Who wants to be happy anyways?

I have the worst anxiety I’ve had in a really, really long time right this second. I told Therapist about Tech Boy and she instantly made me deflate. I was so up, and positive, and productive today. I thought she’d be happy that I was moving on, meeting someone. I was excited, was getting butterflies in my stomach. The good kind! Not the I want to tear my hair out and smash windows kind. He was making me smile today, telling me nice things. I’ve been looking forward to going into work!…. and INSTANTLY she squashed that happiness. I felt totally lost when she said I shouldn’t get involved with him. I know it’s probably not a good idea but I’ve been feeling good! I just want to keep feeling! For a change! I hate this! Why, as soon as I find something to invest in does someone need to take it away? Why?

My stomach is in horrible knots. I’m having a drink. 

She didn’t even give me a chance to talk and be happy about it! She just jumped in and started in on how I’m making good decisions and I shouldn’t take that kind of risk in case of a break up or whatever… when just last week she said I was taking good risks! For months she’s been asking me about guys at work that I could possibly be interested in. Even when I was with Lady Friend! Seriously, what the fuck?!? I just want to feel cared for. For a change. And I was starting to hope that I could be.  With someone that I’m attracted to, and have obvious interests shared with, who isn’t fucking married, who is actually interested in me…. Despite how weird I am. Too much to hope for? Ya know what? Screw it. I’m doing what I’m going to do. 

Maybe she’s just jealous. Seriously. Recently divorced. Recently broken up with her latest boyfriend that she also found a million things wrong with. Admittedly he was probably horrible but that doesn’t mean everyone will be horrible to women right? RIGHT? 

Lucid Analysis – Trials in Therapy : Hard Decisions are Hard

Hard decisions are hard. I feel like I’m coming to a point in my life where I’m going to run again. Pick up my life, leave all this ridiculous NY drama behind and move back with my sister. If only running away actually solved anything. ::sigh::

So let’s start with the easy stuff. Therapist asked about work. In a surprising twist of productivity, I’ve actually been pretty happy with my job lately. I’ve been incredibly productive. Getting organized and getting projects done has come together much easier. I haven’t had the constant mental distractions of extraneous people crap that makes it difficult for me to focus. I’ve been feeling more like a part of the team, even socializing with the guys on my own without having to be dragged along. I brought in a loaf of apple bread and I made my homemade Chocolate-Chocolate Swirl Fudge especially for them. They were ultra appreciative which made me feel good. How they raved about the fudge was even bordering on that feeling of proud embarrassment because I’m just not used to such profuse praise.

I did my homework. Therapist was actually surprised that I did the whole thing.  I read through all of it, but we primarily focused on Sadness and Anger. I had a hard time getting started. Admitting that I felt this way about some things. I was worried that she’d think less of me, that she’d be upset or not like me, or not want to work with me if I admitted how I felt about some things. That my answers would show that I’m weak and a bad person. I shared them anyways. I had written them down already. I just had to open my mouth.

Anger. My revenge fantasy. I thought she’d be disgusted with me, think I was a terrible person for thinking these things. I was totally not prepared for what she did. She laughed. She said it was great. She said what I thought was completely ok and I’m allowed to feel that way. That I’m envisioning myself moved on, to something better that could be mine, is healthy. I felt my shell melt a little after that. It was easier for me to keep going.

My sadness is understandable but not entirely consistent. I wonder if it was real. If I made it all up. Therapist doesn’t think this is true at all. What I described when things were closer between Friend and I was very real. We had a very physically and emotionally intimate relationship. I’m distanced from my own feelings. She doesn’t want to diagnose him because she doesn’t know him, but she says it sounds like he’s dealing with his own inability to understand and express what he really wanted. Or wants. He has his own dissociative problems reconciling his feelings. The last night we were together, I remember feeling so wanted and so loved. It was such an intensely passionate evening. As I was turning to walk out the door he reached out, pulled me back to him and kissed me fiercely. And then it was done. No warning.

I said I’ll never understand why I wasn’t enough. If I was enough he’d want to be with me. Therapist thinks this is transference from my past. Clearly, with how comfortable we were together, I was enough. However, he had his own stuff. He decided to work on his marriage and family. That wasn’t my short coming. It’s not that I wasn’t enough, it’s that he had his own issues.

If I start crying: I feel weak. Therapist was actually concerned about this. I know exactly where this comes from. When I was little my father always invalidated my feelings. If I was sad, or upset, he would tell me to toughen up or suck it up. Showing these emotions wasn’t tough, therefore they were weak. Any display of weakness is not acceptable. I remember when I was 7 or 8 and my grandmother died. I locked myself in my closet so no one could see me cry. I still feel like doing this. Therapist notices.

As a reaction to people from my past that have taken or tried to take aggressive or abusive control of me, I’ve developed this mechanism of pushing back. Of holding back.

I finally told Therapist that I’m afraid to talk about some of the things I feel because I’m afraid she’ll be disappointed with me, or shocked, and won’t want to deal with me anymore. I hold back, not because of anything she’s done or her own issues, but because it’s what I fear from anyone I’m close to: if I show too much, feel too much, share too much, people won’t want to deal with me, will be disgusted, will reject me. I don’t want her to tell me to leave or that she doesn’t want to work with me anymore. It came out as a rush. Like I had to say it quick before my brain kicked in and told me to shut up.

I have trust issues. I don’t trust easily, if I trust at all. I’ve learned that it’s not ok to be vulnerable. I’ve been up walls against it. Secluded myself from people and locked my heart away to avoid it. Then of course, I came up against a malicious invader. One time with Evil-Ex, we were actually sitting down having a conversation where he told me it was ok to be vulnerable. My impenetrable walls make me seem like a robot. Everyone is vulnerable sometimes. It makes me seem more human, easier to connect with and relate to…. So of course, being as in love with him as I was, I wanted to show him that I was human. He just wanted to hurt me. And he promptly used it against me. Time and time again. I did something he didn’t expect though. I had so many secrets, kept so many things to myself, bottled up inside, it was like a treasure trove of nasty secrets he could use to hurt me because I was afraid to let anyone see these bad parts of me. That I didn’t want people to know is what gave him the power to hurt me. So I took that power away. I opened myself up completely, let all the bad things out for our friends to see. Ironically, Evil-Ex was right. It did make me more relatable. A lot of my friendships strengthened. And no one cared at all. Except Evil-Ex. Who sat there and stewed in his foiled plans to torment me.  No one has ever said I was predictable.

