While I was looking

for pictures of our crib bedding and car seat for the craigslist ads, I ran across these two old posts dealing with therapy topics from my PPD days. Good stuff on integration, emotions vs will, reality, and acceptance.

Integration

War against reality

Advertisements

DBT and dissociation

I came across a blog post alleging that many survivors of childhood sexual abuse have been further traumatized by therapists applying DBT to them.

Basically, they are told to stuff their feelings related to the abuse, because it’s in the past. No connection allowed to that past self and his or her experiences, even though those experiences are hanging in limbo and can never be metabolized without revisiting them. It’s yet another authoritative voice saying “Shhh! Don’t tell, or you’ll get in trouble.”

Part of the trouble seems to be in the wrong application of the various skills, as if any of them were always universally applicable.

The skill of distraction is overapplied, as if it’s appropriate for all situations, and as if dissociation were not a danger. The skill of temporarily storing overwhelming emotions is likewise misapplied, as if the therapist were conveniently forgetting the “temporarily” part and the need to revisit those feelings at a more safe time and place. The skill of not catastrophising is applied as if there’s no such thing as a catastrophe, instead of only when the distress is NOT a catastrophe. The skill of acting opposite to feelings is misapplied, as if the idea is to hide one’s yucky self or deny one’s yucky feelings, instead of mere impulse control: being able to have one’s feelings, own them, but act according to wisdom instead of impulse. In fact, I remember DBT focusing on emotions being value-less — that even the so-called “negative” emotions are important and have something to say to us. They shouldn’t be pushed aside any more than they should be deliberately sought after.

Some of these skills seem to me clearly intended for distresses that are mild to moderate, not severe. They’re for distresses that recur after you’ve already dealt with the root issue — distresses that you KNOW are based on lies.

Take the half-smile, for example. Of course it’s ridiculous to think that simply smiling will solve all of your sadnesses. But I don’t think that’s the point of the skill. It’s just one small tool. For occasional no-good-reason blues, it’s a great physiological feedback tool. For deep sadnesses, it can be a very small comfort, again purely physiologically, not as if you’re pretending not to be sad. There’s no “should” or “must” about it, and it’s not about denial or stuffing.

Then there’s apparently an idea that using the skills is a matter of instant perfection, and not practice. The blogger writes about people being chewed out for mentioning their distress in group. Yikes! How can you learn distress tolerance if you can’t even mention distress? And again, distress tolerance isn’t the same thing as distress denial or not being bothered by distress at all. It’s about letting each distress be its own true self, neither making it more of a catastrophe than it is, nor minimizing it less than it is. It’s about trusting that the true self can survive, can get through, will not be destroyed by the distress.

It sounds to me like part of the issue is a matter of language and connotations. When a therapist says something like “acknowledge without attaching,” it might mean something very different to their client. Maybe the therapist means “Stay in the present, but allow yourself to feel the feelings that are coming.” Maybe the client hears “The person that experienced those feelings is not, and never was, you.”

Suppose you’re the client and you’re experiencing distress because of something from your past. I think there are at least three possible approaches.

1) You might get sucked into the past moment as if you’re time traveling, reliving it exactly as you did in the past. In this case, there’s no sense of the present moment at all. There’s not enough separation from the past moment to observe it, listen to it, evaluate it, and respond to it. There is only reliving and reacting. I don’t think this approach can solve anything, and it seems clear that it could cause problems in the present.

2) You might push away, deny, or ignore the past moment as if nothing from the past matters anymore. This approach is even less helpful, even though it might preserve a semblance of functioning in the present. The present self grew out of the past self, and so the past DOES matter. Past experiences — especially those that haven’t been fully metabolized — will continue to exert pressure on the present self, causing all sorts of present problems.

3) What seems to me the best approach, in line with how I understand DBT and what I learned in other therapy as well, is to be present while the past moment is speaking. Don’t time travel, and don’t shut your ears. Feel the feelings, experience the experience, mindfully, neither pushing away nor clinging. Listen with compassion. Listen with your present self’s wisdom. See what the past self is saying, what the past self needs from the present self. The only way to metabolize that past moment’s feelings is to feel them — in the present.

You can’t change what happened in the past, but that doesn’t mean it’s safe to ignore the past. Ignoring the past and time-traveling into it are both ways of fighting against reality. Mindfulness is NOT saying reality is wonderful and peachy-keen, but it is accepting that reality is what it is — including the realities that this is the present, and that the past really happened and really matters.

Maybe a keeper

Had my second session with a potential therapist tonight.

Joe Bauserman was my first and best therapist — local when we lived there, and by phone when I was going through PPD. I always thought I’d be able to “see” him by phone again if I ever needed to. He’s gone, now, though; melanoma, early this year.

So one of my projects for this year was to try to find someone new — so that next time a crisis hits, I won’t have to scramble around looking for someone I can work with, having to start all over with the whole history and background and getting to know one another and all.

