Radical Acceptance

Radical Acceptance is one of the most helpful aspects of DBT (if I’ve understood it correctly).

In essence radical acceptance is the ability to accept a person as they are, including their behaviours and difficulties and, at the same time, without undermining that acceptance pushing for change.

I guess that’s as clear as mud?  I’ll try again….

In response to intense emotions I cut myself.  This behaviour works.  It diffuses and reduces the emotions leaving me able to function more normally.  A DBT therapist will (and I’ve yet to get to this bit with Joy) will accept that in the light of past experience this is a logical response because it is a tried and tested coping strategy.  The therapist will still promote change by giving alternative skills to use in similar situations.  I guess the end result will be when in that situation I will have more than one option of how to deal with it instead of going straight to my cutting kit.

I really like the sound of radical acceptance simply because the last time I tried CBT (cognitive behavioural therapy), much as it made some sense, the starting premise of “You have faulty thinking – your thoughts are wrong – if you had better thoughts you wouldn’t be in this state” was very destructive.  After a few weeks of trying with limited success, and on-going pressure to purge my head of all kinds of distorted thoughts, catastrophising and negative thinking I was ready to quit.  Quit not just the therapy, but life itself.  How could I change thoughts and ideas that were true, into lies (however positive they may seem).  How could I kid myself into being someone I am not.  My failure to grasp these skills just proved the hopelessness of my ability to change and increased the self-hatred and despair I often live with.  Not good!

It is a tragedy for me that knowledge is not the answer.  In my head I understand the concept of radical acceptance and much of what DBT is about – but I can’t live it.  Knowledge without skill is useless.

Confused

The day of my occupational health assessment arrived.  I spent most of the day walking on the beach with my dog and a friend in the unusually warm sunshine.  The coastline here is stunning and we walked on golden sands, climbed across rocks and around clear rock pools.  My dog lay in pools and rolled in the sand – it was glorious, and a perfect distraction from the impending encounter with occupational health.

I arrived for the appointment in good time and feeling unusually calm.  I went in and found the nurse doing the assessment to be lovely and easy to chat with.  It was easy to talk about my BPD and how that affects me in general terms.  We discovered she knew Joy from a few years ago.

At the end she advised me not to worry and told me she would need an additional report from joy to make sure that doing the job will not cause me harm.  She said I might get called back in to see one of the occupational health Drs.

At first I was relieved, but having had time to reflect I am now very uncertain of how things will go.  I still have the fear that having got this far I will not be allowed to take the job after all.

The Summons

The letter arrived at the weekend, the dreaded summons for an occupational health assessment. 

It isn’t even in a morning.  I will have until 3.30 in the afternoon to worry about it.  By that time, subject to a miracle I will be in such a state of anxiety that I won’t be able to get a sentence out with the words in the right order, I will be hideously sweaty, I will need a toilet very close at hand and my blood pressure, should they decide to take it, will be through the roof.

That cliff edge I talked about – the one where I was waiting to be pushed.  Well, the hand is now applying steady pressure to my back.

I know they are not allowed to discriminate on the basis of a diagnostic label – but what if they do?  What if they want to check my blood pressure or take a blood test and ask me to roll up the sleeve on my left arm.  It does not look good at the moment, with recent cuts as well as old scars.  You can’t begin to imagine how much I hate her (private self).  She is so pathetic.  How can I explain that the BPD / private self is separate to my professional self and social self.  I know that sounds mad.  I can’t talk about myself in three persons at an occupational health assessment, they’ll think I have trinitarian delusions or something silly. 

What should I do?  Do I risk the fall and the ensuing devastation if they do push me over the cliff with a rejection?  Do I withdraw from the job offer?  Do I use lots of beta blockers and blag my way through the appointment? 

It’s typical isn’t it – the time I really could do with some help to start trying to use DBT in a real situation, where I am very vulnerable and anxious - it coincides with Joy being on holiday for two weeks.

Trying = Failure?

Why is it so difficult to accept praise?  I even noted on here that I did well in my post “The self Sooth Box” when I said “definitely a pat on the back moment!”

When I last saw Joy and she asked if I’d thought anymore about the self sooth box, I told her.  I explained that I’d made one, tried it out and it had actually helped by delaying and in turn preventing a cutting episode.

