Posts tagged ‘Psychotherapy’

Two Ships That Crash in the Night: Bipolar, Personality, Relationships

The Starry Night

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Failed relationships amongst people with Bipolar occurs for multiple reason, almost all of which are rectifiable, so there IS HOPE.  1) Ignorance – educate yourself about Bipolar in a way that you can accurately relay it to others besides just explaining how you “feel” or what you “do”. Gain more of a medical understanding. From there, consider how and when to educate others – my Journal entry, “Do You Hear Me? Are You With Me?” may be helpful. 2) Alienation – Persons with Bipolar have a low tolerance for distress and difficulty with emotional regulation. All people when highly stressed, revert to unhealthy coping skills and make unhealthy choices.  When we do so, we alienate (push away) others. As we make healthier coping skills habit, learn distress tolerance and emotional regulation techniques, employ tactics for reducing our overall stress-load and make amends for past harmful actions, we ill see improvements in our relationships. Although originally designed for the treatment of Borderline Personality Disorder, DBT (Dialectical Behavior Therapy) is fast becoming the method most successful in treating a variety of disorders marked by emotional dysregulation, including Bipolar Disorder. DBT is an interactive educational therapy, usually presented to a group in a class with the support of individual DBT coaching to learn application of the techniques to personal circumstances. However, even if it is not available in your area, you are not without options. There is a DBT workbook just for persons with Bipolar. You can also check out http://www.dbtselfhelp.com. Therapy in general is a key component of treatment for Bipolar. 3) Withdrawal – Whether because we feel misunderstood, we’re afraid of hurting others or of embarrassing ourselves, or because getting out just seems like too much effort, we CHOOSE to withdraw. Isolating ourselves is probably the worst thing to do if we want recovery but the easiest thing to cling to if we want to avoid change. Recovery requires change. Change necessitates loss. Loss leads to grief. The process of grief, until resolved, is unpleasant. When the pain of remaining the same is more than the pain of change, it is then that we begin to recover. For most o f us, recovery is stop and start. Far too many people stop here and don’t start again. That is called choosing misery. Misery is the opposite of joy. It is an attitude in action, reject and retreat. Misery is not to be confused with sadness, an emotional response to stimuli. It also is not depression, a neurobiological response to a chemical imbalance caused by genetic defect, neurological damage or the exhaustion of our ability to cope. Being miserable is a cognitive response, sometimes a subconscious one, to our emotions. 4) Personality Disorder – The Personality Disorders Described in the Diagnostic and Statistical Manual (DSM) were designed to reflect the natural tendencies of all persons when highly stressed. When unhealthy patterns of relating to others becomes habitually, usually due to diminished coping resources or prolonged high levels of stress, and create disorder (a repeated inability to function in a way beneficial to one’s progress toward self-actualization) in a person’s life, such person usually meets the criteria for a Personality Disorder. It should be easy to see why persons with one of the major psychiatric conditions is also likely to have a Personality Diagnosis. However, it is SO common that many psychiatrist don’t bother making a separate diagnosis. Most therapists operate under an assumption that such a diagnosis exists, with certain ones being more common to each of the various Axis I diagnoses, which in turn often gives them a clue to appropriate areas of focus for intervention. Whether a “full-fledged” Personality Disorder exists or not, our common patterns of relating that arise from our struggle with Bipolar, rather than the actual symptoms of Bipolar are more often the cause of our failed relationships than anything else. This is one of the most compelling reasons to enter long-term therapy with an appropriately trained professional. Armed with this knowledge and these suggestions, you can put an end to loneliness as soon as you are ready. I am on the journey myself. Come join me.

Client Psychotherapy Appointment Communication Tickler

~ Nature Trail Eye Play~

Image by ViaMoi via Flickr

Readers, this a helpful tool to help psychotherapy clients, who distressed, often struggle with their memory, focus and organization. The form, filled out before coming into the session, is a great way to begin discussion, keep things on track, and reduce confusion. The author offers it free, asking only that the source information at the bottom of the page be maintained on all copies. A print-friendly version can be emailed to you by leaving a comment.

