Finished DBT

I was originally meant to be doing the full year of DBT, but due to me passing all my units at uni (yay!) and going on fieldwork next year, I ended up only doing the six months. Which meant I still completed all four modules; mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance, I just won’t be repeating it for the second time round.

I had my last individual DBT therapy session with my psychologist yesterday. When I think about twice when I’ve overdosed/self harmed and ended up in hospital when I had to stop seeing a psychologist, the same when I just thought a psychiatrist was going to stop seeing me, and the rest of the time when I didn’t even properly end with a psychologist, it’s weird not to feel that sense of loss, dread, abandonment and feeling of being ripped apart that I usually feel in ending with a clinician. I guess I just didn’t really feel that sense of connection with her. And it got pretty repetitive and monotonous go go through the same thing every session: diary card, chain analysis, looking at where I could’ve used those DBT skills.

I think I’d feel a much bigger sense of dread and loss when it comes time to be discharged from the mental health clinic and stop seeing my community MH nurse. I was resistant to the idea of seeing a community nurse at the time when I was relapsing with my eating disorder last year, but now that I’ve been seeing her for over a year I’ve come to appreciate being able to just talk to her about whatever’s been going on in my life.

So now that I’ve finished DBT how did I find it? Well perhaps I’m not quite as scathing as I was before starting it. I can see where some of the DBT skills can be helpful when trying to get through a crisis or when trying to deal effectively with other people. At the same time though, I still feel like it doesn’t help me understand myself better on a deeper level and why I feel a certain way then react how I do, and learning the DBT skills doesn’t address if I’m motivated or not to use them in the first place. It’s also quite scary for me that because DBT seems to be regarded as the best damn thing since sliced bread for those who have BPD, now that I’ve completed it, it’s kinda like “Well what now?” So many times when I’ve been in the ED or psych ward, I’ve been told that doing DBT is the solution. Now I’m left wondering “What’s your solution for me now?”

Last psych appt

Yesterday afternoon I was seen by the doctors, and my community nurse/case manager also sat in on the meeting. I was asked whether I wanted to be discharged that day or the next, I chose to be discharged that afternoon. Though I still wasn’t great, I at least felt a little better than when I came in and I guess there wasn’t much point in staying any longer. We also discussed my medication, I still remain on 200mg of Pristiq and 50mg of Seroquel XR but have also commenced on 450mg of lithium as a mood stabiliser. It was either lithium or sodium valproate, but according to the doctor the latter has a greater chance of hair loss, weight gain and sedation occurring as side effects.

Spent this morning in tears as I emailed a uni lecturer about something totally unrelated, and in her reply she again brought up an incident last year which resulted in a general miscounduct and me getting into a whole load of trouble. It feels awful that I continue to have that held against me by a lecturer I will again have this semester despite me completing the disciplinary action that was dealt to me and having damn well learnt my lesson. I then attended the last session with my psychologist at the eating disorders program in which I cried some more both talking about this situation with my uni lecturer, and then saying I felt “A bit sad,” when she asked me how I was feeling about it being the last session. It’s the first time I’ve ever admitted to feeling anything other than indifference towards any psychologist I’ve seen as I’ve always been ashamed of feeling attached to or having any emotional connection to others, especially when it’s not reciprocated. Though it wasn’t easy attending knowing it’s my last appointment, I’m glad I did and handled it much better than I did the last time I had to change psychologists. It’s quite embarrassing when I remember how I spent the second last session crying, refused to come back for another session or to see the psychologist I was being transferred to, overdosed and ended up in hospital thus never having a proper concluding session, then wrote him an angry email about how useless therapy is.

