Saturday, February 28, 2009

I feel Hopeless and Hopeful

I research and read and digest and research some more, and I have come to the conclusion that there isn't a psychologist or psychiatrist alive, or dead, that can repair the lifetime of damage caused by childhood abuse. And that knowledge has changed my view of the expectations on this process, 'my expectations'. This new found knowledge makes me feel both hopeless and hopeful. Hopeless in the sense that I feel as though I have some sort of terminal illness, and hopeful because I believe that someday I, personally, will make a difference somehow. I can almost pinpoint the day when I fell into the dark abyss and was encouraged by a friend to go back into therapy. We had rented a cabin in the Rocky Mountains, it was so quiet and serene, and the silence was overwhelming for me. I was always busy, always in a hurry, the quiet didn't sit well with me. The first night we were there, I woke up at 2am and I couldn't breathe. I sat up and leaned over the side of the bed and I still couldn't catch my breath. I panicked and ran into the bathroom and threw up. I had no idea what just happened but I did know that it scared me. It happened again the next day. And the strong, unemotional woman that I had been had suddenly disappeared and was replaced by this woman who was fearful, confused, depressed. I spent 30 minutes in the shower, crying uncontrollably. What happened? Invasion of the body snatchers? When I returned home I began to research therapists~ and I made that first call to Dear Therapist.

Nearly two years of weekly therapy appointments later, I was much worse than that weekend in the mountains. The intrusive memories, the body memories, the constant reminders of the abuse I suffered were ever present; the internal voices argued and fought with each other, and me, and there was never a break in activity, never a moment of peace in my mind. I had been on several different anti-depressants ~ but they either didn't seem to work for me, or the side effects outweighed the benefit of the drug. The mild sleeping pills I had been given were not working and the lack of sleep was compounding the overwhelming feelings and thoughts. It was unbearable! I began to disassociate and cut my own skin. I needed to see the blood, I needed to see physical evidence of the emotional pain I was feeling. When I saw the blood pooling on the floor it would suddenly make sense to me~ no wonder I'm in so much pain, I'm bleeding! I didn't want to die, I just wanted the pain to stop. There was a voice in my head begging not to be hurt, and a voice responding by saying, "You are bad, you deserve to be hurt" and a third voice, who would chant, "Nothing I can do to save you". And this happened every single day. I began to withhold food from myself~ food was nourishment, I did not deserve to eat. The shame and "badness" were all-consuming and I began to vomit repeatedly, multiple times a day to get the 'badness' out of me. If I couldn't bleed it out, maybe I could puke it out.

Many times I was convinced that I was going to die at my own hands. I was honest with dear therapist, I told her that I knew I was going to die. I knew that my self-destructive behavior would escalate until I took my own life. Dear therapist would tell me it would get better, she encouraged me to seek support from a qualified psychiatrist (I had a bad experience with a psychiatrist and was afraid to try again). She tried to teach me self-soothing skills, she made relaxation recordings for me on my MP3 player, in an effort to sooth me with her voice when I was alone during the night. But nothing worked, nothing could stop the demons in me from destroying me from the inside out. I was powerless, no longer was I in charge of my body or mind ~I had no strength left. I had no way to communicate to dear therapist~ I was trapped inside of myself and I could not find a way out. I was powerless, as the video continued to play over and over, my body and mind reliving the past in the present. My body was bruised and broken, the fog inside my mind made reality unrecognizable; the depression I felt was undefinable. Hope? Completely unfathomable! I wanted to die, and I don’t honestly know how I’m still alive today, but I do think I know why.

Nearly every week I would beg dear therapist to fix me. In her office I would I would wallow in self pity and cry about the unfairness of it all. I repeatedly threw myself on her office floor as though I was a toddler in the midst of a temper tantrum demanding that she deliver me from the pain! "Can’t you see me?" I cried. "You have to do something!" I demanded. "You have to help me, PLEASE! Take away this pain." Her patience was seemingly unending, her encouragement great. But my behavior had now reached the point where she was afraid that I would not be able to keep myself alive. She did not want to take away all of my control, but would gently 'encourage' me to go into the hospital. She would say, "I think it would be the best thing for you right you. They can stabilize you quickly~ they will get you on the right medication. You can get better."

But it was not until the clouds cleared and I could see the sun again that I realized that 'healing' from this was my choice. It was not her choice, my husband's choice, my friends choice. It was MY choice. They could not stop me from killing myself, from hating myself, from starving or cutting myself. It was my choice. I had to decide if I wanted to live in this pain forever, remain imprisoned by my past, wallow in self pity and destructive behavior, or if I was going to help myself and begin to define a new way of living.

I can look in the mirror and tell myself that I am shattered, I am in pieces and it’s hopeless, or, I can tell myself that despite my “trauma” and my struggles afterward, the power to move forward is within me. I have now taken off the costume of the ‘woman without a history of abuse’. I recognize, admit, and accept that I am that woman, and that is my history. And when I look in the mirror now, in the present, without the costume, I see that confident woman, the woman with a long history of child abuse,and trauma. The woman with the lack of feelings, too many feelings, overwhelming feelings...I see her scars~ and I accept her. I hear her voice, I feel her, I can see her confidence and beauty~ and she is REAL, not a costume. She is me.

And I am trying to not be so angry at dear therapist. I am trying to trust her again, to recognize what she has done for me, and let go of what I perceived she did to me. The dim flickering light of trust was smothered by my feelings of abandonment. I am searching for a match, a lighter, even two sticks to rub together~ to relight it.

I am trying to accept that dear therapist is not perfect, and instead realize that like me, she is "Good Enough". I am thankful for everything she has done for me, angry as hell, but thankful at the same time. And I carry a piece of her in my heart every day.

Life ain't all Sunshine and Rainbows

Dear therapist once said, "Once you stop trying to escape yourself, you will have won a big phase of the battle because in reality there is no one you presently have to escape or fear. One, because you are no longer a child, and two, because you have more, much more, personal power and capacities to protect yourself then in the past. Remember, you are my 'Rocky-ette' in training, and I am your coach, with a warm parka, hiking boots and lots of stamina. And when I train my prodigies, I make sure they are well conditioned, agile, strong, confident, flexible, and can think on their feet!"

It was so many years ago when I bought a costume of a confident woman with no history of abuse. I was the only one who knew it was a costume, and when I looked in the mirror, I longed to be that woman, the beautiful, confident woman with nothing to hide, and I never that costume off. I pushed away the thoughts, the disgust that was of the past, I could do it ~it was easy. I just had to stay busy, and not leave time to think about it. But one day that all came to a screeching halt and suddenly my life was so painful, an the pain was so intense~ and I wanted to left alone in my pain, I did not want to share the pain I was feeling. I was afraid to explore the darkness that dwelled inside of me, the darkness that I had ignored and pushed away for so many years. I was afraid if the things that lived in my darkness were exposed to light, they would grow out of control, and overcome me, make me weak and afraid, suck me into the darkness until I no longer existed.

But the darkness was not to be ignored, it snuck up on me during the night, it rattled my windows, and wrote vulgar, bitter graffiti on my walls. There was no escape, I could no longer outrun my past, it had caught up with me, now ran beside me, and I knew it would soon overtake me. I began to have panic attacks, waking in the middle of the night, unable to breathe. I needed a coach, a life coach, and I needed one fast! I needed a coach to teach me to run faster, to escape. So I began to search for a coach and when I found one, but rather than teach to me run faster, she wanted me to slow down, to look she wanted me to feel. What? Why would I allow myself to feel, it would just hurt, cause me pain. She told me that I could run until I wore myself out but I could not escape my past or my pain. I had to learn to face my past in order to move forward and heal. When I told her I was scared, that I didn't have the strength to face it, she told me that she would 'train me', stay with me, help me find the strength within me that she could see. The strength I saw in her was a reflection of the strength I was seeking for myself.

Rocky Balboa said, "It ain't about how hard you hit, it's about how hard you can get hit and keep moving much you can take and keep moving forward. If you know what you're worth, then go get what you're worth...but you have to be willing to take the hits."

I have been hit time and time again in this process. I have had black eyes, bruised and cut skin, broken bones and a shattered spirit. And when I could not find the strength, she would help me, encourage me and cheer me on. I am moving forward, and I am starting to see my worth.

Friday, February 27, 2009

Am I Willing to Take that Chance?

I called out: both verbally and non-verbally.
I was SCREAMING! But no one seemed to hear me. Not even DT…she now saw only the symptoms, the behavior, not the underlying problem. The approach now was to STOP THE BLEED! A tourniquet approach. And I thought to myself, well, if she can’t help me, no one can, so I thought about giving up. I decided that I couldn’t take it, especially alone. I had no strength left, no coach to cheer me on…maybe I could just fade away.I think my erratic, self-destructive behavior scared my dear therapist. Imagine, a therapist, one trained in this process, scared. And the fear led her to seek shelter, so to speak, to seek support from other clinicians, to alleviate the fear she felt. And to know, with confidence, that she was doing “what she, and probably others, thought was best for me” during that time. I made her ‘uncomfortable’. God forbid I ever be a burden to anyone! I think you get the idea…my behavior set of a chain of events: it went like this:
I was self-destructive
Which made DT fearful, which led to seek comfort and advice from other clinicians
Which made her change her entire approach
Which frustrated me and made me feel abandoned
Which triggered the abandonment issues I had as a child
Which made me act out in an even more self-destructive way
Which lead her to become rigid and clinical, to the point of threatening hospitalization
Which lead me to take a more active approach by seeking out PDOC who changed my medication
Which cleared my head from the intrusive thoughts and self-hatred
But consequently did NOT change DTs approach back to the supportive, caring T she was previously
Which frustrated me even more to the point that my frustration grew into anger & because of the ‘new-found’ clarity~ begin to research and learn about treating trauma/PTSD/the resulting ‘personality disorders’
Which made me feel educated
Which in turn improved my communication with her and my ability to discuss my ‘needs’ from the *therapeutic relationship*.
The direct communication lead to my full disclosure of my feelings, and what I had taken away from the past 6 months, or so.

