A DBT Flowchart

A few weeks ago, I posted about my confusion and frustration with figuring out when to use the abundance of new skills I was learning through my Dialectical Behavior Therapy workbook. I have tons and tons of notecards that simplify all of the information the book is spouting at me, but I needed something more comprehensive so that I can have an idea of where to go in the moment when a wave of emotions hits me hard.

I’ve been in a wonky place again for the last couple days and have pretty much been withdrawn from the blog world and the real world whenever I have the choice. The positive thing about that is while I’ve been hiding away from people, I’ve put all my energy into developing that needed flowchart.

I’m pretty happy with the results. Obviously, this is not a perfect system, as no issue is so black and white that it can be resolved by some arrows guiding you. However, I feel that it’s a worthy starting point for me that can replace some of that helpless feeling.

Hopefully you can read my handwriting. It’s broken down into color by unit (the colors I used when highlighting my book). Green is distress tolerance, blue is mindfulness, purple is emotion regulation, pink is interpersonal effectiveness.

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As anyone using DBT knows, there are many things that crop up when you’re trying to use skills which block you from being successful. I couldn’t fit all of that in one diagram, so I ended up with a second flowchart that specifically highlights some of the issues I typically run into.

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I don’t know if these will be helpful for anyone, but I wanted to share them. In a very rocky period as I look towards the beginning of my first real job, this has brought me a sense of calm and peace. There’s something about getting organized that makes me feel so empowered.

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Emotions Are Part of the Package

Acceptance. I’m continuously talking about it. I’m continuously working towards it. Acceptance of past mistakes. Acceptance of things I can never have in my life. Acceptance of just so many things pertaining to therapy.

This post isn’t about those. It’s about a different, and maybe even more difficult, kind of acceptance.

I describe myself as being on a path to healing and I have all sorts of ideas what being ‘healed’ might look like. As such, I judge my progress in therapy based on the frequency and intensity of my low moods, assuming that I’ll be healed when they taper off consistently. When I’m ‘happy’, whatever that means, I’ll be better.

The truth is, I think that my greatest fantasies on what being healed will look like may be slightly off base.

My intense emotions aren’t going to just go away.

Maybe later there will be a reduction in intensity. Over the course of a few years or hopefully at least by the time I’m into middle adulthood. Right now though, my disorder is still very active and intense emotional experiences are one of the biggest pieces of BPD. Add to that all the transition and changes I’ve been taking on (new job, trying to date, thinking about trying to move out, etc.) and it only makes sense that I’ve been so prone to sudden and extreme mood shifts.

That isn’t something that just lifts right out of my life.

As a consequence, therapy isn’t aimed at completely vanquishing my negative moods. It’s aimed at helping me tolerate them. The intention is to enhance the process of identifying the emotions, sitting with them, refraining from judgment, and self-soothing so that they pass faster.

Let me tell you something, each time I remember this it’s like being sucker punched.

You know why? Because realizing this means realizing that for me to reach a place where I can tolerate pain, I’m going to have to endure that pain. I think this realization also involves reframing my idea of what helpful therapy is for me.  Therapy needs to mean discussion of the topics that will ultimately trigger these emotions so that I can practice coping with them. It needs to be a little be difficult and there needs to be vulnerability, otherwise the emotions stay concealed and then definitely no progress is made.

Worse, living my life means engaging with the emotions all the time all by myself! That’s what we’re working for, which I’ve known all along but feels so much more isolating when I remember that supporting myself means supporting myself not just through minor bumps in the road, but through deep pain.

Even when the intensity ultimately fades, I’m still going to have periods of sadness, anger, fear, shame, etc. Humans have emotions, I can’t just get rid of them.

Which sucks, because those feelings are really uncomfortable for me. I’ve been associating having them with doing something wrong, with not doing enough hard work, and avoiding them at all costs. Especially in therapy, I’m been projecting this image of myself as fine and getting stuck behind a barrier for fear of what talking about what is really bothering me will stir up.

So when a really challenging topic came front and center last night and I was in a sea of my own scary and intense emotions, I wanted the ground to swallow me up.

Sometimes after nights like that, the minions come out with their routine doubts of J. She doesn’t care. Obviously, she doesn’t care because if she did she wouldn’t leave me to deal with all these emotions by myself.  These are the same doubts I’ve had about friends time and time again when I’m in a bad place. How could they leave me to handle this by myself? Why aren’t they trying to help?

But really, we can only experience emotions on our own. Others may be present, but the experience is ours alone. J can’t erase the emotions. My friends can’t erase them. They can support me within the boundaries of their respective roles, but beyond that it’s a waiting game for me that can only be supplemented by my own self-care.

That’s the biggest radical acceptance part. That therapy is going to draw out the demons and I will have to slay them on my own after I walk out the door. That this is going to keep happening as we discuss the trigger topics. That this is perfectly normal and isn’t indicative that J doesn’t care or that I’m doing therapy incorrectly.

It’s just part of the battle. Hopefully, accepting this and participating with the emotions will help them subside more quickly and maybe not even hurt so badly one day.

I know this means I have to talk to her about all the other stuff that’s eating at me, even though it’s almost definitely going to feel like utter hell.

In my fantasy world, being healed meant that nothing ever bothered me. Unfortunately, that is not reality. I think I need to work on accepting that negative emotions will be part of my life sometimes instead of striving for longer and longer stretches of positivity. Feeling well isn’t a reflection of progress, being able to cope with feeling unwell is.

Emotions are part of the package. Not just for someone with mental illnesses, but for everyone! It is not shameful to feel negative emotions. It is not a failure. It is not wrong to let them exist and sit in them for a little while.

Fighting them only gives them power. I can’t go around them, I have to go through them.

 

What I’m Not Talking About In Therapy

J is going on vacation next week. While I never look forward to a therapy break, I’m almost relieved that she will be gone.