I’m starting DBT next week with the group component running on Tuesdays and my first individual therapy session is on Thursday. I’m really nervous about DBT and how full on and strict it seems. At the end of my assessment sessions for DBT I was given a contract and asked to sign it, with rules such as not being allowed to miss a certain number of group or individual sessions, having to complete the homework, rules around interactions with other clients and your therapist not having contact with you for 24 hours if you’ve self harmed. I also have a lot of ambivalence about whether I really do want to change and to stop self harming or not, and so much fear when I think about doing so. Plus I’m hesitant about starting all over again with yet another psychologist knowing that if I do develop a connection it will feel like another loss when we have to cease therapy, especially after weekly appointments for a year. 

Assessment appointment for ED treatment

I received a call today from the CCI, which is the only public service in the state that offers an outpatient eating disorders program. I was offered an assessment appointment which I accepted, and it’s been scheduled for next Friday. There’s a part of me though that has doubts about whether obtaining treatment is the right decision or not. As I’m now weight restored after being in hospital, I feel as though I don’t need or deserve treatment for anorexia. After all, I’m not underweight any more so not only do I not look like I have anorexia, I don’t even fit the criteria for a diagnosis any more. Although I know it wouldn’t be a good decision, I’m tempted to lose weight before next Friday because I fear I’m going to go and be told that I don’t really have an eating disorder and don’t need help, after all, I’m not underweight.

I also had a visit from A, the Community Mental Health Nurse this morning. She asked about me appearing on the media about my experiences of ED treatment in hospital, which made for an interesting conversation. She mentioned she didn’t actually see the segment when it aired on TV, but was told by other staff about it. “Which staff?” I asked her, curious to know. “Oh I couldn’t remember names,” she replied. I told her a friend was advocating for better ED treatment in the eastern states, she asked me whether I was interested in talking about my experiences so I did. A asked me what I wanted to see so I told her- a dedicated inpatient ED program like they have in the children’s hospital, for hospital to also address long term recovery and psychological aspects instead of simply force feeding, and for there to be a step down, like a day program, so that people aren’t just going straight from hospital to home with no support.

Intro to Group

Today I had my last session of the four week long Introduction to Group Therapy program. I’m glad it’s over because I have actually gained nothing from going. The content consisted of basic CBT, particularly in relation to depression and anxiety. I feel like I’ve done CBT to death, both as a patient and as a university student. I don’t find CBT helpful and it didn’t benefit me to hear all over again stuff I already knew. I probably spent more time tuning out than in. Apparently I wasn’t the only one bored though- another guy actually fell asleep and started snoring today.

The one positive thing though is yay, I’ve completed it. Which means I can now go on to the intermediate group of Emotional Regulation before then progressing to DBT. I was told yet again when I saw the psychiatric registrar this week that DBT is what will help me- I guess we’ll see.

Home from hospital

No matter how many times I go through this, being discharged always brings about a mix of emotions. Feeling glad to go home yet terrified at the same time. I was discharged yesterday afternoon. The first few days back home are always hard. Feelings of loneliness and everything being too much threaten to push down on me as I try to push them back.

I’ve reluctantly agreed to be referred to the group program. C, who runs the group program and is also my tutor at uni, came to see me briefly. One of the things she asked me is how I feel about her being someone who runs groups as well as my tutor. I wasn’t sure, and told her so. She said that although I may see her at the group place, I probably won’t have her as the actual group therapist because I did already know her. For the actual pre group assessment, someone else came to do that with me. It was explained that to do the DBT group, one must first complete two other groups before being assessed again for DBT. It was decided that I’d first do Introduction to Group Therapy then the Emotional Regulation group. There are two types of DBT groups on offer, DBT skills which runs for 16 weeks, and the full DBT program which runs for a year. All groups go for 2 hours weekly, with an additional 1 hour individual therapy session weekly for the full DBT. During her explanation of DBT, she told me that Marsha Linehan, the creator of DBT also had Borderline Personality Disorder. Is that supposed to make me feel better about it? When I asked her whether there is a waitlist for groups, she answered that sometimes there is, but they’re usually able to get through it pretty quickly. Given I was on the DBT waitlist for a year last time I was referred, it seemed at odds with my experience. I suspect what’s changed is this time I’ve had seven ODs resulting in ED treatment and five psych admissions under my belt plus I’m not seeing anyone on an outpatient basis. Last time I was referred I was still seeing a private psychiatrist, plus I’d only been in the ED twice and had one psych admission.

