DBTwo

Jan. 28th, 2015 12:34 pm
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When last we met in My First, My Last, My DBT, I expressed a great deal of anger and frustration about my first meeting of DBT group.  Following that post, I e-mailed a link to my therapist and told her she'd have 50 minutes to convince me to go back.  She replied that she had no interest in convincing me to do something I hate.  By the time I got into her office two days later, I had already decided I would go back and try it again.  I suspect she was secretly pleased.

Why the change of heart?  After talking with several friends, it became clear that I had spent several days experiencing hints of manic symptoms.  First, there was the extreme anger and irritability.  Also, I was feeling superior to everyone around me.  Most alarming was that I was losing my insight.  It sounds contradictory, as I obviously need insight in order to recognize that I don't have it.  However, I was writing some things in my journal that I wholeheartedly believed, despite the fact that I recognized how completely irrational they were.  I was convinced that therapy and medication were ruining my life.  I was convinced that had I not sought treatment last February, everything would have worked itself out and I'd be fine now.  The reality is that had I not sought treatment, I would be dead by now.

So when I got into therapy Thursday, there wouldn't have been any convincing to be done, even if my therapist had wanted to.  I knew I had to go back and give the group another chance.  What we did discuss made me feel better about the diary card I'd been given, in that I felt I could mention that it wasn't working for me.  We also went over the myths about Interpersonal Effectiveness again and I acknowledged I do need to work on challenging some of those.  Most importantly, we discussed my diagnosis.  My therapist said it's possible she's wrong, and also that diagnoses are fluid and can change as she gets to know more about me.  I admitted that it's more likely I'm just having trouble accepting the diagnosis.

I returned to group on Monday and it was a totally different experience.  Both therapists were present this time.  We had the same number of members present, but two of the ones I'd met were absent this time and two new ones were there instead.  As it happened, the two who were absent were the two who I thought overshared the previous week.  The conversations felt much more balanced this time.

When we reviewed diary cards, they weren't expecting me to have anything to share, but I surprised them with a summary of two pairs of skills I used that week.  In the first half of the week, when I was experiencing all that anger, I used a lot of Self-Soothe and Crisis Survival Network.  In the second half of the week, on a weekend trip, I used Mindful Eating and Participate.  There were other skills I listed, but nothing that stood out as significant.

I solved my problem with the diary card by coming home and creating my own.  My therapist had mentioned that when she led group they added the new skills onto the diary card as they were taught.  So I modified the one I received for group so that it contained just the 20 skills I've learned so far.

As a nifty coincidence, we did Mindful Eating with some chocolate cake.  That was the skill my therapist had just given me last week, which I was testing out on my mini-vacation.  I found it a challenge to do in group, because I was distracted by anxiety about eating in front of other people.  No need to be anxious - they were all way too absorbed in their own cake to even be aware of my presence.

We still didn't reach any actual skills yet, just covered some information about intensity of asking or refusing.  I left with a homework assignment to fill in about a recent situation in which I wanted something from someone.  As it turns out, I had a situation on my trip in which I wanted something, but wouldn't ask for it due to one of those myths - the one that says, "It doesn't make any difference; I don't care really."  As a matter of fact, I do care about a lot more things than I let on, but I have a terrible habit of sublimating my own desires in order to please others.

I feel 100 times better about group after this second meeting.  I still don't think it's going to be all that helpful to me, but I at least feel capable of tolerating it in order to give it a chance to help.


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/28/dbtwo/. Please comment there.
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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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Today Lauren Hayley posted Day 28: Do you consider yourself high-functioning or low-functioning?  The question is in terms of Borderline Personality Disorder, and she includes a description from BPD Central of the traits of these two levels of functioning.  As a general summary, low-functioning BPD sufferers are those who direct their pain inward with self-destructive actions, and are seeking help.  High-functioning BPD sufferers are those who lash out at others, destroying relationships, and are in denial that they have a problem.

I find these definitions weird.  I don't see how seeking help makes a person low-functioning, or why being high-functioning requires fitting the negative stereotype of BPD sufferers being abusive toward friends and family.  By these standards I would have to describe myself as low-functioning.  Externally, I'm one of the nicest people you'll ever meet.  I take things out on myself.  I also am seeking help.

In my latest therapy session, my therapist and I discussed the fact that I often don't list many skills used on each day of my diary card.  One of our theories was that I'm actually using more skills than I write down, but don't think of them consciously when it's time to fill in the diary card.  In some cases, I'm using skills I haven't been taught yet, so of course I don't know to write them down.  One skill that has been referenced occasionally but not yet taught is "Opposite to Emotion Action", which is what I used today.