 

 

 

 

 

 

Client Psychotherapy Appointment Communication Tickler

Name                                                                                               Date

Appointment
Appointment Time:                 must leave by_______    will call to reschedule    please call me
Usual Visit Frequency:    varies    2+ per week    weekly        2-3/month    monthly
Nature of Today’s Visit:    first    as scheduled    extra        emergency    make-up appt
Next Visit:    discuss now    as scheduled    request extra    will call you    please call me

Changes/Updates
General Info:    name        phone#        address        household    insurance
Schedule:      travel        guests        appointments    other        permanent
Medical:    plans        providers    medications    diagnoses    treatment

For You
Updates:    bringing next time    will send/drop off    let’s discuss     on back/attached
Paperwork:    to fill out and/or sign    requesting info    for your use    returning as requested
Other:    things I’ve created    things about me        donations    invitation/request    info

Issues
Concerns:    schedule/availability    client-therapist relationship    personal safety
Stressors:    trauma         conflict        uncertainty/confusion        loss/change
Relationships:    past family    current family    friends/social    occupational    other
Focus:    process feelings        develop skills    gain insight    find solutions    other
Follow-thru:    assignments    resolutions    insights        progress on goals

Goals

Summarize the following:
physical condition
compliance with treatment
sleep
nourishment
hygiene
cognitive functioning
ability to meet responsibilities
use of coping skills
primary thoughts
emotions
resources
other

Copyright 2007 by Molly J. Efflandt, BSW

Surviving Loss: Unexpected Death of a Close Loved One

Inconsolable grief

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Originally published November 27, 2010

Everyone grieves in a unique way.  You can’t do it wrong.  You will do it even if no one tells you how. Any change presents a loss.  One of the losses most difficult to manage is the unexpected death of someone we love dearly and rely on heavily; most often this is a spouse, sibling, parent, or best friend.  You may feel completely overwhelmed and question your ability to cope.  People may be there for you but you can’t even think straight about what you need.  You go through motions that seem like living, but nothing seems real.  Life in rich Technicolor high-definition 3D wide-screen now seems to be trapped in a 12 inch black-and-white TV with poor reception.  You can’t imagine how you’ll carry on.  Luckily, reality doesn’t need to be imagined.

The reality is you will survive.  You will recover . Things won’t ever be the same, but they won’t be worse – just different.  You will struggle.  You will change and you will grow.  You will accept the loss, not because it will mean any less, but because it will become a part of you and your journey.  How do I know?  I know because you want it . You asked for help by reading this article.  Some are content to be miserable.  You aren’t.  You are willing or at least willing to be willing to do what needs to be done to find contentment again.  You are willing to surrender to a power greater than you, even if it is just the people about you with whom you’ve shared this piece of your pain.  You have the will to be filled with and to share what all those who know and have ever known you love.  Where there is a will, there is a way.  The way is your personal journey of healing.

Because much of life does not come with an instruction manual, including dealing with loss, we can only rely on our own experience and that of others to work through such difficult times.  We will discover some people want to help, while others are too emotionally fragile.  Bear in mind that while you are struggling with your loss, you will not be able to fulfill some of the needs others have relied upon you to fill.  Whether purposeful or not, relieving yourself of some of your responsibilities is necessary to muster the energy to deal with your loss.  As you may be struggling to find the support your recently passed loved one provided, others near you may realize they need to build their support system as well.  Though painful, this is one small way in which a significant loss can bring about good.

In today’s society, where family is spread far apart and friends are often few and superficially squeezed into our busy lives, we very often rely too heavily on just a few individuals to meet all of our needs.  We must learn to reach out and connect.  We must learn to identify our needs and search out multiple ways of meeting them.  We aren’t looking to replace the one we’ve lost but rather to join in community with the larger web of existence.  We are meant to be interdependent as a species.  No one or few people should be our sole support anymore than we should put ourselves in that role for someone else.  The sooner we began this journey of self-discovery and connection, the sooner the devastating effects of our loss will subside.  Remember, too, that no one leaves the world untouched. The imprint of your loved one is pressed into more than your heart and memory. How you travel this journey will be unique to you. As a starting point, I’ve offered below what helped me most in my earliest days of grieving different losses in my life. I wish I had had them all at my disposal from the beginning, but surviving loss continues to be a learning process for me. I only hope that my experience will make yours more bearable.

Connect With Your Emotions
*Use art to express your emotions (you don’t have to be an artist).
*Journal, write letters to your departed loved one, or write stream of conscious about one emotion you pick to focus on.
*Make some dates with yourself, maybe 30 minutes twice per day (to start), to fully honor your need to feel your feelings and equally honor your need to take a break from them.
*Attend a grief support group or see an individual therapist specializing in grief;

Connect the Past & Present
*Reminisce aloud or write about happy memories, especially ones that make you laugh, as much as possible.
*Make a list of what you learned from the person who is no longer with you.
*Try to get to know better the younger generation whose genes your loved one passed on.
*Contemplate your loved ones legacy and continued presence: donations s/he made to charities, something s/he helped create, words s/he wrote, causes s/he supported, traditions, etc;

Connect With Others Who Shared in Your Loved One’s Life
*Ask other people to contribute to the above or below.
*Gather some help to put together a memory box or scrapbook of your loved one’s life for a younger generation of your family or his/hers.
*As you are confronted with handling your loved ones belongings or things s/he gave you, consider what you might part with knowing how it could touch someone else’s heart.

