Dialectical Behaviour Therapy, Mindfulness and C: Week 12
Today with C was weird.
We started by discussing the situation with the psychiatrist. Apparently C had been blissfully unaware of the whole fuss surrounding the referral from Lovely GP, despite the fact he (C) had also made a referral. He said he had contacted someone at the main asylum in Norn Iron but she had called his secretary and said she was re-referring me to someone closer to my home. Indeed, tomorrow’s appointment is at the closer location. But C was surprised that he had not heard that there was so much to-ing and fro-ing from the stupid twats in the same way Lovely GP had. Anyway, he is glad that it has been arranged. He feels that ultimately psychotherapy is more important than medication, and he is probably right. However, he does feel that medication is not an insignificant element of treating my condition(s), especially when the tablets I’ve tried to date have thus far been so ineffective. So yay psychiatrist.
During my rant about all the pillar-to-posting with the shrink, I alluded to having gone mental a couple of times since I’d last seen C. Naturally he probed me on these matters, so I told him about both this and this. He quizzed me on the self-harm; how did it make me feel at the time (relieved, and proud of my cuts), how I felt afterwards (indifferent as regards myself, but horrified that I’d upset others) and how I felt telling him about it (that I couldn’t really see the big deal – it helped me feel slightly better at the time, wasn’t that a good thing?).
C monologued for a while on the cutting issue. He accepted that it is a release and talked about the various reasons I, and others, might engage in it. He asked had I done it before. I replied in the affirmative, but it was back when I was a teenager. I was a very prolific cutter at the time. He enquired as to what I had cut – random cuts, words, what?
The answer was that if I was feeling especially distressed or in a frenzy like I was on the night of the concert,I just randomly slashed my arms or wrote random sware words, especially “fuck” and “cunt”. But if I was feeling a bit more measured, it was stuff like “bitch”, “twisted” etc, in reflection of my feelings and beliefs about myself. I also mourned the fact that my scars of the word “Freddie”, carved in homage to Mr Mercury, had faded completely. I was pretty proud of that one. After all, it took ages to carve, and he was the frontman of my favourite ever band. I viewed it as more of a tatoo on the cheap, I suppose.
In conjunction with this, and my vicious self-denigration over being off work (as it was this that set off the recent cutting episode), C said I was looking for ways to put myself down. I laughed in his face and told him about my self-vilifications over not speaking out over the sexual abuse at the hands of MMcF’s husband.
Most of the rest of the discussion centred around this. C seemed taken aback that every time I visit the various elements of the McF clan that MMcF’s husband is there. He took the view that of course this was going to fuck me up. As I told him though, my anxieties about seeing that branch of the family are rarely, if ever, consciously about him. I accepted that perhaps there are a lot of subconscious forces about him driving the anxiety, but they are almost never at the fore front of my mind. Or at least they weren’t until recently.
C asked if I realised that if I were to disclose MMcF’s husband’s name to him he would be bound to report it. “Yes,” I said. “That’s why I’m not going to do so.” He asked why I did not want to bring it out in the open. I have already discussed the issues here and here, so I will not engage in unnecessary repetition by rewriting them here.
I felt a bit sorry for C. He understood my reasons for not wanting to make this issue public, which is more than I can say for some previous therapists. He seemed to so much want to help me find a workable solution to my concerns over MW. For instance, he asked if I was on good terms with MW’s parents. I’m not friends with them, but broadly speaking I get on with them (especially the mother) fairly well, insofar as it is possible to get on well with any of that family. So C asked could I not have a ‘quiet word’ with MW’s Mum.
Of course I can’t, because to tell her would be to tell them all. MMcF’s husband is her grandfather, for whom she apparently has the greatest love and respect. The only circumstances under which she’d believe me would be if it had also happened to her, but I don’t think it did. Her affection for her grandfather is very clear to me.
So I told this to C, who accepted the point. His efforts to solve the problem may have been in vain, but at least he did try, so I am thankful for that. I said I would ring the NSPCC but then when he quizzed me on what they may or may not do, I said that the discussion was in fact pointless because I am such a useless, cowardly cunt that I will probably not do anything at all.
Needless to say this further showed C my endless capacity to blame and criticise myself, as if any further demonstration of that was fucking necessary. Basically he said that when I have self-critical and self-hateful thoughts I should just let them exist.
“What?” I asked. “Just sit there and let myself agree, rather than try and talk myself out of it?”
“Well, that doesn’t work, does it?” he replied. “The point is, just let it be. It’s just a thought, let it be just a thought. It’s there, don’t confirm or agree with it and don’t refute it either. Just let it exist in the moment.”
“Well, that’s nice, C, but how do I stop overthinking it?”
“It’s a skill,” he said. “You learn it over time. It won’t work at first and you won’t take it seriously, but over time you can develop an ability to let it just exist.”