I recently complained about Dialectical Behavior Therapy in I'm a person, not a diagnosis.  I hate DBT.  I'm joining a DBT group on Monday.  In the orientation session I went to today, when I was asked if I wanted to join the group, my mind was screaming at me that it sounded like torture from hell.  I wanted to say no and run from the room as fast as I could.  Instead I agreed to join.

The woman who did the orientation said that they don't like to do "process therapy" with people who haven't yet learned these skills, because there is a risk of triggering negative reactions that the person can't yet handle.  This gave me a new perspective on my struggle with doing DBT in individual therapy.  It's true that when we discuss negative experiences from my past I often leave therapy feeling terrible, crying, and having urges to harm myself as a result.  I need to recognize that I'm in therapy for the long haul - as much as I want it to, it's not going to magically "fix" me in a few months.  I need to have patience with the DBT now, knowing that there's time for other approaches later, when I'm better prepared to handle them.


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/16/low-functioning-high-insight/. 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.
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There was a post in a bipolar support group the other day that asked "Am I the only one who loves coloring?"  The response was a resounding "I love coloring too!"  Nearly every commenter expressed the same interest, with many talking about coloring as the best part of their inpatient experiences.

On my first inpatient stay, I used some dull colored pencils.  When they were beyond usable, I could go to the desk and, with supervision, use a pencil sharpener.  I sharpened a couple of pencils that I needed to finish my current picture, and was tempted to bring the whole box full and sharpen them all, just in case anyone else wanted those colors.

On my second inpatient stay, I didn't do much coloring as I wasn't there long enough.  Had I known what would happen in the next week, I'd have colored to my heart's content.

On my third inpatient stay, a week after the second, the colored pencils were all dull and we were no longer allowed to sharpen them.  In that intervening week, a client we'll call Stefanie had managed to get the pencil sharpener away from watchful eyes, break it open, and use the razor to make a deep cut along her whole forearm.  It required many stitches and staples, a big bundle of gauze wrap, and her placement on one-to-one supervision - someone staying with her and watching her at every moment.

The irony here is that Stefanie was more interested in coloring than any other client.  She was constantly having the staff print off new coloring pages for her.  At first she used crayons, and then her husband brought in the Crayola Twistables colored pencils.  Her only lament was that there were only 12 colors.

Upon my discharge, I found a package online that had 30 different colors.  I ordered them for Stefanie, and attempted to go visit her as she was still in inpatient.  The staff wouldn't let me in.  Something about being too recently discharged.  I was disappointed, as I had fought past a lot of anxiety to even make the trip, but I did have the staff member deliver my gift to Stefanie.

coloring-page

Recently when I've been stressed out, I've remembered how much coloring relaxed me in inpatient and pulled out my colored pencils.  It still helps in the outside world as well.  It helps so much, in fact, that when my therapist assigned the task of creating a "self-soothe first aid kit" I promptly ordered miniature coloring books and my own pack of Crayola Twistables to include in it.  Then I had to brainstorm a while in order to figure out what other items it should contain.

The idea of self-soothe is to use the five senses to comfort oneself when in emotional distress.  Coloring is obviously sight, and I also have photos of family and index cards full of inspiring quotes.  For taste, a pack of chewing gum.  For hearing, an iPod shuffle full of upbeat music.  For smell, a roll-on of scented oil.  For touch, tiny knitted swatches in a variety of soft yarns.  As a bonus, there's also a pill container with a few of my anxiety medication.

My therapist loved the kit.  She spent forever looking at it and said she just wanted to play with everything.  My only dilemma with the kit is that I can't actually have it handy when I need it.  I can't carry something like this into my workplace, where everything I bring has to be inspected by security on the way out.  At this point in the year, it's too cold to leave it in the car, and I wouldn't really have access to it in the moment of need.  I'd be waiting until lunch or after work to go out and fetch a soothing item.  So while the kit was fun to create, it doesn't fit my current life circumstances very well.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/11/22/never-too-old-for-crayola/. Please comment there.
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In my previous post, DBT Freed Me, I mentioned having created distraction and relaxation plans.  There are many more ideas in The Dialectical Behavior Therapy Skills Workbook, which I'm using, but I thought I'd share my personal plans as a preview of what you might encounter in the book.

