Imprint

Therapy: Session #28

…a little late as I spent two beautiful days in sunny Budapest 🙂

At first we briefly discussed how the mindfulness exercises help me quite well with staying in reality and how I’m happy about “little” things since I’ve started doing them – colourful leaves, wind in my hair, interestingly shaped stones…it’s a sort of childlike amazement that feels very nice.

And then we talked about last Wednesday. I had dance class which is a wonderful thing and the teacher explained a pose with me which usually is okay…except that he was unfortunately wearing a certain perfume. My physical reaction suprised me as well as my partner – without having a panic attack I just started shaking and didn’t stop for several minutes. Really weird. The following days were…mixed. All in all I was well, just the physical feeling of being crushed or choked…and then flying away stayed and came with the smallest things, certain songs etc. as well as the urge to self-harm.

It’s not a huge riddle where from the past these feelings stem from: My relative, again and again. When someone groans while sitting down, when someone smells of perfume or even of peppermint toothpaste. When somebody says certain words or makes certain gestures. The list is endless.
For the first time I told my therapist what it was like when I wrote a letter to this relative in which I tried to talk about my memories. At that time I thought it went pretty well. After the initial turmoil everyone agreed that the matter was settled and that it would be okay to start over. But for me it’s not settled. I see a thousand little power games that were being played: How the relative’s wife stood in my way, came to his defence and even got my mother involved. How my request for a conversation was fulfilled – under certain conditions. I wanted to talk on neutral ground but I was compelled to come into his flat, sit at his table, talk about the issue in his comfort zone. Although talking about the issue might be an exaggeration – after all I was just being told that I shouldn’t destroy the family and above all that I imagined all these things. Truth be told, I have to say that I sort of backed down in hindsight.

My therapist wanted to know more about the way he does what he does – that is constantly crossing boundaries of all the women he’s surrounded by. I talk about the victim role he adopts when someone tries to enforce their boundaries. The whining that can last for hours because everything is a terrible rejection a grown-up man can’t deal with. And if that doesn’t work there’s still his wife: She wants to leave him once a year because she’s perhaps the person who suffers most from his behaviour but as soon as someone dares to criticize him she comes to his defence and breathes fire and brimstone – very dramaticalls that is: Traitor, lunatic, do you want to kill him – those are the words one who tries to enforce boundaries hears.

For the first time ever I heard my therapist utter her own personal feelings: “How can you stay so calm? This stuff makes me furious just by listening to it!”
I smiled. And told her that this was pure resignation.
Now my therapist decided that due to the abuse (that was not abuse, maybe you’re mistaken, maybe you got something wrong, you still don’t know if he meant it that way) she wants to work more on trauma (too huge a word, you’re probably just over-sensitive, other people had to make much more horrible experiences). And as scared as I am of what will come with that, as much I am relieved that we’re finally coming to a point where there is space for the topic.

Advertisements

A name for it

A lot of people seem to benefit from naming their disorders, I’ve even read about therapists who suggest finding a name for an illness in order to deal with it. There are depressions called “Gertrude” out there and eating disorders that go by the name of “Monica”. Also, “Ana” and “Mia” might be examples of this although pages that refer to eating disorders like that are usually very very harmful.
Anyway, I’ve noticed two things about this: One, I can only find people who have given their illness a female name. And although I’m totally aware that relationships with women can be very complicated I think it’s a little mean that nobody seems to think that a mental illness could also have a male name. So if there’s anyone out there who named their illnes “Hubert” or “Richard” – please let me know so that this doesn’t have to be so one-sided 😉
Now, on a serious note, the second thing I’ve noticed is that I only know of people who named illnesses that “started” at some point in their life. Be it depression or an eating disorder – the people who live with those conditions seem to perceive them as something that came into their life and could possibly go away again -something seperate from their identities. So what about those of us who have a personality disorder? Would it make sense to name an illness that is utterly linked to your very personality? Unlike someone who first enocountered depression when they were in their twenties, I don’t really remember a “before”. I don’t know what it means to be totally sane and although it is possible to get better with the help of therapy and maybe even get rid of some symptoms most experts agree that BPD is not curable in the traditional sense. It didn’t start at some point in my life and it won’t just go away later. There is no before and there is no after, it’s a part of me and it’s often difficult to tell where a symptom starts and where my character ends.
This is why I can’t name my disorder – although everyone would be too polite to say that my whole personality is disturbed, my illness is still not a seperate thing that could have its own name. I don’t know if what I say here even makes sense to anyone but I just found it interesting how different people perceive the things they’re dealing with. I can imagine that it’s helpful to name your illness and therefore view it as something that, while it may impact you, is not an inherent part of yourself. I can imagine it makes it easier to remember what it was like not to deal with it and what it might be like when it’s gone again. I’d just love to find a way to apply this to my own illness but whilst I’m able to remember a time before certain symptoms started there are others that seem like they actually are parts of me. So I guess there is no name for my disorder but my own.

