Attachment Pain is Back

Things have been up and down over the last few weeks, but one thing is for sure. Over the past few days, attachment pain related to my therapist has sprung back in an overwhelming way and I find myself stuck in that place of rejection and hopelessness once again.

I thought that maybe I was starting to get somewhere with this attachment stuff. But unfortunately my attachment pain hasn’t really got much better. I think it possibly comes and goes in waves more than it used to, and the periods of it taking over my life are probably less frequent than they were; my therapist and I certainly have less numerous and catastrophic ruptures. However, I’m currently in a period of high attachment pain and I cannot say that the distress of it is any less than it has been before.

Sometimes when I’m not in as much pain I forget just how unbearable it feels. But now that I am IN it, it feels like this pain is all that has ever existed and all that ever will.

I love DBT. It has saved my life in many ways. But regardless, when it comes to these attachment difficulties, DBT skills never seem to be enough. I hate it when they tell me that this pain will eventually extinguish because I see no evidence of that. Instead it just seems to peak and peak and peak….. then keeps me stranded, alone, in the most excruciating emotional pain anyone could experience.

Sometimes DBT can feel a bit “surface” and like a mostly “top down” approach. But my belief is that I need to target this attachment stuff from the “bottom up”. My belief is that without the right sort of trauma work I won’t ever be able to fully heal from my attachment difficulties because they are a result of relational/ complex trauma that is pretty much ingrained within my cells. I am in a more trauma focused therapy at the moment although we still use DBT as an underlying framework. I am advised and encouraged to practice the skills as an addition to the trauma work, and my T constantly reiterates the importance of skills such as self-soothing and self-validating whilst we are doing this work.

However it still feels impossible and almost counter intuitive to soothe myself when the only one I want that from right now is my therapist. I am the last person I want any care from (I despise myself, I disgust myself, I want to punish myself, so why would care from myself feel nurturing or even possible!?). I understand that this is where I need to be (and is where the healthy part of me wants to be!) but how to get there is another story.

My therapist tells me the actions have to come first (“act as if”) and the feelings will follow eventually (albeit from the outside in). Like I said, I have little evidence of that as yet, but maybe as I continue with the trauma therapy things will start to shift from the inside out.

Finding My Inner Culinary Artist

Cooking has been something I have struggled to do for multiple reasons. It involves multi-tasking, keeping track of the time, spending money on oneself, associating with food, effort, sharing a (possibly failed) creation and can be time consuming – all things I can struggle with in some way. It is a form of self-care and self-care is not something that comes easily to me, especially when feeling underserving, self-hating or just plain lacking motivation.

But recently, I have been purposefully cooking meals for my family or friends as a way to get creative with DBT skills. I have surprised myself by how tasty and successful each of the meals have been, and the feedback from others has been really motivating, especially because I’ve always been mocked for my inability to cook anything beyond pasta in the past! It has been a way of creating structure for myself, of being productive when going out the house might feel too much, of influencing other more positive emotions during times I am feeling flat, or low, or sad. 

They say that the feeling doesn’t come first – that the actions do – and I see how that holds true here. Feeling proud of myself is a rare victory, but over the last two weeks my culinary creations have made that a reality a number of times. Every time I’ve cooked, I’ve felt more positive at the end of the process than I did at the start. Something I used to find anxiety-provoking and stressful, I’m starting to find relaxing, rewarding and enjoyable.

And the cooking process involves so many DBT skills, especially when you add booming music to the atmosphere like I have been doing (we recently invested in a new and very exciting sound system), that my DBT diary card has many more ticks than usual!

It involves self-soothing through pretty much all senses, such as smell, sight, taste and touch (and the sound of the accompanying music). It involves being fully present and mindful of the cooking process – no phone, Internet or other distracting gadgets. It involves accumulating positives and building mastery as in ABC. It involves the ACCEPTS skills – activities that are positively distracting, contributing (by sharing meals with loved ones, which is a treat for them too) and sensations (as described above). It involves the E in PLEASE skills, by nourishing oneself by eating healthy and balanced food. 

I’ve now successfully made dishes ranging from cauliflower cheese, mushroom pepper and zaatar rissoto, to ratatouille, morrocon spiced fish and tzatziki, and veggie shepherd’s pie. 

So for anyone who needs a helpful distraction, mastery-building, sensory and creative skill, I suggest turning on some music, pouring yourself a glass of wine (if it’s effective!), and getting out a new recipe to try your hands at! 😊

No More Hugs

My therapist told me she’d been thinking about me a lot this week and that she had come to a realisation after our last 2 sessions (1 & 2). She told me it had become clear to her that when she hugs me it actually gets in the way of our therapeutic work. As I sat there in tears, feeling about 4 years old, she proceeded to explain why. 

She said that every time she hugs me she is placating my need to be soothed, reassured and comforted by a mother figure. But that every time she does that, it blocks the reality of my situation that I try so hard to avoid. That reality is the strength and pain of my need as it manifests in the first place. That reality is the reality than needs to be faced.

Essentially what she was saying is that every time she hugs me, it is like she is putting a plaster over the core issue, making it better temporarily but actually hindering me in the long run. What she is referring to is the way I feel when I do not have access to the comfort I crave from her so deeply. It is those intense feelings of loneliness, neediness, sadness and pain, and the experience of not having that distress soothed as a young child, that are the core issues. Those feelings and experiences are ones that need to be sat with, processed and worked with. In her view, every time she hugs me, she is inadvertently getting me further from doing just that.

She thinks that if we stop hugging, it will expose me to all the painful feelings of emptiness and yearning that we need me to experience as a part of my process. I can then bring those experiences to therapy and that is what we can work with. Ultimately this might help me understand where these feelings stem from, develop more self-compassion and better equip me to heal certain parts of myself from the inside out. My stability won’t have to be so dependent on the way she interacts with me. And in time, she hopes, as I heal, my desperate need for her hugs and holding will lose their ‘life or death’ power. 

I understand what she is saying completely. I appreciate her acknowledging and apologising for how hard this must be for me. But, I am devastated nonetheless. I don’t know how to make peace with this change and the possibility that she may never hug me again. 

The Battle of Insatiable Neediness Vs. the Shame of Having That Need

My therapist and I managed to patch things up in my last session, after a pretty serious rupture a couple of days before. Towards the end of the session, I sought some final reassurance from her. I needed to make doubly sure before I left that things were going to work out okay in our relationship and in continuing my treatment.

“So you’re not leaving me then?” I asked, eyes wide and doe-eyed, voice high-pitched and timid like a child, “and things are going to go back to normal between us?”
“Lovey, what have I told you?”
“I know, but…” I pleaded, “…I need you to say it again.”
She breathed out, loud and slowly. Lovingly. “So long as our work together is effective, I am not planning on going anywhere.” She smiled, a gentle smile.

She had that look on her face. The look of compassion and love and curiosity and sadness. The look that says “I am here. I care about you. I see your pain.”

I could breathe a little more freely again.

Usually after these ruptures I need a hug. On one hand I think it’s to confirm that things are okay between us. I need the reassurance. On the only hand, it’s for the comfort. When I’m in that pit of sadness, a hug from my therapist feels like a little spark of hope and light within the dark. When she hugs me it breathes life into me. It makes me feel whole for a moment. She is also the only person I feel safe hugging me like that; the only person I really have to hug me at all. It means the world to feel safe and held for five seconds every week.

An inner tug of war was bubbling inside of me.
“I need a cuddle. It hurts so bad. I can’t leave without a hug. It’s only all better if she gives you a hug. Tell her you need a hug. Quick, you can’t leave without a hug!”
And the other half of me, screaming the opposite. “Don’t do it, don’t you dare. You don’t deserve a hug. What if she says no? It’s not worth the risk. Stop being such a fucking child! She doesn’t want to hug you, anyway. LEAVE”

The urge was too strong to resist. The power of the need to be held was greater than the power of the shame that was holding me back from asking. Two impossibly infinite forces. And yet, only one possible outcome.