DISTRACTION PLAN

  1. Squeeze a stress ball.

  2. Recite the Fibonacci sequence.

  3. Remember happy memories in as much detail as possible.

  4. Hold ice cubes on wrists.

  5. Get out of the house and sit outside.

  6. Write thoughts in a journal.

  7. Listen to upbeat music and dance and/or sing along.

  8. Recycle old papers.

  9. Cook a new recipe.

  10. Help someone with a chore.


RELAXATION PLAN WHEN AT HOME

  1. Play with your pets.

  2. Run your hands through beans, sand, beads, shells, etc.

  3. Listen to a white noise machine.

  4. Turn on a soothing TV show and just listen.

  5. Burn scented candles or incense.

  6. Eat your favorite meal slowly.

  7. Create a Pinterest board full of inspiring images.

  8. Cook food that has a pleasing smell.

  9. Try a new food.

  10. Go through magazines and books to cut out pictures for a collage.


RELAXATION PLAN WHEN AWAY FROM HOME

  1. Carry gum or hard candy to eat when upset.

  2. Suck on an ice cube or ice pop.

  3. Carry something soft or velvety to touch.

  4. Rub a worry stone.

  5. Wear scented oils that make you feel happy.

  6. Listen to saved voicemails from family and friends.

  7. Listen to soothing music.

  8. Take a photograph of something beautiful.

  9. Make collages on index cards to keep in your purse or wallet.

  10. Go someplace where the scent is pleasing to you.


virginia-beach

One of the relaxation exercises asks you to choose a place, either real or imaginary, that makes you feel safe and comfortable.  At peace, in my words.  Then you are to review the details of that place using all of your senses.  My place is Virginia Beach.  I see the sun rising, the surfers out at dawn.  I hear the waves crashing on the shore, the seagulls vocalizing.  I smell the salty ocean water, the popcorn stand just down the boardwalk.  I feel the temperate breeze, the sand squishing between my toes.  I taste the salt water taffy, the cinnamon bears from a nearby candy shop.
Originally posted at http://stuffthatneedssaying.wordpress.com/2014/09/05/distraction-and-relaxation/. Please comment there.
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I was released from the inpatient unit 2 weeks ago.  I was released from the inpatient unit 2 days ago.  Wait, what?  Yes, as a matter of fact, I did get myself locked up twice within a 2 week time period.  Both instances were the result of my inability to STFU and stop saying things that will cause overreactions in people who have the power to detain me.

See, when I went to see my therapist last Thursday, I confessed to the fact that I had lied in order to get out of inpatient the previous week.  I felt honesty was necessary if I wanted therapy to work.  Well, upon hearing that I told the psych APRN in inpatient that I was perfectly fine when I happened to be considering the possibility of overdosing when I got home, my therapist promptly decided I was going back for a longer stay.  Maybe a week or two.  She even offered to find me a different facility if I did not like the inpatient unit affiliated with her organization.

I kept saying no, that I could not do this.  She wasn't taking no for an answer.  When I finally resigned myself to the fact that I was going whether I liked it or not, I asked to go home first and have mom drive me back.  I've done this in the past.  The deal has always been that if I don't report back within a certain time period then the police will be called to do a wellness check.  This time I didn't even get that time period - she said that if I left her office to go home, she'd call the police immediately.  She wanted to drive me over to inpatient herself.

So I spent another 5 nights without any freedom.  I chose to practice my radical acceptance and be calm about the fact that I was there and just let things happen instead of fighting it.  I had a lot of time to think, and while there I saw what would happen if I didn't get better - one client already had a court order committing her to a state hospital as soon as a bed became available, and another one was waiting to see a judge for the same reason.  Watching these events unfold frightened me into a deeper determination that I will work hard to overcome my problems and especially to stay out of inpatient in the future.  

There are a lot of hours in a 5-night stay.  My time was filled somewhat with meals and meds and psychiatrist's visits and group activities, all of which I fully engaged in.  That still left a lot of hours for socializing with other clients, visiting with mom for 2 hours each evening, kicking butt at games of rummy, writing in my journal, and (possibly most importantly) doing exercises in my DBT workbook.  

My stay was somewhat lengthened by the fact that they weren't going to let me out so easily on a return visit - they even considered petitioning for emergency detention - and by the unfortunate timing over the holiday weekend.  However, there were indications that they might keep me several more days beyond that point, and I feel that the reason they chose to let me out sooner was because they were impressed with how hard I was working on the DBT skills.  It even came up in my final visit with the psychiatrist on the morning of my release.  He wanted to know which coping skills I would use if I got home and started wanting to hurt myself.  I told him the ones that were most effective at this point were putting ice on my wrists and reciting the Fibonacci sequence (not necessarily simultaneously).

ladybugs

I learned many more coping skills though.  I created a distraction plan of 10 ways to distract myself from painful thoughts.  I created two relaxation plans of 10 ways (each) to self-soothe using the 5 senses.  One plan can be done away from home and the other can be done at home.  I learned to relax by using a cue word and by visualizing a safe place.  I even worked on identifying my values and setting goals to spend time on those areas of life that I value most.