So Therapist understands why I hold back and act the way that I do. She also lets me know that it’s ok to feel the things I’m feeling. Especially in therapy. My feelings are valid. Then she said something constructive. She’s not here to be my friend. She likes me, she thinks I’m a joy to work with, but I’m not here to impress her or work for her approval. I’m here to work through my problems to heal. In order to do that, I need to be able to express the things I think and feel without worrying that she’s going to judge me. Her job isn’t to judge, it’s to listen, and to help.

She also said something that I’m having a hard time coming to terms with. When Friend and I first started getting to know each other, and even when we were involved beyond just friends, it was a very healing relationship for me. It was a time where I saw that someone could accept me and like me for who I am because I wasn’t hiding who I was. Now, however, I need to consider what continuing this friendship means to me. It is not healing for me anymore. Especially with the frequency which I hang out with him, seeing him so much. Therapist asked me what I’m gaining. All I could really say is that at least when I’m there, I’m not alone. ::sigh:: I’m not usually very connected, but I’m not by myself. That’s something, right?

I don’t want to be alone. But would I really be? I have two guy friends that have been poking me to hang out a lot lately. GF has been texting me and telling me she misses me and wants to see me. The girl from the tattoo shop that I was dating for a while has been texting me and e-mailed me last night to come hangout. There’s this really cute tech that I work with, he just gave me his phone number (**squee** and holy crap!). And let’s not forget Roommate. She wants to do more things too. So what’s holding me back? I am, that’s what. I’m holding on to something that isn’t there. But, why? Do I think something will change? Do I think it’s really worth it? I don’t even know anymore. All I know is I can’t imagine things being different.

But maybe they should be. Therapist suggested that maybe I should consider having less to do with him. See him less. Not hang out so much. I don’t need to cut him out of my life completely, but it might be time for him to have less of a place in my life. ::sigh:: I’m not blind. I’ve had this thought approximately a million times. I just don’t know how to do it. I don’t know how to let go. I don’t know if I can or if I even want to.

What’s worse is, he knows I’m in conflict about something. He even said that whatever decisions I need to make he hopes it doesn’t mean cutting them out of my life. ::double sigh:: He is a good friend. Like last weekend I was disappointed that we couldn’t do our usual Sunday night dinner thing (after he told me this I had an all-out binge, which I didn’t tell him about, and didn’t talk to him until Monday –  yeah I know this is bad), but first thing Monday he IM’d me to make extra all day plans for this upcoming Sunday. Or, his phone is dying so he had his wife contact me first thing this morning to let me know and invite me over for stuff tonight. Or like, I’ve had a kink in my back for the past few days so he offered to rub my back later. He’s clearly making an effort here.  It all makes it very difficult to dismiss and remove myself from. Especially when I don’t really want to.

I just want these residual feelings to go away. I want to be capable of being friends without all this emotional bullshit. I hate emotions. They’re so messy. Hates it.

Homework: And I wonder… what it would be like if he left. Therapist wants me to think about this more and journal my thoughts and feelings. Think about what would happen. What it means to me.  

I can’t right now. I’m not ready to make this kind of decision. I’m not. It makes me want to panic. I can’t think about this anymore right now.

Total random. A buddy of mine just said to me: I think you should be a fitness model. You are sort of kinda hot, yanno, if you’re into physically fit star wars nerd chicks.

Score.

Therapy homework: Not as simple as I thought it would be.

Deep Breath. Release. I finished my homework assignment. I thought finishing these sentences would be easy, but it was a lot harder than I thought it would be. Posting this is actually a little scary for me. Reading what I wrote down makes me feel raw and exposed. Therapist wanted me to focus more about my present than my past, so mostly my responses have to do with me, Friend, and Roommate. I’m sure if I went back and redid this more into my past my answers would be even more volatile. Walking around I feel like I’m clutching everything to me so tightly. Wrapping myself in a blanket of hurt that I can’t release or let anyone see. Like armor that makes moving stiff.

Writing about Sadness

All I wanted was: To be with you. For you to love me.

And I wonder: If I made it all up. How things could have been. What it would be like if he left.

I feel sad when: I go home alone and sit by myself with no one to do anything with.

If I start crying: I feel weak.

I’ll never: understand why I wasn’t enough.

Remembering now makes me feel: Used. Foolish.

One good thing about my sadness is: I know how I don’t want to feel. I can see the things that I’ve done that have brought me to feeling like this.

Writing about Anger

Under all my anger is: hurt and loneliness

I have been: smiling when I want to grind my teeth
Someone needs to: Stay.

My revenge fantasy is: watching his wife go completely manic, ruining their finances (again), and seeing their stress rocket through the roof, while I get my life together.  Having him realize just how good to him I am, want to be with me, right after I’ve found someone that I can actually be happy with, so he knows what it’s like to want something he can’t have. To be happy and cute in front of his deteriorating marriage, so he will always have to wonder what could have been but will never know.

Someday: I hope he’s truly miserable with the path he chose.

I feel most angry when: I’m ignored. When they’re doing things that are ‘couply’ or affectionate in front of me. When his wife refers to him as ‘my husband’, as if I don’t know. When I think about how much better together we are. He can’t hang out because he has to do family stuff, without me.

One good thing about my anger is: it makes me feel strong

Writing about Shame

I’m embarrassed when: I’m not at my ideal weight. I feel fat. I’ve lost control and eaten more than I should have.

