Why DBT and mindfulness is helping me get more out of therapy.

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For anyone suffering from BPD who wants to undergo psychodynamic or trauma therapy, I definitely recommend taking some DBT (or CBT) classes first. This also applies to people with complex PTSD, as the symptoms of C-PTSD and BPD can be almost the same (and for Borderlines, usually co-exist together).

I’ve been in therapy many times throughout my life, but I never stuck with it before. I usually would quit, because I either gave up in frustration or things got too intense. My first instinct whenever things in life would get too uncomfortable was to run. I had zero insight into myself or why I reacted (or overreacted) to things the way I did. I always thought everything was someone else’s fault. Yet I was constantly apologizing for things that weren’t my fault. I know that’s confusing, but I was confused. I was ignorant about boundaries and then wondered why others got offended when I unwittingly invaded theirs. Either that or I put up too many boundaries, not letting anyone in or rejecting people who tried to get too close.  I had a martyr complex, always felt picked on and ganged up on, was constantly paranoid and hypervigilant, always feeling like everyone hated me and was out to get me. I was ready to go off on someone or act out at the slightest provocation, believing I was being attacked unfairly. I was much more likely to attack things than people (I was constantly breaking things; self harm was never really my thing) but my violence toward objects and verbal tirades still upset those around me and upset me too after the fact. People always told me I overreacted to everything, but I always felt like it was somehow justified. I couldn’t see the part I might have been playing in all that.

To be fair, I was horrifically abused both as a child and as an adult, so my paranoia and distrust of others wasn’t completely unfounded. I was trained to be a victim and tended to act in ways that ensured I would remain a victim, without knowing I was doing so. I still struggle with this. I still tend toward codependency.  I still find it hard to connect with people in any meaningful way.   I’m a long way from being the person I want to be or that I could have become, and I may never get there completely. But there’s a big difference between the way I am now and the way I used to be. Mindfulness.

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What is mindfulness? It’s the ability to think before you act, be aware of your own actions and reactions, and have insight into your own motives and why you do the things you do. It’s staying in the present, instead of fretting about the past or worrying about the future. It’s being able to step back mentally and see yourself the way others see you. Being mindful keeps you from acting out in ways you might regret later on. You’re not constantly apologizing because you acted out without knowing, because you can stop yourself before you do. Being mindful is like receiving a pair of magic glasses that allows you a view of yourself you never had before. You might think that having this “inner critic” would make you self-conscious, fearful and awkward, but ironically, it does the opposite. Because you have the ability to know how to act before you act, you have more control over yourself, and therefore more control over how others react to you. Slowly, you begin to find that people are reacting more positively to you, and you have fewer reasons to lash out at others or overreact to things. You begin to trust others more, because you trust yourself more.

Mindfulness is a wonderful tool in therapy, and is helping me get so much more out of it than I ever did before. I took DBT classes in 1996, when I was first diagnosed with BPD, and at the time I sort of blew them off. Because I was still in my abusive marriage, I was still very sick and not really ready to do the work. As long as I stayed with my narcissist, I was not going to get any better, but I didn’t know that. My ex had me convinced that I was the problem, not him. Because of his triangulation and gaslighting, he had everyone else convinced I was the crazy one too and he was just the put-upon victim. He’d systematically goad me into a BPD rage, knowing he could, and then with a smirk of satisfaction, tell everyone how insane I was. His personality and manner came off as more cool and collected than mine did, so I probably really did look crazier and more out of control than he did. But he was pulling all the strings.

Anyway, back to mindfulness. It wasn’t until early in 2014, when I finally went VLC (very low contact) with him (and kicked him out of the house), that I started to change. First I started to write and that’s why I started this blog. Writing every day helped me gain insight into myself and my narcissists. After a few more months, I began to realize I needed to make a few changes to myself. I pulled out my DBT workbook (Marsha Linehan’s Skills Training Manual for Borderline Personality Disorder) and began to do some of the exercises. I had already been doing a few of the things, but this time I took it more seriously and tried some of the things I hadn’t before. One of those things was paying attention to my internal, bodily state whenever I felt an unpleasant emotion. By doing this, I was able to begin to name what I was feeling. Emotions are very physical things. By naming an emotion, you can allow yourself to feel it, realize it’s just an emotion and not “you,” and learn to have more control over it.