Note to all Gertrudes, Monicas, Huberts and Richards out there: The names above (apart from Ana and Mia which aboviously have a background) are just examples and I didn’t mean to insult anyone who happens to be called one of them 😉

(Social) system

He tells me that he used to have a contingent of therapy places. It has been reduced steadily and now he can only allocate one every four months. He hates to make that choice, keeping in mind how many people come to see him. Apart from that he can’t help me anyway if I want to keep working with my current therapist.

This is how my consultation at an advice center for people who can’t perform fully in their jobs due to an illness went. As I’ve been working less since October in order to have more energy for therapy and my social life, paying for therapy has obviously not become easier. I have tried many things during the last few weeks in order to make this issue a little easier to cope with:

  • Statutory health insurance in my country contributes a small part of the costs. What remains is about as much as the rent for my flat.
  • It would be possible to wait for a fully financed therapy place which would mean that I’d have to wait for quite some time until I would get one of them. The most important disadvantage here is that I was sent to people who weren’t even willing to “work with a borderline” when I last tried. One is not popular among therapists with therapy places that are paid for by statutory health insurance when the diagnosis is a personality disorder (this is just my impression).
  • In order to get any refund from the statutory health insurance you have to waive doctor-patient confidentiality which makes the comfort zone “therapy” even more cozy. They want to know quite a lot from your therapist.
  • Also with organisations that offer affordable therapy for people with low incomes there is often a lack of experts for certain diagnoses or they only work with methods I’ve tried and not been able to benefit from. Therapy especially for BPD is mostly inpatient in my country so the fact that I’m in the middle of my career in spite of everything and that I don’t have an acute crisis is not helpful here *sarcasm off*.
  • I also tried to get into additional insurance so that a part of my costs would be covered. Understandably, insurances want to make money so all treatments for current diagnoses would have been excluded. The insurance person let me know that it would have been wise to get the insurance when I was still healthy. When I pointed out that I’m not sure if my problems started in primary school or even before and therefore I would have had to think about this insurance thing really early they didn’t respond anymore.
  • 7% of psychiatrists in my city have a contract with statutory health insurance. The poor, overloaded bastards.
    In the same city with about 2 million inhabitants there are 20 psychiatric day clinic places for childen and adolescents. In one of the richest countries in the EU.

Now this post sounds awfully like whining which is why I want to emphasize that I am in a happy situation as I have low fixed costs and a little nest egg which means I can fund my therapy despite everything. Nevertheless the financial burden isn’t small and my understanding for the lack of insurance-paid therapy places isn’t huge. I am angry with a system that abandons the weakest – all those who can’t work, who don’t attract enough attention for a hospitalization and who could never afford outpatient therapy or wait for an affordable therapy place. They are the people we sadly read about in the newspapers because they were so desperate that they jumped from a skyscraper – simply because there is no extensive, quick, and for many VITAL care. I don’t except myself when I say that you only notice these things when you’re dealing with it yourself. Until then you assume that everything’s fine.
I’m also angry because meds are so terribly easy to get your hands on in my country – I only have to see my general practitioner in order to get painkillers or sleeping pills without any problems. A 15-minute conversation with a psychiatrist who had never seen me before caused him to prescribe 3 (!) meds that can possibly be addictive without thinking twice. I had to ask both doctors about psychotherapy. Both couldn’t give me a satisfying answer, let alone help me. In the middle of depression the few vague colourful leaflets overwhelmed me just as much as the huge amount of phone calls that inevitably followed in order to get information. Statutory health insurance is willing to pay for all kinds of meds, regardless if there even are meds for the current diagnosis – always hoping that this cheap device keeps you inside the system and that you will continue to work like a robot and that’s that. A helpful therapy that works on the cause of problems (and obviously can be supported by meds) takes much too long for our achievement-orientated society. And although I am grateful to live in a social system that helps with a lot of things, I just don’t understand when people claim that there is no stigma surrounding mental illness – if that was the case, there would be more therapy programs, shorter times of waiting, less bureaucracy and arbitrariness…and maybe, just maybe, a lower suicide rate.

