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Apologies in advance that this is a very negative post.  I know I should be giving things a fair chance, but sometimes a situation just sucks so much that it's hard to set aside the frustration and try it again.  This morning I went to my first DBT group meeting.  I also may have gone to my last.

Going into the meeting, I was anxious.  It started hitting me about 45 minutes before the meeting time, when I was trying to figure out exactly what time to leave to be not-early and not-late.  I was anxious about figuring out how to pay - who to pay, what payment types would be accepted, and even whether or not I should pay, given that it will just be tacked onto my ever-growing bill if I don't.  I was anxious about being in a group in general, and especially about joining a group of people who had all been attending for years and already knew each other.  I was anxious about which section of skills they might be working on, and how well that would line up with what I'd already done in individual therapy.  I was so anxious, in fact, that I drove right past the place and had to turn around in a parking lot to come back.

I did pay, in cash, to some confused receptionists who weren't used to a client who doesn't have Medicaid.  I entered the group meeting room and found two women sitting there.  When they introduced themselves, I thought they were the group leaders, but it turned out they were both just members with thick binders of all their accumulated handouts.  We were soon joined by two additional members (one of whom was male), and one of the two therapists who lead the group.  The other therapist and several members had called to say they could not attend today.

The meeting began with each of the other members describing which skills they had used during the previous week.  Two people did this in a succinct way, that avoided too much backstory.  Two others rambled on and on about all the situations they were in when using these skills, which I had been told in the orientation was not the appropriate way to use group time.  However, the therapist made no effort to reign them in.  To be honest, I was sitting there thinking that I don't give a shit about these people or what they have to say.  It was mindnumbingly boring to listen to everyone whine about what all had gone wrong that week and then brag about how they handled it so well.

Then we moved on to actually discussing skills.  They had recently started the Interpersonal Effectiveness section, which is exactly where I hoped they wouldn't be starting.  I've done Distress Tolerance and part of Mindfulness with my individual therapist, so starting with one of those, or even in the Emotion Regulation skills would have been fine.  The therapist went back to the first page of the handouts and reviewed, partially because people missed group so much over the holidays and partially, I think, to catch me up.  Yes, review of the previous week is built into each meeting, but we spent the entire second hour on review and never got to the point where they teach new skills.  In fact, the review didn't exactly contain any skills either.

One member of the group would not stop running her mouth long enough for the therapist to get a whole sentence out, and also used a profanity for every third word she said.  The others could manage to wait their turn, but never seemed to be on the right track as far as what we were discussing.  I was asked at the end of the meeting whether I thought this was going to be helpful.  I said, "Not in the slightest."  This earned me a lengthy speech from the member with diarrhea of the mouth, telling me all about how much DBT has helped her in the FIVE YEARS she has attended the group.  Five years.  You complete the whole set of skills in 6 months, so she has been through it all 10 times.  I cannot even remotely count that as helping, if she still feels the need to attend the group and be retaught these skills over and over again.

At the break in the middle of the meeting, the therapist went and made photocopies of the Interpersonal Effectiveness handouts and put them in a binder for me, along with a few copies of the weekly diary card.  I nearly left the binder on the table when I walked out.  I was already 95% sure I would not be returning next week, and 100% sure that I would not complete the entire program, so it's hardly fair of me to come back and lead them on.  By the end of the meeting, I wasn't anxious anymore.  I was just annoyed and frustrated, and felt that I had just wasted 2 hours and $12 on complete drivel.  I'm giving my therapist one chance to talk me into returning, at our appointment later this week.

What do I hate so much about it?  Well, aside from everything mentioned above, it's repetitive.  The skills are just the same things said over and over in different ways.  I'm not an idiot who needs to hear things a hundred times in order to understand them.  In fact, I'm just plain not an idiot.  We went over a page about challenging myths about interpersonal effectiveness.  After just one of them, I said, "So in other words you just add a negative to the sentence."  The therapist looked at me as though shocked that anyone would pick up on that on the first try.

I also hate that, in looking over the list of skills on the diary card, I once again find that the skills are not the same skills my therapist has been giving me.  The same happened with a DBT workbook I bought.  Oh sure, some of them are the same, and some of them are clearly just different wording.  But there are entire skills that are missing from this list.  How can DBT be some proven program if it's not even the same skills when different people teach it?

I hate that the skills are not things I need to be taught.  We went over and over the idea that Interpersonal Effectiveness is about asking for help when you need it and being able to say no when you need to.  I don't inherently have a problem with these things.  I have a problem with these things because I experience social anxiety, but I don't need to be taught how to do them.  When my anxiety is under control, there's no problem, and when it's not, there's no skill in the world that is going to help.

