Right and Wrong

I thought I was doing ok at DBT.  I was managing to do my diary sheets and homework.  I felt I was understanding most of the theory of the skills being taught in the group sessions.  I thought for a beginner I was doing ok.

I don’t have that many named DBT skills as yet but I was managing to record ones I’d tried on my diary sheet by reflecting on events of the day last thing at night.  With hindsight I would identify the skills I tried to use and record it.  I mentioned this was how I did my diary sheets to Joy in my one to one.  This triggered a big reaction.

 “Using DBT skills by accident won’t enable you to learn to use them when you need them” 

Joy asserted.  It took a good few minutes for her to finish making this point, by which time I was despairing and told her there was no point in reviewing my diary sheets as they were all wrong.  She spent at least as long again trying to convince me that they weren’t wrong she just wanted me to do them differently in future.  I still believe this is therapy jargon for wrong and so said I wasn’t convinced.  This led her to make the point again, that I had done what I knew how, so that was ok, and now she wanted me to do it differently.  In other words, it was wrong due to ignorance as opposed to wilful choice.

Sometimes it would be really nice to hold to a belief that “there is no right and wrong – just opportunities to learn and grow”.  If that were true I could accept what she says as true.  However, this idea is not practicable in real life.  In real life there has to be rights and wrongs.  Rules are essential for existence.  For example, the rules of gravity, if they get broken and become wrong the whole world is in big trouble!  The rules of football – take them away and you have a bunch of people aimlessly charging after a ball and running away with it wherever they like, however they like for as long as they like!  It is wrong to abuse a child, to inflict violence on someone, to take what belongs to someone else without consent – if it was ok we would not need prisons and perhaps the victims of such behaviours would not mind, and it wouldn’t hurt them. 

 

Ignorance does not make wrong things right.  It may well be a reason for a wrong – but the wrong is still a wrong.  When I played in my first ever football match I had never heard of the offside rule.  In my ignorance I went running up the pitch only to have the referee stop me in my tracks for being offside.  (By the way, for any men who may read this, I am female and I do now understand the offside rule).  The ref did not let me off the misdemeanor because I didn't know.  I had broken a rule, done a wrong in football.  I learned from that so I didn't do it again.

The existence of rights and wrongs if an unavoidable fact of life.  It's how you respond to them that matters.  This is one of my areas of weakness.  I hate being wrong, making mistakes, failing, not being good enough etc.  These things feed despair, self loathing, hopelessness, a sense of inferiority etc.  That was how I left my one to one with Joy.

With some water under the bridge the cloud of despair triggered by getting my DBT practice wrong has lifted, and now I have started to try and do it differently.  I aim to name a skill that I will try during the day.  It is much harder this way, and I soon found myself floundering to remember what I had to do for  particular skill.  I think I've cracked it now though.  My i phone  holds a summary of all the skills so I can select and revise the relevant one when I need it.  

I pray I am now really on the right track for DBT success.

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!

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!”

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.

In at the deep end....

I feel like I’ve been run over by a double decker bus.  I’m exhausted, wrung out and would either like to curl up and hide somewhere or weep in a corner. 

I’m not used to a therapist like Joy.  Joy says it’s ok to feel overwhelmed – that’s the purpose of the pre-commitment therapy, to build a foundation and rapport with the therapist that makes it possible to succeed with an intensive therapy like DBT. 

To me Joy lacks a softness in her approach.  For example, John would challenge me on something, even lecture me – but he’d soften it with a comment like “I bet you think I’m picking on you now?”  I would say yes, and then we could negotiate.  Joy bulldozes on!  I know what she says is right, and I would like to achieve the things she is suggesting – but it all feels too much too fast.

She keeps saying to me that “it’s up to me” and “it’s ok to negotiate”, and to tell her what is realistic for me etc. but it doesn’t ring true.  I feel pushed.

I don’t know if you are familiar with speech act theory.  It is basically the action a phrase or word provokes rather than the meaning of the words in a literal sense.  Let me give you an example:  Someone walks in through a door leaving it open.  I say,

“Were you born in a barn?”  The person shuts the door.  The speech act was shutting the door (the action triggered by the words).  Literal meaning is irrelevant – I had no desire to know whether that person was born in a barn, hospital or anywhere else.  The purpose of the words was an action and not a question or even a direct request.

Joy is a master of this!  For example, in my anxiety I shredded a bit of paper I was holding into 2mm square bits which were dropping everywhere by the time I’d finished.  She said,

“There’s a bin over there.  You can put them in if you want to – it’s completely up to you!”  I complied with the required action and put them in the bin.  I went on to peel my fingers instead.   

Perhaps it will all feel a little less overwhelming tomorrow.