Therapy has been weird in the last couple weeks. I have a sort of ambivalence towards going. On one hand, I yearn to see her because she’s kind and safe. She encourages me and reinforces my hard work, which I both appreciate and need. I’m happy when we work in the DBT book because I like talking about skills and I have been able to comfortably discuss some of the issues that have come up in my life.

On the other hand, I’m holding back. There are a few topics I’ve been going to great lengths not to talk about. When she asks me what’s on my mind, I shrug and look away. Then I bring up something else, literally anything. I spent fifteen minutes talking about the girls I babysit during a recent session just because I didn’t want to admit what was really bothering me. J went along with it. She either hasn’t noticed that I’ve withdrawn or she isn’t asking about it.

Of course, the minions think she has noticed and just hasn’t mentioned it because she doesn’t want to deal with me. Always worst-case scenario with them.

Here’s what I’m not talking about:

Relationships. A huge trigger for me right now is seeing other people in relationships. Whether it be pictures on social media, a relationship on television, or couples out in the world, it immediately floods me with emptiness and envy. The immediate thought is: I will never have that. 

I don’t feel pretty or interesting enough to attract someone, which makes it hard enough to meet someone as it is. I fear rejection. I’ve been trying online dating for about the past month and a half, but dating is scary to me. Relationships are a rarity for me, so I’m not well versed on how they operate. Intimacy is even scarier. The second anything seems like it could be a budding relationship, I find a reason to shut it down. I don’t trust myself enough to know if I ghost people because of valid reasons or my own fear.

J and I have discussed this in the past, when I have previously tried venturing into the online dating world. It hasn’t been brought up in a long time and she has no idea that I’ve seen someone four times and gone on first dates with a few others.

Attachment This is perhaps my least favorite topic in all of therapy, talking to J about my relationship with her. I always feel all of six years old, a little girl whining for her comfort item. Recently, I wrote and sent J this letter, which she read in between sessions. If you don’t feel like reading it, it pretty much just outlined my difficulty with accepting her positive reframes and how that was impacting my motivation to continue with therapy and how much progress I thought we could continue to make.

This topic is nothing new to J. Even though I absolutely hate talking about it, I do occasionally. She knows that my negative transference creates thoughts like she doesn’t care enough and feelings of anger at her for being so “together”. She also knows I’m simultaneously very attached to her and I dread the end of therapy. She knows I struggle with containing my feelings once I leave the room.

Yet, I can’t think of a single time that talking about it has left me feeling like the issues were any bit resolved. Maybe this is negative filtering, but I have no recollection of us developing any real solutions. When the job hunt process began, I frequently expressed the fear that I would get hired somewhere too far away from her and it would end our work. She was often quiet when I said this, mostly because, as she later admitted, there wasn’t much she could say that would be helpful.

Even that letter I sent her, we barely discussed. She encouraged me to continue coming to therapy, and she validated a few things I said. She told me there was a lot in it we could address, but I stayed pretty quiet since I was riddled with shame, so we never addressed it. And we haven’t since.

Right now, there’s a lot of transference happening. It’s part of the reason I don’t want to discuss relationships, because every time she offers up a suggestion I want to reject it because she’s married so how the hell can she understand that no one will want me. There’s frustration with her for appearing so perfect and put together, as if because of that she could never possibly understand.

I hope I’m not painting J badly. She does the best she can. She’s a good and competent therapist. Whenever I ask, she’s always willing to remind me that she’s there for me. I have plenty of posts documenting that she cares.

Yet the attachment issues continue to linger.

SuicideI mentioned in the letter I wrote to my suicidal self that I’d actually made suicidal gestures while I was at one of my recent low points. Namely, the skeleton of a plan and three notes. I admitted this to J only after I asked her what I would have to say to make her involuntarily hospitalize me. Because I needed to know where the line would be, how much I could share without getting myself in hot water.

When we discussed this, J did make me assure her that I could be safe in the time between sessions . However, she’s not asked about it since. As much as I think she’s really good at her job, I find this surprising.

I know that suicidal ideation is a characteristic common to sufferers of BPD. For me personally, it is a common product of intense sadness, anger, shame, fear, or jealousy. I’ve expressed the thoughts repeatedly in two years, so J is quite familiar with them.

I wonder, does she assume the thoughts have subsided since the job offer? Or does she assume they’re still there, but that I’m not acting on them?

For over a week, I’ve been having suicidal thoughts each night. Over the weekend, a small trigger saddled me with them for a good portion of time. Even though I’m not actively suicidal at this moment, I’ve been quietly planning. Continuing with the notes. Considering other details. The how, the where. The conditions under which I might give in. I limit myself to how long I’m allowed to do it; only half an hour at a time. Then I must do something kinder. But regardless, it’s been a comfort to know I have it in my back pocket if need be.

Why am I choosing not to talk about these things anyway?

 That’s the million dollar question, isn’t it? Truthfully, there are different reasons depending which topic you’re talking about.

As far as the relationships go, I just really don’t want to talk about it. The intimacy conversation brings up a lot of shame. Plus, like I mentioned, there’s a transference issue there. Despite that we’ve discussed this in the past, and despite that I know I need to face this to have even a chance of moving past it, I don’t really feel confident that anything we could discuss will change the fact that I feel destined to end up alone.

Maybe if this were my only guarded topic right now I’d be more willing to just run right into my fear by talking about it, but there are some other things clouding my thoughts at the moment. Namely, the attachment and suicide stuff.

In consideration of the attachment issues, and this pains me to say, but it seems almost like my complex attachment is a burden to her. She’s never directly said this of course, she’s always kind, so maybe my anxiety is causing me to read into something that’s not there. Still, I feel like her body language changes whenever I say something that is needy or childish. A gaze in her eye, a change in her tone. Whether or not she understands the roots of the issue, it feels almost as though it is uncomfortable for her to hear me talk about how attached I am to her.