She was really pleased and I couldn’t bear it.  She said she was going to tell the rest of the team how well I’d done.  I wanted to shout at her not to but I didn’t feel I should.  (In DBT the therapists work as a team and although you have one therapist to one client, the skills-training is delivered by all the therapists in turn.  Also, one of the key aspects of DBT is the shared load philosophy of the team.  I am their client, and Joy is my keyworker).

I ended up crying because she was so pleased.  To do so well, even before the DBT has properly started means I am doomed to fail and let them down.  I have raised expectations of my ability and so increased the disappointment in me that they will experience when it all goes pear shaped.  Their disappointment will increase my own sense of failure …..

"Negative thinking," I hear you say.  "Self-fulfilling prophecy,  catastrophising!"  I know all the lingo.  I’ve done the CBT stuff.  It helps to a point but the change is never robust enough to withstand life over time.  The fall comes and everything is worse than before.  This has been my experience with CBT and psychodynamic counselling.  I start well, they do help, and then it all goes horribly wrong. 

Starting DBT is a huge risk for me.  I want to make it work for me, forever.  I want to recover on a permanent basis.  The reading I’ve done suggests this is not an unrealistic goal.  My experience tells me that though it is possible for some, I will fail  in just the same way as when dieting.  Some people can do it, but me, I start off well and then my success fizzles out leaving me in a worse state than I was before.  I am haunted by this pattern.  I want to break it, but I am not sure if I can.

Joy says this time is different.  I have never had long term support before.  I won’t have to go it alone before I am able.  I hope she is right!

BPD Animation

Someone had posted this on another page and I think it's really good.  If my bletherings have confused you perhaps this will make things a little clearer!

http://www.youtube.com/watch?v=iraGmA7-9FA&feature=player_embedded#!

On A Cliff Edge...

Back in January, in an “Up” moment and aware of our financial precariousness, I applied for two jobs.  Much to my surprise I was invited to two interviews.

The first interview, as it loomed towards me got me thinking.  I realised that being committed to regular hours would, at the moment, be setting myself up to fail.  There was no way I could manage set hours plus DBT, which when it starts properly will involve 3 hours a week of therapy in a two hour and a separate one hour session, plus a minimum of three hours travelling time, plus homework, plus recovery from the emotional battering it seems to be creating.  I therefore withdrew my application. I felt pretty rubbish that with the equivalent of 2 degrees and years and years of professional experience I can’t even manage a simple job.

I was just swinging into a big low over this when the second invite to interview arrived.  This job gave me the option to choose from week to week how many hours I work and therefore the scope to work around my ups and downs.  I decided to attend the interview.  

At the interview my professional self graced me with her presence and so it went very well.  The upshot is I have been offed a job subject to CRB check (which I know is OK) and occupational health approval.

Occupational health approval!  Terrifying!  I know they are not allowed to discriminate on the basis of a diagnosis alone.   They can only turn me down on health grounds if the specific job would make me a danger/risk to myself or others.  What if they interpret my history of self-harm a  “a risk to me?”  If they do I am probably barred from working for years till I can prove it is a habit from the past (which it isn’t yet – but I am working on it through the DBT).  What if, bearing in mind the reputation a BPD label has, they just find an excuse to say no?

I don’t deal with rejection well.  I cope with failure even less helpfully.  When faced with being judged unfairly or discriminated against, I am a disaster!  

I feel as if I am standing on a cliff edge, waiting to be pushed off.

The Self Sooth Box

Recipe

Ingredients

1 box (shoe box size is probably good but any bag or box will do)

1 item for sense of smell

1 item for sense of touch

1 item for sense of sight

1 item for sense of hearing

1 item for sense of taste

1 item to trigger good memories

1 item for creativity

(there may be more than one for each category and some items my cover more than one category)

Method

Gather together the items you wish to put in the box

Ensure that the container (box) is of sufficient size to hold the items

Make sure the container looks attractive/appealing  to you

Add the items to the box

Put it in a safe but accessible place ready for when you need it

But what is it for?

To be honest, I had heard of a “Soothing Box” before I saw Joy yesterday.  I had even wondered if it might be useful for me – but I never actually did anything about it.