I researched online, made a list of potential folks in the region and some who offered phone sessions, and started sending emails and making phone calls. Eventually landed an appointment at this office, a month ago. This lady is old enough to remember ice delivery, is a psychologist (from past experience I am skeptical of social workers and pastoral counselors, at least for me), and works in a Christian office. The first appointment was basic background questions from her, interview questions from me, and me realizing (duh) that just interview questions and answers would not tell me all I need to know. I’m going to have to actually work through some stuff with her before I can know if we’ll work well together or not.

So I made another appointment — tonight, a month later.

She listens well. She is open to clarification — I mean, when she suggests an interpretation, it’s not set in stone, and she doesn’t get huffy if I challenge or try to clarify. She takes notes. She has good ideas. She isn’t too hasty.

By the end of the session, I had that good kind of shaky feeling — the intensity was just about right for a productive, fruitful session.

So tonight I made another appointment, for next month.

I need to find out how much, if anything, our insurance will cover, but if it’s financially feasible, I could see a monthly session potentially being quite fruitful for a while.

On being a therapy veteran

I called the South Bend Samaritan Center yesterday, in my ongoing pursuit to find a new back-up therapist — someone I could go to in case of another crisis or if I ever feel the need to do more deep therapeutic work.

The receptionist I spoke with was patient and polite and attentive. I like that.

When I explained that I wanted to interview some potential therapists, she was a little surprised, and with a little laugh said that they’d never had anyone want to “interview” their therapists before.

(She was willing for me to make appointments with either of the psychologists on staff, but the person I was most interested in was not available on the days Mark is available to watch Amy, so I postponed appointment-making until he and I could work that out.)

Reminds me a little of the place I went to last year — I had an intake interview where I had to talk about my situation to someone who was not a therapist, and especially not my therapist, so that they could determine which therapist I would see. I complained, and they said it was standard procedure.

When I was new to therapy, I didn’t know about any of this stuff, either. I hadn’t read anything that talked about how to find a therapist, questions to ask, warning signs, etc. I count myself blessed to have been referred to such a good therapist for me, by someone I trusted.

I get the feeling sometimes that some therapists and therapy offices don’t really welcome a veteran — they don’t always want to be questioned, or to let the client choose which therapist to see, and so on.

I can understand that, to an extent. Why welcome someone who might be critically comparing you with their previous therapist(s), or constantly wanting you to do things the previous therapist’s way, or questioning you in general.

And yet, I hope I can find someone who will consider my past therapeutic experience a good thing, a foundation to build on.

Interviewing therapists

One of my summer projects was to interview new therapists — so that in case of another crisis, another major depressive episode and / or string of panic attacks, I’d have someone. It’s no fun to try to find a therapist in the midst of a crisis.

First, I searched around online and made a list of potential people. A month or so later I eliminated one because his website bothered me, and emailed another, whose schedule is full. A week or so later I emailed two more, both in Chicago.

Both agreed to an interview, and although I forgot to mention it until the next round of emails, both agreed to possible phone sessions. Both also agreed to interview via email.

I sent my questions.

One said that after reviewing my questions, she thought it would be beneficial to interview by phone. I was willing to do that if really necessary, but I told her how I’m a visual person and if we could interview via email I wouldn’t have to take notes and would have time to really process the answers. Then she said that she didn’t think even phone sessions would work for her, and that she thought I’d be better off with someone else.

The other hasn’t responded to my questions at all yet.

I guess I’m not that surprised.

I wish the first one had just explained why she would rather do the phone — I was willing, if need be. If she couldn’t even handle my rather gentle pushing on that issue, I suppose she wouldn’t be a good therapist for me anyway.

She also wanted at least one in-person meeting before doing phone sessions, and I agreed to that, provided the interview went well. Perhaps if she’d insisted on an in-person interview, I’d have been willing — I would have rather strongly preferred to have a good interview first before taking the trip to Chicago, but I would have been open to negotiation on that point. Again — yes, I pushed back, yes, I resisted, but hey — that’s part of what therapy is for (not that I was resisting just to be difficult). If a therapist can’t handle what I think is a reasonable amount of resistance, they’re probably not a good choice for me.

I might ignore the second, or I might email again asking when I could expect a response.

If you saw my list of questions, you might say something like “What did you expect? No one has the time to write out thoughtful answers to all those questions!”

And yet, that’s me. I HAVE all those questions. I’m not in a hurry. I can wait — I can accept one question answered at a time. I can even work with “I can’t answer this one fully, let’s try to rephrase it to something more reasonable for a first interview.” I could have even worked with “Let’s do this by phone — that way I can see which of these questions is really most important to you, and how much of an answer you need for each one right now.”

I can’t work with being ignored or being dismissed with only paltry attempts at communication.

Maybe sending my overwhelming list of questions is as good a way as any to weed out therapists who don’t really have the time or energy to deal with someone like me.

The other thing is that I’m not looking to do regular therapy right now — so I wouldn’t be a source of income for anyone right now. There’s not much motivation for a therapist to take my name in case of a crisis. Again, though, I wish I could find one who would have the guts to tell me so — who could say “I would need to have three or four weekly sessions with you to establish a working relationship first; then I would be willing to be a standby in case of crisis.”

What a bummer that the one I had a working relationship with, the one I could have returned to, is dead.

