Chronic Pain

Imagine you are at your best friend’s wedding.  The ceremony has ended and the reception just begun when a trivial matter comes between the two of you.  You end up in an explosive fight, and she is so upset that she rushes out of her own reception.  She drives away, tears impairing her vision, and has a fiery car crash in which she is killed.

Imagine the pain you would be in.  The shame over ruining her wedding day.  The guilt over her death that is seemingly your fault.  The anger that you can’t go back and apologize.  Imagine those images playing over and over in your mind.

Now imagine that you feel this pain, this shame and guilt and anger, every time you think or say or do anything wrong.  Imagine that every minor mistake and every real or perceived criticism triggers gut-wrenching sobs.  You cry so long and so hard that you vomit.  Your nose gets so congested you can’t breathe.  Your heart physically aches.

Imagine being in this much pain on a regular basis for days, months, years, decades.  Imagine that you barely remember the time before this pain.  Sometimes it abates, maybe even for months, but the pain always returns.  It is the one part of life you can always count on.

I wish Sadie could feel this pain just once.  I wish she could know that I would never choose to stay in pain if I could find my way out of it.  No amount of caretaking by others would be worth prolonging such a horrible feeling.

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The Joy of Lamictal

I’m writing this on my phone so it will be shorter than usual, but I wanted to share that I’m really glad I went to inpatient last week.  I wish I had done it 6 months ago, although that would have been bad timing with my then-new job.

I started asking Brent for Lamictal over a year ago.  He consistently put it off, trying to fiddle with dosages on my existing meds instead of trying anything new.  When I threw the idea out there in inpatient, I expected to get a similar response from Dr. Bhatia.  Imagine my surprise when he said, “Okay.”  Well, what he actually said was, “Four medications is a lot, but that’s a class you aren’t already on.”

A week and a half later, I feel stable.  I’ve had days here and there in the past that felt okay, even sometimes several days in a row, but this sense that I am calm and can handle stress and everything is going to be okay?  That’s totally new.

For the past few days I’ve been on vacation, staying with my best friend, her husband, and their 5-year-old daughter.  Their daughter is intense, to put it mildly.  She has not calmed down any since my last visit in summer 2014, and has actually been wilder since she’s getting over chicken pox and has been cooped up in the house.  On my last visit I had a very difficult time handling her and had to practice my newly-learned mindfulness skills to survive the week.  This visit is going much smoother for me.  The mindfulness skills are much easier to put into practice now, partially because I’ve been using them longer, but mostly because I’m just not feeling the stress. 

There have been some studies that indicate Lamictal is also helpful for the day-to-day mood swings associated with Borderline Personality Disorder, and it feels like that might be true.  There have been the occasional thoughts of suicide or self-harm popping into my head, but instead of temptation to do it I just think, “Gee, why would I want to do that?”  The real test will come when I am back home and have my first conflict with mom since my release from inpatient. 

Pill Popping

A couple of weeks ago, SassaFrass posted about her Sunday Ritual of filling her pill containers for the week.  I also do mine on Sunday, and last night I finally got around to taking a picture.  Just one, as I was too lazy to do a series like she did, but as a bonus I’ll explain what all the pills are.

medication.jpg

MORN (taken with breakfast or, more likely, the first time I get up in the morning):

Wellbutrin XL 300 mg – antidepressant
BuSpar 15 mg – anxiolytic
lisinopril 5 mg (half a pill, but it’s kind of hiding under that bigger pink one) – blood pressure
fish oil – for lowering triglycerides
B-complex – purportedly good for depression, and it tastes yummy
multivitamin – general well-being, because my eating habits are crap

NOON (actually taken at 11, which is usually with lunch):

BuSpar 15 mg – anxiolytic
Gildess – birth control

EVE (taken with supper):

BuSpar 15 mg – anxiolytic
fiber x 3 – for lowering triglycerides
fish oil – for lowering triglycerides

BED (taken at bedtime):

Latuda 40 mg – antipsychotic, purportedly good for bipolar depression
fiber x 3 – for lowering triglycerides

Lately I’ve also had the random Pepcid AC for my persistent heartburn over the past 6 weeks, and sometimes Aleve for the soreness after my car accident.

