Self-Esteem Relies On Others

I’ve had two days back at work.  Remember how I was so bored while I was off and so eager to get back to work?  I’m already complaining and counting down until quitting time.  Remember how having surgery changed my perspective and I didn’t feel suicidal anymore?  Suicidal thoughts on the first day of work.  I’m so frustrated with myself.  It’s like my mind refuses to be happy.

I don’t feel like I will ever be ready to work independently without my coworkers to lean on.  I still have so many questions every day.  Every day of work is completely different, with new requests that I’m not sure how to fill.  I get stuck on the things I don’t know and the mistakes I make and am blind to the things I’m doing well.  It doesn’t seem to matter that I did one thing right when there’s a wrong to cancel it out.

Tuesday I got a call from one outpatient department, requesting supplies for another outpatient department.  I was told that we don’t fill orders for outpatient departments, and called back to tell this person the proper procedure for submitting a requisition.  The person I spoke with on my return call got rather snippy with me, and basically demanded the item.  I went back to the storeroom in tears.  I was stuck.  Either I make this caller unhappy, or I make my department unhappy.  I hate when people are upset with me.  My entire self-esteem rests on being liked.  I ended up filling the order, and when I spoke to my supervisor about it she said it was fine to fill an order if it was stat.  Well, that makes sense and all, but won’t these departments catch on that all they have to do is say “stat” and they’ll get what they want without following the proper procedure?  I also hate ambiguity.

And have I mentioned how much I hate phones?  A large portion of my work involves answering phone call after phone call, in which the callers are often incredibly vague about what they want, or use terminology that is not the same as my department’s.  Early in my employment, I was asked for a “condom catheter”.  After scanning through a lengthy list of items we stock, I finally came up with “catheter, male external”.  Condom did appear on the label – in the French translation.  I actually did manage to solve that mystery myself, but I often have to ask my coworkers what the heck the callers are asking for.  Next week I will be alone for 3 hours of one workday.  I will just have to cross my fingers and hope that the phone is quiet during that time.

I’m using a lot of the Keeping It In Perspective skill, and the Encouragement part of IMPROVE.  I talk to myself at work a lot, saying things like, “It’s okay, this mistake is fixable” and “You can do this, don’t worry.”  Some days it helps more than others.  Some days I believe my encouragement, and other days I grumble at myself to stop lying to myself.

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A B C, It’s As Easy As 1 2 3

Dialectical Behavior Therapy (DBT) is filled with skills that are acronyms. Some of these are ridiculously long and hard to remember, such as SPECIFIC PATHS, and as a result I never use them. One of my favorite skills, however, is the acronym ABC. ABC is part of the Emotion Regulation module, and each letter stands for a different way to take action in the present that will create improvements in your future.

A – Accumulate positives

Accumulating positives involves experiencing and remembering positive events which you can use to balance negative events that may happen in the future. For me, accumulating positives often means spending time with friends so that I can remember those times when I’m feeling lonely.

I also accumulate positives by accepting compliments when they are given. A year ago, just before my first therapist ended her internship, we were working on my difficulty with accepting compliments. I still struggle a little with believing that people mean the positive comments they make, but I have learned to at least be gracious and say thank you. Yesterday I received four compliments – two regarding DBT group and two regarding my stage management of a play – and I ended the day thinking about how I could reflect on those compliments when things are going less well.

B – Build mastery

Building mastery is about working on improving a skill. This can mean working at something you are already good at, in order to become even better. I do this every time I write for my blog or my book, or when I work on a knitting project.

Building mastery can also mean improving one of your weak areas. I do this when I practice things that I have a history of struggling with, such as doing business on the phone. Finally, you can build mastery by learning an entirely new skill, such as a previously unfamiliar cooking technique or how to do home repairs.

C – Cope ahead

Coping ahead means planning for things that could go wrong and taking steps now to minimize their impact. I cope ahead whenever I find a potentially useful phone number and enter it in my cell phone contacts. I’ve got the three local police departments and the county sheriff, the local hospital, AAA, my bank’s customer service line, poison control, etc. When I need help, it will simply be a matter of choosing the right contact.