I took the plunge. “Please can I have a cuddle?”
I think I said it in my Little’s voice again. And I could not for the life of me look her in the eye.
She touched my arm, affectionately. “What would the function of that be right now, lovey?”
“I just… I just need a hug”.
“You know I’m happy to give you hugs. But I think you are seeking reassurance. And I think we need to come back to this next session. What is the function of getting a hug from me, right now, do you think?”

My cheeks were flushing and I could feel the shame erupting from within me. The shame. The cataclysmic shame. And so I started getting angry, although I doubt she knew it. It was my usual HOW DARE YOU MAKE ME FEEL SHAME response, typical of this dynamic.

“What’s going on for you right now?” she asked, “what feelings are you noticing.”
“I just NEED you to HUG ME.” I was getting antsy, and my Little was silently raging.
“What feeling are you noticing, lovey?”
“I’m just so fucking embarrassed”, I said, trying to hold back the tears. I cry when I’m angry. I cry when I feel ashamed.

And oh, the SHAME. The shame for asking. The shame for needing. The shame for admitting that need. The shame the shame the shame. The shame for being. There are no words to describe that shame. I wished the ground could swallow me up and make me disappear off the face of the Earth.

She stroked me arm; a gesture of compromise, I suppose. I shrugged her off of me.
“Don’t”, I hissed, “I don’t feel in control when it’s like that.”
It wasn’t fair that she could touch me on HER terms, yet wouldn’t hug me on MINE. I felt more uncomfortable and confused that way than if she hadn’t touched me at all.
“Okay honey. I won’t touch you. We’ll talk about this next week. This is all giving us information; this is valuable stuff. Look after yourself, and I’ll see you in a few days.”

I couldn’t look at her. I left in a sulk. I love her so much. But I hated her in that moment too. I had exposed myself, raw and vulnerable, in asking for that hug. Just a hug. And I even begged. Just for a fucking hug. And she still declined.

My Little doesn’t know the difference between whether a hug is for reassurance or comfort or what, and neither does it care. But my Little knows that feeling of rejection well. That feeling doesn’t need discerning. It is the one feeling I have tried to avoid all my life. That hurt. That shame. That sting.

So I left, defeated and helpless, regressed and broken once again. And as I left, I collapsed onto the stairs in tears trying desperately not to let the progress we had made in that session unravel before me in an instant. And whilst I could rationalise what was happening within me, and whilst I knew on one hand why my therapist did what she did, I couldn’t stop the punitive voices that pelted my brain like a rifle opening fire. All that anger, that rejection, every morsel of negative affect of the last 3 minutes was redirected straight onto myself.
“Well what did you expect? You got what you deserved. You shouldn’t have bloody asked and I told you not to but you didn’t listen. You are weak, so needy, so fucking greedy it disgusts me. You are an embarrassment. You are flawed. And you are entirely unworthy of love.”

Christmas, Cookies and aCcumalting Positives

I spent a good number of hours creating this baby in an attempt to build mastery and accumulate positives during what has been a challenging week. I am proud of the result, and am therefore showcasing it here. BE JEALOUS. Happy holidays, friends.


 

Back To Where It All Began

I wanted to write a profound and meaningful post, but the truth is that I have no words for what I want to say.

I spent the past week in the US, visiting friends I met when I was in hospital there almost 2 years ago. I hadn’t seen any of them since, but many of us stay in touch. When I found out a few months ago about a friend from the hospital who sadly took her own life, I decided that I needed to go back to that group of friends to reconnect, and seek and share comfort and love.

I spent the first half of the trip in New York. I have never been before and it was more vast and awe-inspiring than I ever could have imagined. I played tourist; I went to see a show on Broadway, ate my first garlic knots, viewed the city from the Empire State observation deck, went on a Big Bus tour, and spent a lot of time with 3 different friends in and around the city.

I spent the second half of the trip in Boston. I stayed with a friend, and saw a few others, and did a bunch of touristy things. The highlight of my trip was going back to visit the hospital where I started my BPD recovery journey, almost 2 years ago. I was nervous because my expectations were so high, and I didn’t want to be disappointed. But it could not have gone any better. It was an overwhelmingly special and positive experience.

I was reunited with almost my entire treatment team. I spent a number of invaluable hours catching up and hugging my old therapist, psychiatrist, support workers and other members of staff. Members of staff who don’t even work there any longer came to see me and went out of their way to make my visit the most joyful it could have been. For that – for these people – I could not be more thankful.

I returned the next day because they wanted to spend more time with me. I felt so touched and honoured and grateful beyond words. I felt important. I felt loved. I felt worthy.

I lapped up their attention and affection, I let myself be vulnerable, I updated them on my life, they updated me on theirs. They told me I was a ray of sunshine during such a distressing time (Donald Trump related, I shall say no more) and I was able to internalise how happy they were to see me. They told me that seeing me doing what I am doing is what motivates them to keep doing what they’re doing. They told me that I make their jobs feel worthwhile. I was beaming for the entire time we spent together. My face hurt for hours after from smiling so hard.

I have felt so many emotions this past week. I have cried a thousand happy and sad tears. I have been nostalgic, joyful, scared, proud, anxious, connected, concerned, envious, grateful. I have been every dialectic there is, every paradoxical combination of emotions. I have had urges which I understand are my brain’s way of dealing with some of what I have been exposed to, and what that brings up in me. I have also felt the deepest love and longing for some of the people who have had the most profound impact on my life.

This trip was such a huge deal for me. I wish I could stay in that bubble for ever. But it is time to return home. I didn’t know it was possible to feel so achingly happy and so painfully sad at exactly the same time.

Skill of the Day: Facebook Basketball

I found a new DBT Distress Tolerance activity. It’s basketball on Facebook, believe it or not. 

I’m not usually one for online games or apps, but recently my friend introduced me to this one, and it’s been a real help. When I feel an influx of anxiety or become consumed with unhelpful thoughts, I take out my phone and go back to playing Facebook basketball. It really calms the anxiety as it is so preoccupying and addictive. 

My friend and I also get super competitive so it takes all my focus trying to beat her high score. It’s helpful having her engage in the game with me, too, without having to explain my intentions. Skill use is easier when someone else is involved, I find.

All you do is go onto a chat on Facebook and type in and send the basketball emoji that looks like this –> 🏀

Once it’s been sent, click on it and the game will begin.

My high score is 22. Try beating that, suckers!

Dialectics in DBT

DBT stands for Dialectical Behavioural Therapy. But what does this name really mean? Many of us will understand conceptually what ‘behavioural therapies’ are. But what on Earth is a ‘dialectic’?!

A dialectic occurs when multiple things – which are seemingly incompatible or opposite to one another – can both exist and be true simultaneously. For example, it is possible to be both happy and sad at the same time; to love someone and hate them at the same time; to be both scared but also willing and brave to push through that fear, at the same time.

The core dialectic in DBT is that of ‘Acceptance’ versus ‘Change’. Much of DBT is centred around balancing these two concepts. DBT aims to validate and accept someone’s experiences as understandable, whilst at the same time flagging them up as potentially maladaptive and requiring change.

In many situations, dialectics can be especially difficult for people with BPD to wrap their heads around. Generally, people with BPD tend to perceive life in a very all-or-nothing way. This means that we usually get stuck at the extreme ends of emotions, thoughts or behaviours and find it hard to see any other possibilities. We find it so difficult to live in the grey because often we simply do not see that there even is a grey at all… So, the fact that a synthesis of many different and often contradictory actualities can exist at the same time is a hard concept to master.

For example, if I have gotten into an argument with a close friend, I may become blinded by the situation and start to see them in an entirely negative light. I may experience intense anger and hatred towards them and believe that they are truly very awful indeed. I may convince myself that they are the worst person in the world and that our relationship is over. I may think of all the times they have hurt me in the past and find all the most fitting evidence I can in order to confirm my current negative perception of them as true.
(See this post on Teleological Thinking, for more!).

