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?”
Now that I’ve had both my first individual and group DBT session, I’m still rather apprehensive about it all. During individual therapy while D was giving me more information about the DBT program, as much as I didn’t want them to, tears started rolling down my face. D asked me about the tears, and I told her that I was overwhelmed with fear and anxiety about how full on the program seemed, and that I was thinking that it’s all too hard. I acknowledge that wanting to run away from it because of fear about how hard it is is my problem, but from what I’ve been told by D and the documents I’ve been given, there are certain aspects of the DBT program itself that I have an issue with too. A few of them are;
- I dislike how regimented it is and I find some of the rules and boundaries presumptuous and condescending.
- It seems to run on a system of punishments. For example, the 24 hour rule: If you’ve self harmed, the therapist will not have unscheduled contact with you for 24 hours. I don’t see how your therapist not talking to you because you’ve self harmed can seem anything but punitive.
- Based on the number of rules there are and contracts I’ve had to sign prior to starting, I feel like I’m being boxed into the assumption that I’m difficult, I cross boundaries, am overly needy and time intensive. I’ve never been someone who’s crossed boundaries in therapy, tried to obtain extra therapy outside of scheduled sessions or been demanding of a therapist, and frankly I’m insulted by documents I’ve received that hint I am.
- There’s a big emphasis on not missing either group or individual sessions, especially not “just because you don’t feel like coming”. If you don’t attend a certain number of groups, you’re banned for the rest of the term, and if you miss a certain number of individual therapy sessions, you’re also banned from group for a certain period. Again, I’ve never not turned up or cancelled appointments just because “I didn’t feel like it,” and I’m irritated this point had been reiterated to me even though it’s a non-issue. As for not missing sessions, I try not to, but you know, I have a life. I study occupational therapy at uni, we have fieldwork to attend, and on top of that I volunteer/work in four different mental health groups/organisations.
- I still get the impression that DBT is all about using skills to stop the self harming and suicidal behaviours without actually addressing the actual issues behind it and the hopelessness, fear of rejection and abandonment, not knowing who you are, past trauma, depression etc.
I have however barely begun this year long program so I can’t say yet whether it is helpful or not. Despite all my objections, I do want to be open to it and give it a go. In group a couple of the members who are now in their eighth month of DBT spoke about how at first they didn’t get it and it seemed stupid, but it then clicked and they do use DBT skills in their everyday life, and another group member who I spoke to before group told me about how DBT has been life changing, and she can now cope with things she wasn’t able to before. So who knows, maybe if I use my wise mind, take a non judgemental stance and act opposite to my emotion by fully engaging with DBT, I will be singing a completely different tune about it this time next year.
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.
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.
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.
Is it really that much to ask that the hospital find out the eligibility criteria of a service before referring me? I spoke to D yesterday and apparently YRS is a mental health service for young people who are homeless. Which, living with my parents, I am not. So it’s only now that a referral has been sent to A St, the adult community mental health service. Cool, why didn’t we find this out earlier so it could’ve been sent back in November instead?
In case you’re thinking the name ‘A St’ sounds familiar, yes it’s the same place that conducts the DBT program. The lady from YRS rang me back today. She reported she’d contacted A St to enquire about my status on the DBT wait list. Apparently I’m not even on the wait list any more. Umm, say what?! Maybe it’s my retribution for being so cynical and unenthusiastic about DBT, telling D yesterday I thought Linehan’s book “lame and patronising.” But I…lol, I don’t even know what to say any more in response to the inevitable debacle that occurs whenever I try to access mental health services.