A Change in Perspective

When I wrote Hello Kidney, that was my reason to stay alive.  I’d had a rough day at work on Friday, and followed it up by reading a post on a mental illness message board that struck a nerve.  The board discourages discussion of personality disorders, under the premise that medication does not help them (which I disagree with – I believe there are some symptoms involved that medication can alleviate).  There was a poster who I had greatly admired due to his ability to work in an inpatient psych unit despite his own mental illness.  At least I admired him until he expressed his belief that people with Borderline Personality Disorder give themselves papercuts or take a single benzo and then run to the ER crying that they attempted suicide, taking up resources that should be saved for people with real mental illness.

I was angry.  I have never been openly judged for my mental illness, and to have it done by a fellow sufferer AND mental health professional was an extra blow.  Unfortunately, I internalize anger.  Instead of blaming him for making a callous comment, I blamed myself for being unfit for society.  Maybe all those nights I spent in inpatient last year really did mean resources were being wasted on me.  Maybe I’m not worth saving.  I was busy at my second job for a few more hours, but then I headed home, where I picked up a disposable razor and went back out to wander in the night time.

I thought I’d be going somewhere secluded and sitting in my car as I broke open the razor and slit my wrists with the blade.  First, though, I went to Steak ‘n Shake, where I stuffed myself with comfort food and wrote in my journal.  As I wrote, I thought about how I couldn’t die yet, as I still might be able to donate a kidney to mom.  So I planned for that potential surgery and started researching how I could increase my risk of dying from it.

Despite the lack of immediacy to my suicide plan, I knew I should be calling the on-call therapist.  I couldn’t make myself do it.  I can’t be anonymous if calling in the middle of the night, as the therapist has to be contacted and then return the call.  Also, the chances are ever-increasing that the person on-call will turn out to be someone I know.  Finally, I feared being asked to come to the ER for an in-person psych evaluation, and potentially having cops sent after me if I refused.

Instead of calling, I browsed the internet and found Crisis Text Line.  The idea of not having to speak aloud to someone was appealing.  I entered the number into my contacts, but hesitated before sending a text.  Some other customers were creating a spectacle, and watching them distracted and entertained me enough that I was able to safely return home and crawl into my bed.

I held on to the idea of donating a kidney, and on Monday morning I called the transplant center.  I was asked 5 questions in rapid succession before being rejected.  My name, mom’s name, whether I had high blood pressure, whether I was on medication for it, and my age.  I argued with the lady, questioning her about the reasoning and asking if I could get a clearance from my doctor to allow it.  She firmly said no.  I understand why high blood pressure is a problem – it’s a leading cause of kidney damage and they wouldn’t want to take a kidney from someone who might end up needing one later on.  However, it does not make sense to reject me when my blood pressure is normal with medication, and it especially does not make sense that my age would make a difference.  Would she have said yes if I were younger?  Older?

My new thing, apparently, is to throw up when I cry.  I hung up and started sobbing, racing for the bathroom as the force of my tears made me gag.  It would be one thing to have found out I wasn’t a match, as that would still leave the option of arranging a kidney exchange, where I donate to a stranger and their loved one donates to mom.  Being rejected entirely was devastating.

Mom can live on dialysis indefinitely, and at this point has accumulated 27 months of wait time, with it usually taking 3 to 5 years to get a kidney (her first one only took about 8 months).  It’s reasonable to think she’ll get one soon without my intervention, but I couldn’t stand the idea of her being on dialysis any longer than necessary.  My thoughts returned to my original suicide plan, the one that got me sent to inpatient the first time.  I had planned to accompany her to an appointment at the hospital, pin a note to my chest requesting she receive one of my kidneys, and shoot myself in the head.  Maybe that would be the best for all of us after all.