Finding the dialectic within this situation would involve being able to acknowledge the distressing emotions I am going through and validating my experiences, whilst simultaneously being able to keep in mind the strength of the relationship and possibility that things can be resolved:

  • The ‘Acceptance’ side of the dialectic could look like this:
    I acknowledge that yes, I am feeling incredibly angry towards my friend right now as a result of their actions. They have behaved in a way that has upset me profoundly, and as a result I am hurting. I am struggling to trust that things will resolve between us and have the urge to end our relationship for good. I feel let down, betrayed, misunderstood, angered and saddened by the situation.
  • The ‘Change’ side of the dialectic could look like this:
    My friend and I go back a long way and have a very strong and caring relationship. My friend is generally very supportive, attentive and loving. I have valued them in my life for a long time. Regardless of what has happened, I still care about them, and they still care about me. Perhaps there is a possibility that we will be able to get through this and that our friendship can survive like it has done many times before. 

Being able to hold these two opposing truths in mind at the same time is what we are aiming to achieve. Dialectical thinking encourages us to slow down and be more mindful, remain descriptive and less judgmental, and widen our perspective on what we deem to be true.

The use of the word “and” can be especially helpful here. For example, saying “This is a really difficult situation, AND I can get through it” is a simple but effective way to cheer-lead oneself to get through life’s challenges, whilst simultaneously validating them.

The Hiccup that Put Things into Perspective

This weekend I did something I have never done before. Usually when I feel unsafe, I either push myself through it until I get out the other side (by some miracle), or I combust, give in and end up self-destructing. 

This time, the build up was pretty bad. Bad to the extent that I genuinely feared for my safety and what I might do to myself (although I suppose at the time I didn’t fear for it, because I didn’t give a fuck. I was done). Sometimes even though I feel unsafe, I might know on one level that I won’t follow through with anything totally life-threatening. However, this time I hit such a low that I genuinely believe I could have followed through with catastrophic actions. (See this post here for context!)

Luckily, I didn’t do that. I didn’t force myself to push through. And I didn’t self-combust. I did something I have never done before in this way and I reached out for urgent help. I told my parents I was feeling suicidal. I did it over text because I couldn’t get the words out. But I did it alright. And it was fucking tough.

My dad called my psychiatrist, who in turn called me. Hearing me in such a state and realising the severity of the situation, he recommended I go inpatient just to be safe – both for my benefit and for my parents’. A couple of hours later he admitted me to the psychiatric hospital. It’s the same hospital I was in almost two years ago.

Ironically I am in the exact same room I was in during my last admission. (Well, it’s the same room I ended up in, after I had to be transferred because I had tried to smash the lightbulb in my first room in order to get glass to hurt myself with…!)

Being back in this same spot got me thinking. Physically, yes, it’s the same room, the same bed, the same floor, the same hospital. But besides the physical, almost everything is different. The people are different (none of “the old crew” are here any longer, thank goodness); the staff are fairly different (quick turnover of nurses, apparently); the timetable is different, the food is different, even the name of the hospital has changed. 

The biggest difference, though, is in me.

Sounds cheesy, I know, but hear me out:

Last time I was here, I arrived in an ambulance off the back of a serious overdose from another general medical hospital, where I could have died.

Last time I was here, I cut myself so badly in the bathroom by my bedroom that I was found by staff half conscious in a pool of my own blood, before being carted back off to A&E. 

Last time I was here, I was so ill I had to drop out of university. 

Last time I was here, my therapist had just “split up” with me because she was unable to manage the severity of my illness any longer.

Last time I was here, I had to be restrained and put on 1:1 monitoring after trying to severely harm myself with a can of coke I had found in a bin in the staff smoking garden after being assaulted by another patient. 

Last time I was here, I didn’t even step into the canteen once; I lived for weeks off hot chocolate and cigarettes and lost about 4kg, punishing myself with starvation. 

Last time I was here, I was on 7 different medications, totally hooked and unable to function without them, constantly begging for more in order to get through my day.

Last time I was here I was absconding, smuggling and using drugs on site, yelling down the entire ward and scaring staff who admitted they did not feel anywhere near equipped enough to manage me. I took up their constant time, energy and attention.

Last time I was here, I was being threatened with being sectioned and moved to a more secure NHS ward in another hospital.

Fast forward to this admission and it is a totally different story:

This time, I was admitted after asking for help BEFORE I did anything self-destructive or life-threatening to myself. I arrived in a car with my parents, and walked myself through those doors, willingly.

This time, I have been trusted enough to start not on 1:1 supervision, but 15 minute observations, which have now reduced to hourlys. 

This time, I have been to the canteen (albeit with support from staff) and made sure I’ve eaten an adequate amount in order to take care of myself.

This time, I have asked for support when I’ve needed it using words, not actions – and that has been responded to accordingly.

This time, I haven’t made any scenes, I haven’t shouted or threatened anyone, I haven’t set any alarms off. The nurses are finding me pretty easy to manage – I’m apparently unrecognisable. 

This time, I am not fighting the system, wreaking havoc or worsening the situation for myself nor anyone else. I am working with the staff, and they are working with me.

This time, I am probably the only patient in the entire hospital not on a single pill or drop of medication.

This time, I am feeling safer, calmer, more contained and ready to leave after only 2 days in here. 

Tomorrow evening, if all goes well after seeing my psychiatrist I will be discharged. I will not be discharged to another hospital nor treatment centre nor therapist. I will be sent back into the world and I will go home, where I will go to sleep in my own bed. The next morning I will wake up, at home, and I will continue fighting this battle outside in the real world, like I do every single day. 

I felt a huge amount of shame coming back in here, and was scared it represented a huge set-back, or even a full blown relapse. But the truth is, being back has actually shown me, my family and my psychiatrist just how far I have come over the last few years. Whatever my therapist thinks when I see her (we are in a huge conflict, and they are very anti-hospital in DBT), I have to remain proud of myself and know that I made the right decision.

After all, I’m still here, aren’t I?

Crisis Point

Yesterday morning I was really upset about something. I texted my therapist to say “I notice feeling a disproportionate amount of sadness about…”, which was purposefully very descriptive and “effective”, according to DBT guidelines. I wanted a response but honestly wasn’t expecting anything, as I know the message wasn’t for skills coaching specifically, but more for comfort. Anyway, a few hours later after not having signal for a while, I saw I had a voicemail from someone. I called voicemail and was surprised and touched to realise that it was a message from my therapist. She knew that I was having a hard time and why I was so upset, and had taken it upon herself to reach out to me and offer support. It was a really special caring message; she was validating my sadness and saying that she was thinking of me. I appreciated it so much I was tearing up. So I called her back and when her phone went to voicemail I left a message thanking her for everything profusely.

A few hours later I was at home, and I was struggling with the sadness still. I had been trying to soothe myself and let myself feel sad without it overwhelming me, but it had been getting bigger and bigger until it felt like it was taking me over entirely. I was crying on the floor and struggling to regulate myself but having a hard time doing so. I planned to watch something to distract but was even struggling to get off the floor or even stop the tears.

I called my therapist again and left another voicemail – this time saying that I was really struggling to not fall into my sadness, and that I was in a lot of pain and really needed to talk to her. At the end of the message I told her what skills I was committing to practice, starting with watching Masterchef. She didn’t reply for a couple of hours so I started having loads of worries. I find it hard to regulate myself when she doesn’t reply to me for a long time, and get into my head a lot of negative distortions. I was panicking quite a lot and digging myself further into a rut, barely able to distract myself or summon Wise Mind. I thought that because I hadn’t heard back, I must have done something wrong and that she was angry with me. I tried to rationalise but as usual, it wasn’t helping me. I felt guilty for sending the second voicemail and worried she was thinking that I was taking the liberty, especially after she had left me such a nice voicemail earlier in the day.

(She often says that when she offers me support or reinforcement I just end up wanting more and being ineffective in order to try achieve that, and I was scared she would think this was one of those times. However it genuinely wasn’t. I was feeling very dysregulated and whether she had left that voicemail or not I would still have reached out. I only reached out when it got to point I didn’t feel I could manage any longer after a few hours of trying to contain the situation myself. I was being effective as I was reaching out in order to take her advice. In the mean time I was trying to self soothe, check the facts, challenge the paranoia and validate my sadness.)