I sense this reservation, the tendency she has to subtly disengage, and it immediately makes me back off. It no longer feels safe to talk about in the room. What if I mentioned this fear to her and she confirmed it? I couldn’t even imagine how gutted I’d feel.

She encourages me to talk about it, but her actions don’t always align with what she’s saying. For example, after I wrote her that long letter, she asked what I needed to help me feel more comfortable with our relationship. After some time passed, I got up the courage to ask her if she’d be willing to write me a short letter that I could refer to when I was  having difficulty maintaining a connection with her between sessions. I hoped that I could use it as a resource to keep me motivated to attend therapy. Even better, I thought it could be used as a resource when I’m in a difficult emotional place in lieu of me texting her for extra support. At the time, she said she’d consider it.

Well, it’s been two weeks now with probably four sessions in between, and she’s made no mention of the letter. Has she considered it and decided that she won’t do it, but doesn’t want to tell me? Is she writing it and just has yet to finish? Or has she just forgotten?

The latter seems most likely. Which, if true, really bothers me because it was not easy for me to advocate for myself in this instance. I knew I was risking rejection. Whatever the answer, can you please just give me one?!

Part of me hopes that maybe she’s just going to give me the letter tomorrow as a parting gift before she leaves on vacation, but a more rational part is telling the other part not to get her hopes up. This seems implausible.

The forgetting has been an issue multiple times in the past. I’d ask to table a topic until the following week and she wouldn’t remember to get back to it. I’d feel rejected that she seemed to have no memory that we left a discussion half-finished. She’s told me sometimes she just can’t recall from week to week certain things that I’ve asked of her. I’ve done my best to accept this, because she does have tons of clients and I can’t expect her to be perfect. Plus, I do have accountability in bringing up what I need to talk about too.

Fine. So as a solution, I made her a list of topics I’d like to try to circle back to from time to time. Attachment issues in therapy is on it. Only she continues not to ever address it. 

So either she doesn’t want to meet my needs or she can’t be bothered to remember to meet my needs! Either way, I’m frustrated. Why would I want to keep subjecting myself to this?

Because the boundaries will always need to stay in place and because there are some things about our relationship I just need to radically accept, I honestly don’t know if there is anything that she could say that would help. Even if it is valid for me to want a different response from her, is it realistic to expect one?

Part of me thinks it is not what she would say, but how she would say it. Validating the neediness effectively without the slightest hint of judgement. Checking in throughout the conversation to see how I’m feeling.

Yet how many times have I left a session feeling worse after talking about attachment? Is it worth it to bring it up and continue feeling disappointed?

Then there’s the topic of suicidal thoughts. Which, I admit, is a big one. She should know about what’s going on, but she doesn’t. If she asked, I wouldn’t lie, but I’m having a lot of trouble being upfront about it in session.

It’s the fact that she doesn’t ask. She asks only if I say certain buzzwords: dark place or struggling badly or really, really low. Even then, she rarely asks directly.

Yes, I should be telling her when I have suicidal thoughts…but with an issue as important as this one, shouldn’t she also be following up? She knows that my suicidal thoughts have been chronic in our time together, so why doesn’t she ask?

Is it that she doesn’t want to know?

I don’t want to make assumptions, but my mind will not shut up about it.

There’s a reason I need her to check in with me about whether or not I’ve had thoughts and even made gestures. The topic of suicide is a very severe one. It’s admitting that you’d like to or have even taken steps to remove your existence from this Earth. Talking about it, admitting it, feels dramatic. I’ve been having suicidal thoughts for so long, surely if I were actually going to kill myself I would have done it already, right? It’s like I don’t feel I have a right to my feelings anymore and I fear J feels the same way. Like she thinks I’m being dramatic too. Other people clearly have it so much worse. I just got a new job. I shouldn’t be continuing to feel this way.

It doesn’t matter if that thought is rational or not. I can believe with some certainty that she is not judging it, but the minions are louder. They tell me that she doesn’t ever bring it up because she thinks I’m being ridiculous and I believe them too. I need her to ask about it on her own because then it feels to me like she genuinely wants me to talk about it, that it’s not something she’s just saying because she’s supposed to. If initiates the conversation, I’ll feel like it’s okay.

Right now, I don’t.

I know that some of this is just me testing her. If she checks in, about the suicidal thoughts, it proves she cares.

But at the same time, it’s not a test, because I’ve been very honest and direct about that need with her in the past. I need her to check in about the suicidal thoughts. I need to have the pain validated. I need to be reassured that it’s okay to talk about this. I need to be reminded that it is not going to scare her off. I don’t need all of these things every week, but I need her to make an effort to do them sporadically. I need it to be a priority.

Hopefully, I will not always need these things. Right now, I do.

The concept of “checking in” has been a huge battle between us throughout out work together. Her therapeutic style is very client-centered, while I benefit from a little more therapist-led guidance. We’ve waged many wars about it. Although I think I’ve made the majority of the compromises, she has tried to take the reigns a little more now and then. I see that and appreciate it.

If I were to bring this issue up, I know she will listen. That’s not the problem. I have no doubt she will respond in the typical therapist way, governed by calmness and recognition of what I am saying.

However, if you’ve been following me long enough, you know I’ve been in this place before. J wasn’t checking in about whether or not I’d self-harmed. I worried about the reasons why she wasn’t asking and I wanted her to start. So I brought it up and it felt like a big deal to do that.

Well, it didn’t go well. She got defensive, which of course sent my emotions skyrocketing as I tried desperately to feel heard. We stood on either side of the argument and by the time I left, I felt hurt, invalidated, and unsure of our relationship. We discussed that later and she admitted, albeit somewhat indirectly, that she felt unjustly accused of something. So much so that she wasn’t really able to process what I was asking.

I’m learning effective communication, but I don’t know how to do this without making her feel I’m blaming her for how I feel and like she’s doing therapy wrong. I’m terrified of repeating history.