The next day I was sitting in the DBT group that I planned on quitting within the next couple of weeks (as soon as we complete the Emotion Regulation module), and on the break I pulled out my phone and started doing research for my plan.  A few minutes later, in the course of our weekly mindfulness exercise, I had a change of perspective.  The exercise consisted of three questions asking us to consider how we could view situations differently in order to change our feelings about them.  How could we make the best of those situations and hold out hope for the future?  I began writing answers that turned out to be about the kidney transplant and the things I could still do to support mom and the overall cause without being able to directly donate a kidney to her.

I had already notified the group leaders that I was quitting, but when I realized something enlightening had just taken place I questioned my decision.  The group ended and I asked Sierra if she had an opening in the next two days in which I could come speak with her.  We arranged it for 8 am today.  Later in the day I was also able to schedule a brief appointment with Sadie for 10:30 am today.

The alarm on my cellphone was set for 6:30 am, but it was the house phone that woke me, at 10:50 am.  Sadie was concerned because I hadn’t shown up for my appointment, and if I hadn’t answered the phone she’d have been sending the police.  Sierra was also concerned, but wondered if there’d been a miscommunication so she merely sent an e-mail to check in with me.  I was very upset to have missed both of these appointments as I really needed to talk to someone, and Sadie and I agreed that I would show up at CMHC at 2 pm and wait, because both her 2 o’clock and 3 o’clock clients have been flaking on their appointments lately.

I was there in the waiting room, doing some writing to fill the time, when Sadie came out at 2:10 pm and told me that client hadn’t shown up (and the next one had already called to cancel).  Our conversation looped around through a lot of topics.  She did her usual sneaky assessment of whether I was safe to roam free, and I assured her that I had no intention of killing myself right now.  A couple of days ago I wasn’t sure I could say that.  A part of me really felt like inpatient would be the best option, if only I thought there was anything they could do to make things better.

Sadie told me that mom still needed me, even if I couldn’t help her in the way that I wanted.  She named off all the people I had worked with at CMHC and said that if I killed myself it would impact them all, not to mention all the people I know through work and school and hobbies and family.  I told her this sounded like an argument in favor of not having relationships and she said it was too late, that even people I no longer have contact with, like Wendy, would be impacted.

I had a thought in my mind about a video I watched recently, made by the blogger when she was planning to kill herself.  I had shared it to Facebook, explaining that I’d had many of the same thoughts she expresses.  The only feedback I got was my mom saying, “You never really felt as bad as that girl, right?”  The thought that came up when Sadie was talking was that the impact would just be people thinking there was something they could have done, when they should have thought of that beforehand.  I didn’t get a chance to express this, as the conversation veered in another direction.

Aside from the issue of suicidal thoughts, Sadie and I discussed the rapid fluctuations in my mood.  Despite feeling down and suicidal one day, I can be bouncing off the walls the next.  The past couple of days I worked 3-11:30 pm and found that I could not get myself into bed afterward.  Last night I spent at least half an hour total pacing back and forth in the break room while waiting for work to do.  I was taking the stairs two at a time, and lately I’ve had the non-stop fidgeting of my left-hand that featured so prominently in last year’s manic episode.  I’m driving too fast (60-70 in a 45 mph zone), going out wandering late at night, getting too generous with gifts, and losing my social anxiety.  From the moment I showed up at work yesterday I answered every single phone call that came into the department, despite having a coworker there for the first 5 hours and despite my usual deep aversion to telephones.

On the one hand, Sadie said she was glad I would be seeing Brent next week because it seems like my medication’s not right.  On the other hand, she said she didn’t want me to pathologize everything about myself.  Some of these behaviors can be my personality without being a sign of illness, and the things I was expressing concern about weren’t actually dangerous, with the exception of speeding.  I tried to explain that it’s the combination of all these factors and the fact that it feels like I did before I ended up in inpatient the first time that worries me.  She asked if I had been manic, depressed, or mixed at that point.  I said mixed.  I’ve never directly said that to anyone in the mental health profession.  I know it was the case, but it’s not officially in my records.