Everyone will: Look at me. Judge me. See that I’m not perfect.

And everyone will think: that I’m an embarrassment to be seen with.

And everyone will say: That I used to be so skinny.

I see myself as: Imperfect.

And I want to: Find my willpower and regain my control.  

I feel most embarrassed when: I have to go out in public, to work, to some social function, and do not feel thin.

Writing about Guilt

I should have: been a better roommate; not let her see my breakdowns, maybe I scared her away. Not slept with Friend; been desirable but unattainable.

Sometimes I want to: sit down with Roommate and gossip, or just talk, but I don’t know how, or feel like I’m intruding on her time.

I don’t care if: His marriage fails.

I regret: Letting people get close enough to see my vulnerabilities.

If only: his wife would do something terrible; he would open his eyes; he would care. Things could stay the same with Roommate.

I have to: act like I’m happy for Roommate and ok with her moving so she doesn’t feel bad.

I feel most guilty about: I don’t know. I don’t really feel guilty about anything.

Writing about Fear

No one: will love me enough to stay with me.

I’m afraid to: really open myself up to someone. What if they leave me, or reject me. If I don’t give all of myself then they’re not really rejecting all of me. Invest in people. Confide in people. What if they use what I tell them against me? See that I have fears and judge me? Think I’m weak or not the person they thought I was on the outside and leave me? Think I have too many problems and don’t want to deal with me?

Will I ever: feel like I belong?

I want to: be attached to people, even after they go away.

When I remember: I want my life back.

I feel most afraid when: I’m alone.

One good thing about my fear is: Nothing. I can’t think of a single good thing about it.

Bonus post today because I’ll be writing about therapy from last night. Stay tuned.

Therapy Homework

I meant to post before and totally forgot. I’ve been really bad about doing my therapy homework. It’s been so hard for me to focus and motivate on anything other than work which has required pretty much all of my motivation and control to do.  Anyways, I wanted to post the exercise that my therapist gave for me to do. It’s a simple exercise. But things don’t need to be complex to be helpful. I’m going to post the blank exercise, and then once I finish filling out my own responses I’ll post those too. I’d be really interested to hear what you guys have to say, either in my comments or as an email (havennyx@gmail.com). You don’t have to do all the sections. I might not. But I’ll definitely do the ones that I feel are relevant to my current situations.

It started happening slowly. As my counselor began listening, I discovered  a voice For the feelings deep inside Me. I can finally talk with no One overreacting. I can sit silently with no one looking at me like I’m crazy. I’m discovering that like who I am deep down inside. How did so much of myself get buried? It isn’t ME that’s the problem; it’s what happened to me that was. I’m beginning to see things in a new way. I have more feelings about what happened than I realized. And even though I still have days when I don’t want to feel the way I do, it’s not as scary as it used to be.

There are ways I protect myself from my feelings. I’m learning about the ways I protect myself from people, too. Keeping a journal is a safe way for me to begin looking at what I’m afraid of. It’s been long and slow and sad, but I feel I am recovering.

Finish the following sentences:

Writing about Sadness

All I wanted was:

And I wonder:

I feel sad when:

If I start crying:

I’ll never:

Remembering now makes me feel:

One good thing about my sadness is:

Writing about Anger

Under all my anger is:

I have been:
Someone needs to:

My revenge fantasy is:

Someday:

I feel most angry when:

One good thing about my anger is:

Writing about Shame

I’m embarrassed when:

Everyone will:

And everyone will think:

And everyone will say:

I see myself as:

And I want to:

I feel most embarrassed when:

Writing about Guilt

I should have:

Sometimes I want to:

I don’t care if:

I regret:

If only:

I have to:

I feel most guilty about:

Writing about Fear

No one:

I’m afraid to:

Will I ever:

I want to:

When I remember:

I feel most afraid when:

One good thing about my fear is:

Writing about Counseling

Since the trauma I:

When I’m here I wonder:

And I expect:

I wish:

I won’t:

Healing:

I think I’ll feel finished when:

Sometimes, my feelings cause me to act in ways that end up hurting me or someone else. But I know now it’s not my feelings that are wrong. It’s what I do with them, and how I make sense of them that matter.

Some people still think my feelings are the problem. I can’t control what they think, but I can own who I am, feelings and all.

I have a right to feel every way I do. My feelings help me understand when I need to talk and when I need to take care of myself.

Cognitively Speaking….

Therapy. It’s useful. It’s useful to most people, not just those with characterological problems (a.k.a. personality disorders). There are so many different kinds of therapy and therapeutic techniques that it can be dizzying to decide which is best for you. Fortunately most people don’t have to worry about making this decision. If you’re stressed out from work, having issues with a spouse, not sleeping, fighting drug or alcohol abuse… there are a multitude of programs and therapies specifically designed and tailored for each of these. Especially Cognitive Behavioral Therapy which focuses on treating people that display all those Axis-I disorders that a good majority of the population experience from time to time.

That said, Cognitive Behavioral Therapy likely isn’t enough for someone with Borderline Personality Disorder. In fact, I’m not sure any singular type is as effective as a combination of therapies since not only are we an Axis-II disorder but an incredible majority of us also display comorbid Axis-I issues and disorders as well. It only makes sense to me that if you have a multitude of manias it would make sense that you should use a multitude of techniques to tackle the entire spectrum.  

The very nature of personality disorders means that the way we perceive the world, how we interact with the world, how we experience emotion and our very selves is quite different than your average Joe. By extension, how we are capable of utilizing, dealing with, and incorporating therapeutic technique is also going to be different. That’s not to say that we don’t want to work through things, obviously this may not be the case, but since our base functioning is different, we need to approach these problems from a different point of view.

Quite often traditional CBT makes basic assumptions of its patients that don’t apply to the “normal” state of someone with BPD. Normal is relative right? When ‘normal’ is incapable of feeling these things in the same way, these basic assumptions flounder and fail. Different strokes for different folks and all. So where might basic CBT therapeutic assumptions cause issue for the personality disordered?