I’ve decided to go part time at uni, which means dropping out of two units this semester. In hindsight I should have done so at the beginning of the semester. Up to the point where I was hospitalised, I’d attended all classes and completed all the work, so it feels like such a shame that all that time and effort is going to waste. There are both pros and cons to going part time. The pros are that it means I will be less stressed and have more time to look after myself and do other things. The cons though are that obviously it will add more time to my degree and my friends will progress to the next year without me. I hate feeling left behind like this, while it seems everyone else my age has already graduated and gone on to get real jobs.

Torn

I’m feeling so torn between wanting to give life a good go and feeling like it’s all too hard and I want to just give up. I’m realising how BPD actually affects me, and I fear I’m going to be imprisoned within it for the rest of my life.

My boyfriend has been amazing and very supportive, especially given this is the first time he’s ever had to deal with the world of mental illness before. As much as I love him for it, it also terrifies me. The fear of abandonment has always stopped me from becoming too emotionally attached to anyone to protect myself from getting hurt. He’s told me that he’ll stick by me, that he loves me and wants to be with me. At this point my instinct is to run and push him away. I’ve played out this pattern with psychologists before and I don’t want to play this out in real life. But it feels like such a risk to let my guard down and I’m not sure I could cope with the fallout if he does eventually abandon me and let me down.

The psychiatrists are still keen for me to do DBT and apparently the woman who runs the groups will be coming to have a chat with me about it. Problem is, she is also my tutor for my Counselling and Group Work and I’m not sure how I’m going to face her in class after this. Up until now I’ve managed to keep my professional OT student role fairly separate from being a consumer of mental health services and now they’re about to collide. I’m reminded again how small the mental health sector is.

Psychologist not the right one

I did give it a go. I mean, this was my third time meeting with this psychologist, though the first in terms of seeing him on his own. But I think it’s enough to determine whether I feel I can work with him or not. Unfortunately I just don’t feel I can.

I already had my reservations from that first time when I felt misunderstood and pushed into treatment I wasn’t keen on. And today I think he pushed too hard too soon for me to talk, given it’s our first actual session together. If you’re going to ask me to talk to you straight off about the reasons around my OD which I feel quite embarrassed and ashamed about, no I’m not going to do so. It takes time for me to open up and whomever I’m seeing, I need them to understand that.

He was also rather blunt. Yes, I know sugar coating everything and treading too lightly isn’t going to be the most helpful. But a bit of sensitivity wouldn’t go astray either.

About halfway through the session I could feel myself reacting by putting a barrier up and becoming oppositional. My responses were more abrupt. My attitude became one of indifference. I again grew resistant to the idea of therapy and change. Within this mode I stubbornly told him that I don’t want help and that I’m fine with how things are. That it’d be a waste of time coming back and he’d be better off seeing someone who actually wants the help and is ready to change.  When asked whether I would come back for another session I said ‘no’. He told me he’d send a letter to my GP and I’ll discharged back to her.

How do I feel about that? Rather sick with anxiety really. I’m aware I’m choosing to throw away this opportunity for free psychological therapy that’s not limited by a certain number of allowable sessions. I know I’m lucky in that many people don’t get this kind of help. Just last week in the courtyard at A St I was reminded of this, listening to a woman sobbing to a nurse that she needed to see a psychologist but was still on a waitlist.  But at the same time, I don’t see much good in seeing someone I don’t feel at ease with and cannot open up to. In a medical setting it wouldn’t matter so much, but within the context of mental health being comfortable with the person you’re seeing is important. Within the public system you don’t have to pay and the number of sessions is based on need, but you’re stuck with who they give you. In the private system, the advantage is that you get to choose who you see, but it’s costly and limited to ten sessions per year.

