I’m a person, not a diagnosis.

When I started meeting with my first therapist, who we’ll call Wendy, I had just flown through a month of mania and gone crashing into a mixed episode. I find mixed episodes to be the hardest thing to explain to the non-bipolar. It’s not that hard to understand depression – most everyone has experienced at least a brief, minor form of it at some point and can extrapolate from there. Mania is a little trickier, but again the idea of being filled with energy and not needing sleep or food and feeling like you’re on top of the world has at least some basis in the average human experience. Most of us have felt very, very good for one reason or another, and could understand what it would be like to feel that way only magnified.

Mixed episodes? Now those just don’t make sense. How can you be up and down at the same time? How can you be filled with energy and flying from one task the next, yet feel a deep despair about your useless, futile life? For me, mixed episode meant I was still sleeping a mere 3-4 hours per night. I still raced from one thought to another, talking to myself in words filled with rhyme and alliteration and assonance and somewhat lacking in sense. I still shared way too much with people I barely knew. I still drove too fast. I still felt enlightened.

I also felt agitated and disoriented. I was unable to focus. I obsessed over all the negative events of my past. I couldn’t stand being home and would go out wandering in the middle of the night. I’d berate myself and cry and plot how I was going to kill myself.

So I started seeing Wendy. While we did discuss concrete steps for improving my life, these always stemmed out of conversations where I rambled on and on about my past experiences and current worries. A lot of times what helped was that I said things that it scared me to say, and found that Wendy didn’t react badly. Granted, that’s her job as a therapist – to be accepting and supportive even if she doesn’t actually feel that way. However, it still tricks me into feeling less alone and less like anyone who actually knew me would immediately hate me.

Things were improving for me. I was managing to control my typical overreactions to negative events, and starting to feel a lot better about the past. Then Wendy’s internship ended and I was transferred to a new therapist. We’ll call this one Sadie.

Before I even start, I will mention that I like Sadie a lot. That’s what has made all of this so difficult. If I didn’t like Sadie so much, I’d have a lot more options for how to deal with this situation. What situation? Well, she’s just so very different from Wendy. She’s very focused on tangible things we can do. Don’t like my job? Let’s leap right into hunting for a new one. Stressed out? Here are seventeen different coping skills to choose from.

At one point, pushed to the edge of the cliff on the job search issue, I was prepared to call and cancel all my appointments and see if I could go it alone. I went to an acquaintance for advice, and she talked me into writing Sadie a letter to explain what was not working for me. I got waylaid a little by accidentally ending up in inpatient, but I wrote the letter while there and gave it to her upon my release. I told her that I needed more space to just talk about situations and how I feel. Also more space to talk in general, as she has a tendency to fill the silence when I’m having trouble finding what to say.

The same day that I was asking for less structure, Sadie was preparing to propose more of it. The inpatient unit had strongly encouraged the use of DBT. Her ideal solution would have been for me to attend a DBT group, but it did not fit into my work schedule. So we compromised, saying that I would get half of each session for my freeform talking, and then we’d go over 1 or 2 DBT skills with the rest of the time.

It was a nice proposal, in theory. In reality, it’s now 4 months later and we’ve been doing all DBT, all the time. Learning a skill or two each session would be fine, except Sadie wants to go over the worksheets before I do them, and then go over them again after I do them. I am quite capable of reading and comprehending them on my own, so we only need to discuss my answers once I’m done. Also, she has me doing these weekly diary cards, to rate my urges for negative actions (suicide, self-harm, etc.) and my various emotions (sadness, anger, joy, etc.). Also I’m to note which DBT skills I used each day and how much they helped.

dbt-sheets

So what does a session look like now? I hand over my diary card (with a special notes page I make, because I am an overachiever). Sadie looks it over and tries to identify patterns. She may ask me a couple of questions. Then we go over my completed skills worksheets, then she basically reads the new ones to me, then when there are about 2 minutes left she asks if there is anything else we need to discuss.