Assumption 1: Patients will comply with the treatment protocol.

            Now this doesn’t translate as a desire to be difficult. The first time I went into therapy it was not from a desire to move beyond my borderline, but from a place of needing support to deal with an abusive significant other. I was more interested in obtaining consolation and recognition of my suffering than in understanding and fixing the problems that lead me to be in that situation in the first place. Hell, at the time I wasn’t even certain of the exact problems that fixed me into that black hole of emotional destruction. (I do realize it is unfair to black holes to compare them to my Evil-Ex). But because I didn’t understand the detrimental thought processes that kept me from leaving I couldn’t internalize the techniques that my therapist was giving me to help me cope. My point is, often for PD patients therapy is complicated and it’s not so straight forward for us to take on CBT techniques. With wildly fluxuating mood swings we might one day recognize that we have severe problems that we would give anything to be rid of, while the next we may rail against the idea that what is wrong with us is in need of fixing. It’s not easy to admit that there’s something fundamentally flawed with your make-up. It hurts and it’s hard to see that something you can’t control should hold such sway over your world beyond your ability. You were born this way, that means you’re supposed to be this way, right? What’s wrong with that? Ultimately we were given what we were given and it is our responsibility to manage ourselves. Life rarely turns out the way you expect it would. For anyone.     

Assumption 2: With brief training, patients can access their cognitions and emotions and report them to the therapist.

Cue the broken record. Someone with a Borderline Personality Disorder does not experience emotions the way a normal person does, by definition. Sometimes the buildup of emotion is so frustrating and such a jumble of so many different things that it’s impossible to distinguish individual thoughts or feelings. Or patients may block disturbing thoughts and images in a cognitive or affective avoidance of disturbing memories and negative feelings. When you learn that by avoiding negative stimuli you reduce your susceptibility to pain, it becomes ingrained into your habits and lifestyle. Breaking an instinctive pattern that you’ve developed as a maladaptive coping strategy isn’t easy. To first face those things that hurt you in order to finally move past them takes courage and time to reach that place of strength. Or you have someone like me that is dissociative on top of my other issues. Where something should inspire intense emotions all I can describe is…. A blank. A void of feeling like speeding to the pinnacle of Mount Everest with emotions ramping up higher and faster only to divert into a dark cave before you hit the top and, stop. How do you navigate the void?  

Assumption 3:   Patients can change their problematic cognitions and behaviors through such practices as empirical analysis, logical discourse, experimentation, gradual steps, and repetition.

The problem here is that our problems are rarely so straight forward. Our issues have issues.  “Because characterological patients usually lack psychological flexibility, they are much less responsive to CB techniques and frequently do not make meaningful changes in a short period of time. Rather, they are psychologically rigid. Rigidity is a hallmark of personality disorders. These patients tend toward hopelessness about changing. Their characterological problems are ego-syntonic: Their self-destructive patterns seem to be so much a part of who they are that they cannot imagine altering them. Their problems are central to their sense of identity, and to give them up can seem like a form of death – a death of a part of the self.” Do you know what it’s like to want to be rid of something, to despise it so much, and fear the losing of it in the same breath? Or to feel in your bones that something is so, despite all evidence to the contrary? I do.

Assumption 4: Patients can engage in a collaborative relationship with the therapist within a few sessions.

            I’ve been in therapy 8 months and I’m just now, in the past few weeks, beginning to bond with my therapist in a way that I can internalize. Oh I trust her, cognitively. I believe she wants to help me and has my best interest in mind. Throughout my life my interpersonal relationships with people have been marked by distrust and an expectation that they will implode. I don’t do it on purpose, it’s just happened so often that it’s natural for me to hold back. I don’t even have to try. When you’re so accustomed to having a hard time relating to others, it’s a natural extension that you would have a hard time relating to a therapist who is a relative stranger (at first).  From this point of view it makes sense that not only should a person’s personal problems be at the focus of therapy, but also a focus on developing the therapeutic bond between patient and therapist should come into play.   

Assumption 5: The patient is presumed to have problems that are readily discernible as targets of treatment.

Fill my emptiness please. What? You don’t have a prescription for that? No definitive list of reasons why this may be? It’s hard to treat a problem when you don’t have a clear idea of what the problem even is. Vague senses are difficult to discern for anyone, especially someone who has trouble connecting with how they feel in the first place.

So does that mean there is no hope? No, of course not. It just means that we need an expanded approach. Where we begin, where we go, what we seek and where we search for it will be in different places. Having our own individual reasons, subconscious or otherwise, for therapy means that we will have our own individual starting points. Sometimes it just takes a different approach to find the mark. Where one technique may fail, another may succeed. There are always more options. Don’t give up.

Being individual makes us human. Being human means we all have our own journeys.

Have a seat on my couch: Therapy

Today I was originally going to talk about Hospitalization, but frankly, the idea bores me at the moment so let’s look at something else.

Have you ever noticed that every therapist’s office has a couch? It’s almost cliché in a comforting kind of way. Hell, even my background has a couch/comfy chair. Subconscious foreshadowing? Intuition? Perhaps. So kick back. Pull up a cushion. Relax. And let’s talk about therapy.  

There are a ton of different types and methodologies when it comes to therapy. Maybe, eventually, I’ll be able to discover what they all are in order to talk about them, but for now I want to take a look at the ones I know the most about which are also applicable to Borderline Personality Disorder: Cognitive Behavioral Therapy (CBT), Schema Therapy, and Dialectical Behavior Therapy (DBT).

What are each of these?

Cognitive behavioral therapy (CBT) is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present. The particular therapeutic techniques vary within the different approaches of CBT according to the particular kind of problem issues, but commonly may include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation, mindfulness and distraction techniques are also commonly included.

