This is just a quick blog, which was inspired by a friend but I’m hoping, in a non-cheesy way, that it will give some hope for those of you in therapy for BPD and cannot see it working.
A friend of mine recently asked for some suggestions for role plays for the interpersonal effectiveness module. (As an aside, I actually taught some of this module when I was still in the DBT programme). This led me scurrying off to dig out my DBT folder, which in turn made me think about the process I went through in DBT.
I had my last DBT session at the beginning of October 2013, after having monthly sessions for consultation over the summer. The fact that I had to dig out my folder after such a short time is a testament to the therapy programme itself. It felt tedious at times (hence me ending up teaching a number of sessions of emotion regulation and interpersonal effectiveness modules) but it clearly stuck in my head as a result. However, my life isn’t Carrie + skills, which was a very big worry of mine for a long time during therapy. The skills are integrated into my life. When I’m distressed or struggling with anxiety or just life in general, I know what I need to do. Incidentally, this doesn’t mean that I always do it. I don’t have to think “oh, what DBT skill should I be using for this situation?” I don’t need to go check my file or books. It just happens. I know instinctively what I need to do to help myself from getting too emotionally dysregulated.
That would have all sounded unbelievable to me during a large part of the therapy programme. I spent the first 3 months desperately wanting to harm myself, and really, what I wanted in fact was to be dead. It was horrendous. I was in crisis after crisis even though I wouldn’t say I was depressed as I experience episodes of depression now. I was using ‘phone coaching, which for me was a big deal – to get to the stage of ‘phone coaching I was desperate. I never reached out for help and still struggle with the idea of reaching out for help. Despite that desperation, I managed not to self-harm or attempt to take my life during that time. Looking back, I don’t know how I managed – I was clearly a heck of a lot stronger than I give myself credit.
After those first 3 months I moved onto a different part of my therapy ‘journey’ for want of a better word. I was actually quite angry. My urges to self-harm and/or kill myself were greatly reduced. However, I felt I had been tricked. I was no longer doing those things that cause inconvenience for medical and mental health staff but I was feeling so much pain still. I had only started recognising what emotions I was experiencing let alone learning how to regulate them without frequent recourse to my DBT notes and skills list. I worried that I would be left in such immense pain but without an outlet, which I knew worked for me, albeit temporarily. I think professionals call this “quiet desperation” and it is incredibly painful – I can still remember it now. It felt hopeless in a way.
It gradually got easier (bar a period of depression of a number of months towards the end of 2012 but even then, for the most part (bar a couple of suicide attempts), it was managed skilfully). I started to use the skills automatically, and this enabled me to spend 2013 (the last 6 months of the 18 months DBT programme) working on things personal to me – managing the depression and the ‘highs’ of my ‘mood disorder’, anxiety, family difficulties, coming up with plans to deal with the usual patterns/difficulties I have, etc. This was when therapy came into its own for me. I got good at recognising patterns of thoughts, emotions, and I discovered for myself what I need to do to help myself now and in the future. I developed self-awareness, which is quite frankly, a gift. I can’t explain how much a difference that has made because my self-awareness has also allowed me to consider what is going on for other people.
I do have what I have titled ‘Carrie’s Book of Cures’, which I created using themes I found through my individual session notes I’d made. It also includes the plans for specific problems, e.g. depression, elated mood, anxiety etc. It’s also where I am continuing my own therapy by looking into self-compassion. I also have that nagging voice in my head that a number of the DBT psychs noted I need to address – ‘perfectionism’, but I really don’t think that’s a problem. My DBT therapist laughed when I said that I’m not a perfectionist because I’m not good enough. Anyhow, that’s for another blog. If I am struggling with something, I can refer to that book but it isn’t something to which I turn very often.
I hope that laying out a condensed version of the major parts of my DBT therapy helps those who are currently in the midst of questions such as:
Is this it? I’m no longer self-harming but I hurt so much and I have no outlet for it. Is this the purpose of therapy? Am I always going to have to be me + skills? Won’t I ever just be able to live as a ‘normal’ person?