I’m afraid to bring it up and have it turned around on me as my problem, a figment of my disorders. I’m afraid J will be unwilling to even consider that there might be something she could do differently. This is a pattern I’ve played out again and again over the years with friends and family. I get upset about something, it becomes a fight, they refuse to accept any part in it.

I can’t even tell you how much that would kill me. Our conflict would be settled eventually and we’d move forward, but I believe it might begin to erode some of the trust I have in her.

I can feel one way: that I need something, that my feelings may have some validity, even if they may be influenced by BPD or depression or anxiety. But if she does not agree, it hardly feels like it matters because she’s the one in a position of power. Whether or not I feel like it’s a valid request to have her check in, she holds control over whether or not she will actually make the change.

But I also can’t bear to have a whole long conversation again, have J agree to compromise and commit to trying to adjust to my needs, only to have things end up the exact same way they were before. 

So what am I going to do about it?

Great question. While this stuff is important obviously has been looming in my mind, it’s not completely impacting our relationship. We are still working through the book and I am learning skills. I still trust her and feel safe. There are many times in session that I genuinely smile or laugh at something she says, because she can be quite humorous in a very sweet way.

However, there is an invisible barrier between us right now. She may not be cognizant of it, but I feel it. Sometimes, in the minutes before she comes out to get me, I feel intense anxiety about how our session will go. Once I’m in the room, I feel somewhat more at ease, but I am actively refraining from going too deep or showing too much emotion. I don’t discuss the big feelings, I just handle them independently outside of the room.

Right now, I’m going to do nothing. I have my last session with her tomorrow and then we’ll have a short break. There’s no point in bringing this to her the day before she goes away from vacation with the potential that it could blow up and I would have to go into the break with a shitload of unresolved feelings. I’d just resent her more for leaving me with that.

So tomorrow we will talk about whatever I decide I can handle so that I can at least go into the break feeling stable.

After that? Well, it’s just about getting up the courage. I don’t know how long that’s going to take because I feel like I’m walking into a situation that will not go the way I want and I don’t want the outcome of that to impact my ability to connect and feel safe with J.

In theory, I’d like to have addressed this before I start my new job. At that point my schedule will require I switch back to once weekly sessions. Right now, I’m still seeing her twice a week, so if things were to turn sour at least I wouldn’t have to sit with the feelings for a whole seven days.

I don’t know.  The therapy relationship is a complicated one. I just want things with J to go back to feeling as strong as they did before.

Whenever I finally get around to this, wish me luck.

 

Communicating Pain

*Trigger warning, mentions of self-harm*

Nights have been a challenge for me recently. During the day, I’ve had an easier time maintaining a neutral emotional state. But once we hit the late night hours, the dark thoughts come out to do their bidding. Small triggers release them into the air.

With them, a forceful temptation to break my nearly 2 month streak.

I’m not sure why it is that I feel like I need to self-harm to get the level of support I require. Cutting is a coping tool, but I’m also realizing that I use it as a marker in therapy to describe the emotional place I’m in. By some sick logic, cutting myself helps me communicate to J just quite intense the pain was in the moment, because obviously pain must be severe to drive someone to drag a knife across their skin. It’s like I fear if don’t self-harm, she won’t grasp the depths of the turmoil that’s eating me alive.

There are many other reasons that I cut. Escape from mental anguish. Punishment for myself. It’s not all about expressing pain to J. In fact, it’s barely about her. But I’m noticing that she’s a factor.

I’ve only realized this recently, when I cut harm out of the equation by throwing out my razor. I ached for it, and I began paying attention to some of the thoughts that arose from that ache. How will she understand if I don’t do it? She will think I’m getting better, because I managed not to do it, but she will be wrong because the pain is so strong. 

Like I’ve said before, cutting manifests an emotional pain into a visible mark. It’s evidence of suffering. Even if J doesn’t see the cuts, she’ll know they are there. Their presence speaks the language of how I hurt, even if I can’t articulate it.

As if not cutting means she won’t believe my pain? Or will think I’m just being dramatic? It sounds ridiculous, saying it aloud. Of course she will believe me. Yet holding off from this destructive coping mechanism creates tension in my chest, a fluttering of desperation in my stomach, because I feel like I need to do it.

I see her tomorrow and I’m dying to do it before that. Even though, to complicate it more, if I harmed I would feel the immediate urge to withdraw and not tell her. For reasons that I’ll get to in a post in the coming days.

The urge is hanging around, I even found an old pocket knife that I’ve been cradling in my hands all night. For hours, that was all I did, opening and closing. Tried to replace the urges by naming the emotion, watching it, confronting it with affirmations and coping thoughts. I watched a comedy special. Then, with almost curiosity, I dragged it across my wrist about 1 centimeter in length. No blood, no broken skin, barely a mark. A tiny patch of skin tinted light red.

Did I break my streak? I’m not sure. I’m inclined to say no, but the intentions were there. Either way, I immediately put the knife away, out of sight in a drawer. I’m really trying not to do it. I don’t want to deal with the guilt that would follow.

J says I can be safe within my thoughts and feelings and still behave in a positive way. I don’t want to hear this, because these feelings that spring up at night really suck. She’s right though, I know she is. It can be terrible and still, they don’t control what I do.

Still, I don’t feel that she truly knows the measure of this pain. If she did, she wouldn’t make that statement on repeat like it was the only thing they taught her in school.

Maybe another reason I feel such temptation to do it, to make her understand, is to get something more from her than the standard “you can be safe” line. Look how much I hurt and what it pushed me to do. Look how much I need your support. Help me, care for me, take the pain away. Show me you care and tell me to stop. It’s attention-seeking, in part, but its misguided. Same as everything else I do, thank you BPD.

I wonder if the urges will ever go away. Will I be 40 years old and still taken right to this place every time the emotions get heightened? Will I find a way to communicate my pain that does not involve a razor and my own skin?

I don’t know, but I know that I need to find a way to get through the night without it. Get to tomorrow, where hopefully they’ll subside under the weight of a new day. She’ll see and validate my pain just fine without harming.

