Outpatient Therapy-Final Session

Yesterday was the last session of my group therapy program. I began this intensive program 21 October and we have met three hours/day on Mondays, Wednesdays and Fridays. Yesterday marked my 30th session.

Initially, I was very phobic to these sessions. Similar to my attitude when I was involuntarily committed , and knowing I was only obligated to attend for two weeks, my original intention was to skate through those six sessions with no effort on my part. I was still pissed off at the world for how I had been treated to date; I did not want to be in therapy and I certainly did not want to get better.

You just cannot imagine the amount of rage that pulsed through my veins—think Incredible Hulk. However, as the mandatory two weeks came to a close, something was triggered inside of me. Somehow, I came up with the idea that I no longer wanted to go on feeling the way that I did. That level of rage and profound depression was eating away at me and I simply had no more energy left. I voluntarily agreed to stay in the program having no idea that it would take this long.

There was a very detailed daily check-in sheet we each had to fill out. It was basically a way for the therapist to determine and track our progress. The dynamics of the group evolved over time with old patients being discharged and new ones being admitted during my stay. While the overall group was large (in my eyes), averaging around 18-20 folks, once everyone took the 10-15 minutes to fill out the check-in sheet, we always split into two smaller groups. The groups remained split while everyone reviewed their sheets, and we all came back together as one group after the break to start the second half.

I could handle the smaller group in which we each shared what was on our sheets. Based on our input, the therapist would probe further with each of us and ask penetrating questions. The sharing half had a tendency to be somewhat tedious at times. Every so often, there would be patients that liked to hear themselves talk. Repetition is the key word here. They would go on and on about one particular issue and even talk over the therapist as if they had no interest in listening to her feedback. I could see the frustration on the therapist’s face every once and a while. As a result, sometimes the first half of the session would take a long time.

After the break, when we all gathered back together, I had a major problem. I had a rough time being around large groups of people. The noise level would always increase and sometimes everyone would talk at once. That started freaking me out. Therefore, I retreated from the large table in the room (it was actually five conference room-sized tables arranged in a large square) and sat in the chair against the door right by the back emergency exit—it was as far as I could get from the group. The emergency exit was not wired to an alarm, and when it got to be too much for me, I’d walk out the door and take a breather. Being that it was the end of autumn as winter approached, the cool, brisk breezes usually refreshed me.

The second half of the session was psycho-education [I’m sure that Alfred Hitchcock could have had valuable input here :)]. This outpatient therapy program was based on dialectical behaviour therapy (DBT).  When I tried to commit suicide back in 2005, I went through a DBT program after I got out of the hospital. At that time, I thought that DBT was pure bullshit. It all centres on learning tools or coping skills to manage various stressors (depression, anger, rage, anxiety, etc). Being that I had been diagnosed with Bipolar I Disorder (BP) and Borderline Personality Disorder (BPD), everyone thought that this type of therapy would be one from which I would benefit. Back then, I thought all these coping skills were stupid. Sure, it might work for some, but I just could not imagine me taking the time to think through whatever emotion I was feeling at the time and remembering which tool would help me through that situation most effectively.

When I realised that this time around would be centred on DBT, I was quite cynical. However, after about four weeks into it, I discovered some tools that could actually serve me well (see this for a list of tools). Without a doubt, using these skills effectively requires constant practise. You cannot expect to utilise a skill and then have it at your fingertips until you practise it. Once practised, when you face an emotional obstacle, you can more readily adapt effectively.

I also realise that there is a lot of controversy around DBT. Some who have been through the training think that it is bunk as I did. I can say that I do not agree with the entire skill set. I learned what tools I knew I could use and left the others behind (there are some I still think are bullshit). All I can say is that it is up to each individual to determine what works in his or her best interests.

That being said, the first half of my last session was great. Our small group only consisted of seven patients and our small group never had the loud mouths (I am grateful that Mr. Noisy was in the other group!). I knew three of them; the rest were new patients. When I finished sharing my check-in sheet, I received wonderful feedback from the therapist. She basically said that I had done a 180˚ from the time I started the program and was extremely pleased to see the progress I had made. It had taken me all this time to see the huge steps I had made. Don’t get me wrong; I am far from being all fixed up. That is why I am going to continue with an individual therapist. BP and especially BPD can take quite some time to manage. While some professionals banter about the word recovery, I think the best I will be able to muster is to manage my BP and BPD to a tolerable level. Only time will tell.