After about two or three hours of not hearing back from her (and me using distraction skills myself, but still not feeling calmer, in fact getting more agitated) I wrote her a text as I wanted to apologise in case I had done something wrong, and let her know that I wasn’t trying to take advantage of her support. I apologised for leaving the second voicemail and said I was worried that she may think I was “taking the piss”. I said I honestly wasn’t, but that I felt like I was “going to die” without her, because that’s how much pain I was in. I asked if we could talk because I was very distressed. I sent the message.

Ten minutes later I received a reply from her. In it, all that she said was that she regretted calling me earlier (when she left the voicemail) because it had encouraged my ineffective behaviour and judgments. She said that she wouldn’t do it again. That was it.

Literally as soon as I saw that message, I went into a complete state. I sent a long string of messages apologising profusely, trying to explain descriptively, asking for her help, expressing my current pain and distress and literally begging for her to call me. I explained without judgments what I had meant by “taking the piss” (i.e. I didn’t want her to think I was taking advantage and wanted her to know how much I appreciated her earlier voicemail) and explaining that I used the word “dying” to describe how I felt inside and how much pain I was in. I apologised for any misunderstanding and for being “ineffective” but made it clear that I hadn’t meant to be and that I was trying my hardest. I asked her to call me. She knew I was in a panic attack, you could hear it in my voice, tears and breathing.

The above messages were all a few minutes apart and were sent as my panic attack was progressively getting worse. I also called her during this time, 6 times, in utter desperation, and she wasn’t answering. Two of those times I left voicemails in which I was literally hyperventilating begging for help – expressing how I could no longer reply by text because my hands had gone numb and I couldn’t move, apologising profusely, expressing how willing I was to be effective, how I needed to talk to her and fix this situation because I thought it was a misunderstanding as I had been trying hard all day to be effective and how I needed her to call me back in order to help me calm down.

It hurt me so much that she had said I was being ineffective when I was trying so hard to be effective. I felt so broken that her text said she will never call me again like she did in the morning, due to my “ineffective” behaviour. I still don’t know what I did so wrong. I feel like I always try and do everything I can to be effective and not hurt others, but somehow always end up doing something wrong and making everyone hate me or feel negative towards me. I feel like I am walking on eggshells around her half the time; like if I say something a tiny bit wrong, she will completely turn on me. She didn’t seem able to mentalise that I was in a total crisis and therefore how I may receive her messages – and that what she said and did would obviously make me even more dysregulated. She knows me well enough, believe me.

She reminds me of my Mum when I was a kid. The smallest step out of line and suddenly I’m the worst person in the world and it’s all my fault. I don’t know how much of this is real or how much is based on that – but yesterday provoked an emotional flashback of sorts for sure.

Anyway, after my messages and calls I received a message from her listing some skills (which I was way beyond able to use, considering my current physical state) and reminding me about a commitment I made to not use skills coaching ineffectively. I still don’t know how it was ineffective of me as I have never needed skills coaching more than in that moment, and yet she refused to call me back. I feel as though by that point, it would have been more effective of her to call me and let go of her own reaction because I was at an all time low and unable to manage it alone. Whatever was going on for her, it definitely got in the way of her being effective with me. How she responded to me was exactly what set the entire panic attack off in the first place and she was only making it worse with each response (or lack of one).

So of course her last message was not what I needed, I was literally mid panic attack and couldn’t grasp reality let alone think about being effective. I couldn’t even breathe. I was unable to reply to her at that point anyway because I was on the floor and my hands were numb and in a paralysed contorted position so I couldn’t type. I could just about press my phone (every time I called her I put it on loudspeaker so the phone was with me on the floor and I didn’t have to hold it). I was literally sobbing my heart out, screaming crying, hyperventilating etc, but so desperate to get through to her and show her I was being fucking effective and willing. After I managed to slow my breathing down I called one last time and left a voicemail, breathing through it, slowly trying desperately to make myself clear, and said, very descriptively “Hi, this is the last time I am going to try and call you, I would really appreciate it if you could call me as I am extremely distressed and in need of help, I am willing to do anything to be effective”. Bear in mind this is MID panic attack. The worst one I’ve ever had.

She didn’t reply, she didn’t call me back. I ended up having the worst panic attack of my life. I had to call my mum which in itself was nearly physically impossible due to my hands being so numb. She was freaking out as she was about to get on the train with no signal, so she called my dad, who came over with my step-mum as quickly as they could bearing in mind that my Dad has broken his foot and can barely walk. By that point (no idea how many minutes later) I was lying stuck on the floor in the hallway, my hands were totally totally paralysed and contorted, my hands and feet were numb, my legs were shaking, I couldn’t open my eyes or see properly, I was sweating and apparently burning up despite the fact our house is freezing. Luckily they had a spare key.

My stepmum had to support me and prop me up as I couldn’t move, take my top off and hold about 6 ice packs over my body. The entire thing lasted over half an hour, I was probably shaking and numb for longer, and was the most humiliating thing in front of my Dad and stepmum. I work so hard to constantly hide my distress from my family but I had lost my grip on reality and that was no longer possible – especially considering the uncontrollable physical reaction I was having. My mum had said she wanted to call an ambulance but I told my Dad not to as I was so ashamed. He was freaking out with worry so called my therapist from his phone – she still didn’t answer. He texted her saying “Hi this is X, please help us, she is having a panic attack and cannot move her limbs at all, we don’t know what to do”. She didn’t reply, and still hasn’t.

I can’t express how upset, angry and broken I feel right now. I can’t believe she would do that to me. She left me at my lowest and most desperate point. And her rationale didn’t even make any sense, or if it did, she could have chosen a more appropriate moment to express it. I’m terrified this is going to affect everything, I don’t know how I will ever get over it and learnt to trust her again. Yet again. She won’t even talk to me to sort it or explain it in a way that will help me make sense of her actions until I next see her. I have to live with this shit until our next session and who knows what will happen after that. I don’t know what to do. I am surprised I made it to today as I honestly wanted to kill myself last night. I feel the most suicidal I have in months or longer.

Being Introduced to EMDR

EMDR stands for Eye Movement Desensitisation and Reprocessing. It is a type of therapy that was originally developed for the treatment of trauma, and is most known for its success at helping those with PTSD (Post-Traumatic Stress Disorder) recover. It can also be used to treat other disorders including depression, anxiety, BPD (Borderline Personality Disorder), C-PTSD (complex PTSD) and others.

(I found this link pretty helpful in trying to understand how EMDR actually works)

After months of talking about it in therapy, I am finally about to start EMDR with my (previously DBT) therapist. We have not started any of the reprocessing yet – that is still at least a few weeks away – but we are in the preparation stage, so I am getting a feel for how it works.

Firstly, she has explained to me how EMDR works and introduced me to some of the concepts. Whilst I have done a lot of research online into EMDR, I am finding it hard to completely grasp how it works before actually experiencing it for myself. Because I haven’t started the actual reprocessing yet, I am still unsure of what to expect. So far however, this is what I’ve got:

1) The set-up of the room is different to usual, which at first I found quite unnerving and will probably take a while to get used to. I have gotten comfortable with the familiarity of sitting with my therapist on opposite sides of a small room in big comfy armchairs. Pretty ‘typical’ for psychotherapy. During EMDR, however, we have to sit right next to each other – uncomfortably close – on chairs facing opposite directions, in the middle of the room. This is so that she can guide the reprocessing, which I will outline below:

2) Next, she explained and showed how she can conduct the reprocessing part of EMDR in one of three possible ways (I believe there are more out there). The first involves her ‘waving’ her hand or two fingers from side to side in front of my face, whilst I have to follow the movement of her hand with my eyes. The second involves me placing my hands on my knees, and her tapping on top of my hands with her own – one at a time, continually and in quick succession. The third involves me holding two ‘buzzers’ – which vibrate independently and consecutively, left right left right etc – one in each hand. Different people find the approaches effective to different degrees. So, closer to the time, and perhaps with some trial and error, we will see which one works best for me.

