Posts Tagged ‘Dialectical behavior therapy’

 

One of the things I love about my therapist is that she checks in with me every so often to make sure we’re on the same page.  Do I know what her goal is?  Do I know what my goal is?  Are they the same?  Are we in the right stage, going in the right direction?  Are we moving forward or standing still?  How do I feel I’m doing now as compared to a month ago, 2 months ago?

            Today was one such day where we kind of looked at each other like, okay wait, what are you saying?  Where are you going with this?  I told my therapist that I kind of felt like we were in a holding pattern.  She didn’t necessarily agree with that assessment.  So that is why we stepped back and looked at our game plan.

            To me it feels like I’m playing the waiting game… again.  Waiting for the consultation with the DID specialist.  Waiting to see if she accepts me as a full time client.  Waiting to see if I’ll be continuing with my current therapist in some capacity.

            My therapist explained that even if we do continue seeing each other she wouldn’t be digging into trauma work with as of yet.  She feels that I still have a ways to go in achieving higher functioning in my daily life.  After dissecting what exactly she means, I have to agree with her standpoint.

            The goal now is to achieve some sort of structure in my day to day life.  I don’t have much of a schedule that I follow right now.  And what little scheduling there is certainly doesn’t include things like exercise, getting out of the house, regular meal times etc.  I’m very isolated at the moment which is partly to do with the season but I have been making strides in that department.  I try and accept invitations from friends more often and even initiate an afternoon out for coffee.  But there are other things such as volunteering that I have yet to follow up on.

            So the idea is to make up a schedule of an ideal day/week that strikes a balance between those things we must do and those things that are pleasurable, and then add those things into my actual schedule.  That means scheduling a shower, doing the dishes, vacuuming, going for a walk, going to the dog park, spending meaningful time with my wife.  Scheduling absolutely everything.

            But everything has to start somewhere, so much against my all or nothing nature the one thing I choose to add this week is going to the dog park at least 4 times.  Should be doable right?  I’ll keep you posted.

            In the end, my session with my therapist was quite productive today.  I like knowing where we stand.  It gives me that sense of control over the process that I so desperately crave in my life.

            After all, that’s what therapy is about right?  Building a sense of mastery in one’s life.

Remember, it’s okay to ask in therapy, “Wait, what were we working on again?”

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So yesterday in therapy we talked about the darkness and the light.  We talked about how life has both, needs both, to balance the other out.  The reason we were talking about this is because I have been in a bit of a lull. A period of calm you might say.  With the exception of feeling a little melancholy here and there I’ve had mostly good days.

            I’ve written about this before in a slightly different context.  It is in these times that I find I can’t enjoy myself too much.  I can’t relax too much.  To let my guard down that way would be dangerous and ill advised.  It is hard to accept that things are okay without feeling that the other shoe could drop at any moment.  Of course, this all fits in with the PTSD and so, is somewhat inherently part of my makeup.  But what my therapist would like me to try and realize is that I don’t need to waste the okay times anticipating the bad.  The bad will come eventually whether I am prepared for it or not.  So why not just relax and basque in the glow of happiness without judgement?

            That’s where the DBT skills come into play as well.  Being mindful, present, doing one thing in the moment.  Filling up my time with pleasurable activities and being mindful of what exactly this emotion is.  I guess I truly am learning a few things in DBT.  I still don’t believe it’s the be all and end all that some chalk it up to being but it does have some useful ideas.  I guess really I’m a fan of anything I can do to keep out of the hospital.

            I know that many, if not most DID people have been in and out of the hospital at least a couple of times.  I’ve been close to being admitted a couple of times myself but in those moments of evaluation I was able to pull it together enough to receive outpatient care instead.   Being put in the hospital terrifies me.  I don’t know that I would even stabilize me in a time of need or if it would just scare me to death.  So I hope to avoid that eventuality at all costs.  Perhaps this fear even keeps me from reaching full healing potential.  For if I dig too deep I risk destabilizing and leave myself vulnerable to the need for intervention.  Unacceptable.  Maybe one of you can explain to me what happens in the hospital to take the mystery out of it for me.  Fearing the unknown is a huge issue in my life

            Fear in any form has been a huge issue in my life.  What to do about that?  What to do?

So we’re talking about interpersonal effectiveness in group right now.  Two long words to describe how to get what you need and want.  Or conversely you can describe it as how to say no to what you don’t need or don’t want.  Other words you can use are how to manipulate a situation to your best advantage. 