(shall I draw a diagram)

But what did not happen, what has not happened, during this process: is my ability to forgive her for my perceived abandonment of care. And because she abandoned me, I no longer trust her. And since I no longer trust her~ she no longer represents a ‘safe container’ for me, and so I cannot allow her to see the innermost parts of myself, I cannot share with her in the ways that I previously did~ because I am always on guard, high alert…. And the thought that permeates my mind continuously: “If I allow myself to trust her again, she could, and probably will, do it again at some point.” And even though there is a small part of me that wants to trust her, my reason mind is much stronger, overpowering that part of me, blowing out the dimly flickering light of possible trust. She could break me again if I let her….I got through it this time, and I am okay, well, except for the feelings of anger and betrayal, but maybe that wouldn’t be the case next time.

I ask myself every day, “I am willing to take that chance?”
And every day I answer myself, “I don’t know.”

Thursday, February 26, 2009

Forgive~ Sounds Good...they say time heals everything, but I'm still waiting...

Come and share with me, allow me to show you a piece of myself when I trusted another, and then a piece of me after that trust was broken, shattered. Come and experience the vulnerability, the body memories, intrusive thoughts, the isolation and hopelessness… and the shame! Imagine you have someone to walk with you, beside you, someone you have learned to trust ~ and after a the two of you walk side by side for several long miles, you finally allow yourself to take off the mask and be who you are, you share pieces of yourself that you wouldn’t share with another, and you finally feel accepted.
Then, imagine one day that person is gone. Well, she is still there, but she no longer walks beside you, she instead chooses to walk on the other side of the street. But you don’t know why. Must have been something you did, you must have shown something of yourself that was too scary, too shameful. So once again you walk alone. Only this time, you are no longer searching for another to walk beside you. Your trust has been shattered and you are no longer willing, or able, to reach out. You realize now that he was right. No one will believe you, or understand you, or even try. Because you are bad, you deserve nothing.
You must move on, be grateful for what you learned in this relationship. You are happy and safe now. You must be grateful for the new drug cocktail that has allowed you some clarity, allowed your brain to function once again. You are not completely hopeless or unstable ~ you are an adult once again. The fact that you are once again living in silence of your true feelings, well, that’s okay now, because you did the risk analysis, and it is 75% less painful this way. And you have had enough pain in your life.
Focus on the positives! You have learned to hurt in solitude. You thought you had forgotten! Once again, it is so easy to hide your true feelings, and emotions, well, what are those? You feel smug realizing the recent validation that you were right not to trust, and you know now ~you must be vigilant, stay guarded, and never let your walls down. No longer does the scared and broken little girl exist, this is the “NEW” you~ she is gone for good this time.
People are not like dogs, dogs are always loyal, always accepting, people will hurt you if you give them a chance. Do not ever turn your back for there is always someone lurking with a sharp knife. Lie, lie, lie…if you HAVE to cry, and I suppose everyone does at some point, do not ever cry out loud! Keep it inside ~ hide your feelings! No one should ever see your tears! And smile, don’t frown or act depressed~ those traits show a lack of confidence and weakness ~ remember: you were designed more for public than for private.
Hope for nothing more than what you have~ do not hope for love, intimacy, for someone to care…not about the ‘real’ you. Keep the real you in ‘solitude’ never to see the light of day, this is the only way you will survive. Sweep up the bits and pieces of yourself, and carefully put them back into the box and store the box in the darkest corner of the closet. Show no one anything personal about you, not the real you. The past no longer exists. You are a confident, successful, happy woman…and that’s all anyone needs to know about you. Keep the rest to yourself~ didn’t I tell you that, like, over 30 years ago?


I seem to have a lot of animosity directed toward Marsha Linehan. I think this animosity is a result of several things.
First, and foremost, I don’t agree with DBT. I think it’s basically an expensive way to teach people to shut up and behave by utilizing basic common sense techniques, and adding philosophy and theology – filled with riddles and contradictions. And I find it almost funny, in a ‘DBT half-smile’ kind of way, that Ms. Linehan was never abused, never married, never had children, and was a NUN. And she’s going to teach me how to deal with “pressure”? Come on! I suppose it’s easy for her to “mindfully” wash a dish since she lives alone, I mean, she’s as dry as a bone that has been aged in the desert, so although she claims to be an *expert* in ‘interpersonal skills’, I’m guessing she doesn’t have many friends knocking down her door for companionship and conversation. Now, those of us who have a job, children that need help with homework, dinner to cook, a husband to ‘cater’ too, a house to be cleaned…well, speaking for myself, I really don’t have much time to *mindfully* wash a dish. And anyway, isn’t that why the dishwasher was invented?
And of course the MHPs bought it! It’s packed full of philosophical and spiritual bullshit ~ such a simple, simple program, but so convoluted – Wow! It must be really GREAT!

The sound of her voice, and the hair barrette, my God the hair barrette, it’s like fingernails down a chalkboard for me! But I committed to the DBT classes, and since I gave my word, I will “mindfully” finish the classes. And I will do it for 2 reasons:
I gave my word
The humor I take away from the classes each week, and it is substantial!
But no one will EVER convince me that DBT is anything other than a philosophized, spiritual program to teach COMMON SENSE!

Can You Spare a Life Jacket?

Here is a brief summary of how I think the last year played out:Grace will need to learn to trust DT before she will feel safe. DT will make Grace feel safe by ‘being present’ for Grace, by developing a level of ‘dependency’ so Grace will realize that DT is a ‘permanent object’ and will not abandon Grace.
Grace now trusts DT, but by working through things, Grace has begun to exhibit self destructive behavior that made DT change her approach~ however, ‘new approach’ was not explained to Grace. DT takes Grace on a cruise to the middle of the ocean, and unbeknownst to Grace, who still trusts DT, other plans are now in the works. Grace is thrown from the ship into the tumultuous water, and as Grace looked around for DT, she sees her on the ship, waving goodbye, standing with her DBT friends/support group for clinicians, holding a sign that says “SINK or SWIM”….because after all, DT has tried to do everything she can for Grace and Grace continues to be ‘emotionally disregulated’. Maybe this will ‘scare’ grace into shape. Grace cries out, begging DT for a life jacket, but DT can’t hear Grace any longer, and off she goes, smiling and laughing with her ‘DBT support group’ while Grace is left to be eaten by the sharks inside of her head.
Bye Grace…call me when you get your shit together… And now, now that I am back in functional, adult mode…NOW you want to *SUPPORT* me? Well, it’s a bit too late for that, don’t you think? What can you offer me now? It takes a lifetime to build trust and only a moment to break it. And it’s broken now.

Wednesday, February 25, 2009

The Broken Little Girl Saved My Life That Day

The measure of a man, or woman in my case, comes down to one brief moment: the moment that would determine whether or not I would, or even could, swallow the pills I had counted out. To take them or not to take them was in my court, and even though I held the ball, I was quickly losing the game.

A remnant of a dream I once had when I was a little girl briefly fluttered through my disassociated mind. I was once a child with dreams and aspirations; I wasn’t always this hopeless woman who had lost faith in everything, including those in the helping profession. This is help? This was what they had to offer me? This is the treatment plan? A therapist who seemed to no longer care, one psychiatrist who diagnosed me with an ‘anxiety disorder’ and prescribed tranquilizers (for which, at this moment, I was grateful as I was about the take them all), another doctor who had no idea how to treat me, and changed my medication 10 times, causing unbearable side effects, but never able to find a combination of meds that ‘worked’ for me. Never finding a medication that would take away the intrusive memories, the thoughts, the nightmares, the voices inside my head that would not stop the nightly mantra of: “you’re bad”, “you don’t deserve help”, “you don’t even deserve to live”. I had evidence of the days when I felt competent, sane, and level-headed. And yet, here I was, forced with the choice of taking all of these pills, or continuing to live in the unbearable turmoil that had now become my life. Surely somewhere inside this girl, this woman with the heart of a child, was a person that craved so much more than this, deserved so much more than to find herself standing alone in an empty house with a bottle of wine and a combination of tranquilizers and sleeping pills neatly organized on the kitchen counter. And yet, in the chaos of my mind, the internal voices continued to try and convince me otherwise.

It had been a bad day, a really bad day, but then again, it had been a really bad year, and I had finally acknowledged that my reality now was too much for me to emotionally accept. After all, women are expected to stay strong in the midst of any crisis, even if they have to ‘fake’ it. I had become such a great actress, trained by many years of abuse, that I was an expert at wearing masks and pretending everything was wonderful in my life. The thoughts I didn’t want to have, I would gently push out of my mind, and become so busy that I didn’t have time to stop and think. But now things had changed and I had lost the power of pushing the thoughts out of my head; they had taken over and now I, the reasonable, sane, one had been pushed out. But I was not allowed to fall apart under the pressures of life when there are children to feed and bills to pay, laundry to do, a house that needed to be Martha Stewart clean, a husband who expected to be taken care of, and the never ending politics and pressure of my work environment.

And let me not forget to add sex, and having to live up to the expectation that every man alive believes every other man is getting it at least twice as much as they are, and well, they shouldn’t be expected to settle for a woman who had ‘let herself go’ and was no longer the same woman he married. And, of course we are expected to have our legs shaved, our hair stylish, our make-up perfect, and our body in comparable form to what society had become accustomed to, which is the air brushed women in beauty magazines. And don’t forget to smile ~ frowning and acting depressed shows lack of confidence and weakness; both very unattractive traits. Of course now I realize my mind was taking a road trip, and these expectations had nothing to do with my husband, but were the expectations of the condescending voice in my head that continued to tell me that I would never be the woman he, and everyone else, expected me to be.

How would this play out, how does one do this, what are the ‘rules’ for this game? If I take them all at once, I may just drop to the floor, so that didn’t seem like a viable option. Maybe taking a few at a time would work better….consensus from the group of voices now living inside of my mind? I picked up 5 pills and held them in my hand. They were small, white, pills ~ taking 5 at a time is definitely an option. My reason mind would make brief appearances and ask questions like, “How long after I take the 5 should I wait before taking 5 more?” And then as quickly as reason appeared it was pushed away. I was to far gone, I had no control over me and I no longer cared. At this point, nothing could penetrate the voices or convince me that I did have something to live for. Dear therapist and a few close friends knew that I was teetering on the edge of life and death, and told me many times, “What about your children?” I had really just become more of a burden to my husband and children, they would be better off without me.