3) There is a big emphasis on finding a ‘safe place’ – an image in my head of somewhere I feel at peace in – to refer back to for visualisation at different points within the processing. This image has to be sensed on all levels, including and especially in my body. When we do the reprocessing, it is the felt sense of this image that we want to be transferred into my body, so that I can work towards freedom from the usual trauma-related body sensations that I carry with me.

4) Sessions are longer than typical psychotherapy sessions. They can be anything from 60-90 minutes. My therapists knows me well enough to believe that we will need the full 90. So the entire structure of my therapy is changing – and that in itself brings with it a fair amount of discomfort.

5) With single “big-T” traumas, EMDR can ‘work’ in as few as a couple of sessions. It sounds like a miracle cure really – some studies show as high as 98% reversal of all PTSD symptoms after 6 sessions, for example. However, for multiple-trauma PTSD, complex PTSD, relational trauma, prolonged “little-t” traumas and BPD and the like, it isn’t so clear-cut. Years worth of ingrained trauma will take hours to reprocess. It is going to be painful and it is going to bring up a whole lot of unresolved and hidden issues. I’m terrified.

6) Grounding grounding grounding. I have so much work to do on grounding. It turns out I most likely have a dissociative disorder as well as BPD, and this can really get in the way of EMDR. We use ice cubes in my sessions occasionally, which I find extremely helpful, and I have a ton of skills to practice in between my sessions to help with it.

I still feel far away from fully understanding this therapy, but I am hopeful about it. I have heard great things about EMDR and my therapist is exceptionally knowledgeable and experienced within the field. I have so much faith in her. So, even though I am terrified of the uncertain things in store for me in the near future of therapy, I trust that she will catch me if I fall.

I feel like DBT has saved my life from the outside in, but I am hopeful that EMDR is the therapy that maybe, just maybe, will provide me with the healing I need from the inside out. 

An Invisible Sea of Sadness

For days I’d just been pushing away and distracting. I had so many painful emotions I couldn’t deal with… they in turn turned into urges or thoughts about wanting to die and such… and then to cope with that, I distracted. So I never actually felt the pain of the emotions that had started the chain. 

I spent the entire time that I wasn’t self-destructing, trying not to self-destruct – and I did so by distracting. On Monday that meant that I spent the entire day distracting. I didn’t give myself a single second to actually feel anything, I was so scared of the power of the emotions and the urges I was having but trying not to let myself have. Finally I tried to go to sleep around 11. I was therefore not distracting from myself any longer, and suddenly, it hit me like a tsunami. 

It was as raw as anything I have ever felt. The biggest most painful amount of sadness took me over and I went from complete dissociation and not being able to cry to being unable to breathe through my tears. My breakdown was like a scene in a movie, it was so immense. The sadness was so massive that I literally was choked by it, gulping and flailing for air like a fish out of water. 

I felt absolutely terrifingly connected to the sadness. I was so taken over by it and it hit me so hard, it felt like I was dying. I wonder if it was that that had been trapped within me the whole time. Maybe it was the sadness that had been beneath my efforts to so urgently distract from myself. And yet I hadn’t even realised it, until it erupted out of me, because it had been tucked so deep inside, barricaded from my consciousness by fear. 

I think maybe that’s why when the tears finally subsided, and I woke up this morning (albeit emotionally hung-over, confused and disorientated), there was an element of relief and a shift within me.

Realisations 

It is my second last day in California, and whilst I am immensely grateful for all the wonderful moments I have experienced, the trip has not been without its challenges. As a result of the more difficult moments, I have come to a number of realisations:

  • Why I find it so difficult to make even the most menial decisions:

    Whenever one member of the family asks another for their opinion or preference about something, it is usually met with some form of negative and controlling response. For example, whether it is choosing a meal, an item in a shop, or something so insignificant as a song on the radio, it is never good enough for anyone. The same applies to both the most and least important of subjects. After being consistently asked what my preference is in certain situations, and then met with comments such as “but why would you choose that?”, “I think it would better if you did this instead” or even just looks of judgmental disdain or disapproval, it increasingly grates on me. Why ask me what my needs are if you don’t really care enough to listen to them anyway? I would rather remain passive, apathetic and indecisive than have a strong preference in any direction only to be chronically shut down, dismissed, shamed or disappointed by my family. This struggle has spread to other areas of my life; I am so wary of making any potentially imperfect decisions in a multitude of contexts – because I am so scared of people around me responding negatively – that I simply do not make decisions at all. It is so much easier to not care, to respond with a simple “I don’t mind, you choose”, and to not experience the consequence of my voice being constantly stamped over. Of course it is not ideal, but it is certainly preferable to me than getting all the controlling bullshit I get for saying something *wrong* every second sentence.

  • Why I have such a fragile and complicated relationship with anger:

    When I try and express my anger with certain family members, I get mocked, shamed and made out to be the bad guy. There are many situations in my family when I am the most calm and contained one (at least externally) so usually when I get angry, it is genuinely justified. However, when I express it, it gets shut down and invalidated, my feelings dismissed. As a child I was very angry, but being constantly ridiculed and even punished for showing it meant that over the years I learnt to internalise my anger more, and take it out on myself. This has continued to today. I find myself getting headaches, my chronic pain gets worse, physical anxiety goes up and I can’t think straight. There is no where for the anger to go because expressing it doesn’t go well, and I’m scared I will explode because of how much power it has. Therefore, often when I get angry, it is followed by a period of dissociation. I become so aroused, and so stuck in that arousal, that my system can only shut down in an attempt to deal with it all.

  • How my dissociation manifests amidst my family in further ways and why:

    The constant stressful, dismissive and controlling behaviours of family members easily overwhelm me. The more exposed I am to these experiences, the more painful it is. The more I care, the more it hurts. It is therefore easier to disappear, fade into the background, shut myself down, make myself small, take up less space, silence my voice and reduce the addition of more stress to the mix of everyone else’s shit. I do this by dissociating. If I’m not mentally present to the toxicity around me, then I can cope much better than when I am fully exposed to it. Even if there physically, by shutting off mentally, it provides me with one way of navigating the chaos. When dissociated, I remain unphased by what would usually cause huge distress. Instead of feeling constantly on edge, angry, anxious, unheard and a victim of negative energy as a result of the interactions around me, I can disconnect instead – and it is one way I survive the uncontrollable unpredictable people around me. Instead of being pushed and pulled around by what goes on with them, I become immune to my environment. Dissociating is my shield. It provides (the illusion of) invincibility. Without it I would not have been able to get through the 3 weeks without some form of externally destructive behaviours.

  • Why romantic relationships don’t come easily to me:

    The two parental figures on this holiday spent more time bickering and controlling, yelling and cursing, than they did positively relating to one another. The holiday was just a microcosm of what I have grown up with; I have never seen a healthy relationship between any of my parental figures, almost every conversation is an argument, there are no conflict resolution skills, no productive listening abilities, no understanding of validation. There is more hostility than overt love, more control than encouragement, more shaming than compassion. They are both so negative towards each other, and it feels damaging to be around constantly. I cannot imagine nor foresee myself ever knowing how to be in a healthy relationship. All my “relationships” so far have been toxic, and half the time I haven’t even realised. I have not seen nor been taught an example of how to be in a relationship that works, and as a result it is something I feel completely hopeless and clueless about for myself.

  • Instead of missing people, I pretend they don’t exist:

    When I was little I had to get used to the people closest to me not being around. I adapted by learning once again to dissociate from my feelings of sadness and loss, because as a kid it was too much to deal with in any other way. I went from missing certain people and depending on them, to being immune to the unpredictably of when they would and would not be around by simply *not caring*. Still to this day, I don’t tend to miss family or friends back home when I am or they are away. It puts me in an awkward position when they tell me they miss me and cannot wait to see me – as I don’t relate to that feeling, but also do not want to upset them! The only people I miss are the people I am attached to, e.g. my therapist. Aside from her, I feel like I could go for months without missing anyone. It’s ironic because even though I don’t miss them, I am not left without the deep loneliness. I haven’t seen my sister in months but I feel nothing? My best friend has moved country but after a single breakdown, I forced myself to become immune to that too. It is like I forget people exist, because then it doesn’t hurt when they’re not around or we are apart for long periods of time. I am always reminded of this when I go on holiday in how profound the disconnection I feel from “home” becomes, and in my inability to really feel emotionally connected to anyone I know intellectually I do have back there.