The facilitator of my group said that manipulate doesn’t have to be a bad word.  I had a hard time swallowing that at first.  But then I looked at it another way.  I guess in a manner of speaking we are manipulating the world around us all the time.  Scheduling what we’ll do when, who we’ll see, who we won’t.  We work towards gaining the things we want, plan what to get rid of or ignore.  All of these things are a kind of manipulation.  I think when it becomes a bad word is if you are subversive about it, or hurtful and deceitful

We all maneuver through our lives.  Some of us are very skillful.  We’ve learned highly adaptive ways of dealing with the world while others of us have not been so fortunate.  The fact that the brain can be changed, molded and in some cases stunted leaves us all vulnerable.  An abused person develops completely different from a non-abused person.  A loved person has certain advantages over an unloved person.  That is not to say that we can’t overcome obstacles planted in our way.  In fact it means quite the opposite.  We can train or manipulate our brain chemistry by learning and practicing a new way of being. We can work hard at finding different ways to handle the trials of our lives.  We can adjust our course, choose a new journey, and seek a smoother path.  The best thing to do is find support, find information, and find all of the things you need to accomplish whatever goals you set for yourselves.  Manipulate the world around you in an honest, gentle way and be kind to yourself.

So manipulate away.  It’s not such a bad word after all.

So let’s talk therapy.  There are so many different kinds of therapy.  Different theories, different modes, different styles.  How many different kind of therapy do you think you’ve been exposed to?  I’m trying to remember.  There’s been individual counselling as well as a few couple sessions.  I’ve done several different types of group therapy.  I’ve done online chatting both individually and as a group.  I’ve also done forums and of course this blog I would also consider therapy, albeit self-directed.

I’ve been taught CBT (cognitive behavioural therapy) and DBT (dialectical behaviour therapy).  I’ve had one counsellor that described her style as coming from a feminist perspective, another as a family systems theorist.  There’s client centered healing, oh  and my latest read was based on a Janetian theory which pays much attention to hierarchies of action systems.  There are many things you do in therapy like processing memories and learning practical skills.  There are countless theories and approaches.

I look at this and I think, “I should be the healthiest person around!”  There are a thousand types of therapy I’ve not been exposed to as well.  Do you know what theories your therapist is partial to?  Do you think yo have the right to know?  when I was younger it didn’t even occur to me to ask.  When I was moving to escape the bad guys I did ask that therapist what her main perspective came from so that I could tell any future therapist what I had worked with in the past.  Then I read this article by Kathy Broady and she talks about her approach at great length with her clients.

I have a great deal of respect for Kathy.  I discovered Discussing Dissociation when I was without a therapist after i moved.  i found all of the articles so informative and so in tune with what my experiences were.  Kathy is very knowledgeable and experienced when it comes to DID.  I know there has been some controversy out there about her but from my own personal experience, she’s been great.  A life saver even.

Anyway, I just wanted to p[ut these few questions out to see where you all stand.  Do you know what theories your therapist ascribes to?  Do you have a particular approach you feel you respond to better than others?  For any therapist out there, do you feel you are flexible as to what theory you use according to what client or do you stay rigidly within one or two?  Let me know what you’re thinking.

So I had therapy yesterday. It was a good session. We actually laughed quite a bit. We talked about all the skills I’ve learned with a focus on distress tolerance. I’m coming to the end of my group. I will have been through all the modules when we finish this current one. My therapist asked me if there were any skills I thought I needed more work on. I said of course, there’s always room for more learning. So I’ve decided to go through group for a second time. It’ll be a reason to get out of the house if nothing else.

Then we got serious. My therapist said “I don’t know your whole story and I haven’t been pushing it because it wasn’t the most important thing.” She said she’ll let me make the decisions on how I want to tell her, what I want to tell her, and how much I want to tell at a time. So it’s time.

I think I’m ready. I think I’m going to start from the beginning and just spill out all the parts that I know. I think I’m going to be okay with doing this. Maybe I’ll show her some old journal entries where I talk about memories and that way I won’t have to say it or write it down again. Then there is the point that maybe if I write it down again it will help to process it more.

What do you guys think? Do you have a particular way that you’ve found helpful or easier maybe, to talk about the memories you do have? Let me know what your thoughts are.