Don’t really know where to from here. I guess I’ll just have t see how things pan out.

You’re discharged. Surprise!

After that psychiatrist appointment at A St and the appointment with D the day after that, I was adamant I would not attend any appointments with D again, nor would I commence therapy at A St once an appointment had been made for me. When my mother brought in a letter from A St informing me I have a psychologist appointment on 12 April, accompanied by an eight page pre-therapy questionnaire, a DASS and a K-10, I was close to just ripping the pages up, calling to cancel the appointment and crossing my fingers to never hear from them again. Slowly though, after it became apparent the doctors were quite keen on me having follow up after discharge and talking to a couple of nice nurses, I thought maybe, just maybe, I’d attend and see how it goes. That was before yesterday. After which it occurred, forget it.

I had obtained permission to attend my placement for a few hours and so I was away from morning until about 2:30pm. I arrived back at the hospital and was told by the nurse to clear out my room as “You’re being discharged right as we speak.” Umm. What? No forewarning whatsoever, except for Monday when I asked the doctor when I’d likely go home, to which she replied it’d probably be sometime this week. Yes, I wanted to go home. Providing it had been discussed with me and I’d been given prior notice so I could mentally prepare myself for what’s to come. Not when I’d been booted out with n0 notice whatsoever because someone sicker than me clearly needed the bed more.

“You’ve been discharged, but the doctor wants to talk to you before you go,” I was told by the nurse after I had packed my things. Lol. She does, does she? But I’ve been discharged so am not your problem any more! “Do you want to go home?” the doctor asked once we had sat down in an interview room. I almost laughed, had I not been so upset and angry. Clearly, it doesn’t matter, as I’ve already been discharged. And so, being ever the obliging patient, I tried my best to make their job easier. “Will you harm yourself once you get home?” “No.” Can’t wait to get home so I can cut. “Will you call a helpline or crisis number if you need to?” “I guess so.” Not if my life depended on it.

I had come in with some of my own medication, Pristiq and Seroquel. As expected, it was taken off me on my admission, and I was told I’d get it back when I left. Did I get it back? No. Instead the nurses told me they couldn’t find it. They attempted to search for it. Leaving me to wait there for an hour while they did. It took them that long to come to me with the conclusion that they could not locate it, and it had probably been discarded of. Great, so you’ve just wasted an hour of my time for nothing and thrown away medication I had paid for, that is not exactly cheap either.

Still, that hour of waiting wasn’t completely unproductive. I took that time to give a call to A St to inform them that I would not be making that psychologist appointment on the 12th. Apparently the psychologist will call me back today to reschedule an appointment. Lol, don’t bother. I either a) will not pick up the phone, or b) will make it quite clear I have no intention of seeing her, nor any other clinician.

I don’t think there’s ever been any mental health professional that has not ended up leaving me feel let down and/or hurt in the end. So as far as I’m concerned, I’ve had enough. The whole lot of them can get stuffed. I’ll go my own way.

Therapy is too hard

I attended the appointment yesterday with the psychiatrist and the clinical psychologist who is meant to be taking me on. Afterwards I spent some time sitting on the garden ledge with my sunglasses donned, crying.

Did I like the psychiatrist? Well it doesn’t really matter seeing as my medications remain unchanged and he’s told me to simply continue seeing my GP. Alrighty then, back to Dr L I go. Did I like the psychologist? I’m not entirely sure and that’s part of what upset me. The advantages of the public system are of course that it’s free, but it means you don’t get a choice as to who treats you. I’m afraid of being stuck with someone I dislike and whom I don’t feel I can work with.

I also felt as though I was being pushed into doing DBT and that is the only option I have if I want to receive treatment through A St. As you may recall I don’t have the fondest impressions of DBT. I also dislike that so many mental health professionals seem to think DBT will be the magic answer that cures all. Because I was intimidated though, I wasn’t able to voice the issues I have with it. So I reluctantly shrugged and okayed doing DBT even though I despise feeling like I’ve been pushed into doing something I really do not want to do.

