·         If I talk to her about how I feel at our next appointment it might help but it will probably make things worse.

As the saying goes, “I am between a rock and a hard place!”

Tale of a Shaggy Dog - part 5

Jake's closing comment

After the day I went upstairs by myself we were even closer.  She didn’t go to school as much after that.  She would dress for school, go out and come back once her mum left for work so we had whole days at home together.  That was lovely!  It was good to be with her and not locked in the kitchen all day.  She still seemed sad, but she kept her promise to me.  When she was really sad she started to get angry.  One time she even kicked me – I was scared and she was devastated.  After that she used to beat her arm against furniture.  She said she was trying to break it, and got upset when she couldn’t.  I didn’t really understand, but like she stuck around for me, so I stuck by her.

When she was sixteen her brother left home. It was a bit more peaceful after that.

When she was nearly eighteen I became ill.  My heart and kidneys were failing and I asked a friend to write this down to give her because I knew I would be leaving her soon.  I needed her to know I’m glad she stuck around for me and that I hope and pray someone does the same for her.

Tale of a Shaggy Dog - part 4

Recounted by Jake.

We were hiding in her room one day when she told me about school.  She said she had no friends, even the people she hung around with had turned against her.  Calling someone “Penny” had become the ultimate insult amongst her year group.  

People from her brother’s year were picking on her, too scared to get back at him.  One day a boy she didn’t know walked up to her, punched her and said “that’s for your brother!” and walked away.  The other kids around her seemed not to notice. No-one commented.  She was so sad.  She stopped doing sports and dance and hid in her bedroom much of the time writing poems or in her diary. 

One day a few weeks later she got home well before her brother.  She was different.  I could feel the sadness from her but she pushed me away, locking me back in the kitchen and went upstairs.  I knew something was very wrong.  

When her brother got back, I slipped past him to find her.  She wasn’t downstairs so I did something I’d never done before.  I went upstairs without being taken by her.  Her bedroom door was pushed closed.  I nudged it with my nose and went in.  She was sat on the bed with one of her dad’s drinks and a bottle of sweets or something that she was eating.  I went and put my head on her lap willing her to understand that I loved and needed her.  She looked at me and tears fell onto my head.  I lifted my paw up to her and she took it and held it.

“I’m sorry,” she sobbed, “I don’t want to leave you but it’s too hard to stay.  I’m sorry.  I do love you.”  I looked up and nudged her arm with my nose.  I wanted her to cuddle me.  She lifted me onto her lap and held me tight, crying harder now.  After a while she spoke again.  “I won’t leave you.  No one else will feed you or walk you or care for you properly.  I promise I will stay till you don’t need me anymore.  Then it won’t matter.”

I stayed up there with her till her mum was home and shouted upstairs to see where she was, and to call me down.  What happened that day was our secret.