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In therapy, I find I’m constantly focusing in on my bodily state, whether there’s any tightness, pain or strange sensations. There always seems to be pressure or tightness in my stomach, chest and throat that goes away when I can name the feeling and begin to express it. Being mindful this way of my internal state and naming my feelings, I’m much less likely to act out against other people or break things. I’m working now on breaking down the protective emotional wall I’ve developed that overlies softer feelings of sadness, grief, empathy, and connection with others. For many years it seemed the only emotions I ever could access were fear (sometimes straight up terror), shame, guilt, anger, and rage–and mind-numbing, zombielike depressions where all I wanted to do was sleep.

There are many ways to be mindful. Some of them are very simple, like counting to ten before acting. Others require more concentration. We need to learn how to self-soothe, something we never learned how to do as babies or young children. Being mindful allows you room to learn self soothing techniques. The insight you gain into yourself by being mindful also allows you the ability and courage to dig deep when you decide to undergo psychodynamic therapy. You’re going to experience powerful emotions when you’re searching for the root causes of your illness, and being mindful allows you to experience them without overreacting, acting out…or quitting therapy.

When your therapist rejects you.

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I just read a post from a blogger who describes how her therapist suddenly terminated her without warning.  She writes,

I spend pockets of time here and there throughout the days just wracking my brain trying to figure out what went so wrong. I replay our conversations in my head and try to decipher what this meant or why she said that. I try to figure out what the fuck I did wrong.

It’s devastating and crazymaking.  Unfortunately, being suddenly rejected by a mental health professional seems to be pretty common.   People who have never been in therapy sometimes have trouble understanding how devastating this can be.  We become extremely attached to our therapists through a process known as transference, especially when the therapy is of the psychodynamic type (as opposed to behavioral/cognitive methods like CBT).  The therapist acts as a surrogate parent and for a therapist to terminate a patient without warning is akin to a parent rejecting their child. It’s extremely traumatic and the victim often develops PTSD from the rejection, especially if they already have attachment or trauma-related issues due to rejection or neglect by caregivers when they were children.   The problem is that many people with mental disorders themselves become therapists, often to work out their own emotional issues by proxy.  They may not be aware they are doing this, but it happens all the time.  That’s why therapists are encouraged and even required to be in therapy themselves, in order to address any counter-transference issues that may come up with their patients.

If my therapist ever rejected me like that…ugh, I don’t even want to think about that. I think I would just want to crawl into a hole somewhere and die.  I know he would never suddenly terminate me without good reason and without explaining why, but because I worry about everything, sometimes I worry about that too.

I’ll give you an example of how ridiculous this worry gets.   In my last session, toward the end, I asked my therapist if he had any children.    I don’t think I had any reason to ask other than simple curiosity.   But after I asked I felt liked I’d somehow overstepped his boundaries (he did answer me).   I don’t even know why, really.  He asked me what made me ask him that.  Maybe he thinks this is significant.   I imagined I saw an angry or concerned look on his face after I asked.   But I always imagine negative looks on people’s faces even when their expression is actually neutral.   I feel like I should apologize.    I don’t even know if he was upset by my question but I still feel like it might have been a boundary invasion.    I know he wouldn’t terminate me for this, but I still worry that he might like me less because I *might* have invaded his boundaries.

It’s so dumb that sometimes I feel like I have to be perfect even for my therapist.

Further reading:

50 Warning Signs of Questionable Therapy  (red flags you should know about):

There are over 700 comments under the above post. I was shocked at some of the stories I read about horrible therapists who make their clients even worse.

Infatuation and Transference:  Please be aware that I wrote this post over a year ago and my views about transference, which were mostly negative at that time, have changed.

 

Storyteller.

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My therapist told me I’m a good storyteller.
This was one of the most validating things anyone ever told me. He likes my stories. I keep him entertained. I make him laugh and keep him on the edge of his seat.
Yay me!