I closed my eyes and I saw a small little girl, she was about 6 years old and she was wearing a tattered white dress. She was barefoot and her feet were dirty, her knees scraped. She had tears in her eyes, a look of worry and fear on her face. She pleaded with me, begged me not to do it, “Please don’t kill us, I fought so hard all those years just to stay alive, to survive, to become you. Please don’t do it. I want to live, please just let us live. You can do this; you can fight harder now, just like I did then.” I didn’t really care about my own life at this point, but this little girl was obviously in a state of panic, desperate to save me, although I had no idea why. I wasn’t feeling panicky, and I told her to calm down; there was no reason to panic. But although I felt calm and surreal, she was obviously afraid and in turmoil over my decision.

The rebelliousness and willfulness inside me grew weary and began to empathize with the little girl’s panic, my plight for calmness and silence defeated, I submitted to her request. I put the pills away, fell to the floor and sobbed for what seemed like hours.

Ironically, my lifetime of people pleasing and striving for perfection, and the overwhelming feelings of failure that had led me to this attempt to end my own life, were also the traits that saved my life. My need to please that little girl, to stop her from crying and meet HER needs because she was counting on me, saved my life.

But for many months after that day, the voices continued and my soul remained empty and void of meaning.

Monday, February 23, 2009

Dear Therapist

Dear Therapist,

Tonight when I arrived @ DBT, “emotional counselor” was reading the book, ‘Women who hurt themselves’, and she said it was a great book, and really gave her a different perspective on women who SH. I mentioned the book during the ‘assessment/interview’ the first time we met. I don’t know if you have read the book I gave you, or not, but I was happy to hear another clinician validating my thoughts about the book. I still don’t agree with the concept of DBT, and Marsha’s voice, or the sight of her – like fingernails down a blackboard. But I wanted to tell you that you were right, about my broadening my support network (clinically speaking) – I really do like both PDOCand Emotional Counselor. I’m glad you continued to press that. I think they’re both quality, caring clinicians.

I have felt very ‘emotionally regulated’ these days (lamictal complimented w/seroquel)– in fact, I feel kind of numb – but maybe my body will adjust to the new dose of lamictal and that will lesson. I guess I’ll find out when it happens. Minimal anger, practically no sadness – for real - I don’t think I could hurt myself if I wanted to and tried.

Which makes me think – if the meds (and at this point – I believe it’s all medication related – my thoughts are clear again, and it makes me wonder if ‘revisiting’ the past is really what I want. Good or bad – it is what it is – I don’t know what that means really – like if I can ‘accept’ it and move on. And maybe someday help someone else. I don’t know – just thoughts. (I know – thoughts that need to be discussed IS – not EM). But I’m wondering why bother?

Last night, dear daughter was ‘emotionally disregulated’ and when I tucked her in to bed, she asked me to come back and check on her in 10 minutes. I didn’t really want to go back upstairs – I was busy cleaning the kitchen…but then I thought about how important it seemed to her, and it wasn’t really ‘putting me out’ so I did…and she was so happy, exclaiming, “YOU CAME BACK!”… and I was glad that I did. I tell you that because I made a connection with that, and how I used to view ‘you’….as validating, ‘there’ for me, etc…and perhaps I didn’t tell you how much it ‘helped’ me to know you were there, maybe I didn’t shout, “You ARE here for me – you ANSWERED me in a time I needed you”….but that’s how I felt. And in that moment, I knew how dear daughter would have felt if I would have decided not to check on her in 10 minutes – I didn’t really agree to do it, I heard her say it, but I didn’t commit. She would have felt like I did, when you started chanting, “DBT-marsha linehan has all the answers” maybe she would have felt like I didn’t care, like she didn’t matter to me because her ‘perception’ of my caring depended on that. Sure, she would have gotten over it, forgiven me because I’m her mother, but still, I was glad I did it.

But I have not forgiven you for changing. Despite what you may think, I did feel accepted and validated by everything you did for me, for being there for me when I needed you. And although I realize you did what you thought you needed to do to “keep me alive”~ and I heard what you said the past 2 weeks during our “sessions”, I still disagree, and I still feel abandoned by you. I know that I looked you in the eye and said that to you 2 weeks ago, so I’m not expressing something to you right now, in writing, that I didn’t say in session. You kept me alive by accepting me and caring about me and being there for me and validating how I felt. Not by changing into someone I perceived as abandoning me. That just made me feel like you didn’t care at all, which, if it was your intention, it sure made me independent again~ but from a trusting therapeutic standpoint, it really just makes me feel abandoned, invalidated, and distrusting of you now. And therefore I am afraid to tell you anything else about me, and my past - because I no longer feel accepted by you.


When Will We Stop Turning our Heads...

I feel it inside me, and although it remains hidden from plain sight due to the medication, it is always there. And I find myself questioning the ‘professionals’ who treat CSA survivors. I have researched – read article after article, book after book. And the only book I have read that adequately describes the after effects of abuse is the book “Women who hurt themselves” by Dr. Dusty Miller - Not surprising, Dr. Miller is a CSA survivor, therefore has a personal perspective to offer in addition to a clinical one. I am so sick and tired of the *standard* treatment protocol – Patient needs medication and DBT. No one ever gets that there are these crazy, irrational people inside of me, and they are trying desperately to get out, to gain control, to display their “feelings” ~ of rage, fear, sadness, worthlessness, hopelessness, dependency….but they have had their say before, and it’s become obvious to me that there is no place for them here, in this methodical, logical world we live in. This world of order, where “beauty” not “ugliness” is accepted…. A world where “truth” prevails, well, if it a “truth” that others want to hear.

We turn the channel on the TV, or the station on the radio, when stories are told that make us “uncomfortable. I do it too – tune out to things I wish not to hear: children being abused and murdered, women being raped and killed~ and worse when they are blamed for it (they were dressed provocatively, they shouldn’t have been walking alone at night), animals being abused. We all do it. Why? Because those stories make us sick, sad, angry, and we don’t want to believe that the world is like that. But, in reality, the world IS like that ~ and it will never change as long as we continue to look the other way. It will never change as long as the ‘abused’ continue to be treated symptomatically, medicated until they no longer feel, and sent to classes to teach them to ‘shut up and behave’ like the rest of society.

I have fears – they are very real to me. But contrary to what the MHPs think, my greatest fears are not rejection and abandonment.

My greatest fear is that everyone will continue to turn their heads while victims are screaming.
My greatest fear is that survivors will express exactly how they feel, whether verbally, or acting out, and they will continue to be invalidated by being told they need medication and DBT in order to control their behavior, thereby reinforcing what they learned as children.
My greatest fear is that victims will continue to be silenced by DBT, or numbed from medication, and the clinicians, the researchers, will continue to ‘theorize’ and develop treatment that, in the long-run, is not helpful because they, themselves were NOT abused and have no idea what really should be done.
My greatest fear is that survivors will continue to be lab rats in the development of treatment that is not helpful, they will continue to drop out, time after time, and they will continue to self-harm, ‘repeat the trauma’, and possibly commit suicide because they believe no one cares.
My greatest fear is that the statistics will grow and no one will do anything about it because they do not know what to do.
In 2006, US state and local child protective services investigated 3.6 million cases of children being abused or neglected. 64% of the children were classified as child neglect, 7% victims of emotional abuse, 9% victims of sexual abuse and 16% victims of physical abuse. Some statistics show that as many as 14% of children are abused or neglected. And this number reflects only what is reported. Imagine what that percentage would be if all of the unreported cases were included.

And of the 3.6M+ children that survive the abuse, many grow up to be adults who are able to put it behind them, succeed and present themselves as an acceptable member of society, and many of them do not. But what are we DOING about it? When will people stop turning their heads? When will we finally stop, look and listen to these children being abused and to the adults who were abused as children? When will we, society, decide that child abuse, and rape, and sexual assault are important, and affect millions of lives every year, and that it can be just as deadly as cancer. When will we finally stop whispering and turning our heads and actually face it and do something to stop it, and affectively treat those who ‘survived’?
I hope it happens in my lifetime, and I hope I can make a difference!

Sunday, February 22, 2009

Dear Therapist ~ I've known you for 3 years, but I don't think we've met...

My heart is an organ that pumps blood through my veins…it is NOT a room for my "inner child" to live in. And no, I cannot see, or hear "little Grace" talking or sitting beside me, and no – I will not comfort her or let her sit on my lap. I will not do those things because she is not here. "Little Grace" does not exist – I cannot see her, or hear her – she used to exist, but she grew up and became me, "BIG Grace", "Adult Grace" – and honestly, I like the Adult Grace much better….big improvement. And "little Grace" doesn't live in my heart

If someone asks ME, Adult Grace, I have no problem telling you about how unfair life can be sometimes. People do bad things –and I accept that. I guess my life will be filled with a perpetual struggle to find my voice. In essence, it all comes down to that. And perhaps rather than face the struggle in defensive move, always poised, on guard, ready to fight, I should embrace that ideology as one of comfort, something to look forward to. Maybe the difference between living and a life is found, not in the degree to which one succeeds in finding her voice and making it heard, but in having a voice to find in the first place. Without that constant, continual fight – you are silenced, and a spirit silenced begins to die (I know this to be true). And once this happens, one becomes empty, numb- a shadow or a shell of one's former self, with nothing constant to hold on to. My cutting/vomiting – that was my "constant", my "comrade" – when everyone else walked away – I knew that I could depend on this. But perhaps I've been wrong about this too. It's not the cutting, the puking that's been the constant, but rather, my struggle to be heard. That struggle has never gone away. When everything else is stripped away, what is real will still remain. When you take away my cutting, puking, my restricting, my past….the one thing that remains is me, Grace, still trying to make my voice heard in a world that has never listened, never cared. And rather than fight for it, my voice, rather than embrace that struggle as one that lets me know I'm still alive, I have spent all this time fighting against it, keeping it quiet, never saying what I needed to say. Never expressing my feelings, or allowing myself to just "BE". Here – now – right in this moment. Instead, I spent my time acting out, or looking back, trying to make sense of things, or looking forward trying to get everything figured out. And I've missed the little things – the seemingly unimportant things. The "everyday stuff" that makes life what it is. Without it, life would be nothing more than a series of empty moment. And that emptiness would in turn, only fuel the hunger, the drive, the need to find one's voice…a never-ending circle. How do you find your voice and "be" heard. A search for meaning hidden inside photographs, poems, turning thoughts into "written words"…. Searching for meaning….It's a universal struggle, regardless of the art form, I suppose….