Most importantly, I hate that I'm not doing this because I want to do it, or think it will help me.  I'm doing it because it's what my therapist wants me to be doing, and I feel that if I tell her I've had enough of the DBT and that I'm not going to the group or letting her teach me the skills anymore, then even if she can work with that there will always be a tension between us.

I don't even really believe my BPD diagnosis is correct.  I don't have most of the stereotypical symptoms, and the ones I do have can be easily attributed to bipolar.  I don't always use self-injury to cope or think about suicide, only when I'm depressed.  I don't always drive too fast or overspend, only when manic.  If the diagnosis is wrong, and the therapy is not what I need either way, then why the hell am I doing it?


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/19/my-first-my-last-my-dbt/. Please comment there.
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When I started meeting with my first therapist, who we'll call Wendy, I had just flown through a month of mania and gone crashing into a mixed episode. I find mixed episodes to be the hardest thing to explain to the non-bipolar. It's not that hard to understand depression - most everyone has experienced at least a brief, minor form of it at some point and can extrapolate from there. Mania is a little trickier, but again the idea of being filled with energy and not needing sleep or food and feeling like you're on top of the world has at least some basis in the average human experience. Most of us have felt very, very good for one reason or another, and could understand what it would be like to feel that way only magnified.

Mixed episodes? Now those just don't make sense. How can you be up and down at the same time? How can you be filled with energy and flying from one task the next, yet feel a deep despair about your useless, futile life? For me, mixed episode meant I was still sleeping a mere 3-4 hours per night. I still raced from one thought to another, talking to myself in words filled with rhyme and alliteration and assonance and somewhat lacking in sense. I still shared way too much with people I barely knew. I still drove too fast. I still felt enlightened.

I also felt agitated and disoriented. I was unable to focus. I obsessed over all the negative events of my past. I couldn't stand being home and would go out wandering in the middle of the night. I'd berate myself and cry and plot how I was going to kill myself.

So I started seeing Wendy. While we did discuss concrete steps for improving my life, these always stemmed out of conversations where I rambled on and on about my past experiences and current worries. A lot of times what helped was that I said things that it scared me to say, and found that Wendy didn't react badly. Granted, that's her job as a therapist - to be accepting and supportive even if she doesn't actually feel that way. However, it still tricks me into feeling less alone and less like anyone who actually knew me would immediately hate me.

Things were improving for me. I was managing to control my typical overreactions to negative events, and starting to feel a lot better about the past. Then Wendy's internship ended and I was transferred to a new therapist. We'll call this one Sadie.

Before I even start, I will mention that I like Sadie a lot. That's what has made all of this so difficult. If I didn't like Sadie so much, I'd have a lot more options for how to deal with this situation. What situation? Well, she's just so very different from Wendy. She's very focused on tangible things we can do. Don't like my job? Let's leap right into hunting for a new one. Stressed out? Here are seventeen different coping skills to choose from.

At one point, pushed to the edge of the cliff on the job search issue, I was prepared to call and cancel all my appointments and see if I could go it alone. I went to an acquaintance for advice, and she talked me into writing Sadie a letter to explain what was not working for me. I got waylaid a little by accidentally ending up in inpatient, but I wrote the letter while there and gave it to her upon my release. I told her that I needed more space to just talk about situations and how I feel. Also more space to talk in general, as she has a tendency to fill the silence when I'm having trouble finding what to say.

The same day that I was asking for less structure, Sadie was preparing to propose more of it. The inpatient unit had strongly encouraged the use of DBT. Her ideal solution would have been for me to attend a DBT group, but it did not fit into my work schedule. So we compromised, saying that I would get half of each session for my freeform talking, and then we'd go over 1 or 2 DBT skills with the rest of the time.

It was a nice proposal, in theory. In reality, it's now 4 months later and we've been doing all DBT, all the time. Learning a skill or two each session would be fine, except Sadie wants to go over the worksheets before I do them, and then go over them again after I do them. I am quite capable of reading and comprehending them on my own, so we only need to discuss my answers once I'm done. Also, she has me doing these weekly diary cards, to rate my urges for negative actions (suicide, self-harm, etc.) and my various emotions (sadness, anger, joy, etc.). Also I'm to note which DBT skills I used each day and how much they helped.

dbt-sheets

So what does a session look like now? I hand over my diary card (with a special notes page I make, because I am an overachiever). Sadie looks it over and tries to identify patterns. She may ask me a couple of questions. Then we go over my completed skills worksheets, then she basically reads the new ones to me, then when there are about 2 minutes left she asks if there is anything else we need to discuss.

Last week I'd had enough. I warned her in advance via e-mail that I was not getting enough time for just talking, and then that's what we did. I did give her my diary card, but then we actually discussed all the events that I had noted on it. We talked about how I felt, about why certain events upset me. We did talk about concrete things I could do, but in the context of the greater conversation. It all felt right. It hurt, but it also felt like there was hope. I even conceded to receiving a new skill worksheet, on the condition that I get to read and fill it in myself before we discussed it.

