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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