When you changed the "approach" of our "therapeutic process" I felt a loss of autonomy and respect….that I was no longer an adult, but instead~ a badly behaved child in need of discipline, not care….which is, apparently, a trigger for me. "I don't believe you! You can to do it!" – sounded very similar to "You're being a bad girl! You'll be punished!" – and so dear therapist, you became like the “professionals” from my childhood – the ones who really didn't care about what happened at my house. No one cared about the 4 year old brought to the hospital with recurrent bladder infections and vaginal tears. That wasn't their job, their job was to "fix" the symptoms, not understand why they were there in the first place. When my mother went to treatment for her drinking, time and time again, and I was required to "participate" – all I ever heard was, "you're very angry" – but no one took the time to "ask" why I was angry – because no one wanted to get involved. No one wanted to take the time. Why do you think that is? Why do you think it is that a neighbor wouldn't question the constant fighting, screaming, yelling – why an ambulance would show up time and time again. Why is that?

And all the latest "DBT" mantra, ranting, training, teaching, talking….all treatment focused on making me stop self-harming. I wanted to feel less depressed, I wanted to feel less anxious and less distressed, I wanted the memories and the nightmares and the compulsive thoughts to stop. And until they stopped – I had no desire to stop cutting or violently vomiting– because cutting made them stop (at least for awhile). And it seemed to me as though no one wanted to deal with the depression and why I was depressed and self-harming…the focus seemed to me, to be much like Pavlov's approach when he trained the dogs……it seemed to me that you thought, "if I say MINDFULNESS, or DBT, or MEANING-MAKING, she will make the connection that she must stop cutting & puking." Or perhaps the experiment of the rat who received a shock each time he displayed an unacceptable "behavior" – eventually, the rat will no longer do it. There was no longer an interest, or a care, about *me*, but only interest and care in stopping the unacceptable behavior….so that the patient can go back to work, and function as a normal human being, in society. I no longer existed- and that confused me – because I cut myself – I bleed – I see the blood – I must exist. But you insisted that DBT was the answer! You no longer saw *me*, you saw only the behavior, the behavior that needed to stop. Suddenly I am lost in a sea of "symptoms". And I exist no more.

And yet, I do exist – because here I am. Not the "trauma patient" the "cutter" the "ED" the "CSA Victim"~ not "the stubborn child" "the willful child" "the angry child" – but ME. The ME that somehow got lost in this process – ME – the intelligent, successful, caring woman who succeeded in spite of her childhood. The woman with a heart of gold, the woman whose smile could light up a room.. ME! ME! Grace – my favorite color is pink, my favorite flower is a gerber daisy and an orchid – my favorite food is pizza with black olives– I love the smell of clean laundry and rain when it just starts falling, I love the feel of a newborn baby’s head. I love to watch the sun set over the Rocky Mountains. I love to drink coffee out of the cup my son made me 5 years ago that says, "Happy Mother's Day”. I love to make my husband dance to Air Supply even though he pretends he doesn't like it. I love to tuck my daughter into bed and it melts my heart when she tells me I am the best mom in the world.

ME…Grace ~ I’ve known you for 3 years, but I don’t think we’ve ‘met’.

Saturday, February 21, 2009

The Pink Leather Journal

Pink is my favorite color. Yes, I confess ~ I am a very ‘girly-girl’. Now I never believed in fairy tales, or wishing on a falling star…. I knew at a very early edge that glass slippers and fairy godmothers and princes on white horses never existed. But I love pink, I love high heels and purses ~ and I love dressing my daughter in the frilly clothes I always wanted as a child, but never had.

I also love to journal. Writing, for me, is cathartic. To put my thoughts on paper, it somehow makes me feel better, kind of the same feeling I used to get from purging (probably a bad example ~ but fitting for me). I have filled journal after journal the past few years writing my thoughts, poems, letters to myself, my mother, my step-father….and others. But I have not written out the memories of my childhood. There are a few memories I have written in emails to dear therapist, but I’ve never spoken them aloud, or even put the majority of them on paper. Maybe fear has kept me from writing out the past, perhaps fear that someone will read them and judge me or feel sorry for me…I want neither of those things; judgment or pity. Or perhaps I fear that I will fall back into that little girl, and once again, live through the abuse I suffered as a child. I don’t have the answer to the question why.

Recently I was out shopping for a new journal ~ sometimes it can take me awhile to find the right one…I have a red one with a black buckle, an orange one with an owl on it, a brown leather one, one with giraffe print, and many more. As I was looking through the racks I noticed a pink leather book and I picked it up. It’s light pink, soft leather and has the word, “journal” in gold calligraphy on the cover. The pages are off-white with pink lines, thicker than regular paper. I held the book in my hands, feeling the soft, cool leather, and I knew that this was the one. This was the journal I would use to write out the abuse of my past. Somehow, I thought the memories, the filth and shame that I have carried with me for over 30 years would seem softer, more acceptable to me, held inside a soft pink book. I decided I would write the words in light blue ink, soft blue and soft pink ~ the colors that remind me of the innocence of a baby, a small child. For a moment, I was thinking like a dialectician, the book and my memories, the thesis and the antithesis.

Shortly after purchasing the journal, I sat down with a glass of wine, the journal and the pen in front of me, looking at the cover, wondering where I should start. What did I want to say first? Maybe I should start at the end with his death, and work my way back to the day that I died. But, then again, I thought, that might make it worse; maybe ending with his death would serve as closure to me, and thereby making it more difficult for me to handle, emotionally. Closure to a book, a memoir, shouldn’t start with the ending, right? As I pondered the thought of what to write first, I became hesitant to write anything at all. I thought back to the few times I felt brave enough to share some things in writing with Dear Therapist and I think about those things now, locked away in the file cabinet in her office, locked away in the back of her mind, and it makes me feel exposed, as though she has seen me at my most vulnerable…my secrets…my shame.

It had been months since I had allowed myself to willingly come to this place, the ugly place inside of me. Dare I begin the game of hide and seek once more? Sometimes I hide and my memories find me, but now I am the seeker ~ do I really want to find them? I am in a much better place now, stronger emotionally; my head clearer than it has been in a long, long time. The children in me are quiet, for the most part, allowing the adult Grace to lead ‘our’ life and keep us safe.
I picked up my pen and I started to write. I looked down at the paper, the soft paper; lined in delicate pink, and the words, the words I had written in light blue ink, filled the page. And these words written in my left-handed script were laid out before me, I had written them, composed them, but they looked foreign to me. The handwriting seemed too beautiful to have been written by me, but I did write them. I scanned what I had written and I saw his name on the page, his name, in soft blue ink, in my delicate pink journal…and I felt the familiar warmth on my face, and the bile rising in my throat. Once again, I had allowed him inside me, and something that was once beautiful now seemed ruined, dirty, soiled; just like me.

I realized then that tears had stained my cheeks. I don’t know if the tears started during the course of writing, or in the realization that came after, but I closed the book and ran my fingers over the soft pink leather one last time, and I whispered, “I’m so sorry I ruined you, I polluted your beauty and I took away your innocence. And now you are like me.” Like me, the cover of the book is not scarred, it is delicate and beautiful. But the inside, the inside is dirty & shameful…and full of secrets; secrets that I don’t know if I will ever have the courage to write in my journal, or speak out loud.

Friday, February 20, 2009

I prayed for the relief that death would bring...the only way out of the pain

I used to wonder how someone could get to the point where things seem so hopeless, so filled with pain, that the only way out is to die. There were times as a child, and as an adult where I would beg God to make him stop, make it stop – take away the pain. I didn’t want to die, I just wanted the pain to end. Last Summer I no longer ‘wondered’ how someone could get to the point where they saw death as the only way to make the pain stop. I no longer wondered because I was that person. I was overwhelmed with emotional pain that I was unequipped to handle and I became so hopeless that I welcomed, and actually pursued death. Some people think, “how selfish” – suicide is such a selfish act…and there was a time in my life when I shared these same thoughts. But I now realize that life can seem so hopeless that one can feel as though they are more of a burden on the people in their life, that their death would not only bring them relief, but would also be a relief to others.

One afternoon, after a particularly difficult therapy session, I knew that I was going to die. I remember pulling it together enough to pick my children up from daycare, and knowing I could not take care of them, I called a friend of mine to come and take them for the evening. And although I had spent the drive home from dear therapist’s office planning my death, a part of me must have wanted to live, because after I took a handful of anti-anxiety medications and a few sleeping pills, washing them all down with glass after glass of wine, I called a very close friend of mine. I did not ask her to come over, but I was crying, inconsolable and incoherent, and when she offered to come over, I did not tell her not to come. Some part of me, a small voice inside of me must have wanted to live.

I don’t remember much after my friend arrived, there are moments I remember, but much of the evening, I remember only from what she has told me. I do remember her offering, practically begging, to take me to the hospital, and I remember refusing to go. I wanted to die, why would I go to the hospital? To make my point clear, I took the empty wine glass I had been drinking from and shattered it on the floor. I then picked up a shard of glass and begin to make deep, jagged cuts into my forearms. I remember doing this and I know that it was me, but it was as though I was watching it from outside my body. Even though the cuts were deep and my arms were quickly covered with my own blood, I felt nothing. My friend grabbed some towels to soak up the blood but as I remember it, she remained calm; she did not panic or act like this was in any way an unusual situation.

The next thing I remember is talking to dear therapist on the phone and her trying to get my attention, to assess how ‘sick’ I really was. I was tired; I couldn’t understand why she was asking me questions, or calling me at home. I just wanted her to be quiet, but she wouldn’t stop talking. “Grace, what have you taken? Grace, how much have you had to drink? Grace, who is there with you? What did you take?”
Leave me alone! Why are you calling me! It’s too late ~ just leave me alone…let me go, leave me alone. I can’t do this any more.
But she would not leave me alone. She would not hang up the phone.
In those moments I was so angry at her for interfering with my plans.
It was weeks before I could talk about this night with dear therapist, and months before I would be trusted enough to have more than 2 days of medication in my possession at any given moment….I apologized to both my friend and my therapist for my behavior and for putting them both in such a terrible position. My friend shrugged it off as though suicide watch is part of the normal duty of friendship. Dear therapist later told me that she desperately did not want me to be her first suicide.
I never thought I would get to a point in my life where I would choose death over life, but I’ve been there, not so long ago. Life is fragile, and sometimes other people do things to shatter the lives of innocent people….but it is not hopeless. I have fallen since that night, and each time I fall, dear therapist reminds me that I am still alive, that I have gifts to offer to this world, and that she will not abandon me on this journey. And as much as I have fought myself, my past and dear therapist ~ she is still here with me. I have tested her over and over again; the children within me cling to her, and then push her away and then scream at her for not being there. But she has been true to her word, she has not abandoned us…even though the little voice inside me will add….not yet.