Sadie apparently didn't feel the same way I did about the session. She said, "I don't want to take away from your opportunity to just talk, but DBT is the best treatment for your diagnosis." I'm a person, not a diagnosis. Even if I were just a diagnosis, I'm not just BPD. Maybe DBT is the best treatment for BPD, but until you strip away the bipolar, strip away the non-disordered parts of my personality, strip away my past experiences and my thoughts and feelings and all that makes me a human, then perhaps it's not the best treatment for me.


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/11/im-a-person-not-a-diagnosis/. Please comment there.

"Rumors"

Aug. 14th, 2014 08:32 pm
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I have never been quiet about my bipolar diagnosis.  My family members know, my friends know, my coworkers (even my supervisor) know.  The one area where I've kept it secret is with my employer's HR department.  Until last week.

I do a combination of inventory control and quality assurance for a fulfillment center contracted by a major national brand.  I work 3-4 days per week, spending up to 12 hours per day at work.  This was all well and good when I was manic and had boundless energy (and needed virtually no sleep so I was able to do fun things in the evening), but once I sank into depression it became torture.  Actually, the job may have contributed to the depression.  My manic episode ended and I wasn't exactly depressed, but due to a series of unfortunate events I spent weeks working in extreme pain.  Also, my blood pressure was ridiculously high, which was not helping my stress level.

At any rate, depression + long work days = bad.  Depression + long work days where I don't know exactly how long they'll be and what I'll be doing that day = extra bad.  Depression plus long work days blahblahblah in which I sometimes have to spend all day on a task I loathe = unbearable.  It actually got to the point that my therapist wrote my supervisor a letter recommending that I not do that particular type of task.  I've done it much less since then, but recently it has been unavoidable.

Said therapist has highly encouraged me to find a new job, and by "encouraged" I mean "pressured to the point that I asked her to please stop".  Then I ended up in an unscheduled appointment with her the following day to tell her she was right.  It's been a few weeks since then, maybe about a month, and I have not made much progress in the job hunt.  I managed to write my first resume though, and baby steps are better than nothing.

Last week, the secret came out when I went to the HR department to see if they could suggest an alternate position in the company that may be more suited to my skill set and scheduling needs.  The HR rep I spoke with, who we'll call "Kara", came up with several possibilities.  None of them were ideal, but I made a very rational decision to apply for an available job at our other local warehouse.  The hours might actually be a bit worse in some ways, but it was the biggest change out of all the options and I figured if my life's not working I should make a radical change.

A few days later my supervisor hunted me down where I was working (on that task that causes me so much emotional distress) and said Kara wanted to speak with me.  I figured it was news about the job I applied for, but then he escorted me all the way to HR.  I was anxious, but had no idea what was about to happen.  Kara took me to the conference room, shut the door, and sat much closer to me than she did last time I was there.  She told me that the job I applied for had been filled by someone else.  I relaxed a little.

Then she dropped the bombshell.  She said that she'd heard some rumors that may or may not be true about things I was doing at work.  I knew exactly what she meant, but was terrified I was about to be fired and pretended I didn't know what she was talking about.  She said she wouldn't pry if I wasn't comfortable talking to her, and handed me a brochure for the Employee Assistance Program.

It took a few rounds of her saying she wasn't sure if it was true, but it finally sunk in that I was not going to be fired and I admitted that it was true that I injure myself, sometimes while at work.  She said she wished she knew how to help.  She went over the possible job alternatives again, including a new suggestion for one that would be available in a few months.  She told me I could come talk to her anytime.

Of course that meant I couldn't do it.  I have a tendency to drive people away somehow, and I knew without a shadow of a doubt that I couldn't let that happen with her.  There was something on my mind that she might be able to help with, but I kept it to myself for days.  Then this happened:

arm-writing

It's not as bad as it looks.  Last time I made such a list (on paper) it was much longer and I actually felt what I was writing.  Now I just feel blank.  Like maybe writing this would make me feel something.  Even if it was a bad feeling, it would be better than this inability to cry, to smile, to get angry.  It only made me feel a detached sort of worry that I would take the next step in trying to feel and do it in a way that would leave a scar.

I wasn't feeling that impulse yet, but knowing that I could led me to finally go see Kara.  I told her that one of the techniques I had learned to avoid injuring myself was to put ice on my wrists, but the only place to do that at work is in the break room, where security will come yell at me and make me leave if I walk in there outside what they think should be my break time.

In reality, my particular department is so small that we are allowed to take our breaks whenever we feel like it, as long as we spend the appropriate amount of time on break.  Also, the idea of me spending a few extra minutes "on break" is a lot better than spending those same minutes in the bathroom, crying or hurting myself.