The second half of my last session was surprisingly smooth. While Mr. Noisy was present and accounted for (as well as the other few loud mouths), the group discussion on the continuing module of assertiveness was quite ordered. It was quite appropriate that my last module would be on this topic. As I have mentioned previously, despite my butch bravado, I really could bolster this skill.

Saying goodbye was harder than I thought. All of the patients who had been around for a while (with the exception of one other patient, I had been there for the longest duration) took their time saying goodbye to me and wishing me luck for my future. As someone laughingly said, “Hope to see you at Wal-Mart should our paths ever cross again.”

Overall, I have to agree with the therapist. I have come a long way since I tried to commit suicide on 10 October. It has been a long road for me, some of it fought tooth and nail against any type of recovery. I know I still have a long way to go, but for now I will just accept the fact that I am in a better space than I was almost 12 weeks ago.©2009

The Perfect Borderline Dream

This morning at 1145, I was out on my porch enjoying the beautiful sunshine when I found myself nodding off. I thought, shit I am not getting much sleep at night; I might as well try taking a nap. I went back to my dark bedroom and snuggled under the covers just so certain that I would finally get some sleep. After about three hours I was still awake (but still feeling very sleepy), so I just stayed there all cosy (such a different experience than at night). Then I *woke up* at 1715 (yay for me, I got some sleep). Almost immediately, I recalled this vivid dream (I always have vivid dreams, I just never remember them upon awakening—they are just fleeting images), and began sobbing. The emotions flooding through me were painfully piercing.

Evidently, I was a mother to this cute, precocious girl of about 6 who was very obese, yet happy as lark to my suggestion that we go out to our swimming pool. My husband (egad, is that Freudian or what) was played by John Travolta (I kid you not) and had disappeared on us yet again (this dream came complete with this woman’s memories). He was employed as a hit man and received his orders in the mail. Well, this little girl ran out to get the mail and I heard her shrieking. When she put her hand in the mailbox, a shard of glass had practically shredded her wrist at the site where most people slice their wrist (yet again, how Freudian) and was bleeding profusely. Then she goes limp in my arms. Somewhere there was this a strange man (a neighbour perhaps responding to her shrieking outside??) was standing there and I yelled to call 911 while I tried to staunch the bleeding without removing the glass. I remember feeling that it was all my husband’s fault because of the line of work he was in. All of a sudden, the dream flash-forwards to the ER while I am in there waiting, so sure she wasn’t going to make it. My “husband” magically appears running into the ER demanding to know what I had done to his daughter

OK, so here is the BPD breakdown and my reaction to the dream: 1) I hate myself because I am a horrible mother. I let this adorable child get as obese, so therefore I am a failure; 2) my “husband” abandons us at our time of need—rejected and abandoned yet again; 3) again I’m a horrible mother because I had no idea that my child had gone running out to the mailbox situated on a street curb nearby traffic that could have killed her if she had walked out into the street; 4) based on my “husband’s” reaction upon arrival to the ER, everything is my fault—more guilt and shame.

Give me a fucking break. If I am going to enjoy some sleep and have dreams, can’t they at least be dreams of escape from my wretched life?©2009

Unimagined Sense of Loss

I sit here, unable to sleep even though I need to get up at the crack of dawn because I am so far behind in my work. And all of sudden I am hit by such a profound sense of loss... At the end of the day, I can take stock in my life and it really adds up to one big zero. I guess I’m not getting to experience the manic phase after all. Seems as though I am sliding right into the pits. It’s actually a mixed-phase for me. I can’t sleep, yet the wholly encompassing envelope of loneliness engulfs me, while at the same time of fighting off all these racing thoughts that never amount to anything. It’s as if my brain has been stuck in 11th gear with nowhere to go. The utter randomness of the racing thoughts are probably most disconcerting. It’s absolutely amazing that I can be in a room filled with people I know and still feel so estranged.

I feel that when I am in a room of people, especially those with whom I have a relationship of sorts, I am always on the outside looking in. I feel invisible. This is the beginning of my downward spiral, and I never know each time just how bad it will get. Suffice it to say, that now I am in this space, I will do nothing to extricate myself from it. I will only continue to burrow further down, keeping everyone at arm’s length. My rather cognizant brain has the capacity to tell myself that I can remove myself from this environment by choosing to engage with those around me. But, the sad fact is that there just isn’t anyone out there with whom I can engage. I really do not have a real friendship base.