I hate Fridays

It is the feeling of being ripped away from that spot of hope looming in the distance, the spot where you wake up and realize that the past few months and years have been nothing but a horrible nightmare. You look around and you realize that the past was real but now you are safe at home, snuggled in a blanket. The air is still and you hear the sound of the dog snoring on the floor beside the chair you’re curled up in. This is your home. The home that you have made, the home you live in with your husband, your son, your daughter and your dog. But tonight those thoughts don’t bring you comfort so you turn your mind to the morning, knowing you’ll wake up and you will be okay. Everything seems better in the light of the day. The past is over, there is no longer a boogeyman to invade the protective bubble that surrounds you, and your children are sleeping soundly in their beds. If only you could let go and sleep…After awhile you give up and accept your impending demise. You begin to reach the point where you no longer care. The garbage that fills your mind now hinders your ability to focus on a task ~ most nights there is movie screen in your head – playing horror films that loop continuously ~ you search but you cannot find a way to stop the movie. You cover your face with your hands, trying to hide from the visions of the past. Sometimes there are tears, other times, anger. And always a feeling of confusion, the helplessness of being a stranger in your own body, unable to pull yourself out of your unwilling host and scream for help. Help me! Help! This is not me! I am hurting. Do you see this smile? It is not me – it’s all an act. I am not perfect ~ I am not innocent ~ I am afraid to be alone. And although this happens night after night you never find the strength to make it out. You keep falling, you keep changing into this unrecognizable person you weren’t meant to be.

That is how I feel. That is my story, my life. Each “you” is really “me”. I can cover up these feelings for awhile, pacify them with medications and relaxation techniques but I always come back to “this”. These moments when I feel hopeless and shameful for all that has happened lead to the realization that I am alone in this ~ this is all up to me, no one else.

Friday nights are difficult for me, more difficult than most. I know why and I recognize the triggers now, but recognizing and being able to change something are quite different. So once again, this Friday night, everyone is in bed, the dog is curled at my sleep and the only sound I hear is the ticking of the clock soft hum of the dishwasher – and despite the medication, the relaxation tools – I am once again, curled up in my favorite chair, wrapped up in my baby blue security blanket, the familiar lump in my throat taunting me, tempting me cry, to let go of the control. But I do not give in~ I do not dare cross that line. Because I know that once I cross that line I will not turn back. Although my eyes are watering and my stomach is churning, I will not listen to her voice….I will find a way to hide from her until morning, until the light breaks through the darkness, bringing with it a new day, and with the new day, comes hope.

Week 2 - Repair and Continue or Closure

DT heard me last week, I was confident of that, but I still was unsure of what she would decide to do. Would she be willing to meet me somewhere in the middle, or was she married to her recent ‘approach’ and plan of treatment? During my appointment this week, we discussed many of the things I had covered in our previous session. She told me that she did not see anything ‘unreasonable’ in my list of ‘things I need’ from the relationship, she showed me her ‘treatment plan’ for me, and she shared with me her thoughts about ‘our therapeutic relationship’ and my treatment the past few months. DT told me that I had been exhibiting self-destructive behavior that seemed to grow to the point of her having to take control of the process and intervene, and make some decisions that she knew I would not like (hum….like becoming completely non-communicative, threatening to put me into the hospital, only preaching DBT to me for weeks?). I believe the official term is ‘therapy interfering behavior’. I will take complete responsibility for my behavior – there were times when I would disassociate to the point that I was no longer present in my body, and I would only know what I had done the previous evening by reading the emails in my *sent* box. DT then said that now, in the present she doesn’t think my behavior is interfering, and I seem to be in a better place, emotionally, and I agree. She went on to say that she understands how damaging it was for me to have her completely take control and put some things in place in order to keep me alive and allow her to sleep at night.

She and I spent a lot of time talking about trust – I told her that because of her recent ‘behavior’ I no longer trusted her. In fact, I viewed her complete change in approach, and lack of communication no differently than I viewed my own mother abandoning me as a child. And since I no longer trust her, I wasn’t sure if I could continue working with her, and be vulnerable, since she could not be trusted. DT said this is ‘all part of the process’ – and my response to that was I was really tired of wasting my time and money week after week to work on the ‘issues’ she and I had!

DT told me she does care about me (I roll my eyes at that – I’d care about someone too if they were paying me $100.00 an hour every single week) and she wants to continue to work with me, to try to help me ‘find a life worth living’ (what’s that about anyway? That phrase!)

“So, where do we go from here?” – complete silence in the room. I didn’t know what to say.
What if I say I want to walk away and then I regret it?What if I say I want to continue only to find that I can’t rebuild the trust that I lost in her?

Finally, she broke the silence by saying that she would like me to come back next week so we can talk about the emails I sent to her in Jan and Feb (the emails contained information about my lack of faith/trust in her and the mental health profession as a whole, my interpretation of the *new* DT, and DBT…as well as information on the ‘research’ I took upon myself to do when began to feel like she wasn’t being honest with me about the treatment plan). I hesitated, but then agreed to an appointment. A part of me doesn’t want to continue, a part of me is holding onto the belief that she can’t be trusted and is using me as a resource to make her monthly car payment ~ but another part of me does believe that she cares…at least that’s what I see in her eyes….and that’s the part I went with. Maybe because I so desperately want to have someone know the ‘real’ me and still care.
I don’t know.

But as I was leaving, she said to me, "I am not perfect, I am human and I am going to make mistakes. But maybe through my imperfections, you will realize that you do not have to strive so hard to be perfect. It's okay to be human."

*Eyebrow raise* From Grace

DT Response: "Maybe a little?"

See you next week, DT....see you next week

Week 1: Repair and Continue or Closure?

Two weeks ago, I met with DT to discuss our ‘relationship – whether it was possible to repair the break and continue working together, or come to the conclusion that we should draw closure, for now, leaving the option open to continue at some point down the road. I spent 2 days preparing for the appointment. I needed to be ‘clear’ on what I thought I needed from her, what I didn’t want, my interpretation of ‘our therapeutic relationship’ the past several months, as well as issues around trust, boundaries and approach. Being in the business world, I have no fear of public speaking, and I had decided in my mind that I needed to treat this meeting like a business meeting. I needed to be confident, clear, direct and unemotional. Everything based on fact, not emotion. Of course, it isn’t exactly like a business meeting because there are ‘feelings’ involved.

I arrived at her office with 2 copies of my ‘presentation’, one for each of us, as well as articles and books that I had read recently about trauma, PTSD, DBT, etc. I could tell by the look on her face that she was surprised by the information I provided as well as my communication skills that day. In her initial communication about the meeting she said that we should take the time to “honor” our work together, and that’s just what I did. I needed her to understand that I am an intelligent, educated, articulate adult (well, most of the time) and if we were not able to come to a consensus (if she were to continue her recent controlling, non-communicative, clinical, ‘treatment by diagnosis – not person) I would end the relationship because it was not helpful for me.

DT had said, in her email about the meeting that I should be honest and candid (I was) and she would do her best to understand and ‘explain’ her position. I told her that I had complied with everything she ‘suggested’ (as I remember, it was more of an order)…I had started DBT, regular visits with PDOC, medication compliant, SI and SIB behavior reduced to nearly nothing….and yet, rather than make any improvement in “our relationship” – I was continually frustrated, feeling that she could no longer hear me. In fact, I went into the meeting with preconceived notions or expectations. If this were the end of the road with DT, so be it. I would get through it, I’ve lived through worse. We did not make it through everything that needed to be said, no conclusions were drawn at the end of the meeting. DT asked me if I would at least commit to an appointment the following week to continue our conversation. I agreed.
I left that meeting feeling like she HEARD me. She heard every word I said – and she heard it from “Adult, Professional, Confident, Intelligent Grace”. And I’m not sure she’s seen that side of me before…she has fought many times with angry and fighting Grace. She has comforted sad and lonely Grace, she has tried to reason with self destructive Grace, and she has witnessed dependant and clingy Grace on an occasion or two. But as I walked out of her office that afternoon, with my head held high, knowing that I had done the “best” I could… I glanced at her face, and I knew in that moment that she had *HEARD* every word I said.

Thursday, February 19, 2009

You have 3 choices

It was a warm day in June. I had spent the prior two weeks angry and overwhelmed with feelings of abandonment from my dear therapist. It started when she sent me an email that she was going to be away from her computer for the day so she would not be reading emails for the day, but she still had her phone, and if I needed her, I should call her. I emailed her back and told her that I was too much for her, and she responded by telling me that wasn’t true, that she was still here for me, that she did still care about me, and her availability had not changed. She validated my anger and said that she wanted to hear my anger and that I could call her and tell her how angry I was, on her voicemail.

Later that evening, I heard the familiar voices inside of my head, “You know she doesn’t care about you, don’t you? No one does – and for good reason too. It’s because you are bad, unwanted, and unlovable. No one will ever love you, or care about you. You feel shame because you should be ashamed. I hate you! Everyone hates you! You deserve nothing but pain!” Listening to the voices, I took a razor and I locked myself into the bathroom and I began to make long, deep cuts on my right wrist and forearm. Tears streamed down my face and a small, meek voice was begging, “please don’t do this, please don’t hurt me” – but soon her small voice was difficult to hear, a louder male voice, his voice, was yelling, “you deserve this! You are bad! You deserve to be hurt!” I could see the blood streaming down my arm and pooling onto the floor but I could not make the connection that it was ME that was being hurt. It didn’t hurt, I didn’t feel anything. It wasn’t really me…I was watching this woman hurting herself from above and I there was no connection between her and I.

At this point, I was no longer an adult, but had been taken over by the angry, frightened child inside of me. The child who felt abandoned, alone and scared – and she could not be consoled. And so the little girl sent DT a text message and told her she would leave her a voicemail, but if she called and DT answered the phone she would hang up! The message she left on DT’s voicemail was filled with anger and abandonment ~ promising that she would never return to therapy ~ not that DT cared anyway!