Connect With the World Around You
*Force yourself to be around people as much as possible, but don’t force yourself to interact if it’s too exhausting.
*Invite people over; let them know you don’t feel like being alone but don’t necessarily want to do anything particular.
*Visit museums or library events or explore other out-of-home interests, especially ones your loved one may not have enjoyed, that don’t expect anything of you.
*Fully engage yourself in whatever you are doing, redirecting your attention to your five senses if you become distracted by your inner turmoil.

Healthy Boundaries, An Introduction

Healthy boundaries protect us. Persons who have been deeply hurt often have had or develop difficulty establishing and/or maintaining such boundaries. We can’t avoid some hurt, as when we are truly powerless or ignorant (not knowing) that we are in danger.  In all other cases, not establishing boundaries to protect ourselves is not much different than handing cocaine to a drug addict.

Sometimes, people don’t establish appropriate boundaries because accepting abuse fulfills a subconscious need they don’t know how to fill in a healthier way. Others have developed a false sense of powerlessness due to low self-esteem and/or a lack of information about helpful resources. Many others don’t know what an appropriate boundary is or how to put it in place or protect it. We are not at fault for these things. We might not even have realized the problem. As adults though, it is our responsibility to ask for help and to be willing to accept it. Even this is an idea new to some of us. Once you know, though, it is time to act. Start anywhere in whatever way you can. We may gain invaluable guidance from therapists, trained to assist in these areas among others. Books and classes may supplement our therapy.

source: Samuel Orgelbrand's Universal Encyclop...

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Immanuel Kant, a famous philosopher and ethicist, once said, “Maturity is the ability to exercise one’s intelligence without guidance.” Putting it more simply is the quote often heard in 12-step programs, “Stupidity is the tendency to keep doing the same thing over and over, expecting a different result.” If we acknowledge what isn’t working and seek solutions, we are ignorant yet intelligent. If we are well-schooled but do not seek solutions to our problems, we are either cowardly or prideful, and most definitely stupid. Another common 12-step program slogan reveals an apt universal lesson, “Ignorance can be fixed; stupidity is forever.”  Thankfully though, while stupidity may last forever, we are no longer amidst it the moment we make a change. Even if what we do is not the “answer,” we progress by exploring a new alternative.  If you’ve repeatedly been a victim, isn’t it time for a change?  Ask for the help you need.

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A Letter to Sexual Offenders

Sexual Offenders,
No matter who you abused or how, you created pain and a lasting mark.  The wound scabs over and gets ripped open repeatedly until finally, at some point in active recovery, it becomes a scar.  I used to feel I didn’t belong, that people could see I was different.  Regardless of the circumstances, I was ashamed I didn’t fight back more, that I didn’t stop it from happening.  I didn’t think I even belonged in a victim support group because my story of abuse was different, not so bad.  But I discovered our story after the abuse is what bound us together.

When I first started remembering the abuse and started in consistent therapy to deal with the issues, I was having the panicked feeling of being followed almost all the time.  I started only hanging either in large groups or by myself.  I began having body memories of pain in my genital area and other areas I later discovered were related to the terrifying visuals that soon after began to destroy my sleep. Sometimes I disassociated, losing all awareness and memory for a length of time.  You can imagine the impact on my safety, daily routine, and relationships.  I also had no memory of my childhood at all, only recalling the still photos of our family albums.  I felt so incomplete.

So, what about the scab-ripping?  One way it occurs is through re-experiencing the abuse when triggered by sensory cues. Another, more subtle way is the ingraining of self-destructive beliefs and patterning of self-destructive behaviors.  I honestly can’t verify some memories of my abuse, but they emerged without any suggestion or prompt and my “experience” of them is very real.  Other memories, some I can verify, are so horrific that my mind still doesn’t want to believe.  Likewise, other people also don’t want to believe.  Thus, years after starting recovery, I still struggle with doubting my reality, even beyond my memories of abuse.  Consequently, I sometimes feel disconnected and insecure.

I lived in a household where personal boundaries weren’t respected much and the earliest of my abuse occurred when I was just a toddler.  I internalized this, believing it was normal to be violated, and was sexually abused by a few more people over a few years starting about 5 years later.  I growingly felt “dirty” and powerless.  Another 5 years later, I agreed to degrading sexual acts with a peer under the manipulative promise it would stop if I cooperated.  When it didn’t stop, I told and my freaky peer was firmly scared off, but I wasn’t given opportunity to say anything more.  He wasn’t punished.  I wasn’t comforted.