Reading Joe, mid-August to mid-September

A good many of Joe’s posts were about the fear of the Lord, translated to the fear of the self — fear of self-government, self-reliance, self-trust. Fear of letting go of God, fear of separation from him.

Abstract like that, it sounds reasonable.

I know that I am wayward, and I have learned that when I am discontent or anxious or feeling empty, it’s a sign that I’ve strayed, and I should turn back, and I am being called back and that’s how I recognize my waywardness.

But some of his posts seem so strident, like he couldn’t rest in or enjoy any little thing because of his fear, his confidence, that there is sin in it.

I think I must be missing something, because that doesn’t really sound like the Joe who was my therapist. Joe so often counseled me to know and trust myself — to have a more internal locus of control — to listen to my intuition.

It reminds me of my little theory of health — that what looks like holy behavior and holy words can come from either sub-healthy or super-healthy places — the sub-healthy is no self, but a doormat, a robot, an empty vessel. The super-healthy is so secure in Christ that he or she no longer needs to protect and defend self.

You can’t get to super-healthy without going through healthy first, which looks a lot like what secular psychology tells us — good boundaries, self-awareness, reflection, all that sort of thing. Not a lot of cheek-turning yet, because a developing self must learn to protect and defend itself before learning how a greater Protector and Defender bests its own efforts.

It is so difficult to discern anything.

I want something — is it something God wants? Is it something I am allowed to want? Just because I want it, does that mean God is against me having it?

I fear something — is it something that should be feared? Is it something God wants me to flee or to face? Is the solution I imagine God’s plan of deliverance that he is revealing to me, or my own attempt?

I suppose the main point is to stay with God — not to fear leaving him so much as to hope, intend, and desire not to leave him, and to trust him to bring me back when I do stray. Perhaps someone who, like me, struggles so much with general fear and anxiety, does not need more encouragement to be fearful, but more encouragement to trust — and to fear the right things.

But again! Discernment! How does one trust God and fear waywardness, and still live in this world, making use of all the resources that have been provided, such as food and therapists and friends and computers, but not making idols of them?

Not a map, but a navigator — not a checklist, but a guide — “not a religion, but a relationship” — I need to more and more be relating to, interacting with, talking to, listening to, following God, and not just thinking and talking and writing about him.

Lord, teach me to listen, and to hear you. Please answer my questions. Please guide me. Please give me faith and wisdom. Because it would sure be a lot easier to trust you, and to obey, if I could know for sure where you are, what you look like, what you want me to do, and all that sort of thing.

PS — It’s funny how much I fear becoming so “holy” or “close to God” that no one wants to be around me, or that I don’t want to be around anyone, or can’t enjoy anything. Again, I’m pretty sure there’s some deep misunderstanding involved in that fear. I have been around people who are annoyingly “holy,” but I have also been around people who are restfully, beautifully, welcomingly, inclusively “holy.”

Emotions and interpretations

I’ve been reading Joe’s blog, the one he and his wife kept while he was going through cancer treatments, up until he died several weeks ago. I just started at the beginning and am slowly making my way through. In his near-daily reflections there’s a lot that I remember hearing in therapy, and it’s good to be reminded.

One post I read today tells a story from Joe’s past when he was feeling burnt out as a therapist and went to complain to a friend. The friend told him he needed to remember who he is in Christ, and assured him of his confidence that the Lord would help him.

My mind has been chewing on the story today, in the background as I play with Amy, make the bed, do the dishes, contemplate how sleepy I am, wonder why I keep getting fraudulent calls purportedly from American Express.

One of the things I learned from Joe is that emotions themselves have no moral value. Whatever you feel, it’s valid — it’s true — it’s real — that is, the feeling is valid, true, and real.

And so, if you’re feeling burnt out, frazzled, in the pit, surrounded by rotten turnips, you can acknowledge those feelings and experience them in their full reality.

At first glance, Joe’s story seems to be contradicting that — you might be tempted to think his friend was telling him to buck up and deal, stop feeling sorry for himself, stop complaining — telling him he was wrong to feel the way he was feeling.

But that’s not quite it. The correction isn’t directed at Joe’s feelings, but at the way he was interpreting them and thus the way he was interpreting reality.

And that totally meshes with what I learned through DBT, particularly the prompting event worksheet. That worksheet has you name your emotion(s), describe your physical and mental state during the emotion(s), list the interpretations you apply to the emotion(s), and then challenge those interpretations as needed.

Most of us resent being told to stop feeling a certain way. My hunch is that most people who give such advice might be confusing feelings with their interpretations.

Another thing. Part of my response to this post of Joe’s was / is to be annoyed with God, and a little dismayed. Isn’t there ever a time when I’m allowed to complain, allowed to acknowledge that not everything bad in my life is my own fault? WITHOUT having to also acknowledge my participation in the bad, my need of repentance, my waywardness? And I have to remember that it isn’t that God is out to make me grovel, to keep me down, to take all possible joy away from me — and that it is exactly his goodness and mercy that allow me to see my sin without despair and excessive grief. Humph. Sort of.