This all sounded like bollocks to me, which I think he could see. So then he continued:
“We need to think about some practical solutions. It seems to me especially from today that you have severe difficulty controlling emotions that you experience particularly at times of stress. They become overwhelming for you.”
I agreed, but opined that it was impossible to stop oneself getting into a maniacal panic just like that.
“I have a book,” declared C, triumphantly. “It’s a workbook that you could use, with some very practical solutions.” He went to his desk, picked it up and handed it to me.
My heart fucking sank. It was about Dialectical Behavioural Therapy and included reference to Mindfulness, both of which I had already discovered on the internet (incidentally, he knows I know about them. He knows I try to develop some awareness of all types of psychotherapy and guessed I’d already discovered these two). I had actually blocked someone on Twitter who kept wanking on about Mindfulness because it sounds like a complete pile of fucking shite to me, just like DBT. To me, they both sound like more elaborate versions of CBT, which I found to be a complete pile of nonsense. C is aware of that.
Evidently he detected my skepticism. “Look, we have to take a pragmatic approach,” he sighed. “Some of it will seem basic to you [‘patronising’ is the word I’d have used], but just read it and try it, then over time we can move on to the more advanced stuff.” He did say that if it doesn’t work in any meaningful way we could re-evaluate things, but essentially only after I’ve given it a chance.
He went on to remind me that intellectualising our sessions was something that was mutually attractive, but nonetheless something that needed to be avoided. He said, “you’d be interested, intellectually, in a more psychoanalytic approach to all this, but we can’t let it become just about intellectualising. Psychoanalytic therapy may uncover stuff, but it won’t solve problems in the here and now on its own.”
I asked him if he thought our therapy had become something of an intellectual discussion.
“No,” he said. “I actually don’t. And I don’t think we should drop our freeform psychodynamic discussions either. But I do think we should devote some time each week to these more practical approaches.”
I agreed to take some photocopies of the book and work on them before next week. A quick glance through them seems to confirm my feelings that it is rather condescending in places, but there are some useful things I suppose. For example, and C drew particular attention to this one, if I go mental and want to cut, it suggests you hold ice cubes against yourself instead. It still causes intense and abrupt pain, but there is no lasting damage. I’d heard about this elsewhere and dismissed it – who the fuck has access to ice cubes everywhere they go? At least knives are found the world over. But then this is unfair. Frozen peas or something could have a similar effect.
I also showed him the mood chart to which a nice Twitter friend directed me. C had seemed excited about the book, and his interest seemed considerably piqued by this too. He felt that perhaps the left hand column was slightly redundant as (as yet) I only take sleepers and anti-depressants (in relation to madness, anyway) and it deals with anti-psychotics, Lithium etc. Actually he felt in general it was a bit convoluted, though I did tell him I thought the lines on the right hand column were potentially useful as they provide a graphical representation of one’s madness on a day-to-day basis. So his plan is that we formulate our own mood chart together next week, which may hopefully help me to work out patterns and triggers.
So as I said, today was weird. The discussion was a lot more two-way than normal, and although it seems odd to have been offered a chance to explore practical solutions, after 11 weeks of psychodymanic-ish discussion, it is potentially useful to learn techniques of madness-management. I am dubious about DBT, but I will try and follow C’s advice by being pragmatic and keeping an open mind.
An aside: DBT is a therapy devised for BPD (though I suppose in fairness it can translate to other mental illnesses). If C thinks I have BPD, why didn’t he just tell me that when I asked him directly what, in his clinical opinion, was wrong with me? I know he’s not qualified to make diagnoses, but it was an informal question.
Oh well. At least he’s doing something, and at least he seems to be thinking in a long-term way about my psychotherapy. At least he still wants my input and I do trust him to listen to me if I voice the view that, after giving it a chance, I think all this is a load of cack. Maybe A and D will see his value now!
This afternoon’s plans: write list of problems for the psychiatrist and try not to catastrophise about the psychiatrist. Hurrah! Post-mortem tomorrow as ever, I’m sure.
(NB: I’m sure you all realise this, but the dialogue between C and me as detailed above was almost entirely paraphrased. I can’t remember all the exact words, naturally. I’m just paranoid that I will be done for slander if I make out our conversation followed the literal routes as outlined above. Reassuring to know I’m still crazy, then!).
This entry was posted on Thursday, 28 May, 2009 at 3:51 pm and is filed under C, Moods, Psychotherapy with tags anxiety, bipolar disorder, borderline personality disorder, bpd, clinical depression, cutting, dbt, depression, Dialectical Behaviour Therapy, insanity, insomnia, madness, major depressive disorder, mania, manic depression, mental health, mentalhealth, mindfulness, panic, panic attack, psychiatry, psychology, Psychotherapy, sadness, self harm, social anxiety, suicidal thoughts, suicide, suicide ideation, therapy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.