So I got to come home, and today I go see my therapist for the first time since she dropped me off at inpatient.  She made a comment at the time that ended with "if you're not furious with me" and I said that I wasn't.  After all that thinking time, I decided that I was.  Well, maybe furious is too strong of a word, but I am definitely upset with her about the fact that I came into her office prepared for a very productive session, with a thought diary and several of the DBT exercises to discuss, and instead we accomplished nothing because she latched onto my confession which was never intended as more than a passing comment.  

I have a poem that I wrote for one of our group activities, which addresses that situation using a theatre metaphor.  My plan for the past few days has been to give her that poem as part of a little speech I prepared that has some negative criticism about how she handled things in our last appointment.  The speech ends with "As a result of this experience, I will never be able to fully trust you.  The next time I go to inpatient it will be kicking and screaming in handcuffs."  I am no longer sure about giving the speech, but I do still intend to share the poem.  It may be more powerful than the speech was anyway.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/09/04/dbt-freed-me/. Please comment there.
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colonial-williamsburg-jail

A week ago I was being held prisoner.  No, I didn't get arrested, although I guess you could say someone arrested my negative thoughts.  See, I was having a bad day at work the previous day.  Objectively, it wasn't that bad of a day.  I spent nearly 8 hours doing one task, because I first did it using the wrong login and had to start over and do it all again.  Then in the course of doing this, a coworker made some comments that offended me (saying that anyone who wouldn't do one of my other tasks a certain way is retarded, although she knew nothing about that task and was completely wrong about how it should be done).  Neither of these events sound that bad, right?  Well, as will be further addressed later on, I have very few skills in the area of distress tolerance.

In response to this situation, I wrote "kill me now" on my arm.  Then it looked so lonely there that I started writing related words.  Words like "noose" and "pills" and "razor".  Eventually my entire forearm was covered in suicide-related terms.  Did I actually feel suicidal?  No, not at all.  It just seemed like a thing to do to channel my frustration.

I had been planning to write a letter to my therapist and give it to her in my appointment 2 days later.  Some things have not been working for me, and I knew I'd freeze up if I tried to explain it out loud, so a letter seemed like the best way to bring up the topic.  Suddenly I felt as though I couldn't possibly wait 2 more days.  I was even willing to try saying it out loud, if that was what it took to get it over with.  So the next time my boss checked in on me, I asked if I could leave after I finished up the task I had almost completed (for the second time).  He said yes.

I was out of work in the early afternoon and showed up at the mental health center to ask the receptionist if my therapist had any openings.  She did not.  I was halfway out the door when she asked if I needed to see the on-call therapist.  I declined and kept walking.  As soon as I stepped out in the bright sunshine I started crying.  I sat in my car and cried until I couldn't tolerate the heat anymore, then got out and went to sit on a bench by the building where there was shade and a nice breeze.  I kept trying to talk myself into going back and saying I'd changed my mind.  I sat there for nearly an hour before going in.

What convinced me?  A random man walked up to use the ashtray by the bench.  He introduced himself.  I introduced myself.  He said, "Want to see a neat tattoo?" and pulled off his shirt.  As he turned around to show me a silhouette surrounded by flowers, he said, "My son committed suicide.  He took my rifle and shot himself."  I managed to say the socially appropriate things: that it was a nice tattoo, that I was sorry about his son.  After he left, I burst out laughing at the absurdity of the situation.  There I was with suicide-related words written all over my arm and someone coincidentally came up and mentioned suicide.

Once I contained my laughter, I went back inside and said I'd changed my mind.  I was sent over to a different facility where the on-call therapist was currently located.  I had to fill out pages and pages of redundant paperwork, and was almost done when she came out to tell me I didn't need to finish that because she had all that information on file.  Now, I was planning to just get some things off my chest.  Maybe talk a little about my plan to discuss some potential changes in approach with my therapist.  Maybe share the frustrations of my work day and get some advice on how to better handle those situations in the future.

This is not what happened.  Yes, I shared those things.  Then she started talking about wanting to admit me to inpatient.  I said that wasn't necessary, that I wasn't really going to kill myself and I would have mom hide my medication again just to be safe.  She was not buying that.  She tried to convince me that I'd feel better in a safe environment, and that maybe I needed some medication adjustments that can be more easily done in inpatient.  I am weak and just went along with what she was saying.  I guess maybe part of me wanted that little vacation from reality.