Dialectical behavior therapy (DBT) is a system of therapy originally developed by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat people with borderline personality disorder (BPD). DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. DBT may be the first therapy that has been experimentally demonstrated to be generally effective in treating BPD.

All DBT can be said to involve two components:

An individual component in which the therapist and patient discuss issues that come up during the week, recorded on diary cards, and follow a treatment target hierarchy. Self-injurious and suicidal behaviors take first priority. Second in priority are behaviors which while not directly harmful to self or others, interfere with the course of treatment. These behaviors are known as therapy-interfering behaviors. Third in priority are quality of life issues and working towards improving one’s life generally. During the individual therapy, the therapist and patient work towards improving skill use. Often, a skills group is discussed and obstacles to acting skillfully are addressed.

A group component in which the group ordinarily meets once weekly for two to two-and-a-half hours and learns to use specific skills that are broken down into four modules: core mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills.

Schema Therapy was developed by Dr. Jeffrey E. Young for use in treatment of personality disorders. Schema Therapy is intended for use when patients fail to respond or improve after having been through other therapies. Schema therapy is a combination of many different therapy techniques, including Cognitive Behavioral Therapy, object relations, psychoanalysis, mindfulness, Dialectical behavior therapy, interpersonal relation skills, discussion one-on-one, group discussion, and constructivism. Schema Therapy also borrows extensively from a range of theoretical concepts and methods from Transactional Analysis (I’m not even sure what this is).

As opposed to some of the more widely known and popular therapy methods, Schema therapy is most often used and considered a specialty form of therapy in the treatment of personality disorders, most commonly borderline personality disorder. Schema Therapy is based on a theory that childhood and adolescent traumas are the most likely causes of Borderline Personality Disorder and other similar personality disorders. The approach of Schema therapy emphasizes patients, psychiatrists, and therapists building bonds of trust with each other.

Each one of these topics is HUGE. All containing vast amounts of ideas, techniques, theories…. Given my compulsive nature we may be exploring therapy for quite a while. I promise you this. If you’re at all interested in the deeper aspects of the psyche these are absolutely fascinating.

My therapist uses a combination of all 3 of these therapies but she specializes in Schema Therapy. I own a copy of the Practioner’s Guide and I’m going to be getting into a great deal of it, but hopefully in a way that is more accessible and easy to relate to.  If I start to sound like a text book, please feel free to poke me.

Treatment of Borderline Personality Disorder: Medication

Something that has been on my mind a lot lately. Treatment. So let’s take a leap down the rabbit hole and see where treatment for Borderline Personality Disorder takes us.

There are 4 basic strategies that are utilized for treatment of Borderline Personality Disorder: Psychotherapy, Medication, Hospitalization, and Self-Help strategies. Over the next few days I’ll start on the last 3 and then I’ll just take a dive into some of the therapeutic techniques that my therapist specializes in, what we work on, and what is beneficial for Borderline…. And not. Because let’s face it, every person is different, every disorder is different, and some strategies just don’t work well enough on their own to be effective for every case.

Psychotherapy forms the foundation of treatment for borderline personality disorder with medications playing a lesser role. While there is no known medication that can target Borderline Personality Disorder on its own, prescription medications can address many of the common symptoms of BPD. This is something my Psychiatrist told me upon diagnosis. There is no medical cure for Borderline Personality Disorder. However, we can work to manage some of the symptoms and co-morbid occurring issues in order to improve quality of life and aid psychotherapy so that treatment will be successful.

Medications typically used in the treatment of BPD include antidepressants, mood stabilizers, anti-anxiety drugs, and antipsychotics.

 Antidepressants Used for the Treatment of BPD Symptoms

A variety of antidepressants have been studied for use in treating the low moods, sadness, and depression that can occur with BPD, including the following:

–          Fluoxetine (Prozac)** <~~~~ Check

–          Sertraline (Zoloft) <~~~~ Check

–          Citalopram (Celexa)

–          Escitalopram (Lexapro) <~~~~ Check

Mood Stabilizers Used for the Treatment of BPD Symptoms

Medications with mood-stabilizing properties, such as lithium and some anticonvulsant (anti-seizure) medications, can help address the impulsive behavior and rapid emotional changes associated with BPD.

Mood stabilizers used to treat the symptoms of BPD may include:

–          Divalproex sodium (Depakote)

–          Lithium carbonate (Lithobid)

–          Lamotrigine (Lamictal)  <~~~~~~ Check

Anti-anxiety Medications Used for the Treatment of BPD Symptoms

Anti-anxiety (anxiolytic) medications can help with the intense anxiety some people with BPD may experience. However, there isn’t much research that supports the use of anti-anxiety drugs to treat BPD. Some research actually indicates that one class of anti-anxiety drug — benzodiazepines (e.g., Ativan, Klonopin) — may actually worsen BPD symptoms for some people.

Examples of anti-anxiety medications used to treat the symptoms of BPD include:

–          Alprazolam (Xanax) <~~~~~ Check

–          Clonazepam (Klonopin) <~~~~~ Check

–          Lorazepam (Ativan)

–          Diazepam (Valium)

–          Buspirone (Buspar)

Antipsychotic Medications Used for the Treatment of BPD Symptoms

Antipsychotic medications can help address occasional breaks from reality as well as the paranoia, anger, or hostility that people with BPD may experience.

Some antipsychotics used to treat BPD include:

–          Olanzapine (Zyprexa)** <~~~~ Check  

–          Risperidone (Risperdal) <~~~~ Check

–          Aripiprazole (Abilify) <~~~~ Check

–          Haloperidol (Haldol)

–          Paliperidone (Invega)

** Symbyax was the atypical anti-psychotic Psychiatrist had me on. It’s a combination of Olanzapine and fluoxetine.

My medication-go-round has been a bit exhausting. And by a bit, I mean, I am more tired and have less energy now than I have ever had in my life, even in my worst depression. At my lowest point I’m still a very high-functioning person and could at least stick to my routines of get up, go to work, go to the gym, shower, eat, bed. At the very least. I no longer have the energy to go to the gym, which makes me have even less energy to do anything else. I have begun to lose my motivation for the things I love. I just feel weighed down by everything. The weather has even cooled down a little so there’s no attributing it to the heat. My only conclusion is that it’s the medication because, surprise, that’s when I started to feel so off.