Note: Obviously these are just my experiences – neither do I claim that it’s like this for everyone nor am I an expert. And I am grateful because I’m very lucky to have the support I have and completely aware that there are many countries with a much worse health care. Just to be sure…

Therapy: Session #27

My therapist is moving. Within the few seconds it took her to explain that her new office will be even closer to my flat then the old one I went through the whole scenario of “SHE IS LEAVING ME!!!” – stupid head. Whatever, everything’s just fine :D.
The slight scepticism this left behind might be the reason for another weird feeling. It seems to me that my therapist is actively avoiding “big” issues that would take several sessions at the moment. The only reason I can find for this is that the extension request has not yet been authorized. She always assures me that it won’t be a problem but of course I don’t just believe that. The fact that we’re only talking a little bit about this and a little bit about that and my feeling of being stuck enhance my impression of “She also isn’t sure if the request will be authorized, that’s why she doesn’t want to get into anything bigger…”

Apart from that the session was quite okay. My therapist is still trying to understand where my “drifting off” is coming from, which purpose it used to serve and if it still has a purpose now, also why emptiness is so hard to handle for me and what dissociation feels like for me. As it’s so important for me to be able to influence these things she proposed some mindfulness exercises. They always seem quite banal to me in the beginning but I can see how they increase my quality of life when I use them everyday – to consciously perceive colours, smells or textures throughout the day and also give names to those things keeps me in reality pretty well. When I’m already completely “gone” I need stronger stimuli but when I manage to do the exercises regularly I don’t drift off as easily in the first place. As so often the case, preventing something from happening is much easier than acting when it already happened.
When we talked about relaxing we also mentioned meditation. I always thought it was great of me to be able to just sit and think nothing for long periods of time, as if I had a gift for buddhism…if only it wasn’t for the fact that this is not actually an achievement when you’re not really there anyway. So my therapist prescribed the oppsite of the usual “don’t think of anything-meditation”, that is: focussing on the outside and consciously perceiving sensory impressions. It’s nearly a little embarassing how hard this task is for me and it makes me realize just how often I simply “zone out” in everyday life, as if a vital strategy has turned into a bad habit at some point…

Of the same kind

If I think back I can’t recall a time when I didn’t feel drawn to people with mental “special features”. Neither do I mean to glorify illnesses nor do I strife to be a little helper who likes to engage in other people’s problems. It’s just that there is a certain…tenderness, a kind of compassion I feel for people who struggle with their own heads. Again and again I wonder where this comes from:

Is it because honest laughter from a person who has depression has a special value?
Is it because I appreciate how cautious traumatized people often are with their choice of words?
Is it because I can’t bear when someone rants about vanities for hours and others who have thought of suicide often feel like me in that regard?
Is it because nobody understand longing better than an addict?
Is it because I feel like people with anxiety can sense boundaries better than others and are more careful about them than “normal” people?
Is it because I’m good at seeing the soft core under the hard shell?
Is it because I’ve somehow always known that I’m “different” and felt where I would be understood long before I got my diagnosis?

Whatever it is – do you know it too?

Alive

Do you know that? This moment when you just feel alive – not tired, not spacey, not uneasy but simply alive? Full of energy in a strong body that breathes without having to struggle. A body that you can feel without it having to hurt and lips that just have to smile when there are goosebumps all over you as you glide into the freezing plunge pool after the sauna? I love it!

Damn stupid idea

Sometimes I wonder just how dumb a person (in this case I) can actually be. I really have a lot of practice at dealing with my disorder, I have skills I can use, I have a supporting environment…and yet I make total beginner’s mistakes. Today was a good day. Actually very good but also very emotional. And emotional always means that I’m a little more vulnerable than usually. Furthermore I am on my own – which can be nice but also is a factor that means I have to be extra careful. So one could assume that I’d think of going into self-care-mode, treat myself cautiously and take things slowly in the evening. Instead I think I have to get things done that I don’t have any energy for, listen to songs that are never good for me and submit search requests that show me pictures that would trigger me on the best days. Why do I do that? Automatic self-destruct-mode. Of course I only notice that when my thoughts are pretty much out of control. The only intelligent idea that keeps me from getting down to some self-harming business is “But I want to enjoy the sauna the day after tomorrow!”. So a skills chain is necessary after all. Once, twice, three times I’m through with it by now. And now I need distraction so I write and afterwards I’ll watch some sitcoms. What annoys me isn’t the fact that I nearly couldn’t withstand but that I drove myself to that point. I know my triggers. Why am I still so dumb and deliberately go looking for them? Why does my borderline brain still think I have to make things even harder than they already are? Why isn’t there just a little angel that’s holding skills unser my nose but also a little devil that tells me that being healthy would be really boring?