She sent me out to the waiting room while she consulted with the psychiatrist, then came back to tell me he agreed with her.  I had another brief moment in her office, then was sent to the waiting room again.  She wouldn't let me leave to take my car home and have mom drive me back, and as it turns out mom wasn't even home at the time so I guess that worked out for the best.  However, I sat in that waiting room obsessing over the idea of running out the door and driving off and being anywhere but home when she sent the cops to find me.

It felt like an eternity, but I guess it was only about 15 minutes that I sat there before I was called back again, this time to actually walk into the inpatient unit and start the admission process.  It was a weird feeling this time, knowing exactly what to do and say, what questions I would be asked.  It was also weird feeling so strongly that I did not want to be there.  From almost the moment I walked in, I was desperately plotting how to get out as fast as possible.  I had realized that I was going to miss a major event at work.  I had realized that I would probably miss some dinner dates with friends that weren't firmly scheduled yet, but I had been planning to try scheduling them for a few days later.

I was sure I'd be there for 4 nights again this time, but on the first morning after I arrived, I spoke with the psych APRN and immediately started asking when I could leave.  At that point she said she'd speak with the psychiatrist but if I left that day it would probably be AMA.  In the afternoon, after many hours of going stir-crazy, I called and left a message for my therapist that I was being held prisoner and wanted to know if she could come see me there in the event that I wasn't released in time for my appointment the next day.  Mere minutes later, the woman who had insisted on admitting me came up and asked if I really felt like I was being held prisoner.  Yes, I did.

The evening was filled with drama pertaining to mom's wishful thinking that my request for a prison break meant I was coming home that evening.  I ended up storming off to my room during visiting hours, pulling myself together, and coming back to talk to her more.  However, I did have her leave half an hour early as my medication was sending me into the land of grouchy and exhausted.  I went to bed without attending evening group or having my final snack of the day.

The next morning, the psych APRN came to talk to me about being discharged.  I continued telling her that I felt fine, just like I did when I was admitted.  She told them to release me, and I got out of there a little before 11 am.  What I didn't say to her is that I didn't actually feel fine.  I felt impatient and agitated.  I was fighting to not find ways to injure myself with the "safe" objects that we were allowed to have.  Most importantly, I was strongly thinking of overdosing the moment I arrived home.  I felt terrible about lying, but at that point I valued freedom over honesty.

I did not overdose.  I held out until the next day, and then handed my pills over to mom and admitted that I lied to get out of there.  In the time since my release, I have been depressed and clingy, and mom has asked if it was a mistake that I came home.  I think it was, but I'm scared to say it in front of anyone who can send me back there.

Inpatient this time was a very different experience from when I originally went there in March.  The only thing that was different was me.  The first time around I was in such misery and so convinced that I was going to kill myself, but I had hope that being there would help solve the problem.  Plus I was curious about what the experience would involve.  This time I didn't feel nearly as bad going in, so I fought against being there with everything I had.  Maybe it could have helped me if I'd been more honest.  Maybe they could have adjusted my medications then instead of having me wait 3 more weeks to see my outpatient psych APRN.  Maybe talking with the other clients could have changed my perspective.  I didn't give it a chance to work.

What did come from this experience?  The day I was released I went to my therapy appointment.  I handed over the letter I had written while being stuck in inpatient.  My therapist said we could try to make some changes to our approach.  However, the inpatient staff had strongly recommended making an addition to my diagnosis.  Previously we had a deferral on Axis II, with a note to rule out Borderline Personality Disorder (BPD).  Now it has been ruled in.  I'm still struggling to come to terms with this addition, despite the fact that I know it fits very well.  It explains the missing pieces to the puzzle that weren't covered by my existing Bipolar I diagnosis.

So our new approach is going to involve half the session spent on a more freeform approach where I can ramble on about whatever pops into my head (my preferred method) and half spent on the highly structured Dialectical Behavior Therapy (DBT).  I was asked which set of skills I wanted to work on first, and there was no hesitation when I said "distress tolerance".  Like I mentioned before, I have no skills in that area.  I do not cope with things going wrong, no matter how minor the wrong is.  I get frustrated by what people say or don't say, by dropping things, by breaking things, by just not feeling perfect.  Let me tell you, I never feel perfect so it spirals into me always feeling miserable.

Tomorrow will be our first time with this new approach, and I am anxious but hopeful.  As much as I love the freeform talking and feel it's necessary in order for me to feel like I'm being heard, I can admit that the structured approach is probably good for me.  I need to feel like there are tangible things I can do to make progress.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/08/27/the-prison-break/. Please comment there.

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