Maybe I really could write that novel and keep millions entertained and become rich and famous after all. Why not? Its never too late. Hell, Grandma Moses didn’t become a famous painter until her 90s. There’s nothing wrong with being a late bloomer.

I always thought of myself as a pretty boring person and an even worse storyteller, because I didn’t think I had any stories worth telling. But I’m finding out that’s not the case.
We all have a story to tell. We’re all actors on this stage called life.

But feeling complimented isn’t really the reason I’m over the moon about what he said. It doesn’t matter if I have the capacity to entertain anyone. I don’t really care if I can make people laugh or keep them quaking in suspense or move them to tears. That’s not my reason for being here.

It means a lot because I feel like he cares. I keep him entertained because he cares about me or at least does a pretty good job pretending he does (but I don’t think it’s pretending). He’s very good at what he does, but more importantly, after four sessions, I feel like we have established trust and a good working relationship. He’s one of the few people who ever showed me any real empathy. I feel like I could tell him almost anything.
Except one thing.

I realized this week I’ve developed strong transference feelings. That’s supposed to happen in psychodynamic therapy. It’s like limerence but without the sexual aspect. I just want to be cared for and protected by him, as if he’s the nurturing and caring surrogate parent I should have had. These feelings can be intense. They replicate ancient attachments from early childhood. You’re supposed to work through them. Right now I just feel incredibly excited to be seeing him again tomorrow.

I know this euphoria won’t last. It might even become painful. I’m prepared for that. I’m idealizing someone I don’t even know. All he is is a mirror, in which I can see whatever I want–or see aspects of myself I can’t own yet. I went through this when I was 22 and wound up walking out on my therapist because I couldn’t handle the intensity of my feelings anymore. But I’m older and more mature now, and know a lot more about how this stuff works than I did back then. Therapy isn’t easy. It’s work, hard work, and I’m prepared to roll up my sleeves and get busy instead of slacking off and expecting to just suddenly not have any problems anymore.

He doesn’t know yet. I don’t know if I’m ready to tell him. He may figure it out even if I don’t say anything. Maybe I can tell it like a story.

Mental health madness.

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Good mental health treatment is becoming increasingly a thing of the past. Many times, it simply isn’t available to those who aren’t wealthy. Most company-sponsored health insurance plans don’t even cover mental health anymore, unless it’s short term or if your problem directly affects your job. Most of the time, they’ll just fire your ass.

Mental health for the poor is even worse. If it’s even available in your community, it could take weeks or months of waiting after an entire day spent filling out forms before you even get your foot in the door for your “intake session.” Once you do get in the system (if you do), you’re sent to a bored psychiatrist who wants to pump you full of drugs instead of send you for long term psychodynamic therapy. Then you have to check in weekly with some condescending nurse-practitioner who asks you a litany of prefabricated questions (one size fits all!), takes your temperature and weighs you (why?), and asks you about your drug use.

That’s right. Drug use. It seems like psychotherapy programs for the poor try to siphon you off into a “drug treatment program” if you admit to even sipping a glass of wine a few times a year or having a few tokes of weed on occasion. Where I live, the only free “mental health” program is a drug-treatment program in disguise. Having little money, I went there not too long ago to get therapy for my depression and anxiety and had to fill out about 10 pages asking me about my “drug abuse history.” I walked out.

That’s why I’m currently paying out of pocket for a real psychodynamic therapist who focuses on digging into your childhood and stuff (eg, the kind of therapist rich people pay for) even though I’m poor as fuck.

Welp, I have a therapist!

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I didn’t think I could afford psychodynamic therapy, but there’s a program called Open Path Collective, and the rates are about half the market rate. All you need to do is pay a $49 lifetime membership fee to have access to their list of therapists. I already chose a therapist in my area who has weekend and evening hours and who specializes in trauma, PTSD and attachment issues. This is real psychodynamic therapy that gets to the roots of the problems, not just behavioral treatment, which is usually all that’s available when you’re limited on funds.

I feel really good about this decision, because for months I’ve known I really needed it. I can’t do this on my own anymore. I’m actually excited about it. As soon as I get my Member ID in my email, I can set up my first appointment. 🙂