A soothing box is an aid for reducing stress, negative emotions, bad/unhelpful thoughts and the urge to self-harm.  The idea is that you go to that box if you are feeling bad.  The box contains things that you have chosen because they may help you feel better and distract you from whatever thoughts / feelings are causing you problems.  It isn’t a solution or cure, but something that may help an individual cope with intense emotions a little better and at least delay if not prevent them falling back on self-harm or other unhealthy coping strategies.

One of the core DBT skills is mindfulness (staying in the moment without judgement) – whatever that means!  I haven’t really got it yet.  One aspect of it I have started to get though, is focussing on just one external thing.  For example, if I use some hand cream, taking the time to be aware of the texture, temperature, feeling, smell as I rub it in, smell etc.  It gives me a means to recognise and appreciate simple, pleasurable things without losing them all to the maelstrom of intense emotions I frequently experience in a day.  This in mind, it is suggested that a soothing box should contain items to cater for all the senses.

Today I have been making my box (not literally - I have bought one of those nice folding boxes).  I made a list of possible things to put in it and then had a good old rummage to find suitable ingredients.

My personal ingredients include: The collar from my first dog; my daughter’s first ballet shoes (they are so tiny and cute); a cup a soup; a scented candle, a piece of my special blanket from childhood; a small cuddly bear from my first mother’s day as a real mum; a small bible; a favourite prayer; some tic tacs; a picture of my phone with a music note (reminding me to listen to some music I like); colouring pensils and paper; small tub of modelling clay; some of my dog’s hair – I’m sure the bits and bobs will change over time.

Of course, the big question is, does it work?  So far the results are promising.  Something happened earlier that made me quite angry.  My first instinct was to want to self-harm, however, instead I took out my box, chose some hand cream and did the mindfulness exercise Joy taught me last week.  Having stepped away from the feelings for a few minutes, when I looked at them again they weren’t half so huge, indeed I would go as far as to say I might have over reacted a little!  I reckon that was pretty revolutionary for me – definitely a pat on the back moment!

The Day before...

I have noted a pattern emerging.  I have an appointment with Joy and I’m wrecked for three days afterwards.  It isn’t just I feel wrecked, I become an out of control monster.  Joe and Jenny (my husband and daughter) suffer the consequences of my irritability and unpredictability.  The only one who is Ok with it is Jed my dog.  I hate it, and tomorrow I’m set to start the cycle again.  Time for the whole household to brace themselves!

A little anxiety before this sort of appointment is normal, but I’m dreading it.  I don’t want to put my family through this every week.  I have to ask the question, how much pain do I have to put my family through for a long term benefit to all of us.  How much is too much?

Bring it on…… (I think)

Base camp

If this is what pre-commitment is like, then what the blazes am I letting myself in for doing DBT?  Session three was hard!

Of course hard and bad are entirely different things.  Last week, after session two I was on the verge of pulling out.  Last week was bad.  This week, I think I am up for the journey.  The session was hard but I am left feeling that there might be a way forward after all.

I made a choice this week, after last week’s session and the awful few days that followed.  I chose to give Joy a chance and allowed myself to be very honest with her – even to the point of admitting I’d failed to achieve my goals in a big way and that I felt one of the exercises we tried was a bit stupid.  For me it was an immensely massive risk that paid off.  Joy was okay about it and now I can go at a more manageable pace.

The DBT path still looks huge, daunting and so high I can’t see the top of the mountain.  Above the tree line there are sharp rocks and snow.  I pray there is a trail to scramble and I won’t have to actually climb – but I can’t see it.  The snow vanishes into the clouds.  It looks extremely steep.  The lower mountain is clad with trees – a tightly packed forest that lets little light in.  It smells musty, damp and it’s so quiet.  All sound is muffled as if I am trapped in a box.  It is terrifying.  It is an adventure.

In my twenties I was hooked on outdoor pursuits.  I loved rock climbing and especially white water kayaking.  I took up kayaking because I was scared of water.  Even then I lived with the BPD tension of wanting to die and wanting to overcome.  Kayaking was the ideal solution.  Either I overcame the fear or I died in the attempt.  That’s probably not entirely logical, but it made sense at the time.  The outcome was that I became pretty good at Kayaking (level 4 inland and sea).  I reached a stage where I could not push myself beyond my fear to stretch my skills any further.  I had overcome my fear as far as I possibly could (and I was still scared of big water).

Somehow, I need to find that adventurous spirit again so I can take some big risks and push myself well out of what is comfortable to reach the top of my mountain.