Late that Sunday night, the angry little girl became so overwhelmed emotionally, with memories and fear, that she sent several emails and text messages to DT, telling her that she couldn’t do it anymore – and the only way out was to just end it – for good. DT called back at 12:10am, and on my voicemail, she gave me three options:
1. Call 911 or go to the nearest emergency room – and call her to let her know I was there, or on my way there

2. Call DT back within 30 minutes and assure her that I could keep myself safe until she could see me the following day

3. If she did not hear from me within 30 minutes, then she would have no choice but to call 911 and send someone to my home to check on me

Her voicemail shocked the adult within me back in control and I called her back, I promised I wouldn’t kill myself that night, and we arranged a time for us to meet the next morning.
I was not present during the events of that night. I watched what was playing out, but I was not in charge, nor did I have the ability to take charge ~ it was as though I was watching a movie, I was playing the lead role, the star of the movie, and I knew the star was in trouble, but I could not help her. There was no way to pull myself back into that body, to take control of her, to stop her. It was not me. I was no longer there. And the girl who had taken over my body, felt alone, abandoned and hopeless. And that little girl wanted it to end ~ she did not want to live through the pain of abandonment again. She couldn't.

ED knocked ~ I invited him in.....again!

I don’t feel well tonight. I still find it hard to name my ‘feelings’ so I’ll just say I feel sort of anxious and sad. And I can’t really explain why, I can’t point to anything and say, “Oh, that’s why I feel bad tonight.”

I have been doing so much better, emotionally. I haven’t cut in at least 6 weeks, I rarely vomit now, which was something I was doing multiple times a day. Of course, as much as I hate to admit it, I seem to have traded one self-destructive behavior for another. Once again, eating has become a struggle for me. I have only eaten a few apple slices this week. PDOC asked me about it 2 weeks ago, and I was honest with her. She told me it’s a control thing and I’m sure she’s right (She is the ‘expert’ after all).

I haven’t weighed myself, but I can tell I’m losing weight. My husband commented last night that I’m getting too thin and he tries to get me to eat something. But I’m not hungry. Tonight I fed my dinner to the dog when everyone left the kitchen. Gawd ~that makes me sound like I’m a teenager and not a 37 year old woman!

People at work comment on how great I look and it feels validating and motivating. As if it’s a contest…Grace, how many notches did you tighten your belt this week. TWO! Tell her what she’s won!!!! If someone offers me food, I either tell them I’ve already eaten or I’m not feeling well. I have zero interest in food. And the harder someone pushes me to eat, the more I push back and refuse to eat.

In two more weeks I have another appointment with PDOC and she will ask me about it, and I know I have to be honest with her…but I don’t see it as a problem. I am compliant with my medication, I go to the DBT classes (even though I have found ZERO benefit from them), I have seen dear therapist both last week and again today, and I haven’t SI’d for weeks…. Just let me have this. This small bit of control over my own body…. I need this now.
And I don’t want to go to IOP.

Baptized in the holy water of psychotherapy

In the last 3 years I have spent a lot of money on "therapy"... I haven't taken the time to "add" it all up, but I assure you, it's significant~ I could have probably purchased a new Ford Focus.

Someone once told me that in this 'battle'
"Therapy is not a luxury, but a necessity."

Just to be clear, I am not remorseful about the time or money I have spent, but I do find myself wondering if there will ever be 'closure'. I wonder if someday my dear therapist, and my psychiatrist and my 'radical acceptance' counselor, and my nutritionist will take my clinical chart (which has more pages than War and Peace) and stamp "HEALED" on it in red ink, and file it away in the 'dead files', never to be reopened. I wonder.......

The reason I wonder is because the past 6 months have been harder for me than the first 2 years. I believe I have made progress, but through researching on my own, it appears that I am still standing on the first step in this process....the first step of many.

Some days I feel defeated, I question the point of all of this 'therapy' and I find myself thinking that I could be baptized, submerged in the *holy water* of psychotherapy/cognitive behavior therapy/supportive therapy - and I would still not be *cleansed* from this.

Today is one of those days...................

Wednesday, February 18, 2009

Solace through Writing

I am so tired tonight~ I don't know if I even have the energy to let out the tightness I am feeling inside my chest. I don't want to lie down, or close my eyes ~ I fear I will become overwhelmed with negative thoughts. I find solace by clicking the 'create post' button and typing in this box. Writing is cathartic for me.

I sit here, night after night, oblivious to the storm raging in my head....please, don't let me hear....please, make me not feel anymore....and I barricade myself, waiting for the night to end.

Some days I feel like this is HELL ON EARTH
It's on these days when I swallow my screams, I tell myself "this too shall pass"...and I hear a faint voice inside my head echo my thoughts....'soon...soon...soon', she tells me. There is no use screaming, or begging, or reasoning with with myself, or the others within me. Please don't let me lose it tonight...I don't want to fall back is not worth it.

WHY? I ask the question in my mind over and over again: WHY? WHY? WHY?
There is no answer tonight, there is never an answer. There is only anger, and sadness, and so much pain. I don't want to hate. I tell myself I don't have to take it anymore...soon...there is an end. His face taunts me, his angry voice fills the silence, his sarcastic laugh envelopes me in fear, his evil snort makes me cringe, his stale breath makes my skin crawl.

Where are you? I cannot find myself. Some days I see a shimmer of hope which I visualize with every beat of my heart. But I no longer hold any *expectation* ~ it's easier this way.


I was watching a video on YouTube, it was called, Chinese Translation.
In the video, a young man asks a "wise old man" 3 questions:
1. What do you do with the pieces of a broken heart
2. How does a man like me stay in the light
3. And if everyone says that life is so short, then why is the night so long

Why does the night seem so long?
The anxiety I feel as night approaches is at times unbearable. I talked to my PDOC about it and she told me to take 2 ativan - instead of 1 and see if that helps. I am about medication compliance, so I take 1 ativan around 8, another at 9 - then I take Seroquel around 10(ish). The meds seem to help (or perhaps it's the wine I wash them down with?) .... well, something is helping with the dissociation.

Now, rather than finding myself on the bathroom floor with a razor or some glass, I find myself in a chair, clutching a blanket....sometimes just quiet sadness, other times it's his voice I hear - only now I can't escape it. I have to just "be" - and when that happens, I can't sleep and I feel so so sick to my stomach. And I wait it out - I wait for the meds to take affect, and just before I fall asleep, I stumble up the stairs into my bed for a few hours.

But it's "okay" - because I am "managing". There's no blood ~ there's no cutting or burning myself. I "sit" with my feelings and my nightly mantra is to remind myself that I am "okay", I am an adult, I'm no longer a child~he is dead, he can no longer hurt me. Only I can hurt me now.

And every night I find myself wondering if this is as good as it gets. Maybe there is no *finding a life worth living*, perhaps instead, it's *finding a life worth 'tolerating'. And I can accept that. For now.

I accept that in order to not exhibit self-destructive behavior that no one wants to see, that I take a strong mood stabilizer every morning, and every evening I wash down 2 ativan and some seroquel with alcohol, and "accept" that this is me. - there's no one else here, there's no one else who can help me, no one else to care. I accept that I am a strong, independent woman, who has always, and still can, take care of myself....and it's okay - because I accept that right now this is the best I can do.

Tuesday, February 17, 2009

Latin word: INCESTUS

Two years ago, Dear Therapist suggested a book that she thought would be helpful for me to feel connected to others and not so alone in the world. The book is called, “Secret Survivors – uncovering incest and it’s aftereffects in women” – by E. Sue Blume.
I agreed to read the book, and because of the shame I felt by the title, I ordered from Amazon rather than picking the book up at the local bookstore. And even today, 2 years later, it is a book that remains hidden in a basket, not on the beautifully hand-crafted bookshelf that was designed to show off the vast collection of books I own.

The word “INCEST” is derived from the Latin word INCESTUS- which means, sexual impurity. Impure! I am impure! He made me impure! I am not offended by many words, but I find the “I” word the most difficult word to say. For me, it is charged with emotions – it means so many things to me, and I’m sure for others like me. It means fear, betrayal, abandonment, humiliation, secrecy and shame. The word is full of shame. It is sadistic, painful, brutal… and for me, the very word, incest, has the power to drain the life from my veins. It makes my brain convulse with a torrent of emotions and thoughts, images and memories.
I try to convince myself that it’s just a word, just a word….but it isn’t just a word – it represents so much more than that for me. It was incest – sexual impurity. It happened to me, it was forced upon me – I had no control over it, it was no longer my body, I no longer owned it, he did.

The book, Secret Survivors, is well written, very informative – but parts of it are triggering. I find it interesting that even the title of the book is written as though it is to be spoken in a whisper….SSHHHHH! *WHISPER* “secret survivors*…don’t speak it out loud, they are full of shame…it must be kept a secret…

Certain words are not meant to be spoken out loud. For me, *incest* is one of those words.

What Works/Doesn't Work for me in the "Therapeutic Relationship"

The past few months have been a struggle for me in therapy. After my recent conversation with PDOC, I realize I need to take a stand IN PERSON, and either come to some agreeable terms, or agree to terminate therapy with my current therapist. I decided that I need to take a stand in “MY” healing process, and really state what I NEED from Dear Therapist. So after spending some time pulling my thoughts together, putting down on paper my thoughts of what works and what doesn’t work for me in this process, I came up with the following list.

Respect me as an individual and not a diagnosis
Validate my feelings – be warm and caring
Trustworthy and open with communication ~ if something needs to be changed, or you don’t think something is working, COMMUNICATE with me
Be genuine and real~ don’t be afraid to call me out about something I am doing that is harmful or non-productive
Focus on the WHY and not the SYMPTOMS (what’s the underlying problem – that is causing the symptoms?)
Ethical, sensitive and tuned in
Ask questions, push me when I am stalling, encourage me and be supportive, engage me
Communicate with me (within reasonable boundaries) – if I hurt your feelings or offend you, or if there’s something going on w/you that is impacting “our” relationship.
Availability via phone, text, email ~ within reason
Be willing to work WITH me, not AGAINST me
Be honest with me about your “therapeutic approach” and “boundaries” ~ I’m smart! If I don’t understand something I will ask you!