I’ve also coped ahead today by finally learning how to operate a fire extinguisher. There was a large section in the paperwork from my new employer regarding what to do in case of a fire, and I felt very intimidated by the responsibility. I won’t know everything that needs to be done until I’m actually familiar with the layout of my workplace, but at least I now know how to use the equipment.

DBT Freed Me

I was released from the inpatient unit 2 weeks ago.  I was released from the inpatient unit 2 days ago.  Wait, what?  Yes, as a matter of fact, I did get myself locked up twice within a 2 week time period.  Both instances were the result of my inability to STFU and stop saying things that will cause overreactions in people who have the power to detain me.

See, when I went to see my therapist last Thursday, I confessed to the fact that I had lied in order to get out of inpatient the previous week.  I felt honesty was necessary if I wanted therapy to work.  Well, upon hearing that I told the psych APRN in inpatient that I was perfectly fine when I happened to be considering the possibility of overdosing when I got home, my therapist promptly decided I was going back for a longer stay.  Maybe a week or two.  She even offered to find me a different facility if I did not like the inpatient unit affiliated with her organization.

I kept saying no, that I could not do this.  She wasn’t taking no for an answer.  When I finally resigned myself to the fact that I was going whether I liked it or not, I asked to go home first and have mom drive me back.  I’ve done this in the past.  The deal has always been that if I don’t report back within a certain time period then the police will be called to do a wellness check.  This time I didn’t even get that time period – she said that if I left her office to go home, she’d call the police immediately.  She wanted to drive me over to inpatient herself.

So I spent another 5 nights without any freedom.  I chose to practice my radical acceptance and be calm about the fact that I was there and just let things happen instead of fighting it.  I had a lot of time to think, and while there I saw what would happen if I didn’t get better – one client already had a court order committing her to a state hospital as soon as a bed became available, and another one was waiting to see a judge for the same reason.  Watching these events unfold frightened me into a deeper determination that I will work hard to overcome my problems and especially to stay out of inpatient in the future.  

There are a lot of hours in a 5-night stay.  My time was filled somewhat with meals and meds and psychiatrist’s visits and group activities, all of which I fully engaged in.  That still left a lot of hours for socializing with other clients, visiting with mom for 2 hours each evening, kicking butt at games of rummy, writing in my journal, and (possibly most importantly) doing exercises in my DBT workbook.  

My stay was somewhat lengthened by the fact that they weren’t going to let me out so easily on a return visit – they even considered petitioning for emergency detention – and by the unfortunate timing over the holiday weekend.  However, there were indications that they might keep me several more days beyond that point, and I feel that the reason they chose to let me out sooner was because they were impressed with how hard I was working on the DBT skills.  It even came up in my final visit with the psychiatrist on the morning of my release.  He wanted to know which coping skills I would use if I got home and started wanting to hurt myself.  I told him the ones that were most effective at this point were putting ice on my wrists and reciting the Fibonacci sequence (not necessarily simultaneously).

ladybugs

I learned many more coping skills though.  I created a distraction plan of 10 ways to distract myself from painful thoughts.  I created two relaxation plans of 10 ways (each) to self-soothe using the 5 senses.  One plan can be done away from home and the other can be done at home.  I learned to relax by using a cue word and by visualizing a safe place.  I even worked on identifying my values and setting goals to spend time on those areas of life that I value most.

So I got to come home, and today I go see my therapist for the first time since she dropped me off at inpatient.  She made a comment at the time that ended with “if you’re not furious with me” and I said that I wasn’t.  After all that thinking time, I decided that I was.  Well, maybe furious is too strong of a word, but I am definitely upset with her about the fact that I came into her office prepared for a very productive session, with a thought diary and several of the DBT exercises to discuss, and instead we accomplished nothing because she latched onto my confession which was never intended as more than a passing comment.  

I have a poem that I wrote for one of our group activities, which addresses that situation using a theatre metaphor.  My plan for the past few days has been to give her that poem as part of a little speech I prepared that has some negative criticism about how she handled things in our last appointment.  The speech ends with “As a result of this experience, I will never be able to fully trust you.  The next time I go to inpatient it will be kicking and screaming in handcuffs.”  I am no longer sure about giving the speech, but I do still intend to share the poem.  It may be more powerful than the speech was anyway.