I understand why Psychiatrist put me on the Symbyax even though it ended up exacerbating my eating disorder. I was harming myself and bordering on suicidal and he wanted something that would help me immediately. Unfortunately this was not good for me in the long run. The Lamictal didn’t work at all. Because of the issues with the Symbyax I’m afraid of anti-psychotics but agreed to the Abilify.

I do feel a little more stable, but I also feel deadened and weighed down. Nothing is as fun, nothing is as beautiful, being with people is not as enjoyable, I don’t feel love and I can’t get swept away. This is not the kind of stability I’m looking for. I’m constantly fatigued. Getting out of bed and sitting upright are a chore. I’m losing my desire to do things I love. I look forward to the day ending so I can sleep. Then when I wake up all I want to do is continue sleeping. This. Is not me.  This has never been me. I refuse to accept that this is how I should be. Friend once told me that the meds might just be making me ‘normal’, “now you’re just not a superwoman, you have a normal person’s energy, you’ll get used to it”. If this is the energy level that normal people have than no wonder our country is so slow. I hate it. I am not a slow person. I think sometimes they like me on these meds because they don’t feel so bad being lazy themselves. The meds are bringing me down to their level and it makes them feel better about their own short comings. Screw that. Or I’m paranoid. (indicator of meds not working? Eh?) Whatever.

I’d rather be a little crazy but fully functional, then mostly ‘normal’ and utterly immobile.

I’m going to talk to Psychiatrist tomorrow about going off medication. At least for the rest of the summer. Give it a trial run. See if my energy ramps back up. If it does, then it’s definitely the medication that’s slowing me down and I’ll know. Which means what I’m on is not ok for me. If I continue to feel this way off the medication than there’s something else going on and I may have to go back to two sessions of therapy a week to work on stuff. It’s a process. I’m still open to the possibility of medication, but right now I feel I need to reestablish my baseline and get myself back to a healthy normal for my body. The funny thing about taking care of your body, your mind usually follows….

Lucid Analysis: Trials in Therapy

 

Yesterday was a productive day in therapy I think. I was in definite rapid cycle mode shift. I didn’t really feel like sharing anything, didn’t really know what to talk about, tired, irritated, hopeful, pleasant, irritable, angry.

She keeps telling me I have a healing, peaceful energy that I bring with me. That people are drawn to my natural ability to heal and ground. That I really have a wonderful influence and role model. Everytime she says things like this I get angry. I don’t see it, I don’t believe it.  

She was creating an assignment for another bulimic client of hers. She said this girl reminded her of me and in creating this assignment for her she was heavily influenced by the things I do to center myself. She handed me the assignment. As I read it was a wash of peaceful, calm, creative outlets to focus energy towards. Healthy things, not destructive. I could easily see how most of these things were influenced by me and my interests. I had these small flashes of, maybe I’m not so terrible as I think, maybe I do have redeeming qualities to offer, maybe how other people see me {positively} is not so inaccurate, not just a lie to make me feel better or manipulate me.  These small flashes were fleeting but they were like little mental peeks into a pretty part of my self-perception.

She’s very concerned about my bulimia. I only had the one incident this past week, despite wanting to more, so I say bravo for me. We’re working on why I feel the need to do this.

Triggers: The state that I am most likely to do this is when I am more stressed than usual, more emotionally taxed.  The times I am most likely to do this is when I am alone, when someone has just left.

Sometimes I think this is just practical. When I’m sitting down to a meal with someone I moderate myself easily and don’t binge. When I’m alone I have no moderator. I lose control over what I take in and then panic in a need to punish myself for this loss of control. Control is clearly an issue. Again she believes this has to do with the Punitive/Critical Parent schema.  She asked me if I believed this personality schema was all bad? I said no. There should be a part of your brain that lets you know when you are doing something wrong or detrimental to yourself or others. It’s normal. It’s when it takes over in an exaggerated, hurtful, debasing, demeaning manner that it becomes punitive and is no longer healthy or normal. This is the part that I need to work to correct. Sunday I wanted to binge after I left Friends and came home to my empty apartment, but I managed to stop myself. I was able to talk myself into just going to sleep. Ireminded myself that if I were to eat, I would feel guilty (I’d had a healthy lunch and a good dinner, no starving), eat more, and need to purge. Instead of indulging the cycle I convinced myself to lie down and just go to sleep. It’s not easy.  Not easy at all. I had to walk myself step by step through what I would end up doing and reiterate every sentence and reason for why I shouldn’t or didn’t need to; why just going to bed would be better.

NOTE: I should write out this process. Write down the feelings that come before the cycle starts in order to recognize them. Write down each action that would typically follow. Then write down a sentence to counter each action in order to bring me to a healthier conclusion. That way I have an established tool when this happens.

I showed Therapist my paintings and she was really impressed. She even wanted to give me a homework assignment having to do with expressing myself through painting. I can’t. I just can’t. She first suggested creating a picture of the Critical Parent when we talked about the unrelenting pressure I feel from my father. This idea immediately filled me with dread and anxiety like a sucker punch to the gut. I practically panicked when I told her I wouldn’t. I immediately thought of my dad and I don’t want to paint him. Especially since he is actually impressed with my painting. He thinks I have some talent here. Thinks I should look into taking some formal art courses (which I’ve never had) and pursuing this further. I don’t’ want this to be homework or a chore. I have so little time free to follow my love of this I just want to enjoy myself and let my ideas flow where they will. She tried to suggest another painting assignment but I’m not turning this into homework. I won’t.