A therapist that hears me but doesn’t LISTEN
Too professional and by the books
Does not validate my feelings
Is non-communicative with respect to MY treatment
A therapist who is SILENT
A therapist on a power kick who views me as a paycheck
A therapist who does not follow through on what she says she’ll do, or drops the ball
Unwilling to negotiate what is and is not working
A therapist who only nods or paraphrases – “standing still” therapy does NOT work for me
A therapist who is dismissive
A therapist who labels me, or talks in circles without really saying anything
Unclear boundaries, not ‘agreed’ upon – blurred. I cannot respect what I am not aware of
A therapist who will not admit or apologize for mistakes
A therapist who is a blank screen
A therapist who only believes in ‘tough love’ or ‘containment’

Choices ~ Stay or Walk Away?

I am the one who put everything behind me and moved on with my life. I am the one who is now in the midst of trying to piece the fragments of myself back together. I realize that I have, perhaps, been a *burden* to Dear Therapist, that she tried to support me, until last summer. When suddenly something changed….and, of course, as a “client” it isn’t appropriate for me to ask – WTF? So I began to research. And I have been trying to “analyze” my therapist – I have researched treatment for trauma, complex PTSD, BPD…I have spent hours in the library, days on the internet and lots of money on Amazon – trying to find out what the hell she is doing in MY treatment plan. Because ultimately, I know it is MY responsibility to “repair” EVERYTHING that has been the result of my childhood abuse. Mine! And recently, I have found myself wondering if therapy is doing more harm than good. I find myself not only trying to deal with the fragmented parts of myself, and the memories and the inner voices, but also the frustration, week after week, in therapy. I honestly question if she knows how to help me.
After I leave her office, I still have to function like a “normal” human being. I have a job, family obligations, friends….. And in addition to those responsibilities, I have to deal with the memories, the flashbacks, the intrusive thoughts of what was done to me in my past. I am the one who has to take care of myself and my family. I am the one who has to deal with the nightmares and I am the one who has to talk myself back to the present when I wake up in the past. I am the one who has felt like the only way to deal with the overwhelming emotional pain is to literally cut my own skin. And I am the one who has to live with the scars and the questions.
I am the one who has a *team* of clinicians who consult and decide what to do *TO* me and I am the one feels like a rat in an experiment gone wrong. I am the one who has to endure the side effects of ALL the medications I’ve been “put on” – the nausea and vomiting, the dizziness, the sleeplessness, the irritability, the migraines, the inability to concentrate, the weight gain…… ME! I am the one who has to *fake* being ok- when my therapist threatens to put me in the hospital….or *ordered* into IOP classes for ED, or DBT. I am the one who I am the one who trusted a therapist and laid myself bare for her to see and I am the one who must deal with the feelings of being ignored, invalidated and treated with disregard – now – in the present. And I take responsibility for all of the above.

But I will NOT take responsibility for HER behavior, for her seemingly lack of understanding about me. Nor will I take responsibility for her lack of communication of her treatment plan, new approach, or her newly developed boundaries, which are apparently a moving target. I will not take responsibility for she has decided is “therapeutic” in her mind, or her “ideas” about how things should be done in MY treatment. I will not continue in a “therapeutic relationship” with someone who clearly does not even know me after 3 years!
There is no logic to this treatment – there is no “one way” to treat trauma. It isn’t like a physical ailment. I have read Judith Herman, Marsha Linehan, Peter Levine….and others! I’ve read everything Van der Kolk has written! And everything is subjective! EVERYTHING! Read about borderline personality disorder – no one knows what “causes it” (I think it’s just a way to label “difficult” patients, patient’s who don’t just roll over and accept what their therapists say, but instead question things, try to educate themselves, and even *GASP* have the nerve to disagree with something a “trained professional in the field” says.) Everyone has an opinion on treatment: Schema is the answer, no it’s cognitive-behavioral, well, maybe it’s “supportive”, no the real answer is transference therapy, nope DBT. There’s no answer – no consensus on what actually helps.

Some “Mental Health Experts” say, “you must talk about and process the trauma”, others say, “no – don’t talk about it, stay in the present and manage the behavior in the present”.
Of course the past shapes the present, which will shape the future – and the life I am living now and who I am. And I am the person who is FORCED to take responsibility for the harm that was done to me and to my life and not just from the abuse of my past. And I shouldn’t have to fight my therapist, but alas, I have had to repeatedly, and it is exhausting. Why? Because NO ONE wants to listen!

And despite what is “said” by the MPH – “if you’re treating a pt w/BPD, 99% of the time, you are to be silent – don’t fall for the “sense” of urgency or their “demands” – you treat them by “standing still”. Do not respond or intervene even when the patient virtually demands some help for some relief! Yes, why would anyone do that? If a PERSON, a F***ING HUMAN BEING is having intrusive memories that won’t stop, and the only way to get them to stop is by cutting their own flesh – why would anyone need to respond to that? As long as the MHP is “the same” when the door to the office is opened, and the “crazy pt” is asked to come in, as long as the MHP is “present” during that 50 minutes each week. If the “borderline” expresses feelings of “abandonment” do not make any unusual interventions to calm the patient – this is a mistake. The MHP should ‘stand still’ and take no action in the face of the patient’s demands for help. The MHP must not “saddle” themselves with the role of trying to make the patient feel better”….. ALL PATIENTS – NOT “therapy as designed for each individual”. High functioning BPDs, quiet and loud BPDs, IP and OP BPDs….just *stand still*. “If you build it, they will come.”

I don’t know where I will go from here, but I am NOT an diagnosis, I am not a “plan of treatment”, I am not intellectually challenged - I am a PERSON and I will not be placed into a treatment plan that was developed by professionals who have no first hand experience of abuse and are not interested in what I say works or doesn’t work for me. No one listens – and yet I am still talking – and just because you, dear therapist, are standing in your office week after week, always the same….”Here I am, crazy girl. I am standing here, the same – it doesn’t matter which “you” shows up (angry, sad, happy or frustrated) – I am the same, I am here, “standing still” acting like I am happy to see you" - does NOT make you the "expert" on what I need!

You tell me it’s my “choice” – yes, my choice – you give me 2 options, both of which are ridiculous and clearly not what I need and tell me to “choose” one – but tell me again, it’s my choice! Of course, what do I know….I’m way to “volatile” and “fragmented” to know what I NEED from this process.

Well, turn up your whisper 2000 and “stand” or “sit" still and LISTEN to me, HEAR me, interalize, and PROCESS what I have to say because it is important! You tell me what I “need” from you, now let me tell you what I thought I “needed” from you. I thought I needed someone to listen and hear me, someone who would allow me to speak, to believe that I mattered, and someone who would support me through this process. But I was wrong……
Clearly, by your recent “behavior” – what I really needed was someone to tell me to “regulate my emotions” and “stay in the present”, control my unruly, abnormal behavior so no one, including you, would be ‘bothered’ by it. What I needed was for you to teach me to feel, and have you tell me that ‘feelings are always okay’ and then stuff it all back down again when it was ‘too much’ for you to ‘deal with’. What I really needed was a strong mood stabilizer and an anti-psychotic, and an anti-anxiety – which would take away my ability to *escape* the pain, but not provide me with the tools to *deal* with the pain I can no longer escape from.

Of course, it’s all transference – I must be transferring my feelings from my past onto you – therapy interfering behavior – but it’s all me – you know what you’re doing. I’m the “client”, you’re the ‘expert’. And the pain I feel, it has nothing to do with your recent sins of omission, or misplaced trust. Or your sudden lack of communication and your “change in approach” that you won’t even admit has occurred!
You want to talk about ‘choices’ - yes, there is always a choice. I’ve always had choices.
“Do you want to lie there quietly, or would you rather scream and fight me and I will beat you and then F*** you.”

I can *choose* to call you and ask you for help and you can *choose* whether or not to call me back. I can *choose* to continue to be frustrated by the fact that you *chose* not to call me back. I can *choose* to continue to be frustrated by the fact that you *chose* not to call me back – or I can *choose* to accept it.

I can choose to stay, or I can choose to walk away….. Sometimes both choices suck – but you’re right – there’s always a choice!

Monday, February 16, 2009

Focus on being "REAL"

Sometimes we enter into a therapeutic relationship without doing our research and understanding what the process is about, what we expect from the therapist, etc....and this makes it difficult to ask for what we need, state what we don't need - and come to a consensus with the therapist on plan of treatment, boundaries, expectations, etc. At least this has been true of me. Of course, there are many of us who enter into a therapeutic relationship because we know we aren't "mentally healthy" and we are 'nudged' into therapy by someone who cares about us. And if we aren't 'healthy' enough, on a mental plain, it's difficult to know what we need, or even communicate the basics in therapy.

If we have come from an abusive past, it may take a year or more to actually begin to see the therapist as someone we can trust, someone we can count on to help us, well, understand ourselves. We may go into therapy limiting information about ourselves. Perhaps we tell the therapist in the beginning of therapy that we are *depressed* - but do not disclose much of the past. We do this for good reason, too. We grow up with the belief that no one can be trusted, that we are 'bad' and no one loves us - and that eventually everyone we meet will either abuse us, use us or leave us. At least this has been true for me.

My mother is an alcoholic. I grew up knowing that my mother did not love me, that she never wanted me and the only reason she 'kept' me was because my maternal grandmother would not let her give me up for adoption. I know this because my mother took advantage of several opportunities through the years to tell me this. My mother abandoned my older brother and me in a hotel room when he was 2 and I was 6 months old. She and my father took us 1000 miles away from our 'home' and left us in search of booze and cigarettes. A few days after she left, we were discovered by a woman who called the authorities, who then notified my grandmother. My grandmother flew 1000 miles (standby!) to rescue us and bring us home. Grandma was a school teacher and the time and she had to take off work, AND miss her Aunt Bea's funeral, to come and get us. I know this because I have heard this story many grandmother loved us so much she took off work, missed her favorite aunt's funeral and flew stand-by 1000 miles to "rescue" my brother and I). By this time, my mother was back, and she decided to come 'home' with us. Of course the "best" place for a child is with her parents, so we were not taken away from my mother. And really, (she says dripping with sarcasm) it wasn't her fault, it was the alcohol that made her do it. I did not grow up feeling loved or wanted, and was often shuffled back and forth between my grandparents and my parents - because my grandma thought it was important that I have a "relationship", albeit an abusive one, with my mother.