Yet another 5 years later, I was acquaintance-raped.  I laid stiffly without word or reaction, disassociated most of the time.  By that time, I had deeply repressed all memories of former abuse.  At one point during the rape, I had the opportunity to yell out to persons passing by not far away, but my mouth was covered and I was restrained by my abuser’s body.  I realized afterward that someone might have heard my muffled yell for help, but in that moment, I had thought only, “He’ll kill you… and you deserve it.”  Then I left my body again.  In the few years after, I entered into two brief but emotionally abusive and physically threatening relationships because I reveled in the moments I was treated as if I was special and I felt so very lucky that someone said, “I love you.”  I didn’t feel lovable anymore.  I stuffed everything more and more until one day, about 3 years later, the wall started to bust open.  I entered therapy to begin dismantling that wall, intending to rebuild it as a proper retaining wall with a gate I could control.

I started writing this letter to you about four years into recovery.  I’ve since added.  At that time, I thought the wounds had mostly become scars.  My perspective had changed to seeing myself as a survivor rather than a victim.  I had been in a healthy relationship for over a year.  I had learned how to trust and build meaningful, interdependent friendships.  At that time, my panic attacks had become few and infrequent and remained so for years.  I had learned and practiced incessantly how to define and defend boundaries, how to identify and share my emotions, and how to recognize and assert my rights.

Nonetheless, I remained afflicted with recurrent bouts of depression lacking clearly identifiable causes.  I was still easily triggered, almost always on edge, and felt as if the wall was crushing down on me anytime I tried to let my emotions through. Less than a year after finishing this letter the first time, I decided I was recovered enough and chose to not continue therapy when I relocated to another state.  Even when I did start therapy again, I glossed over my abuse history, unwilling to feel too much, to feel victimized by my own lack of emotional control.  I lost touch with myself, ignoring unpleasant feelings so I could deny them.

Recovery is a long process that requires active, committed participation.  I had quit recovery.  For a number of years, I carried on – but only by expending a tremendous amount of energy to stay “in control.”  In actuality, I was losing more and more control.  My life became increasingly consumed by obsessions and compulsions into which I channeled my anxiety.  While I fell in love and much of the time managed to relate in a healthy way, I made choices that deeply impacted my life out of fear that expressing my feelings would crush me and the relationship.  I continued to doubt my reality and my worth, but denied that unpleasant reality as well.

One night, I ignored clues of something askew.  I put myself in a vulnerable position.  I had lulled myself into believing I was so in control that when confronted with needing to be in control, I instead once again became mentally impotent.  A person in an authority position touched me in private areas, directed me to do the same, and held onto me when I tried to pull away.  Instead of summoning my strength and persisting to free myself, I shrunk in fear.  Like the nearly powerless toddler I once had been, I drifted in and out of awareness.  I didn’t want to believe what was happening, so I had tried to find humor in the situation.  Now I couldn’t laugh anymore, except cruelly at myself.  In one instant I illogically feared further harm if I resisted, while in another I felt I deserved all the pain I was enduring and more.  Someone I trusted was taking advantage of me.  I hated stupid, stupid me.

I was at last able to talk myself out of the situation, but left still locked in a behavioral fantasy of “everything is fine.”  I felt an incredible self-loathing.  All of my memories re-emerged full force.  My emotions alternately hid well-cloaked in denial and spewed out like vomit.   All the symptoms that I had been struggling with and the ones that had previously dissolved now preyed upon me endlessly.  I found no relief until I committed myself to recovery again and began the difficult process of acknowledging and accepting my reality and myself.  I’m still struggling, wanting the relief of recovery but fighting the process.

I’ve discovered more of who I am and who I want to be.  I’m developing courage, a passion of the heart.  Sometimes I despise my therapist because she makes me work so hard.  She pushes me until my own anger breaks away that unhealthy wall, but she’s there to help me rebuild – mainly by helping me grasp that I am capable.  When time stretches between sessions now, I feel the momentum of my self-discovery lapse.  I’m going to start seeing her more for the very reason that it terrifies me, but staying the same terrifies me more.  I don’t want to be a victim again and I don’t want to hurt others by my refusal to become the better me I’m meant to be.

Recovery is a choice.  I know many if not all offenders were victimized in one way or another themselves.  I forgive you.  I give you your guilt back for my peace of mind.  You hurt me and you have no excuse.  We are adults.  We each have a right and a responsibility to be the best person we can be.  I won’t blame you.  I won’t give that power away.  I am not powerless, even if I sometimes feel that way.  I will choose as many times as needed to accept MY reality, including you and my “experience.”  I will choose – as often as needed – to change, to grow into the me I’m meant to be.  I choose to believe I am worth it and to believe you are too.  When I can see me for who I am, my wounds will only be scars.  And when I can see that those scars do not define me, I will at last be the me I’m meant to be.  I am committed.  I won’t quit again.  I will succeed.