The struggle never ends.

 

 

Confusion and Frustration with DBT

For almost four months now, J and I have been reading from a Dialectical Behavior Therapy skills workbook. I bought the book after seeing that there was a research base supporting the effectiveness of DBT in alleviating symptoms of Borderline Personality Disorder. Since I can’t quite afford (money-wise or time-wise) to invest in attending an actual group just yet, it seemed like a great place to start.

I’ve completed the worksheets, developing a safety plan and looking at the big picture with my emotions. We’ve done some of the meditations in session together. I’ve written notecard after notecard with radical acceptance statements and coping thoughts and self-affirmations.

We’ve slowly been combing through each chapter and discussing ways to infuse those skills into my life. At this point, we’re just about done with the emotion regulation unit.

Can I tell you guys something? IT’S SO MUCH STUFF!

I mentioned the notecards. I have made probably about 20 of them. A notecard with a Relaxation Plan. A notecard on Effective Communication. A notecard on Opposite Action.  I’m trying so hard to take all this material and jam it into my brain. To make it fit in a way that I’ll be able to recall it. The notecards have become almost like a study strategy, and I’ve always been good at schoolwork.

When I’m well, it’s easy for me to go through and organize the material. I find that the information between units connects more naturally in my mind; I can see the skills holistically. Plus the rationale of DBT makes more sense to me; I feel invested in the skills because I believe in the outcome.

But when I’m not well, when BPD creeps in, it’s like I’m standing over a toolbox without a single clue of which tool to grab for. I have so many questions. Do I need a distress tolerance or a mindfulness tool? I might know I need to use an emotion regulation skill, but am I identifying emotions or am I problem solving? Or maybe both? If I choose wrong, will it be like trying to screw in a nail with a hammer?

The units overlap. We aim to identify our emotions and the urges they evoke as one part of the process in regulating them, which requires using distress tolerance skills to cool the emotion’s intensity by distraction or relaxation. To do any of this, can’t be judging ourselves. We need to accept our current emotions and ground ourselves through mindfulness. By tolerating distress and focusing on the present moment, we aim to see that we can behave more effectively in coping with the emotions, instead of making destructive choices.

I’m sure interpersonal effectiveness will tie in there too, when I get there.

Because all the skills play off of one another, I think that doing something would better than tapping out when the emotions intensify. But that also complicates things for me. If I’m spinning out in a frenzy of emptiness and guilt, do I need to use a distraction plan strategy to shift my focus or do I need to use emotion exposure to sit in the feelings?

Like I said, there’s so much information. So often when I actually need to use the skills, I’m overwhelmed to the point of paralysis. I use none of them and then I’m angry with myself and think that I’m not making any progress at all. I’ve said to J so many times in the last couple months: I just never know where to start.

I wish they had a little flow chart or something.

J reminds me that it’s okay, that if all of this stuff came easily then I’d be doing it already. Even she thinks that it’s a lot to learn.

Now I understand why people in DBT will run through the units multiple times before graduating from the program. It takes long for this overflow of information to sink in!

Speaking of which, I’m sure it doesn’t help that J is not trained in DBT. It’s not like she’s teaching me these skills. We’re both reading a book and discussing them, determining how to generalize them into my life. So obviously there’s a bit of a knowledge gap there. I look forward to the time that I can really immerse myself in it a verified DBT group.

The confusion is just one part. I mentioned that when I’m in a good place, I truly believe in the skills. When I’m not, when my disorder is running me ragged, that perspective changes.

It’s not that I stop believing that DBT could work, but I resent the skills. Radical acceptance feels like invalidation; like I’m just supposed to move on and ignore my pain. Effective Communication feels much the same way Tit feels like I’m expected to sweep my emotions and problems under the rug just for the good of the order. It even tells says in the book that effective communication isn’t “selling out” or “caving in” to other people; but sometimes, in the moment, all I can focus on is that I have to suppress my feelings to keep a relationship strong.

It’s super frustrating.

I see the reasoning behind it. Radical acceptance limits suffering and effective communication is used to remove the blame and accusations from peer interaction so you can reach your goals. Totally makes sense.

Same with meditation. Mindfulness makes sense too, and I think it can be helpful in observing and letting go of thoughts. However, sometimes when I’m most escalated I just want to scream that it’s not that simple, that sitting quietly and focusing on my breathing for five or ten minutes doesn’t eliminate all the feelings that have overhauled my body!

The skills are good, and their intentions are great, but they don’t adequately take into consideration how intense the highest points of the tidal wave can be.  How complex. It makes me feel like I’m just another borderline that they’re trying to fit into a box of “normal” without really paying attention to my unique neuroses.

So I resent DBT for existing, because it feels isolating that I’m supposed to figure it all out myself, to contain it. Like my problems don’t deserve to exist for the eyes others and need to be squared away quickly and quietly. It feels invalidating. Like I’m not allowed to lose it sometimes.

The voices of the minions in my head tell me these things. Of BPD. I want the pain to go away, but I struggle with the idea of being told to take it away. I want to be able to manage it, but I want to be cared for and supported by others.

Then I resent myself for needing skills. More voices, perfectionist ones with impossible expectations. Of course the minions fight back, they always will. They want to remain, even as I’m trying to kick them out the door.

This is the struggle. Knowing which skills to use and wanting to use them. And it is a struggle for me.

Yet, I’m very thankful that I have undertaken this self-help project. Even when I want to fight back against DBT, I’m happy that I’ve found it. Because it’s something. It’s hopeful. While I don’t always know which tool to use, or even remember all the tools at my disposal, I am learning. Storing away resources for when I’m ready to use them.

I’ll continue to work with the skills, to push through feeling indignant, defeated and confused. Hopefully, there will be payout. Hopefully, the path to follow becomes easier to see even in the middle of a storm.

I can handle each challenge that comes my way. I will focus on what I can change. 

“How Are You?”