  • There are certain toxic people I really do not want nor need in my life; my self-respect is growing:

    Being away I have had limited interactions with friends over social media. The friends I did speak to showed interest and compassion in everything I shared – and vice versa – we shared only pleasant interactions. Then there are those who seem only to care about and get in touch based on their own needs. In the past I would have just let people walk all over me, stayed silent when affected by their behaviour or put their needs ahead of mine. But now, when confronted with those who don’t listen to my own needs or respect my boundaries, who have such high standards that no one will ever be able to live up to them, who are judgmental and invalidating of my experiences and feelings, and who I really do not miss nor feel the desire to contact whilst away, I feel no need to pander to them any longer. In fact, contact had been more of a bother than a pleasantry and I am happy because it has forced me to think about what I want. A sour interaction was the last straw for me and forced me to reconsider my values and needs. It enabled me to gain some perspective and practice some self-respect in terms of what I want from the relationship – or if I even want it at all. I am very much relieved. I don’t owe anyone anything, but I know what I owe myself.

Life on an Adolescent Intensive DBT Psych Unit

My bedroom was a tiny box of a single room. I had shuffled the furniture around so that my bed was tucked beneath the slanting of the ceiling at the far side of the room – so that I had a little safe cove I could hide in. Next to my bed was a stained wooden bedside drawer and a matching flimsy cupboard. I had not allowed for much legroom around the bed, after the furniture rearragement. The bed itself was low and the mattress paper thin. I always had two duvets because they were really thin also. They were these weird American duvets that go straight into the washing machine; they didn’t even need duvet covers, you just chuck the whole thing straight in.

Beyond the foot of the bed, nearer the bedroom door, was a desk which had all my writing equipment and books on it. (There was also a little glass angel my best friend had sent me in the post – which one night in a moment of desperation, I crushed so that I could use the shards to self-harm with.) On the floor I had laid down a yoga mat which I obsessively did puzzles on, because the floor itself was contaminated; everything seemed to stick to it no matter how often or obsessively I hoovered.

You would think that in an American hospital as expensive as that one, the rooms would be luxurious. Well, I assure you they were anything but. They were plain and old and in need or urgent renovation. When I moved in, it felt so dirty, dusty, old and damp – the kind of place you would not feel comfortable walking around bare foot. The kind of place that feels “hairy”, although I’m not sure exactly why that word came to mind. But by the time I left, the unit felt more like my home. I think I cleaned up well, making it as comfortable as I could for myself.

On one wall I had stuck tens of photos I had taken from home and cards and letters people had sent me, from half way across the world. Right by the door, where everyone could see, I stuck a large hand-crafted chart which I used to tally my behaviours and days free of self harm. (Until I ripped it down in anger and self-loathing after relapsing, that was).

Every weekday, we had a morning group which lasted 15 minutes, which was like a ‘check in’ session. I am sad because I cannot remember the exact name of this group. We would all write our goals on the stained whiteboard in creatively thought-out acronyms and varying colours of ink; most of us half asleep and with our moody teen attitude faces expressing how unenthusiastic we felt about starting a new day. I would grab muesli and yoghurt or fruit and take it with me in a plastic bowl to the lounge (where we did the check in), where I would subsequently be told off for eating outside the kitchen. Sometimes I would bring breakfast into the classroom instead, where even though I got told off, the ‘teachers’ (M and L) were too in love with my English accent and overall Britishness that they let me get away with these slight overhauls of the usual unit rules.

I would sit in the classroom with my hot water bottle and 5 or so other girls learning the DBT skills hour after hour, day after day. During our breaks I would go for a cigarette, if there were enough staff available, which often there were not. When the latter occured, I would inevitably throw up a hissy-fit, just because I could. Being on a psych ward allowed me to embrace my inner Hulk, you see. For once, it was safe for me to express my anger externally. I feel sorry for the staff, but it really helped my process.

If anything came up in class that was difficult, you could leave and go to the ‘nook’ at the other end of the hall, where a CRC (community residence counsellor) would be sitting for skills coaching availability. This was a regular occurrence – I don’t think any class went by without at least one girl having to leave for skills, whether we needed it or not! We worked our way through the massive DBT binder, compiled proudly by D (an old-timer CRC, who as yet had not been scared away), day after day after day. When we completed the binder, we started it all over again. Originally, I was not meant to be there for that long, but there was a slight delay in my transfer to ‘step-down’, due to how much I was still struggling on ‘intensive’.

Some groups and classes we had were in the ‘fishbowl’ – the room where the clinical meetings, handovers and assessments took place (not to mention the emergency ice-diving sessions). These groups included ‘relational dilemmas’ and ‘BA-CA-SA’ (behaviour-analysis, chain-analysis, solution-analysis – yes, what a mouthful). Lunch was from midday until 1pm. Overall meal times felt super early, and it was like being back in primary school. We had a shopping list for food we could add to on the fridge, and I ordered the same things every week. Animal crackers, sugar free hot chocolate, and a concoction of ingredients for my famous salad. Every day I made the same America-inspired salad – kale, feta, craisins, seeds, veg, raspberry dressing – and sometimes I made it for the members of staff, too. At lunchtimes, I always tried to get a seat at the table with the most clinicians – to ensure my daily dose of attention was attained. (We all ate together, informally, over 3 round tables, which often got full pretty quick).

Classes continued in the afternoon until 3pm, which was homework hour. I think I was the only one who actually did every single piece of homework, being the keen-bean that I am. Twice a week we also had the infamous ‘community meeting’, where everyone came together in the lounge to work through a structured outline. This included a mindfulness activity, rewarding people for effective behaviour, community issues, introducing new people and saying goodbye to leavers, etc. I managed to avoid leading ‘community meeting’ until many weeks had past, when my therapist decided it would be a grand idea to expose me to anxiety and shame – and my fear of my face going red. 

At 4pm, we had exercise hour, which was more like ‘exercise 15 mins’. We would much rather take our 3rd naps of the day, or eavesdrop on the ‘handovers’ going on between staff in the ‘fishbowl’. There were options for the exercise we could undertake: ‘tunnel walks’, or boring outside walks, or yoga when certain members of the team were available to facilitate it. When it snowed I wanted to be outside the whole time, building snowmen and singing Frozen with my friend T, much to everyone else’s annoyance. (We were the only two who had never experienced snow to the extent they had it in New England that year, being from abroad).

Tunnel walks were pretty cool too; replaying scenes from Girl, Interrupted, singing and shouting down hallways, hiding around corners, running into a wall with a poster that read ‘Unit 9 3/4’ – getting together to make the unbearable somewhat more bearable again. On Fridays for one group we were taken to the main canteen where we were allowed to buy anything up to $5, before sitting together and having ‘Cope Ahead’ group in the empty seating area, overlooking further empty seats. On occasion, one of the girls would try and run away. Usually, I just asked to go to the bathroom, so that I could sneakily take advantage of the wifi and use my phone (which had somehow gone missing from the office in the unit, having safely found a hiding place in my bra.)

On Thursday nights we had ice cream outings, which were everyone’s favourite. (Except for the time that one girl ran away, and the police had to arrest her. Poor girl in her PJs carrying her teddy bear, who we never saw again, as she was shipped somewhere more secure).

On weekends it was quiet – fewer staff and fewer patients. We went on outings (Americans apparently do not say ‘trips’, people) such as ice skating, cinema, walks, museums, pottery painting at MadeByMe, shopping, Build a Bear, bowling, you name it. If you got through without having a panic attack, it was on occasion actually enjoyable. (Unless someone else had a panic attack, which was not so much fun either, especially in the middle of shopping ‘mall’ (as they say), or during a ‘U’ rated movie (such as Big Hero 6… don’t even ask).)