Last week I’d had enough. I warned her in advance via e-mail that I was not getting enough time for just talking, and then that’s what we did. I did give her my diary card, but then we actually discussed all the events that I had noted on it. We talked about how I felt, about why certain events upset me. We did talk about concrete things I could do, but in the context of the greater conversation. It all felt right. It hurt, but it also felt like there was hope. I even conceded to receiving a new skill worksheet, on the condition that I get to read and fill it in myself before we discussed it.

Sadie apparently didn’t feel the same way I did about the session. She said, “I don’t want to take away from your opportunity to just talk, but DBT is the best treatment for your diagnosis.” I’m a person, not a diagnosis. Even if I were just a diagnosis, I’m not just BPD. Maybe DBT is the best treatment for BPD, but until you strip away the bipolar, strip away the non-disordered parts of my personality, strip away my past experiences and my thoughts and feelings and all that makes me a human, then perhaps it’s not the best treatment for me.

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6 thoughts on “I’m a person, not a diagnosis.

  1. This is such a brilliant description of an experience so many of us have unfortunately had with therapists. And I admit to some I’ve-been-there laughs when reading about those damn worksheets…CBT (the OCD treatment) is the same, and I can only tolerate so much of it before I start snoring in sessions. :)

    Yes, DBT is what’s done by default with bipolar patients. Every IOP/PHP program I’ve ever been in, the bipolar patients were in a specialized DBT track. But maybe 15-20% of the time, those patients would be be given a modified plan or put into a new track entirely. They were moved because the staff realized the DBT *wasn’t what they needed*. And it’s not a big deal for that to be true. Your therapist shouldn’t be afraid to try something else.

    I think you have the same problem that I have, which is that you have multiple diagnoses at once and they each need something different. Your bipolar needs the DBT, but your depression needs more traditional talk therapy. And if you focus solely on one problem, the other will grow, and it becomes this unpleasant cyclical thing

    I’m really, really proud of you for a slew of reasons, but right now especially because of your introspection and evaluation of the situation. You have identified the problem and you know the solution. The trick is finding someone who will respect those needs. :/

    I broke up with a therapist of five years whom I would give a kidney to. I still love her, but I had to take care of myself. If it’s time for you to look elsewhere, don’t be afraid.

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    • It sounds horrible to break up with a therapist after so long. I haven’t even been seeing this one long (relatively speaking) and one of my less-good reasons to stick with her is that I don’t want to start over with someone new. I can’t imagine how hard it would be to leave someone who knows you that well.

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  2. The other poster made a good point that if you don’t feel you are being best served by your current form of therapy or current therapist, don’t be afraid to look elsewhere. Your therapist should be working for you, not the other way around! Also, it may help to consider yourself the first therapist of yourself, and your therapist as your co-therapist.
    I agree that DBT and the diagnostic can be superficial, limiting and depersonalizing. I recently wrote about the contrast between DBT and more in-depth therapy/understanding of so called “disorders” – you might be interested in that. This writing is about borderline conditions, but there are parallels.

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    • My therapist and I have broached the subject of switching to someone new in the past. I have a good reason and a less-good reason not to. As I mentioned to the previous commenter, the less-good reason is that I don’t want to start over with someone new. I’ve already done that once and it was really hard to have to go over all the same territory again.

      The better reason to stick with her is that one of my problems in life is my tendency to be unable to resolve conflict. Sometimes this is due to the other person never giving me the opportunity, but either way it comes down to me not knowing how to continue a relationship with someone after having a significant difference of opinion. It also leads to me having rather superficial relationships, because I don’t tell people how I really feel if there’s any suspicion they may not be accepting of it. It’s good for me to have this one relationship where I get to be assertive about my needs and continue coming back after we disagree.

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  3. Pingback: Low-Functioning, High-Insight | Stuff That Needs Saying

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