Something that I’ve learned about myself in the last few months is that when I start to go into crisis mode, dropping from a high to a low, something that is strangely comforting to me is to go online and read about the experiences of others with Borderline Personality Disorder.

I like my diagnosis. I don’t like that I have it, and I don’t like the pain that it saddles me with or the stigma surrounding the label, but I like that there is a name for what I experience. Something that acts as a reminder that my brain isn’t the only one that’s invented these issues I deal with. Other people have stories too, and they often write them with words that echo pieces of my own life.

Since I’ve struggled on and off lately, I’ve been doing a lot of reading. I like themighty.com, and I follow the BPD topic. It’s a connecting experience.

Today I read a piece that I really liked, because it highlighted a very small but common part of the day that my disorder compounds: Responding when people ask me how I’m doing.

We live in a culture that defines certain phrases, questions or traits as the baseline for politeness and human interaction. Perhaps the most common of these is the question we all ask some version of several times a day: How are you? How’re things? How’s life? It often seems this question is asked more out of a sense of tradition or obligation than genuine care.

When someone asks this question, a mathematical equation to deduce the “right” answer immediately takes place in my head. Can I trust this person with my honesty? Do they really care or are they just making conversation? Will my answer burden them? And the most challenging aspect of this question: How can I possibly respond to this with any measure of accuracy?

I think about this all the time. It is truly commonplace to ask that question more as an extension of a greeting than an act of probing for an honest response. At work, teachers say it to me in passing. At the grocery store, the cashier asks as her attention is divided scanning my items. Rarely does anyone really get out of their own head to really ask and listen for the answer. 

I always say the same thing to these people. “Good.” “Fine.” “I’m doing all right.” It doesn’t really matter, because often they’ve tuned out the second the question left their lips. And that’s okay, I suppose. I wouldn’t really feel comfortable spilling to an acquaintance or stranger that I’m having a bad day or feeling emotionally overwhelmed.

Although, wouldn’t it be nice if we could? Society expects us to have it together all the time. When you don’t, when you fall apart and show negative emotions in front of others, it makes them uncomfortable or even panicky. They’re upset, what do I do?! It’s regarded as going against the norm and we’re quietly taught to avoid it,

So we lie. A kindness to others. Conforming to the ideal. Still, that’s hard for me, to feel like I have to stuff my feelings into a box and hide it away.

I don’t need to tell anyone my life story, but I’d love to not have to don a happy mask and play it off like life is grand when my BPD has sent my emotions to through the roof. I’d love to be able to say, “Today’s a tough one” or “I’m actually a little sad right now” and have the other person respond in a brief but validating way before I moved on with my day.

Then there’s the other side of the coin. Friends and family.

Like the original poster stated, I’m often caught in a rock and a hard place when someone asks me that type of question. How are you? or How was your day? All of those considerations she listed apply so well. Do they really want to know? Or was it just out of obligation?

There’s no way to know that answer for sure, either.

On one hand, part of me is always itching to be truthful because part of me desperately wants to be cared for. So there’s always this little force urging me towards honesty when I’m in a bad place, with the expectation that maybe the other person will respond in the exact way that I need from them. Which will prove that they care and that I deserve support. It’s like what happened after I found out I didn’t get that job a few weeks ago. I wanted her to see I was upset and ask if I was okay because I wanted to be held and soothed.

If I do choose to be honest, there’s always a boundary for how honest I can be, a line I won’t cross. Seldom will I admit to feeling so low that I am suicidal and I almost never mention self-harm. More often I use words like struggling and difficult days. I’ll say that I’m stressed or maybe that my emotions have been back and forth. Not giving away too much.

I used to try to describe exactly how I was feeling, in the past. If you’re a long-time reader, you know that high school version of me let it all my feelings spill out to whomever asked me how I was doing, with a yearning that someone would just magically understand.

Expectations are killer in that way.

Now I know better. I know this isn’t effective, and I know that BPD and mental health in itself is very difficult to understand if you haven’t weathered the storm. People have their own opinions, and I’m reticent to be so vulnerable only to be hit with anything that feels rejecting or invalidating. If I’m not completely sure that you’ll be able to support me, forget it.

Plus, the truth is that those words, that knowledge, it scares my friends. Knowing that I’m feeling that way or have hurt myself just quiets them, because they want to help but are unsure how and fear making it worse. Usually they offer some meager messages of support and I end up having to reassure them that no I’m not actually going to kill myself and I’m getting help.

For these reasons, I rarely admit anymore when I’m in a bad place, even if it might be obvious to other people. If asked, I may give indications that I’m not well by saying a curt “okay” or “just a little stressed” but I’m less likely be direct. More often than not, I’ll just say that I’m tired. That’s almost always a code that I’m in deep pain.

Sometimes I will cop to it later, when I’ve come back into a stable place and my expectations of the other person are rational or at least more tolerable. For example, I’ll tell someone I was in a bad place for a few days, and I may give more detail on what that meant, but I quickly wave it away by saying I’ve moved past it and I’m better now.

No matter what, when I say something, I feel like a burden. I always feel like I should have said nothing at all.

How are you is a scary question in a way, because I feel like I’m weighing between an honesty that could sour a relationship and a falsity that ignores my feelings but ensures things are good between me and the other person.

Yup, all of this from one simple question.

J and I have talked at length about this. I think she really wants me to reach out during those difficult times and be as honest as I can be. To not even wait for the “how are you” question, but to just find support. We’re always going back and forth about my expectations of others and the knowledge that sometimes no persons response will meet the high bar my BPD sets. Sometimes I just have to accept whatever type of support they have and find comfort in the fact that the intentions were good.

Which sucks. Radical acceptance again.

Anyway, we’re way off track here, The point is, it is interesting, isn’t it? So much goes in to even just responding to one small question, a question which I hear many many times a day. You can break it down into a bunch of different concerns to consider.

That’s BPD, my friends. Nothing is ever simple, not even basic conversation.