Therapy: Session #26

An uneventful session, we talked a little about this and that but nothing too sepcific. We also had to go through some morw paperwork for the insurance, fill a few gaps in my biography we hadn’t yet had the oppurtunity to talk about. No big emotions, no big realizations. And now I’m really starting my holiday 🙂

Gone again

After last week’s high it has been difficult again for the past few days. I constantly feel like im underwater, somewhat subdued, not really there, sometimes I also can’t feel my hands. Depersonalisation and the urge to cut that results from it and that I can barely fight right now. When I feel like I’m dead already some skills that usually work fail. Occasionally I struggle with a sort of overstimulation, as if every few hours somebody was turning up all colours, lights, noises and touches to the utmost. Whatever, I only have to keep going today and tomorrow, then I’ll have made it through my last five-day-week at work. Next week I’m on holiday and afterwards I’ll only have 4-day-weeks and more time to relax. Perhaps it will get better then.

“Just” talking?

Although I had a vague idea of where I wanted to go I couldn’t imagine how change would, or even could happen when I started my therapy. I trusted in the fact that psychotherapy is scientifically proven and that I had the will to change things but I simply had no idea how “just talking” was supposed to do anything. I guess that many people feel like that – after all we all know how it can be good to speak about something that makes us unhappy but such a conversation is not yet a therapy session. So what is it that helps me so much?

For me the most important thing is the perspective from outside. My therapist can assess things much better than any friend ever could which is why I believe her when she says “But that was really awful!” or “You should take that seriously!”. If she says it from an objective point of view I can accept it.

This acceptance allows me to think about certain things in the first place. I am really, really good at trivializing things. While this can be quite funny at times it doesn’t help with actually working on problems. My therapist doesn’t give me any oppurtunity to belittle anything but at the same time she doesn’t dramatize (friends tend to either being deceived by my humour or worrying horribly).

So how does this thinking help? After all I used to brood a lot before therapy as well. But this is different. For example I slowly start trusting in my ability to find triggers for certain symptoms. Everything used to be blurry, I felt like symptoms just “happened” to me and I experienced them as unchangeable. Most times that’s still the case but not always. Too often have I seen how things suddenly became clear with the help of my therapist and how I suddenly knew where something came from – and therefore what I needed for it to go away (keyword schema modes). It feels incredible! At this point I hardly ever manage it without help but at least I know that it’s possible. And therefore I think, ask myself questions my therapist usually asks, write down which situation has occured before a certain symptom set in or where I know the feeling from. And sometimes I can find a solution.

The word “solution” leads to my next point: Such a solution can look quite unconventional. Therapy encourages me to simply do stuff that helps me even if it comes across as weird. Nobody has to understand why I’m talking to myself or why I run up and down a staircase or why I sit down with lots of colourful modelling clay and listen to nursery rhymes. The only thing that’s important is that it helps. Everything that helps without harming is good. Period.

This summarizes what therapy has changed for me in general. And I could never have achieved this by “just talking”.
Very important for me is that I connect with my therapist – without that it wouldn’t work. If I didn’t feel safe with her or we had a different sense of humour or I would feel pressured – no way!
Furthermore it’s important for me, personally, that it’s not “just talking” after all. If we can’t make progress by talking my therapist has lots and lots of exercises that help with working on a problem: describing interpersonal relationships by using coloured buttons, sitting in different chairs that symbolize different parts of me, imagination exercises…. I think there wouldn’t be any progress without these exercises. This also applies to the exercises, questionaires etc. I get for home – for me, personally, behavioural therapy is much more suitable than other approaches simply because I have the urge to do something instead of constantly asking why. It’s important for me to learn how to live with my disorder and for that I definitely need to know where it comes from. But exercises that help me handle my life are more useful than the “just talking” most people think therapy consists of.

As most of you who are reading this might have some experience with this I’m probably explaining things that aren’t new. But in my life I often meet people who can’t imagine how exhausting therapy can be, what is different from a “normal” conversation – and why it helps. And as I felt exactly like that I’m writing this for everyone who hasn’t dared try therapy so far or who (like me) was disappointed by the first try. When therapy works you can feel things click into place and change. For real.