Stuff That Needs Saying

On this day one year ago, I was Celebrating February 14th.  It's been a long, hard year since then.  While I was released from that visit with a mere Contract for Safety, I was back at the ER a month later, being admitted to the inpatient unit because I was dangerously suicidal.  I had another three inpatient stays throughout the year, including one that followed an overdose of Benadryl.

I've signed at least half a dozen Contracts for Safety and laughed at the idea of many more.  I'm no longer asked to sign them.  I've had a total of 63 therapy sessions across 3 therapists.

I've gone every month or two to the psych APRN to have medications adjusted.  Each time that he has set the appointments 2 months apart, something has happened halfway between them.  The first time, I ended up in inpatient.  The second time, I had to call him with a problem, and still ended up in inpatient.  The third time, he gave me permission to call for a sooner appointment and I did.

Currently I take Wellbutrin, Latuda, and BuSpar, with a few leftover trazodone on hand in case I can't sleep.  During the past year I've also taken Seroquel (made me suicidal) and Abilify (didn't seem to help as much as the Latuda).

A month ago, I started attending DBT group therapy each week.  Next week I have an interview with Vocational Rehabilitation to see if they'll pay to have the supported employment services help me with job hunting, as anxiety led to me quitting my full-time job in December.

As I said, a long, hard year, but things are starting to look up.  Not only do I not want to kill myself, but I'm no longer passively suicidal and am even starting to find some enjoyment in activities again.  I still feel pretty hopeless about my life as a whole, but at least I have some ability to take steps toward a better future.

One such step, which I've been planning for some time, is the writing of a book about this first year of treatment.  I have some ideas of information I'd want to include, but am opening this question up to readers: what would you be interested in reading more about if I were to write such a book?

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Originally posted at https://stuffthatneedssaying.wordpress.com/2015/02/14/one-year-of-treatment/. Please comment there.

I commented to another blogger recently that my therapist and psych APRN have no idea of the extent of things that make me anxious.  They know I'm not good with crowds or social interactions, but that's about it.  So I decided to make a list.  I started it the day before a therapy appointment and thought it was pretty well complete.  Then I awoke suddenly in the middle of the night and a dozen more anxieties popped into my head.  I kept getting out of bed to add them to the list, and then my fear of making mistakes took over and I laid awake for hours obsessing over things I've done wrong.

My therapist got the completely random and illogical original version of this list, but I've tried to reorganize it so that related fears are together.



* crowds
* having people behind me
* hospitals
* going to appointments, especially sitting in the waiting room
* standing in line
* mirror mazes
* haunted houses
* elevators
* tunnels
* asking for help
* making special requests
* talking on the phone, especially when someone can overhear
* risking rejection
* conflict
* talking in a group
* committing to anything
* being hit on
* auditions
* eating in public
* hearing languages I don't recognize
* risking failure
* change
* trying new things
* job hunting
* thoughts of mom dying
* dogs
* pictures of insects
* heights
* ladders
* walking on snow and ice
* uneven terrain
* fire
* lightning, especially when in a car
* crossing the street
* motor noises, such as vacuums, blenders, etc.
* driving, especially in bad weather, on unfamiliar roads, or with passengers
* roller coasters and most other amusement park/carnival rides
* men
* going inside banks
* the woods
* being followed on the road
* cell phone battery dying
* security guards
* police officers
* managing money
* shopping

When I shared this with my therapist, she commented that some of these are completely reasonable fears.  I agree, to an extent.  What made me sad about making the list was recognizing just how much of my life I've missed out on by trying to avoid these things.  I currently take BuSpar (10 mg 3x per day) and it has helped reduce the completely paralyzing anxiety that was afflicting me, but I still avoid the things on this list as much as possible.

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Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/31/cant-sleep-clowns-will-eat-me/. Please comment there.

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?

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Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/19/my-first-my-last-my-dbt/. Please comment there.

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.



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.

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

Today I read an article titled A Kinder Take on New Year’s Resolutions for 2015.  Mere minutes later, my therapist handed me a set of questions asking me to reflect on the past year and set goals for next year.  She was quick to point out that she likes the term "goals" much better than "resolutions".



I had already planned a post about resolutions - I mean goals - and my goal involves revisiting The 101 Things in 1,001 Days Challenge.  My original end date for my original list was September 26, 2008.  Obviously a few years have passed.  I only completed 11 tasks from my original list, and had a few others in progress.  At this point I revised my list, because my life had changed drastically since creating it and many of the items were no longer relevant to my interests.

When I didn't get very far before quitting for months, I decided to create a new list and start over.  I made plans to restart on January 27, 2008, but never actually created the list of 101 tasks.  That is my goal for 2015: to create the list.  I'm not required to make any progress on it, simply to create the list of 101 tasks.