My favourite outing I remember was an adventure to a local common, when I witnessed a pond that had totally frozen over for the first time in my life. I pretended I was going to walk on it, just to freak out the staff, who were essentially responsible for my life. (Then I found a lollipop on the floor and gave it to K, because she sucked sweets 24/7 when trying to quit smoking. Goodness knows how or why I remember that, out of everything.) I remember being happy that day, and people always mentioned thereafter how much they had loved seeing me like that. Especially because of the simplicity of it all, the fact that my glee was all because of a frozen pond.

Back at the unit, I had therapy twice a week with W, and family therapy over the phone once per. I also saw my psych S twice a week, although this was usually doubled because of the complications with my meds at the time, or halved because she forgot (bless her) or was busy. I usually was my own boss anyway, constantly making my own ‘appointments’ to speak to many members of the team whenever I needed a dose of attention. I also played many games of Scrabble with the head psychiatrist and read many chapters of my book in the clinical director’s office whilst she did her paperwork, curled up like a cat on her sofa (begging for cuddles).

On my last day I read out a speech I had written that was 4 pages long. I thanked everyone for all they had done for me, not that words could do it justice. I recounted memories, the good and the bad. I laughed, I cried. I put on my best British accent, and then my best American one. I joked and referenced multiple members of staff, some of whom starting crying too. My ‘hugging ban’ was lifted, and I left to the airport having felt more held (both physically and emotionally) than I ever had in my life.

Idealisation and Devaluation in BPD

Idealising and devaluing the same person under different circumstances is a typical feature of Borderline Personality Disorder – and one I am all too familiar with.

Idealisation is the tendency to experience someone more highly than they actually are and to put them on a pedestal as ‘all good’. Conversely, devaluation is the tendency to attribute a disproportionately negative opinion to someone, so that they are portrayed as ‘all bad’. 

The number one person in my life who gets the brunt of these extreme variations in opinion, emotionality and behaviour from me is my therapist. As the main person I am attached to, interactions with her are often a huge trigger for my unresolved abandonment issues and developmental trauma to rear their heads. As a result I switch from loving her to hating her incredibly fast.

This flipping between devaluing and idealising in BPD is commonly referred to as splitting. A person who struggles with splitting can drastically change in their perceptions of someone very quickly and very frequently, which understandably can lead to great instability within many interpersonal relationships. 

The other day I found out that one of my friends who has the same therapist as me recently had a therapy session at our therapist’s house. This is not something my therapist has offered me, nor something I knew she offered, full stop. Being very attached to her and protective of our relationship, I find it especially hard to hear when others receive different (and more special) treatment to me. It brings up a ton of cognitive distortions and sparks all of my childhood abandonment fears (“She doesn’t love me”, “I’m not her favourite”, etc). 

Even though things had been going remarkably well between us (that week), as soon as I found out that my friend had been to her house, I split on both my friend and my therapist in a second. My anger, jealousy, envy and fear sky-rocketed from 0-100 and my love for them both switched to total aversion and hostility. 

I’m seeing my therapist tomorrow and all I want to do is lay a bunch of accusations, judgments and ineffective ways of communicating onto her. I’m not going to, but I want to – I need her to know how I feel. The whole palaver is really getting to me and I am struggling to cope with the huge effect our relationship continually has on me. Add to that the immense shame because of how *ridiculous* I am being – it does not make for a fun experience. 

Oh and the worst part: I know I am being irrational and pathetic (hence the additional shame) but BPD really does not give a shit… 

A DBT ‘Pros and Cons’ Example

Off the back of this post here, and the continual angst it has been causing me, I decided to call the substitute skills coach for her advice. She does not know me as well as my therapist, and I did not want to delve into it with her. But I gave her the facts and the pros and cons discussed in the previous post, and we decided together that it would be best for me to not go to the research team meeting.

She then asked me to use the DBT skill of writing a Pros and Cons list to inform our next steps – weighing up whether I express my needs to my supervisor transparently or not.

Here it is:

Pros of being transparent with supervisor:
• Acting opposite to shame will give my brain the message that shame isn’t justified (even if I don’t believe that that’s true)
• She is very knowledgeable and non-judgmental about this stuff – it’s her field of expertise – she, more than anyone, will understand
• She may appreciate my being transparent with her
• It may help her consider the unspoken needs of other service users/ people with similar struggles who she works with and inform her future practice
• Me stating my needs may foster self-respect and feel empowering
• If she responds in a supportive way it will show me that there genuinely is no current threat – and the emotions attached may become easier to manage
• Being something that I do not ever talk about or expose, expressing it could show me that it is actually acceptable to do so (with a safe person, like her) and that nothing bad has to happen as a result

Cons of being transparent
• Insurmountable shame and self-disgust etc
• I am paranoid/ hyper-vigilant about how she sees me already and it is so hard keeping up this façade – this will get even harder
• Physical consequences (panic, red, sweaty, dissociation, dizzy, flustered, shaky, etc) depending on the context of the conversation
• She may try and talk about it with me or want to discuss it further
• Once she knows, she knows – there will be no going back
• Will be challenging to look her in the eye and have the same “pure” relationship with her… the relationship will feel “contaminated”
• My constant worry thoughts regarding her perception of me if she “knows the truth”
• “Borderline me” who cannot cope with life will have won over “functional competent me” and the façade of the former version of me will be blown
• I may be perceived as weak, unprofessional, not far along enough in my recovery, etc…
• … She therefore may feel less inclined to put me on sensitive projects in the future
• She may feel guilty for not considering this actuality/ my needs earlier/ of her own accord
• She may “walk on eggshells” around me more or treat me differently having been exposed to my vulnerability

Pros of not being transparent
• It is easier
• Sometimes saying no is enough – why should I have to justify myself?
• Can avoid the excruciating shame of her knowing
• No risk of “shame attacks” and other physical reactions that I hate
• Will be easier to face her if she doesn’t know
• There are other more appropriate times to expose information such as this, especially having barely even started this work in therapy
• I can hardly talk to my therapist about it, I do not think I need to push myself to start with talking to my supervisor about it, in any capacity
• Feels safer to not expose this – it is important to feel as safe as possible with regards to this regardless of if it is avoidance or not

Cons of not being transparent
• Going with shame and fear will give my brain the message that these emotions are justified
• Avoidance behaviours will keep me stuck in avoidance – perpetuating a mindset of “I have to avoid this stuff in order to survive it”
• Giving my past power over my present, letting it dictate and control me feels like… shit. Opposite of self-mastery.
• Will deny myself the opportunity of doing things differently
• May feel like I am hiding something from her and that she is aware, leading to paranoia…
• … This interpersonal paranoia could strain our relationship
• She may push for further information to understand the situation more clearly, which would be challenging

Therapy Update: 17th May

Today, something came up, and I wanted to be there for my therapist, instead of having her be there for me. I felt guilty because of the circumstances and was struggling to talk about myself in the usual way. I just wanted to look after her feelings, not for her to look after mine! Interestingly, she seemed to know pretty much exactly what was going on for me before I had even elaborated, (once she had dragged it out of me)!

It got me thinking about how unusual it is in life to be in any sort of relationship that is, for the most part, totally unidirectional. Personally, I am used to giving and helping; to being there for everyone around me; to extending myself quite a lot to those in need – and often, to the detriment of myself. I am incredibly codependent, regularly attempting to soothe the pain of those around me far before even considering soothing my own.

But I can not do much of that with my therapist, and whenever I try to, she knows immediately and blocks me from engaging in my usual patterns. Today, it was not even a matter of codependency. I just genuinely wanted to protect and be there for her, due to various reasons, and because it is important to me to try and support people I care about and show them that I am there.

Anyway, as the session continued we starting talking about childhood matters, again. I panicked when she asked me to go into my body, but luckily averted a panic attack by doing some grounding exercises. These body sensations are terrifying me though, and are a huge block to me feeling able to do this deeper work together. We talked about that a little, and she really seemed to know what she was talking about with regards to body memories. She told me to read a book called “The Body Keeps the Score”, which everyone in my old treatment centre was obsessed with. I guess I should knuckle down and read it…

So, it is clear that we are moving on to bigger things, beyond Stage 1 DBT. I know this because she said that the health insurance people had emailed for an update, and that she had told my case manager that we have come to the end of the stabilisation phase of therapy and are now moving on to trauma-focused work.