Unsurprisingly, as is always the case with people I don’t know, I found it difficult to talk. They were lucky if they got more than a “Don’t know”, “I guess” or “Okay…” out of me. I don’t want to do this any more. I’m completely fed up with continually having to start all over again with someone new. It’s hard to start to open up and trust a person. By the time I start to do so, I’ll find that therapy with them ceases. Yet again. Plus, the clinical psychologist I am meant to be starting with is going away for a few weeks, so it has been suggested I see his replacement before starting with him. Considering how hard it is for me to open up, I see little point in doing so.

I had an appointment with D this afternoon. The majority of the session was spent in tears, noticing that he wears brown shoes with red socks and that the carpet in the room is chequered, alternating between a lighter and darker shade of blue. After lots of prompting on his part and shrugging on mine, he eventually established I was upset by the appointment yesterday. I told him it’s “too hard” and “I don’t want to do [therapy] any more.” Upon him saying he would see me again next Wednesday, I replied that I have fieldwork. Every Wednesday. “What about Monday?” he asked. “I have uni,” I told him. “What about a later time on Monday?” I again replied that I have uni. He asked until when? “June,” I replied. “Did you have fieldwork today?” I confirmed I indeed did. “Did you have to leave early to come here?” A little sheepishly I admitted I did not. He said he’d see me next Wednesday. I’ve never not turned up to an appointment because a) I don’t have the guts, b) it is rather rude and c) other people could have used that appointment slot. If I don’t turn up next week though, well, he did have prior warning…

D also suggested I may be upset due to the change of having to cease seeing him. I cannot emphasize enough how much I resented that statement coming from him. Even more so that a few more tears escaped when he said it. I am absolutely repulsed at needing and relying on someone, especially when the feeling is not reciprocal. I refuse to need anyone emotionally more than they need me. It puts me in a vulnerable position and gives the other person immense power. Can’t let that happen.

Counterattacking schemas

I received a letter on Thursday from A St informing me I have an appointment with one of their psychiatrists on March 13. An appointment less than a month away? In the public system too? A-mayyyy-zing. Is this really the same service that left me on the DBT waitlist for over a year before removing my name without my knowledge? I’m not quite certain how it works though. Do I only get one appointment for a psych review and that’s it? Or do I get ongoing sessions with this psychiatrist?

You’d think it gets easier to say what you want and need to tell them after starting over so many times, but in fact I’ve become more reluctant to do so. It’s become tiresome having to retell the same story over and over again that I don’t know what to say any more.

In the meantime I’m still seeing D. Same problem. Not that I had much to say to start with. We, or rather he, has been talking about some of the schema stuff I had done when I was still seeing R in therapy. One of the schemas R and I had identified for me was subjugation. According to this sheet;

This schema refers to the belief that one must submit to the control of others in order to avoid negative consequences. Often these clients fear that, unless they submit, others will get angry or reject them. Clients who subjugate ignore their own desires and feelings. In childhood there was generally a very controlling parent.

According to the Reinventing Your Life book there are three ways you can cope with your lifetrap: surrender, escape or counterattack. These three terms are fancy names for what roughly equates to a freeze, flight or fight response respectively.

I guess at times I can be a bit resistant in therapy. I will sit there in silence or fail to do what the psychologist has asked me to do during the week. D has accused suggested I am in fact counterattacking the subjugation schema by not doing what he’s asked, whether it be practice relaxation or grounding exercises, record when I’ve self harmed or read certain handouts he’s provided me. How I’ve seen it though, my silence is indifference, not wanting to be there in therapy in the first place. I don’t do relaxation and breathing exercises because I find them lame. Not doing them is my passive aggressive way of saying so. Could D be right though? Is this my way of fighting the subjugation schema? I’m not quite sure. I’ve never looked at it like that before.