She asked if I’m mixed now and I said no, that it’s rapidly switching between the two, which is a little less dangerous.  Mixed states are bad because you feel the despair of depression and the energy of mania simultaneously and are at increased risk of suicide.  We talked about how to describe my symptoms to Brent in a way that he will take seriously.

I fear what he will say when I complain about moods being up.  I had complained before about being down all the time and sleeping too much and he decreased my dose of Latuda, thinking I might be overmedicated.  Well, that’s clearly not a problem anymore.  Maybe what I want is not possible.  I want to have energy and motivation.  I want to not be bouncing off the walls.  I want to sleep 8-9 hours a night and wake up refreshed.  I want to be able to cry over sad things, but not become suicidal over them.  I want to not feel anxious.

What my medication does now:

Wellbutrin – Mostly keeps me out of suicidal despair.  I still have suicidal thoughts, but they get much worse if I go off the Wellbutrin.  Also, it usually prevents me from crying when I’m upset.  My eyes might get a bit watery, but it has to be something really bad (like the rejection from the transplant center) to induce real tears.

BuSpar – Wipes out the cripplingly severe anxiety, but I still have fear that prevents me from doing certain things.  Except, of course, when I get a bit manic and then all bets are off.

Latuda – Slows down reactions to situations.  Makes me sleep more than I’d like.  If I skip it, I’ll be up all night (although the past few days I’ve been wide awake despite taking it).

A few months ago, I had shared a few medication options with Brent and he said, “#6 is Not An Option“.  That was the point at which he reduced the Latuda.  In looking back over the options I provided, there should have been a #7 and #8.  I didn’t bring up the possibility of lithium, probably because the idea of the frequent blood tests intimidates me, and I didn’t account for the fact that the solution might involve more than one of those changes.  Brent and I need to have a serious conversation next week, because I am just not okay with the way things are right now.

This is why a small part of me wants to go hide in inpatient, because I know something needs changed, and I’m a little scared of doing that with minimal supervision.  I’ve reached the point that I haven’t experienced serious side effects from my medication in a long time, and the idea of new side effects hitting me as I try to make it through my work days is daunting.

Asking for Help

A little over a week ago I wrote that my mood was on the way up, but it was a good kind of up, although I wasn’t discounting the possibility that it could go too far.  A few days later, it started to go too far.  Nothing extreme, just driving too fast, going wandering late at night, buying random crap that caught my eye…  I was tempted to skip my Latuda to encourage this feeling, but then one evening it started to alarm me and I no longer had any desire to skip medication.  The next morning I woke up in a completely different mood.

I was dragging myself through work and every little thing got me down.  I got upset about something I can’t even remember and wandered through the halls of the hospital trying desperately to harm myself with my keys.  24 hours later I still had pink streaks on my arm and it was sore to the touch.  I wasn’t depressed enough to be all weepy and suicidal, but I was still alarmed by the sudden shift.

I’ve been on medication for over a year and a half now, and the mood cycles have never completely stopped.  The intensity of the highs and lows has lessened, but the cycles have actually become more rapid.  Where I used to have alternating months of depression and hypomania, I now have more of a monthly cycle, with about 1 week building into mild hypomania and the rest of the time fluctuating through various levels of depression.  I keep trying to pretend this is okay, but it’s really not.  I feel like I’m constantly doing damage control on either the recklessness of hypomania or the listlessness of depression, and never get to just be kind of okay for a while.

I last saw Brent in September and he told me to come back in 2 months, so I still have a month to go.  I didn’t know how low my mood was going to go, but the drop was sudden, and I called to ask if I should come in sooner or wait until November.  After a talk with his nurse, she consulted with him and called back to leave me a message saying to wait and see him in November.  Oh, but call back if things “get worse” and are “no longer tolerable”.

I did not anticipate this response.  Brent knows how very hard it is for me to call and ask for help, and I expected that the fact that I managed to make myself call would have him concerned.  I felt like the unspoken meaning was that he thought I was attention-seeking and nothing was really wrong, and I got angry and frustrated.  My initial response to being told to call back if things got worse was to think, “By then it might be too late” and both my mother and a coworker echoed that thought.