Kara's response to the statement that security would yell at me was, "It's none of their business."  It may not be, but they've done it in the past and I told her as much.  So we now have an agreement that if I feel a need to go ice my wrists I will come see her and she will tell security I have permission to be in the break room.

So writing all over my arm led somewhere positive in the end, and although I was terrified by the idea of HR finding out about all this I'm starting to be thankful that someone spread those "rumors" in their direction.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/08/14/rumors/. Please comment there.
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As with my previous post, this was originally shared as a Facebook note.  I had hoped on this blog to tell this story in a much more chronological fashion, but chronology is working against me these days.  So here is the summary of recent events, and the more descriptive posts about these events will follow in due time.


Image


Four months ago, I shared a post titled "What if no one is listening?"  At the time it felt like a huge scary step to share my long history of depression with everyone, and I was leaving out a major point.  One that it seems timely to bring up with the recent premiere of the new series Black Box.


For those who haven't seen or heard of the show, it is one in a long line of stories about someone extremely talented in his or her field who has a secret struggle.  In the case of this show, the struggle is bipolar disorder.   Like the main character, I have bipolar disorder.  Unlike the character, my life happens in the real world and does not actually involve the cool special effects hallucinations or the really hot mania-induced sex.  Do these things happen to some real people with real bipolar disorder?  Absolutely.  But the reality more often includes a lot less TV-worthy excitement and a lot more pain and suffering.


The best written explanation I have found so far is the book Take Charge of Bipolar Disorder.  I've been through several fairly useless books so far, and this was the first where I was reading through all the descriptions of symptoms and thought processes and yelling, "YES!  It's exactly like that!"  The book does have sidebars aimed at friends and family, but the main parts of the book would be even more informative for anyone deeply interested in knowing more.


For those less deeply interested, here's a brief synopsis: bipolar disorder (of which there are several varieties) is an illness caused by chemical imbalances in the brain.  There is some genetic component, but it appears to develop as a combination of genetics and stressful life events.  It pretty much always requires lifelong medication, and even with medication there can still be occasional episodes of mania and/or depression that break through.  A combination of medication, therapy, and lifestyle changes is the best way to reduce the number of episodes.  Bipolar disorder can appear anywhere from childhood to the elderly years, but most often starts somewhere in the teens or twenties.  It's common for it to go undiagnosed (or misdiagnosed) for many years, and this time spent without proper treatment can increase the severity of the illness.


The well-known symptoms are periods of depression alternating with periods of mania (or hypomania, a less severe elevated mood).  Depression includes both a decrease in energy and an increase in negative thinking.  Mania includes an increase in energy and also an increase in positive thinking.  There are so many more things that go on though.  Trouble focusing, having intrusive unwanted thoughts, paranoia, anxiety, irritability...all these and more can happen even when not in the midst of a major episode.  Obviously these past two paragraphs are an oversimplification, but hopefully enough to satisfy those who are not going to pick up other reading materials on the subject.


So what about me personally?  I have type 1, generally viewed as being the "worst".  The technical definition is that people with type 1 have had at least one episode of full mania (as opposed to hypomania) lasting either at least a week or any duration if it's severe enough to require hospitalization.  There are also typically episodes of depression lasting at least 1-2 weeks at a time.  I was manic for a full month in January/February of this year, and when it ended I felt so terrible that I may as well have been depressed even though I technically wasn't.  I ended up at the emergency room due to a friend calling the cops, in counseling due to the emergency room visit, back to the emergency room when I told my counselor I had a suicide plan, and into inpatient care for a few days in mid-March.  Despite clearly having this illness for the vast majority of my life (at least back to late middle school/early high school and possibly farther back in childhood), I was not diagnosed until that inpatient stay.


To bring this back around and tie it in with Black Box again: yes, there were some moments that felt very familiar.  Staying up all night writing frantically after missing a single pill.  Feeling so agitated at waiting for the elevator that she gave up and took the stairs.  Worrying about the possibility of passing this illness along.  Desperately begging someone to give her one reason to live.  Wondering if it's better to live a longer life when medicated into a normal (aka. boring) state, or die young after a brilliant madness.


I hope that it is possible to be medicated and still be interesting.  To be medicated and still be creative.  I want to believe that there's something special in me that will still be there even if the illness is tamed.  So I'm in counseling and at this point still having medications adjusted.  Some days go pretty well.  Some days are epic failures.  I'm hoping that the ratio between good days and bad ones will improve over time.  I am sharing this because I don't feel there is any shame in having an illness, and I may be able to help someone else by answering questions or showing someone that he or she is not alone in feeling this way.  So please, if there is anything you wish to know more about, feel free to ask.  I will do my best to explain, at least from what my own experience has been.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/04/27/lifting-the-lid-off-the-black-box/. Please comment there.

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