The walls slowly begin to close in; my options slowly cease. I am left with nothing but the four walls of my house. Is this what I really have to look forward to as my life as I know it? I don’t know if I can survive my life like this one more time. I’ve been in this spot before and the solutions presented then to help me crawl up to the land of the living really didn’t offer me much hope. The majority of me is quite content to just sit in my four walls and never venture outside or interact with anyone else. And, at the same time, that realization causes me so much emotional pain. To feel all alone can be the most frightening feeling. Every day I find myself just slipping a little further from reality. My reality is what is inside these four walls and nothing else.

I feel myself slowly shutting down—distancing myself from everything. My answering machine is off; my cell phone vm is disabled. I have effectively begun to build my walls where I can keep everyone out. I have completely cut myself off from my family of origin to even include my son. I just simply want to be left alone. I find it to be quite an oxymoron. When there are those who are hurting at church, it’s all I can do to just want to take them into my arms and show them God’s love. In those moments, I want to give of myself to help someone else.

But my disease is invisible. No one can perceive the profound loss and sadness I feel. No one understands bipolar for all its implications and trappings. I just want so much for someone to see the pain I feel and reach out to me, but part of the façade is to never let anyone in. Catch-22. Damned if I do, damned if I don’t.

Maybe I’m just a phony. Maybe I really don’t have anything to offer someone who is hurting. I want to, but would it ever be received? As I sit here tonight, I feel hopeless, unable to help myself, unable to help anyone else, and most importantly, totally unable and unwilling to receive anything from someone else. What can they offer me? No one knows the dark corners of my mind, and the room dims with every growing minute.©2009

The Absence of Being

Tension fills the still air
The cigarette left unattended
Smoke fills the sterile clean room
The coffee grows cold in its cup

The woman sits all alone
Unaware of her own surroundings
Left to her own devices
She absorbs the thoughts in her head

No where to go
No one to see
She’s left all alone
With no one to help

Emotions abound to process
Too many to cleanly develop
Overwhelmed by the flood that washes
And coursing through her maddening mind

She looks for answers to come
And discovers there are none to be found
She sits there and ponders her life
She’s immune to the outside world

She desperately seeks the reality
Trapped by the pieces in her brain
She lights yet another cigarette
And drinks from the cold bitter coffee

Nothing to stare at before her
Blank walls fill the entire room
The quiet cannot stop the madness
That fuels her desolate space

She gets up to open the door
To the world that has nothing to offer
She stares at the blank cloudless sky
With hopes of a future to come
©2007

The Need for Clarity

Doubt is the seed of discontent
It robs you of the capacity to believe
It deprives you of the ability to judge
It denies you the competence to consider

There is a long road from the head to the heart
What you may believe to be true in your mind
You will doubt as ever possible in your heart
For some, that trip is long at best, endless for others

If doubt is the seed of discontent
Then wisdom plants the fruit of the unexpected
It’s not stupidity that is the opposite of wisdom
But uncertainty in knowing to do what is right and just

Wisdom gives us the power to be decisive and sure
It sanctions us to make the correct conclusions
Doubt only allows us to twist in the wind
Never knowing in which direction to take the next step

Clarity depends upon that wisdom upfront
There is no room for doubt to determine the good
It requires a sharp and precise course of action
With results deemed to be superior and true

The unclear mind plays tricks on what you believe to be fair
To act upon misjudgment only impedes the deliverance of power
Power to stand up for what is accurate and exact
Authority to rule and control the results of your actions

The mixed-up heart can be a dangerous playground on which to stand
It is ruled by the power of emotion, fueled by the passion of reaction
That journey that ultimately takes you from the precise mind to the heart
Can provide for the release of doubt and the beginning of wisdom
©2007

Between the Ears

Tornados twisting thoughts in my head
Hurricanes hurling heaving judgments across my brain
Switching synapses snipping ideas all over the place

Why is there no peace to be found when I am all alone
Why does my brain have to interfere with this option of silence
Why can’t my head just be a resting place of peace

I want this madness to stop—a cease-fire if you will
No more racing bullets shooting through my skull
Only more idiotic notions to plug up the holes

I close my eyes for the briefest of time
Where darkness should be only jarring colors appear
A veritable kaleidoscope of patterns eating at my lids

I keep them closed now to watch the blueprints on my brain
Oh, if it only held the smallest of prototypes of peace
Then maybe I could experience that coveted freedom of rest

No, the cacophony created in this space between my ears
Can only be heard from deep within my mind
A mind that no longer has control over the simplest of tasks

Rage flies in every direction
Unable to contain the explosive emotions let loose by this noise
And then I collapse unable to move, yet stillness does not pierce the heart
©2007