After she said that, I hid behind my coat in an attempt to block out reality. It reminded me of how I used to cover my ears as a child and scream “LA LA LA LA LA LA LA” as loudly as I could, whenever I needed to block the rest of the world out. Suddenly it all felt very real and I was about 6 years old again. Come to think of it, I have been feeling about 6 years old for quite a long time now, actually.

Radical Acceptance in Action

To cut a long story short, 19-year-old sis and I bought Birthday Sis a pair of sparkly platform trainers for her birthday, which is coming up at the end of the month. We agreed to wait until the day of the birthday before giving her the present, even though they had arrived in the post a few days ago. We planned to give the trainers together, and with the other presents arriving this week.

However, today on my way home from DBT Skills Group, I received a message on the Family Whatsapp group from Birthday Sis, with a photo of her sparkly new trainers.
“Thank you so much for the trainers, I love them!!”, it said.

I immediately felt full of rage towards 19-year-old sis as I knew she must have given Birthday Sis the present out of the blue, without me, without asking me, and weeks before we had agreed. I had all sorts of assumptions and judgments and urges to call and scream at her for being so thoughtless and selfish –
“How dare you give her the present without me”, “How dare you take credit for something of joint effort”, “How dare you assume that my opinion doesn’t matter, I clearly am worthless to you”, “How dare you break our agreement”, “How dare you be so selfish”, “How dare you always neglect my needs and feelings, always putting yourself first”, etc etc etc.

I started calling her, ready to give her an earful, when something made me stop.

We had just covered Radical Acceptance in the DBT session, and there I was, in a situation that I essentially had no control over and could not go back in time to change. What was there to do but radically accept the reality for what is was?

First Willfulness crept in, and I had a little debate with myself about other possible solutions. I thought that maybe I could take the trainers back from Birthday Sis, hide them, wrap them, and give them back to her again on her birthday, in the way we had originally planned. Then, I noticed thinking about how unnecessary and ridiculous that option was, so moved away from that possibility! I thought for a while and realised that it really wasn’t such a huge deal after all about the trainers; it was more about what 19-year-old sister’s behaviour represented to me. I took a step back and considered if I really wanted to blow this one up, making it into something it wasn’t. The answer was no, fortunately… And I knew I could still communicate my feelings and needs to 19-year-old sis effectively, later on when all was calm.

I realised at some point that there was not much else to be done, except laugh at the fact we had such spent an hour talking about Radical Acceptance, and there I was, needing to practice just that. Accepting the situation would not change anything in objective reality, I knew that. It would mean only one thing: that I would not have to perpetuate the suffering that comes with such anger and non-acceptance. I said to myself “It is what it is”, refrained from lashing out or hitting anyone over the head, and somehow managed to let go of that anger remarkably quickly, so that I could get on with the rest of my day.

The McFlurry that Saved the Day

Yesterday I had a rough day and an even rougher evening. By 10pm I was experiencing the strongest self-harm and drinking urges I had had in weeks. I was walking in the warmth of the night, feeling triggered by absolutely everything around me. The shards of glass on the floor were begging me to pick them up so that I could hurt myself with them down an alley. The pub was calling my name, beckoning me to go in for a drink, or two or three or more. I was in an unfamiliar slightly dodgy area, almost wanting something bad to happen to me, because the feeling of needing to be destroyed was so overwhelmingly strong.

As I was walking past the pub in slow-motion, grasping at all the reasons as to why going in would be a terrible idea vs an amazing one, I noticed a McDonald’s on the other side of the road. In front of the McDonald’s was a banner with a photo of a McFlurry on it.


The whole evening I had been stuck in a wilful state of thoughts, urges and intense emotions which I was perpetuating by refusing to help myself by using skills. However, as soon as I saw the McFlurry sign, something within me shifted. I had a moment of “insight”, or something similar, and felt my brain kick into a different gear.

Suddenly there were two roads in front of me instead of one: A destructive path, versus a loving path. It was like I could see the options for what they were, and actually make the choice about which one to go for, instead of feeling so driven to act on my urges. There was option A) the pub, which would be highly ineffective for me in that moment, or option B) McDonald’s, which would be much more wise and kind. I didn’t even mean to but something within me had decided in that moment to stop being so wilful, and actually do something about the way I was feeling. I said to myself in my head, “Okay, you can stop being a bitch to yourself now, and go buy yourself some bloody ice cream”, mocking the wilful part of myself in a loving way.

So I walked past the pub, quickening my pace, and crossed the road in the direction of McDonald’s – where I purchased a Dairy Milk McFlurry. In doing so it was like I was actually looking after a part of myself that felt really young and was hurting, instead of metaphorically trampling all over her as I had been just minutes earlier. I took my 99p plastic cup of creamy goodness, walked back out into the warm night, and savoured the first McFlurry I have had in at least a year, whilst walking under a blanket of stars.

I think the act of doing something to soothe myself intentionally, as opposed to the specifics of the act itself, was what helped shift something within me. Before I saw McDonald’s, all I could fathom was hurting myself in some way. As soon as I saw it, it was like my brain realised that being destructive in that moment was a choice, and that actually I could do something nice for myself instead – even something as simple as buying myself a McFlurry. Considering how rotten I had been feeling prior to that, the change in how I was relating to myself actually felt pretty profound.

A Special Therapy Session

Today in therapy I adopted a somewhat different mindset to usual. My usual level of dissociation (after 20 minutes of talking) was accompanied by a notable (and atypical, for me) lack of enthusiasm about being stuck in that room. Being attached to my therapist however, I still wanted to spend as much time with her as I could – I just didn’t feel up to doing it in the conventional therapeutic way.

So, I put on my best puppy-dog-eyed look, turned to her and said,
“I’m really not ‘feeling’ therapy today, wanna go outside and sun bathe instead?!”

She was humming and haa-ing and wondering out-loud, clearly wanting to take up my offer (she loves sun, and would get to have a smoke) but weighing up whether that would be effective or not.
“If I say yes to your request, missy”, she asked, “Would I be encouraging your avoidance?”
“Maybe!” I said, eyes still wide, “But it’s sunny out, we need to make the most of it, and we both REALLY need a cigarette!”

She rolled her eyes but secretly I’m sure she was pleased. So we gathered our stuff and ventured outside to a little green area by the practice, where we laid down on the grass in a patch of sun. We chatted and chilled for the rest of the session and it was rather cute. Awkwardly, she only had one paper left so we had to share the promised cigarette. At first, that felt super weird given our relationship, but then relievingly it was pretty normal, like how it would be with a friend.

We talked about therapeutic matters and emotions but also non-therapeutic ones. She analysed my motivation for suggesting we come outside, and I cracked some jokes about it which made her laugh although they were actually more true than not – and she probably knew it too. I told her I felt happy and that I wanted to stay there for a long time.

“What about this makes you feel happy?”, she asked.
“It just feels so normal”, I responded, “I’m not used to feeling safe around people in social situations.”
“I’m not sure about normal!” she joked, “I can’t say I’ve ever taken another client to lie down, sunbathe and smoke outside during therapy!”

I felt so special, peaceful and in the moment, it was such a lovely half hour. I got a bit sad also, so I guess I was ‘happy-sad’, because the truth is that I do not have someone in real life with whom I feel as safe and cared for as I do with her. I have people who love me and who I love, but I am not attached to them, nor do I crave their affection, in the way I do hers.

I feel like such a small child around my therapist, and today meant the world to me because the needs of that lost and lonely child were met by her. But the relationship that we have, as beautiful as it is, is also a sort of illusion. It is not something that can or will ever exist in ‘reality’, outside of the therapeutic context. And for that, I am very sad.

As we walked back in the direction of her office, almost getting run-over because we both suck as crossing roads, I joked,
“Imagine if I got run over whilst on this adventure with you…”
“Yikes”, she joked back, “Now how would I explain THAT one to your Mother?!”