At the time that I planned to restart my list, I did some writing about how to create a list.  Confession: the rest of this post is nearly identical to what I'd written before.  Someone needs a nap before getting up to celebrate the new year.

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"How can I possibly think of 101 tasks?" you exclaim. The flexibility of having 101 spaces to fill with your own choices is great, but also quite scary. Here's a suggested outline for giving your list a bit more structure:

• 18 Categories X 5 Tasks


• 9 Specific Tasks for the Past, Present, and Future


• 2 Purchases

The first part of forming your list involves defining 18 categories of tasks that are important to you. My 18 categories are listed below as an example. It's unlikely that anyone could directly use my set of categories since we all have a different combination of interests (my list is heavily weighted toward the arts, since my education and most hobbies are in that area), but marking out the categories that don't interest you and then finding replacements is a good way to start.

My Categories:

1. Education


2. Theatre


3. Creative Writing


4. Photography


5. Knitting/Crochet


6. Music


7. Culture


8. Recreation


9. Social


10. Family


11. Health


12. Civic Duty


13. Financial


14. "Adulthood"


15. Organization


16. Adventure


17. Overcoming Fears


18. Special Skills

After you have 18 categories selected, list 5 tasks relating to each category. It may feel a bit restrictive having only 5 tasks for your current favorite activities, but this limit encourages you to think carefully about what your most important goals are and to aim for improvement in multiple areas of your life. Once this section is completed, you will have 90 tasks on your list.

The next 9 tasks on the list come from three groups known in brief as Past, Present, and Future. While you certainly aren't required to do these exact tasks, especially if they are things that are already done in your life, I feel they're important for everyone and you ought to consider whether you can improve upon what you've already done or replace the task with a different one that fits the category.

Recalling the Past

1. Create a genealogical record for at least 4 generations of your family (yourself, parents, grandparents, and great-grandparents)


2. Compile a scrapbook of your childhood, with pictures of yourself at each age, your close family, your friends, and your pets


3. Start writing an autobiography (there are many great books out there with prompts to help you figure out what topics to cover)

Recording the Present

1. Assemble a time capsule to be opened in 20 years


2. Record your daily life in photographs for a week


3. Start a journal (your choice as to how often is reasonable for you to write in it, although I'd suggest at least once per week)

Preparing for the Future

1. Start a savings or investment plan


2. Get health insurance (if you've got adequate insurance already, get life insurance payable to your next of kin...if you've got that, well, lucky you!)


3. Write your will and advance directives

Now we're up to 99 tasks, and the last two are fun ones. Select two significant purchases you'd like to make. These should be within your long-term budget but not things you'd make a casual decision about purchasing. Many of us would probably choose a new computer as being one of those things we'll want in the next few years, but anything works so long as you wouldn't just hop into a store and throw it in your shopping cart without a second thought.

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No matter how you choose to structure your list, here are a few tips for selecting individual tasks:

• Make your tasks very specific and concrete. You have to be able to measure whether a task has been accomplished or not. Don't just write "learn to tap dance"...how will you know if what you've done constitutes learning enough? Instead, choose tasks such as "take a tap dance class at the community center". Class ends, you've had the experience, and your task can clearly be marked as complete.


• Make your tasks achievable. There's a difference between challenging yourself and setting yourself up for failure. Base your tasks around your own actions, and aim for things that don't involve reliance on the actions of others. If you want to get a poem published in a literary magazine, you can't aim for getting published. It's not entirely in your control. What you can and should aim for is sending a certain number of submissions to the magazines in which you'd like to be published. Then your part is done, and it's time to let it go and focus on another task that you can do.


• Choose tasks where you can apply the old adage "If at first you don't succeed, try, try again." The fastest route to misery in this project is declaring that you will do a specific task every day for the entire 1001 days. It's simply impossible. Forming a good habit doesn't mean that you have to be perfect from the start, but that you can pick yourself up and start again if you slip up. Tasks that involve forming good habits are great to have on the list, but you need to limit the duration so it's possible to accomplish them. For example, "quit drinking caffeinated beverages" is a purely evil goal to set for yourself. One little mistake and you'll beat yourself up and probably quit trying entirely since you've already "failed". Instead, try something like "Limit caffeine intake to one 20 oz. cola per week for two months". If you don't manage it on the first try, look how many more two-month spans are available in which to attempt it again!

The final and most important tip for success in this project is: don't trap yourself into completing tasks if the course of your life changes. If you find out that the task you listed a month or a year ago is no longer relevant, replace it! There's an important lesson here regarding willingness to assess a situation and make necessary changes. Making changes is what this project is all about.

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Originally posted at http://stuffthatneedssaying.wordpress.com/2015/01/01/101-in-1001/. Please comment there.