Learning Effective Communication with BPD

Prior warning, this post is super long. There’s really no reason you would want to read it. Unless you find it difficult to navigate relationships when your emotions escalate. Then maybe you do want to read it. And maybe you want to tell me I’m not alone.

Because figuring this stuff out sucks.

Friendships are hard for someone like me with BPD. I have always known this to be the case. However, it’s interesting to find out that the more I learn about my disorder and the skills I can use to combat it, the more complex the I struggle with communicating.

I mentioned briefly that I got some difficult news on my birthday. My friend and I were both up for a school psychologist position. We were 2 of 3 finalists and we’d both interviewed on that Tuesday (my birthday was a Friday). We were told we would hear within a week, no matter what the outcome. I thought about asking her that we let each other know first if the other got the job, this way no one had to find out from someone else, but I decided not to.

I spent much of the week in a very anxious place. My thoughts lay only on that job. It cluttered my mind as I tried to sleep, work, and relax. I had an impending sense of dread, like I knew I was about to get bad news. Even as I repeated to myself “my feelings are not facts,” I could not erase that foreboding.

Cut to Friday. I’m in a pretty good mood. My parents have tried to celebrate my birthday, I’ve spent the morning taking it easy, and then I went over to babysit H & S for a little bit. They celebrated me and it made me smile. Their mom needed me to take them to a birthday party. I’d been texting with people sending me well wishes all day, including my former supervisor from the internship I just completed. I’d dropped the girls off and was walking back to my car when I saw he’d messaged me again:

“Sorry to hear about [school district].”

My heart sunk into my stomach. I felt the rest of the world grey out around me. I responded to him. “What?” Even though I knew, immediately, that for him to know I didn’t get the job meant that my friend did. We worked in the same district.

His reply: “Uh. Maybe you’d better talk to [friend].”

My mind was swirling with 1,000 different thoughts. I didn’t get the job, I didn’t get the job, I didn’t get the job. I knew this would happen. On my birthday, no less. I’m a failure. I’m worthless and they probably knew that and no one will ever offer me a job. I’ve been passed over twice now for someone else from my district. Failure. Loser. I should kill myself. Why did I have to find out today? That figures, it’s because these are the kinds of things that happen to me and always will and I can’t control that. These thoughts were all automatic, flooding out like a pipe had burst.

Then there were more. She got the job and didn’t tell me. Everyone else knew first. How could she do that? I felt angry and betrayed and hurt. I rapidly fired off text messages to her before I could even take a moment to think. “Did you get the job?” I asked. A minute passes. Then she was typing, but not quick enough for me. “Seems like you did” I congratulated her, but also caveated it with something else about how I was hurt that I had to find out from someone else on my birthday. I’ve since I deleted the text messages, so I can’t go back and look, and I don’t really want to anyway.

She replied that she had found out the day before and wanted to tell me, but didn’t want to hurt me or seem like she was bragging.  She’d thought maybe she’d wait until she knew it was a sure thing. She felt stuck.

My eyes zoned in on only one part of her message. She knew yesterday? She could have told me yesterday and I could have processed this with J instead of spending the session a neurotic mess? Why couldn’t she just tell me? Betrayal. Bad friend. She’s just making excuses.

I was in no place to hear what she had to say. We exchanged maybe two or three more texts back and forth. Me saying things like “I’m happy for you, but…” and her saying things like “I didn’t want to hurt you.” I grew so frustrated that I had typed out this whole long message to her, but I deleted it and just sent her something, again, about how I was happy for her and knew she did a good job. She knew it wasn’t genuine and so did I (although I wanted it to be, and had a lot of shame that I wasn’t). She responded with a very simple “Thanks for the kind wishes.”

I was internally panicking, my emotions hot like fire. I felt sure that if I had the option to, I would have hurt myself.  She doesn’t understand. She won’t understand. She won’t validate your feelings. Your feelings don’t matter, they never matter to anyone. You better just shut up now and deal with it alone. Like always. No one will ever understand you. 

We said nothing to each other for a little while. I went back to the house, cried to the girls’ mother, and then tried to be productive by getting the girls packed for their vacation. A few hours later, she texted me to apologize for the fact that I’d been hurt, again explaining her position.

I took a deep breath. This was all I had wanted, for her to recognize that what happened, the way it had happened, had hurt me. That even though she’d not meant to hurt me, it had. Part of me knew that focusing on all of this was taking away from the joy she’d received when she found out she got the job. But the other part of me just wanted to badly to communicate how I was feeling. I struggle greatly with the balance of that, with knowing when is the right time to speak up for myself.

At that moment, I decided for speaking up. I sent her back a long message, saying that I understood her position and what she’d been thinking, but that I’d been humiliated to find out from my supervisor and that the whole office knew before I did. I told her that I was sorry, because I didn’t want to take away her joy. She deserved it and deserved to be happy, but I just needed a few days to be hurt and angry. I told her I’d do that privately, because I didn’t want her to feel guilty about getting the job. I didn’t want her to worry about my reactions, I just needed to have the space for my feelings and I needed her to hear that.

She responded saying she understood and that she’d leave me alone. She also said that she wanted me to know that she didn’t tell the whole office, her supervisor did, and it had surprised her to learn everyone knew. I read that text, but I ignored it, because I didn’t have anything left in me. I’d used up all my energy and wanted to just move on from it.

I was proud at the time for how I articulated what I was feeling, while still trying to take her perspective into account. I actually considered it progress. Briefly, I considered that I probably shouldn’t have said anything when I first found out, I should have waited. When I read that text to J, I told her as much. But I quickly forgot that in favor of other things.

For a few days, I totally thought I was in the right here. I thought I had a genuine reason to be angry and upset. Then I texted a group of friends inviting them to come over to use the hottub where I was housesitting. My friend responded the way you might when declining a business lunch, saying something like “Thanks for the offer, maybe another time.”

