As Evidenced By…

Thursday was my first time seeing Sadie since I dropped in on the on-call therapist.  There were new developments in that situation, as well as me being in the midst of a stressful day.  Mom was having surgery that wouldn’t be over until after my therapy appointment, so I had to leave her there and drive home from the city, then drive back, and then back home again with her in the car.

Working on my anxiety about driving is an element in my latest treatment plan, which ended up being the topic that dominated my appointment.  The plan was due that day, so although we’d discussed some aspects of it over the past couple of weeks, we had to drop everything and get it done.

I think the treatment plan is a terribly frustrating aspect of therapy.  I understand the necessity of outlining my goals and how we will measure them and what steps the CMHC staff will take to help me.  However, it has to be updated every 3 months, and there is nothing I’m trying to accomplish that can be completed in only 3 months.  We carry goals over from plan to plan all the time.  It’s a pain to have to give up a whole appointment to complete paperwork.

The treatment plan form has space for three goals, and under each goal there is space for three objectives with details about how they will be measured, deadlines for completion, and therapeutic interventions.  At the time of my last treatment plan, the three goals were “to improve social and recreational life”, “to improve daily living situation”, and “to improve self-esteem”.

I wanted to add “to graduate from DBT group”.  It’s easily measurable, and I expect to actually complete that within the timeframe of this treatment plan.  So I had to drop one of the other goals, and opted to defer working on “to improve daily living situation”.  We weren’t actually doing anything in that area anyway and nothing is going to change in that regard given my current situation, so it seemed futile to keep setting that as a goal.

So my objective under that goal was “will attend DBT group and use skills daily” as evidenced by “no harmful actions for 2+ months”.  Today marks 3 weeks down.  If I don’t screw up, I will graduate by the end of the year and not have to attend group at all in 2016.  When we had everything all filled in, Sadie said, “I forgot to include Brent anywhere.”  I said, “We’re not very happy with Brent right now, so you can leave him out.”  She couldn’t.  Somewhere under one of the objectives we have to have a note that he will prescribe and monitor medication and how often I will see  him (1x per 1-3 months).  She shoved that under the DBT group goal, with another objective stating that I “will attend psychiatric services as scheduled”.

We didn’t make changes to the “to improve self-esteem” goal, other than the target date.  The only objective under that goal is “will be able to identify reasons she is valuable” as evidenced by “Rosenberg Self-Esteem Scale”.  The two times Sadie has administered this I have ended up scoring a measly 6, with scores between 15 and 25 being a normal range.  I just took it again on the internet and scored a 12, so even though all of my answers were negative, they weren’t strongly negative anymore.  Yay for progress?

The goal that was massively reworked was “to improve social and recreational life”.  The old objectives had to do with joining activities and making plans with friends, which are fine but sort of put the cart before the horse.  My anxiety is a major obstacle to achieving those objectives.  I find things I want to do all the time, but some combination of social anxiety and anxiety about driving usually prevents me from actually doing them.  A couple of treatment plans ago, Sadie encouraged me to sign up for and  I did.  I made a dating profile and I joined a bunch of Meetup groups in the tri-state area.  I proceeded to insta-delete all e-mails from those sites without reading them.

When I mentioned that anxiety was an obstacle, Sadie pulled an anxiety workbook off her bookshelf and showed me some hierarchies for desensitizing oneself to various anxiety triggers.  We decided two of the objectives in my treatment plan would be to create and work through hierarchies for social anxiety and driving anxiety.  This had already been entered in the treatment plan form before Thursday’s session, but I pointed out one more obstacle.

Although it was deeply embarrassing, and something I’ve struggled to bring up in the year and a half that I’ve been seeing Sadie, I mentioned that I will never be able to go on a date until I resolve my fear of sex.  It’s sort of the inevitable conclusion to the dating process, and I can’t even fathom starting that process feeling this sense of dread about where it will lead.  After some thought, Sadie entered this objective as “will work to resolve fears of intimacy”.  Then she opened up my last ANSA, an update to which is not due for another 3 months, and updated it to include the “Sexuality” need.  I knew that list of needs wasn’t done growing.

The “as evidenced by” section on all three objectives is very concrete.  To prove I’ve accomplished these things, I have to join a club or group, go on a date, and – my suggestion for the driving anxiety – go to the NAMI Peer-to-Peer classes that are being held January-March in a town 45 minutes away from home.  The local NAMI group only offers Family-to-Family and the Family Support Group, neither of which I’m eligible for since I’m the actual mental illness sufferer in my family.


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