Foreign relationship dynamic. I mentioned I don’t feel very connected to Lady Friend yet. I don’t know if it’s because it’s still early in our relationship or if it’s because when I first meet people I tend to actively keep myself held back. I don’t actually know her well and I’ve been so badly abused I hold myself at a distance. No one can plant a knife in your back without you first allowing them within arm’s reach. When people get close to you is when they can hurt you. It’s only been a month of casual dating though and she does seem to be very into me.

Therapist’s first question was: So when was the last time you had a healthy, nurturing relationship like this? Blank. I honestly cannot remember. I’ve had a lot of long, emotionally unattached/unhealthy relationships or very short relationships that I’ve either bolted from or set on fire and burned to the ground. But not healthy, nurturing relationships. Therapist thinks that part of my problem may be that I simply don’t recognize this feeling. Since it’s not fraught with conflict and upset it’s such an unfamiliar concept to me that it doesn’t register with me as what a relationship should look like. Just let it flow as it will and try to be receptive to where it goes without putting pressure or expectation on it.

Future consideration: Telling Lady Friend about my BPD. I haven’t really dated seriously since my diagnosis {having been very involved with Friend for so long and he knows} so I haven’t had to have ‘a talk’ about my BPD with someone. I don’t know how much to tell her. When is appropriate to tell her? What will happen if I tell her? Or if I even want to tell her at all? Honestly I think she’d probably take it in stride. I’ve mentioned things like my past OCD, anxiety, and my issues of object constancy; sort of bringing up pieces when the conversation is relevant. I don’t know though.

Holy crap let me tell you how freaking irritated I get with Therapist. She talks so bloody much it drives me insane. And she gets on this one topic of inter-subjective fields that I want to gag her. I know her perceptions of inter-subjective fields and how she wants therapy to be a safe space for me and how since I’m very perceptive that she doesn’t want her life or the spaces of her other clients to interfere with my space because therapy is just about me and she doesn’t want these other influencing spheres to cross any boundaries. I drift off and cannot focus on a word she says. Or if I do I just get so irritated and angry I don’t want to listen to her.

Especially since I don’t think I have boundaries.

She asked me what I meant by this. I don’t know honestly. It seems to me that I’ve always held such rigid beliefs, hid so much of myself away, feared embarrassment or humiliation for so long – very, very rigid boundaries… then after living with Evil-Ex, he would take every little piece of ammunition he could gather against me and if he perceived a vulnerable point in me or an opportunity he would use what he had against me to humiliate me. What strikes me is my reaction or lack of reactions. I have almost a casual resignation to these experiences. They happened. There’s nothing to do for it now. I believed I would feel a certain way, that my world would be impacted in a way that was so detrimental, and yet, it wasn’t, nothing that I believed would happen, happened. In fact, probably no one cared at all. Just me. So if all these rigid ideas and beliefs that the thought of having them crossed created so much anxiety in me, if they’re not what I believe they are, is anything I believe what I think it is. Is any of this imposed rigidity necessary? It seems to me that regardless of whether I believe I need these things, when I’m presented with a violation of them, I continue on anyways. Move on. Nothing stops. Nothing ends. Do I need these concepts of boundaries at all if they aren’t enforceable? They no longer seem to be there anyways.

In a way this may seem very Zen. Therapist is pretty adamant that boundaries are necessary to establish for oneself. I can see how this is unhealthy for me because in regards to myself, I’ve let things like rape and assault wash over me. I detach, dissociate, repress, and continue on, but I don’t devastate. In the moment, maybe, but it doesn’t last for long. If it doesn’t last, than are they really hurtful? If I pull myself together and keep going was it really so traumatic? Would having boundaries have helped me out of these places or prevented me from being there in the first place? Probably. But not having boundaries didn’t kill me. What doesn’t kill you and all… but do I really want to continue to test that theory? No. There absolutely are things that are inappropriate. Violations no one has a right to breach. Just because I got through does not mean that I no longer need to build these back up; reestablish what is acceptable for the future. Having gone through it before, lived through it before, does not make it okay for it to happen again, even knowing that it is survivable. Should be more than mere survival to really live.

Around and around my ruminations go.  

Homework: Create a space within you in order to establish boundaries which you believe are acceptable for your life.

Take home therapy

Lucid analysis post is too long so I’m putting this assignment in it’s own post.

Homework:  Pay attention, from within yourself to the experiences of being with the special and/or important people in your life. Pay close attention to your internal senses about the experience. Try to fully engage your sense of sight, your hearing, your sense of smell, your sense of touch, what the experience felt like to you.

In therapy each week: try to write about at least one meaningful experience each week in session. You can write about before session if you’d like to. Try to describe the experience in detail, fully engaging your senses.

Visually, how it looked around you, the beauty or starkness of the experience,

The music or sounds you heard,

The smells around you what you were able to hold and feel in your hands with our sense of touch,

How the experience made you feel.

One positive thing that stands out the most about the experience that has meaning for you. Draw a picture that represents something important to you about the experience.

Suggestions for enjoyable bonding times:

Go for an exhilarating nature walk in a beautiful place.

Go kayaking on the bay early in the morning or at sunset.

Together, read chapters of a favorite book outside in nature.

Walk together through a colorful flower arboretum on a summer day.

Get acrylic paints and sit by a lake to paint a picture of the scenery around you.

Prepare a healthy lunch and snacks and have a picnic at a park

Go swimming at a fresh water lake on a warm summer day.

Get your favorite ice cream cones and sit in your car together overlooking the bay or ocean and watch a storm over the water.

Wash your hair outside on a hot summer day, in a passing heavy rain.

Take a few free yoga courses to learn the restorative and relaxation poses, and then get your yoga mats out in your home on a rainy day, light candles and practice the yoga poses or asanas as they are called, in a favorite room in your house.

Teach each other a dance that you remember learning or always wanted to learn when you were younger or that you want ot learn now.

Share you favorite music, and then sit and talk together about whatever comes to mind.

Have a spa treatment day in your home.