I knew immediately that she was mad at me. Immediately. And I knew, at least partially, why. It took me days before I got up the courage to message her and ask if we were okay. Secretly, I hoped I was reading into it. My feelings are not facts. But nope, I was right, she was angry.

She told me that the fact that I had blinding assumed she told everyone without giving her the benefit of the doubt was hurtful, especially when I’ve gotten upset at her for assuming that I’d done things purposely to hurt her in the past. She brought up some other comments I’d made recently that bugged her. It was a long message pretty much detailing every interaction between us in the last month that had either hurt or angered her. For the most part, she wasn’t mean, just honest. I’d reacted poorly, she felt attacked and saddled with the burden of ruining my birthday, and it had stolen her excitement over a job she earned.

Well, shit.

Let me tell you something. Whenever I consider how I manifest the typical symptoms of BPD, I’m usually pretty proud of the fact that I don’t verbally assault my friends. I’m not someone who blows up and calls names or goes off on long tirades of negativity. But in this case, my anger had left destruction in its wake, even though I didn’t realize at the time.

She was right. I’d never given her a chance to say her side of the story. Once the emotions took hold, I’d told myself a story and just assumed it to be true. I had to admit that to her and take responsibility for it. I had to sincerely apologize for the joy I’d taken from her in favor of my own feelings.

I also had to admit to the place a lot of the “snapping” and hurtful comments she’d mentioned came from – jealousy. I make comparisons the way most people breathe; automatically. When I am jealous, it is physically hard to control, and that almost always came out towards her in a curt remark that stung her. Of course, I don’t mean to do this and I always feel remorseful later, which I told her too.

I apologized a lot and I really tried to find ways to make up for my behavior. I tried to be honest without using my disorder as an excuse. I just wanted her to understand my intention, while simultaneously accepting the role I played and promising that I was working towards doing and being better. Because she is important to me, and I wanted her to know that. She earned and deserves the job, and I needed her to know that too. I told her I’d understand if she needed a break from me

Which, by the way, is a BPD thing too. A statement I make all the time: it can’t be abandonment if I give you permission to do so.

(It can, it totally can).

She accepted my apology. We went back and forth texting for a little longer and came to mutual understanding. Now things are fine, I think. We’ve been texting like normal today and are trying to make plans for next week.

This whole situation has lit a fire of different feelings for me to deal with.

First and the most obvious was my bewilderment over what I should have done differently and whether or not any of my feelings were right or valid. I struggle endlessly with what the “truth” is, so I’m never quite sure if I’ve erred or if I’m justified in what I’ve done.

Here’s the conclusion I’ve come to. I was valid in feeling upset in both the fact that a friend received the job that I wanted and that I found out about it in a less than ideal manner. It was okay to take the time and space to be upset and angry about those two things.

However.

The communication piece still requires a great deal of work. I impulsively reacted using fabricated information (e.g. that she’d purposely told our co-worker and not me) and made statements about my beliefs and feelings that perhaps would have been valid had she actually done what I assumed she had done.

But she didn’t, and I would have known that if I could have approached the conversation in a different way.

One of the basic tenants of effective communication is waiting until you are in a grounded emotional state before addressing a controversial topic. I have to be able to recognize when my emotions are so fiery hot that I am unable to be rational or articulate. I didn’t do that on my birthday, I just reacted from a place of hurt. And in return, I hurt both of us.

I should have waited, at minimum, a few hours before I reached out to her at all. And even then, there were so many different ways I could have approached how I was feeling. Using I statements. Using just the knowledge I had at the time and letting her fill in the rest.

I was so damn hung up on what the minions were telling me was true about myself (failure, loser) that I never gave my friend a chance to tell me what was actually true about what had happened.

I can work on this. It will be a challenge, but I can work on it in the future. Not responding until I’m sure I can articulate myself effectively and without blame.

Then there’s the other piece of this. Living with the fact that I made a mistake that ruined both of our days. One I cannot fix. I can’t give her back the joy I stole and I can’t give myself back my birthday.

When I sent her that group of apology messages last night and was waiting for a response, I was able to firmly use some radical acceptance statements.

I made a mistake and I feel sorry about that, but I’ve taken the steps to make it right and I can’t do anything more right now. If she does not want to continue being my friend, it will hurt, but it is a natural consequence. All I can do is learn from this moving forward. I can not go back and change it. 

I was proud of that. But it didn’t hold, because the minions are creeping back in with blame and judgment. You suck. You should know better by now. You’re going to make these mistakes again and it will mess up the relationship.

Part of it is true. I will, probably, make those mistakes again. Hopefully the rest of it is not true. She is a good friend, but everyone can only take so much. Sometimes you have to move away from others to protect yourself. I would hate to make one mistake too many, and put her in the position where she has to do that. Or anyone else.

Abandonment fears, they never completely go away.

It continues to be a challenge, sitting with the discomfort of knowing I messed up. I replay it in my head again and again, hoping for a different outcome, which just cannot happen. I want so badly to be better than that, and I feel that I have made progress, so it disappoints me when I fall back into patterns I thought I’d outgrown.

We’ve moved past this now. She wants to, and so do I. I’m still worried and will be anxious before I see her again, because I will fear that things won’t feel right and it will be my fault.

But I’m also trying to remind myself that continuing to hold onto this just increases my suffering. I can accept that I made ineffective choices and unintentionally hurt a friend, and resolve to move forward by making different choices. Being and doing better.

Radical acceptance is a hard skill to master, and I’m still just doing my best to use it sparingly.

I really hope to avoid things like this in the future. Effective communication is one of the biggest pieces of DBT; I’m not quite to the interpersonal effectiveness unit yet, but I’ve already been introduced to the topic. I want to be good at it, especially in situations that are emotional and ambiguous. My emotions always interfere with my ability to respond appropriately to friends and I’m tired of that.

Hopefully I can start to make strides to communicating better in my friendships. Hopefully I can put this situation on a shelf and look forward to better choices.