So I made another call I never make, and left a voice mail for Sadie.  A babbling, incoherent voice mail, about moods and Brent and being frustrated, and ending with a couple of repetitions of “I don’t know” and then “never mind”, because I really had no clue what I was trying to say.  It’s not like she could do anything to help, so the call was pointless.

In response I got an e-mail, which I’ll just include in its entirety since a paraphrase would end up covering every sentence:

Donna, thank you for calling me.  I am not sure if you need something from me as you said “never mind” at the end of your message, but I wanted to remind you I’m leaving shortly and will be out of the office until next Thursday.  If you do need something during my absence, you may contact Jan, Sierra, or Nelly.  Use that TRUST skill and trust your ability to Ride The Wave as you experience different moods!  And remember it is ok to ask for help if you need it.

Sincerely,
Sadie

It’s okay to ask for help?  No kidding, that’s what I’ve been trying to do and it’s not getting me anywhere.  I tried to persuade myself to go talk to Jan after work, but I have way too much fear that it will result in an inpatient stay, which I don’t want for several reasons.  I haven’t been there in nearly a year, and if I can hold out a bit more than a month after that I’ll be able to avoid going there at all in 2015.  Also, I’m working nearly full-time at the hospital and part-time at a haunted attraction, and I don’t want to let either of my bosses down by missing work.

Plus, I don’t know how productive such a stay would be.  A coworker questioned me today about whether I’d ever had an inpatient stay that wasn’t at CMHC, and tried persuading me that it might be more helpful.  Maybe it would, but I haven’t the foggiest idea where I would go or whether I’d be able to afford it.  At least with this particular facility I know my insurance will cover it.  Before my diagnosis, when my life was a complete trainwreck, I thought staying somewhere for a month and only being responsible for taking care of myself could be very helpful, and I still feel like there’s something happening that could be addressed in inpatient better than through these scattered appointments I tuck in-between all the responsibilities in my life.

As is probably obvious, I didn’t go talk to Jan.  My moods are toying with me, and by the end of the day my mood was back up, but in the irritable fashion.  After 8.5 hours at job # 1 and a brief break before almost 6 hours at job # 2, I am drifting down from the irritable agitation and am ready to go crawl into my bed for 12 or 13 or 14 hours straight.  I guess I’ll just wait and see how I feel when I wake up, and like Sadie said I’ll Ride the Wave.

My First, My Last, My DBT

Apologies in advance that this is a very negative post.  I know I should be giving things a fair chance, but sometimes a situation just sucks so much that it’s hard to set aside the frustration and try it again.  This morning I went to my first DBT group meeting.  I also may have gone to my last.

Going into the meeting, I was anxious.  It started hitting me about 45 minutes before the meeting time, when I was trying to figure out exactly what time to leave to be not-early and not-late.  I was anxious about figuring out how to pay – who to pay, what payment types would be accepted, and even whether or not I should pay, given that it will just be tacked onto my ever-growing bill if I don’t.  I was anxious about being in a group in general, and especially about joining a group of people who had all been attending for years and already knew each other.  I was anxious about which section of skills they might be working on, and how well that would line up with what I’d already done in individual therapy.  I was so anxious, in fact, that I drove right past the place and had to turn around in a parking lot to come back.

I did pay, in cash, to some confused receptionists who weren’t used to a client who doesn’t have Medicaid.  I entered the group meeting room and found two women sitting there.  When they introduced themselves, I thought they were the group leaders, but it turned out they were both just members with thick binders of all their accumulated handouts.  We were soon joined by two additional members (one of whom was male), and one of the two therapists who lead the group.  The other therapist and several members had called to say they could not attend today.