Take a photo together from one of these occasions, and frame it for both of you to always have.

After each of these times that you share together, tell your loved ones how much you love spending time together, how much joy they bring to your heart, and how happy having them as your friend or family member, makes you feel.

Road to Recovery…

Last week a Reader asked:

Do you think you could share a little about how you decided to address the pain and try to recover? There is someone in our life who we WISH would seek treatment, and I’m wondering what might get her there. Thanks.

How I decided to address the pain and try to recover. I wish I could give a completely selfless answer and say that I saw how I was affecting the people around me, that I realized how hurtful I was. I wish I could say that I wanted to stop lashing out and devastating the world around me. Unfortunately when I was taking out my emotions on other people I mostly felt like it was everyone else that did not understand me and the only thing wrong with me was that I was misunderstood. I felt hopeless. No one and nothing could help me because no one understood and if no one understood how could anyone do anything at all. Eventually I began Acting Out less and turned inward. I took out the majority of my turbulence on myself, Acting In. This doesn’t mean that it doesn’t still affect the people around me. It does. I’m just not as actively aggressive towards other people. Anyone close to me is still caught in my wake, or at the very least, sees what I go through, realizes that I’m hurting, and wishes better for me. It came down to the fact that I wanted to stop feeling so turbulent. I wanted it for me. First and foremost I want to feel better. That doesn’t mean I don’t want to be a better friend and be better to everyone around me. I absolutely do, but this wasn’t my main driver though it is a product of what I’m working towards.   The people that I’m close to care about me and they truly want me to be happy.

I’ve been an emotional disaster, especially when it comes to relationships, for as long as I can remember. It’s depressing. It’s painful. How I take it out on myself is excruciating. How I take it out on others is worse. I finally came to the realization that there has to be something better than living in constant pain and depression.

Growing up I fought the idea of therapy and medication. When I moved to New York I was involved in a very abusive relationship.  I bottomed out.   Finally, I sought therapy as a last resort.

Unfortunately as is often the case, it takes hitting bottom to have the greatest motivation to dig ourselves out of the holes we’ve dug. I wish I could say that was the only time I’d hit bottom, but it happens a lot. However, it got me to open up to the idea of therapy. Having the help to work through is invaluable and I strongly encourage this.

I think the last big kick in the ass was what lead me to the Psych ER {Intro, Part 1, Part 2, Morals}. The relationship I had been in wasn’t good but it wasn’t bad. It was just boring. I had no reason or inclination to stay in it and yet, when it ended I Acted Out in a way that got the cops and an ambulance called on me. I scared the hell out of my friends, terrified my parents, could have lost us our new apartment, could potentially have lost future employment… the repercussions of my actions were just not acceptable.  Especially when there’s no rational reason for my reactions to have been as extreme as they were. I knew something was very wrong for most of my life, but this was the last straw. I determined to stay on an anti-depressant, which ultimately was not enough, but it was a start. All these things; the realization of just how bad my actions could affect me and everyone else, remembering that through previous therapy I had begun to see bright spots again. I could see glimpses of better ways of living. I wanted not just glimpses of a better way, but actually walking a better path completely. Constant depression is a vortex of joylessness. I wanted to escape the blackness. No. Not black. Everything was grey. Grey, dreary, dull, nothing being crisp or vibrant for long enough to glean any happiness from. It’s no way to live and it doesn’t have to be that way. Finally I began to want for myself what my friends and family have always wanted for me; the chance of happiness. It’s why I created this blog; to help me as I work towards this. It’s something I want for anyone fighting a Borderline Personality Disorder.

The turning point came for me when I realized I want to get better.  No one can understand me, if I don’t help people understand me. If I don’t reach out to allow myself to receive the help I need. This is also my responsibility. This is a big world. I’m only one person in this world. There are plenty of people that love and care about me, but they also have their own lives to deal with. Ultimately, I am responsible for my own happiness and healing. This sounds like a sagely bit of wisdom, but for someone with BPD who wants so much to be close to other people without actually knowing how in a  functional way, it’s anything but easy. But it is possible. And it gets easier the more we work to embrace this.

I don’t know. I’m so tired of being so self-consumingly lonely, so sad and depressed, so misunderstood… so afraid… of everything. Life does not have to be this way. I refuse to believe that this is simply my lot in life. There is only one thing that can determine my fate, and that’s me. If I choose to be a different way, I can take control of my world and make it something that is worthwhile.  

In order to do this, therapy has helped me immensely. Writing this blog has helped me more than I expected. Being able to reach out, connect with other people struggling with a Borderline Personality Disorder, knowing that I’m not alone, hearing from other people as they also fight, or as they seek advice, or simply leave a few words to let me know they’ve been by… knowing that I’m reaching out and connecting with others like me; helps. I’m also determined to stick to a medicinal regime as well. I’ve previously floundered with this a little, but I’m working with my Psychiatrist to find meds that will aid me. There is no medical cure for personality disorders, however there’s hope that meds can alleviate some of the symptoms like depression and anxiety.

Realizing just how much I could lose. The opportunities, the people I love , my friends,…  the disappointment… The thought of losing them or letting them down is my biggest motivation now. I have a lot of people that I love and care about, and I want to be able to be with them in a healthy way that won’t drive them away.

You need to understand that I’ve lived with this for well over half of my life. Almost two decades of feeling like things would never get better. It’s not something you can just turn to someone and say ‘cheer up, it’ll all work out’ when so far, for so long, it hasn’t. It’s hard to see a better way when you’ve never known a better way. It requires a leap of faith. A leap that is incredibly scary when so often things smash to bits on the rocks below. It’s looking for a safe way down to the ground when your path is lined with jagged rocks and chards of glass. Fortunately there’s never just one way around the obstacles set in front of you in life. It takes a shift of perspective, but that sense of being safe in your own Self, is absolutely attainable. At least, I believe it is.

I  hope that gives some insight into your question. Thank you for asking.