I had been in therapy before....therapy, ACOA, Al-Anon...I tried them all on, and I never found a fit. And I was so good, such a fine actress that all of the "professionals" dismissed me as someone who had it all together and didn't need therapy. I always did well in school, I was a 'model' student, bright and studious, I had many friends, was involved in many school activities, active in church, I never rebelled....why, they were simply amazed that a child who came from such a disruptive background could escape unscathed. The only 'professional' that said anything at all to me, who questioned my facade, was when I was in high school and my mother was in a treatment (again!) and I attended meetings once a week, as part of HER treatment. The man (I have no idea if he was a "therapist") told me I had a lot of anger. Wow Einstein! That was tough to figure out! But that was it, he didn't inquire as to why I was angry, or ask any questions....just a statement, "You have a lot of anger."

About 3 years ago, a friend of mine at the time told me that I needed therapy. I was having panic/anxiety attacks, obvious signs of depression...I knew she was right....and so I conceded and picked a therapist who took my insurance plan and made an appointment. What could it hurt? At most I'm out a $15.00 co-pay for a visit. I don't know what made me continue to go week after week after week. I don't know why this therapist seemed different. But after about a year, my therapist said to me, "Isn't it tiring? Being so fake all the time?" What? I wasn't fake - I was bubbly and energetic...busy and successful! Fake? That week she gave me a home work assignment: read the "Velveteen Rabbit" (and I have to admit, I'd never read the book before). I read the book - big deal! So a rabbit wants to become *real* and so he can feel pain? Why would I want to do that? I realize that isn't the 'message' of the book, but that was what I took from it at the time. I didn't get it. I had no idea what she was trying to say to me, what was the message?

I entered therapy because I was 'depressed', 'anxious'.... My therapist treated my depression/anxiety. But there was much more than that, and I don't know if she is just intuitive, or a private investigator, but she seemed to know it. And she seemed to know just the right time when she had gained enough of my trust to ask some deeper questions. I guess you could say Dear Therapist knew that I was complex, even with what little background we had covered, but she had no idea of the extent. And I couldn't tell her, a stranger, about my pasts. It was shameful, a dark secret I had locked away years ago and placed in a box on the top shelf in my closet. The things that were in that box were things I wanted to forget, things I was unable to talk about, reveal to anyone. Secrets that were shameful. Things I had escaped from and ran away from....But they followed me.

Sunday, February 15, 2009


I recently started DBT classes. For those of you who are unfamiliar with DBT, it is “therapy” originally created to treat those “difficult” to handle patients who suffer from *GASP* Borderline Personality Disorder (BPD). DBT stands for Dialectical Behavioral Therapy, which promotes LIFE SKILLS for EMOTIONAL health. Dialectical behavior therapy (DBT) is a psychosocial treatment developed by Marsha M. Linehan specifically to treat Borderline Personality Disorder. While DBT was designed for Borderline Personality Disorder, it is used for patients with other diagnosis’s as well (such as Complex PTSD & Trauma).

DBT combines cognitive and behavioral therapy, and incorporates mythologies from various spiritual practices including Eastern mindfulness techniques. DBT is done in a group setting, which meets once a week for 2-2.5 hours and clients are taught 4 specific skills:
Core Mindfulness skills
Emotion regulation skills
Interpersonal effectiveness skills
Distress tolerance skills

Let me provide some color around the above skills to give you a flavor of the goals of DBT, and what the “therapy” is supposed to accomplish (or, I should say, eliminate). In addition to the group DBT classes, the client should also be in a “therapeutic” relationship to discuss “issues” that come up during the week. Self-injurious and suicidal behavior should be first on the radar screen closely followed by therapy interfering behaviors.

Mindfulness is the first skill taught in the class. Mindfulness comes from the Zen tradition and the core skills are:
WHAT skills:
HOW skills:
There is a super fun DVD on this! But please ensure you've consumed maximum caffeine dose, because Linehan on DVD - YAWN!

Mindfulness is the first module taught, rightfully so – if one finds oneself on the bathroom floor at midnight, with a razor in one hand and a glass of wine in the other, feeling no pain while watching blood drip down one’s wrist – all while watching the scene take place while outside one body, mindfulness obviously is not a skill being practiced. Each class begins with a mindfulness practice. While mindfulness comes from a meditative perspective from Buddism and western contemplative spirituality, DBT carefully avoids any religious connotation.

Interpersonal Effectiveness is similar to assertiveness and problem-solving classes, such as those taught in business school or human resource management classes/seminars. These skills include saying no and coping with interpersonal conflict. (enough said)

Distress Tolerance skills teach one the ability to “accept” oneself and the current situation, in a non-judgmental fashion (there is a “reason” why a person does something/anything – and we “accept” that person as they are – except of course, if the patient is “expressing” self injurious behavior, and one is a mental health professional – “acceptance” does not come into play in the aforementioned circumstance). *Note that “acceptance does not mean approval. While most approaches in mental health treatment focus on “changing” distressing events, these approaches place little emphasis on learning to bear pain “skillfully”. Clients are taught 4 crisis survival skills: “self-soothing”, “improving the moment”, “distracting” and “pros and cons”. Some examples include, if one is in the throes of an “intrusive memory”, or depressed – try taking a warm bath, or having a cup of tea. This should help - if not, clients are encouraged to have a *distress tolerence list* handy - and this would be a good time to whip that out!

Emotion Regulation is the forth skill taught in DBT. Learning to regulate your emotions is crucial to these volatile clientele for they frequently exhibit suicidal and self injurious behavior and are often emotionally disregulated – angry, frustrated, depressed and anxious (perhaps no different than most of society in today’s troubling, uncertain economic times).
Emotion regulation skills taught include:
Identifying and labeling emotions
Identifying obstacles to changing emotions
Reducing vulnerability to “emotion mind”
Increasing positive emotional events
Increasing mindfulness to current emotions
Taking opposite action
Applying distress tolerance techniques

Opposite emotion is perhaps my favorite. If one finds oneself crying uncontrollably, or overwhelmed with feelings of self hate or hopelessness, just put on 'The Wedding Singer' (don't become emotionally disregulated if you don't own 'The Wedding Singer' - any comedy will do - 'The Wedding Singer' (or any movie with Adam Sandler and Drew Barrymore - are at the top of my distress tolerance list!) or, if you prefer books to movies, pick up the latest romance novel – this should provide immediate relief! But, be careful NOT to read anything potentially triggering, such as researching BPD, or Trauma, I wouldn't suggest picking up 'The Courage to Heal' during these "distressing moments".

There is another key piece in DBT that I have not yet mentioned and this is “phone coaching”. Frequent, short “coaching” calls with the DBT instructor are encouraged with one caveat – if the client has already utilized a “maladaptive behavior”, such as drinking, cutting, overdose of ativan, the rule is that the “Coach” is to tell the client “Please don’t call me – you’ve dealt with the pain for now” – and must not talk to the client for 24 hours. (Now, should that client be seriously suicidal (especially after not being “accepted” by their *trusted DBT coach* - of course she should call 911 or go to the nearest emergency room (or, just kill herself – since the person she reached out to has refused to help).

DBT is NOT for everyone – it was developed for clients who have been diagnosed with BPD, or other “severely disordered” or “self-injuring” clients. It is not for “normal” people. An example of a “perfect DBT client” is someone who has repeatedly been in trouble with the law, inappropriate anger, mood swings with intense depression, irritability and anxiety. Recurring suicidal threats or self injurious behavior, unstable personal relationships, black/white view of people and situations (alternating between: all good/all bad) and frantic efforts to avoid abandonment.

DBT promotes “acceptance” rather than denial and shame and therefore uses language that is descriptive and non-judgmental and pejorative overtones are avoided. For example, rather than say “Gawd, she must be PMSing – she sure is *bitchy*”, you would instead say, “She seems to be emotionally disregulated today”.

And good news for “clinicians”! Working with this *highly volatile client group* is draining, so there are consultation groups for clinicians to talk about “cases” they’re working on and review their responses.


As I mentioned earlier, I have been attending DBT classes so the opinion that I offer is not from a “clinical” perspective, but from a “client” perspective. First, I would like to say that DBT is not “therapy” – it is in no way designed to focus on the symptoms that lead to the “abnormal”, “bad”, “unacceptable” behavior of these “highly volatile clients”. Read any article on DBT and you’ll see that DBT was designed for the “HOPELESS”. Second, I would offer that these clients are *ordered* to attend DBT classes because they are exhibiting “bad”, “unacceptable” behavior – and DBT is their *last hope*. Furthermore, these PEOPLE (and they are REAL PEOPLE, with REAL EMOTIONS – NOT a “diagnosis”) already believe that they are “bad”, and “abnormal”, and have lived their lives “hiding” behind a mask that is acceptable to society, never revealing how they really feel because they KNOW that they will be deemed “insane” or “incurable”, and now, being sent to DBT – is VALIDATING what they learned as children!




DBT teaches PEOPLE, adults who were abused as children, women who have lived their lives in silence for fear of ridicule and blame – that their “abusers” were right; they should not cry, they should not tell, they should behave themselves and hide behind a socially acceptable mask – and DBT will teach them to do this in an “acceptable” way. Not by dissociating or self-injuring – but by “noticing”, “distracting”, and being “mindful” of the fact that no one really wants to hear or know that abuse happens and the affects of the abuse never go away.

DBT has taught me to “suffer in silence” – because if it gets to be too much, if the pain bleeds out, if I exhibit behavior that is “unacceptable” to my therapist and others – then I may be labeled as a “volatile client” who is “difficult” to handle and told that DBT is my last hope!
My friendly advice to all the CSA survivors, victims of repeated abuse, or rape – don’t think about the past, put it all behind you – because if you’re unable to “deal” with the pain without “acting out” than you too will be attending classes to teach you how to “forget the pain and stay in the present” and to “half-smile” when you’re sad. And chances are, you already learned these “skills” as a child and it didn’t cost you $2-$4 grand to learn them! In my personal opinion, DBT does nothing a good “mood stabilizer” and an “anti-psychotic” can’t do…..for a fraction of the cost!

*DISCLAIMER: While factual information on DBT has been researched and presented in this article – the opinions expressed are those of the author through personal experience. While Marsha Linehan was contacted, she refused to comment. For additional information about DBT please consult with a *qualified* DBT clinician in your area.