The meeting began with each of the other members describing which skills they had used during the previous week.  Two people did this in a succinct way, that avoided too much backstory.  Two others rambled on and on about all the situations they were in when using these skills, which I had been told in the orientation was not the appropriate way to use group time.  However, the therapist made no effort to reign them in.  To be honest, I was sitting there thinking that I don’t give a shit about these people or what they have to say.  It was mindnumbingly boring to listen to everyone whine about what all had gone wrong that week and then brag about how they handled it so well.

Then we moved on to actually discussing skills.  They had recently started the Interpersonal Effectiveness section, which is exactly where I hoped they wouldn’t be starting.  I’ve done Distress Tolerance and part of Mindfulness with my individual therapist, so starting with one of those, or even in the Emotion Regulation skills would have been fine.  The therapist went back to the first page of the handouts and reviewed, partially because people missed group so much over the holidays and partially, I think, to catch me up.  Yes, review of the previous week is built into each meeting, but we spent the entire second hour on review and never got to the point where they teach new skills.  In fact, the review didn’t exactly contain any skills either.

One member of the group would not stop running her mouth long enough for the therapist to get a whole sentence out, and also used a profanity for every third word she said.  The others could manage to wait their turn, but never seemed to be on the right track as far as what we were discussing.  I was asked at the end of the meeting whether I thought this was going to be helpful.  I said, “Not in the slightest.”  This earned me a lengthy speech from the member with diarrhea of the mouth, telling me all about how much DBT has helped her in the FIVE YEARS she has attended the group.  Five years.  You complete the whole set of skills in 6 months, so she has been through it all 10 times.  I cannot even remotely count that as helping, if she still feels the need to attend the group and be retaught these skills over and over again.

At the break in the middle of the meeting, the therapist went and made photocopies of the Interpersonal Effectiveness handouts and put them in a binder for me, along with a few copies of the weekly diary card.  I nearly left the binder on the table when I walked out.  I was already 95% sure I would not be returning next week, and 100% sure that I would not complete the entire program, so it’s hardly fair of me to come back and lead them on.  By the end of the meeting, I wasn’t anxious anymore.  I was just annoyed and frustrated, and felt that I had just wasted 2 hours and $12 on complete drivel.  I’m giving my therapist one chance to talk me into returning, at our appointment later this week.

What do I hate so much about it?  Well, aside from everything mentioned above, it’s repetitive.  The skills are just the same things said over and over in different ways.  I’m not an idiot who needs to hear things a hundred times in order to understand them.  In fact, I’m just plain not an idiot.  We went over a page about challenging myths about interpersonal effectiveness.  After just one of them, I said, “So in other words you just add a negative to the sentence.”  The therapist looked at me as though shocked that anyone would pick up on that on the first try.

I also hate that, in looking over the list of skills on the diary card, I once again find that the skills are not the same skills my therapist has been giving me.  The same happened with a DBT workbook I bought.  Oh sure, some of them are the same, and some of them are clearly just different wording.  But there are entire skills that are missing from this list.  How can DBT be some proven program if it’s not even the same skills when different people teach it?

I hate that the skills are not things I need to be taught.  We went over and over the idea that Interpersonal Effectiveness is about asking for help when you need it and being able to say no when you need to.  I don’t inherently have a problem with these things.  I have a problem with these things because I experience social anxiety, but I don’t need to be taught how to do them.  When my anxiety is under control, there’s no problem, and when it’s not, there’s no skill in the world that is going to help.

Most importantly, I hate that I’m not doing this because I want to do it, or think it will help me.  I’m doing it because it’s what my therapist wants me to be doing, and I feel that if I tell her I’ve had enough of the DBT and that I’m not going to the group or letting her teach me the skills anymore, then even if she can work with that there will always be a tension between us.

I don’t even really believe my BPD diagnosis is correct.  I don’t have most of the stereotypical symptoms, and the ones I do have can be easily attributed to bipolar.  I don’t always use self-injury to cope or think about suicide, only when I’m depressed.  I don’t always drive too fast or overspend, only when manic.  If the diagnosis is wrong, and the therapy is not what I need either way, then why the hell am I doing it?

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.