innerlight


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dialectical vs. cognitive behavior therapy

These excerpts speak about the experience I had with cbt, and seem to illustrate well what is different about dbt from cbt. click on the headings to view the sources. Continue reading


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journey of healing: part 1

'rebirth' by unknown

'rebirth' by unknown

Mainstream Mental Health Services on Vancouver Island

It’s been a while since i have posted, as i have been having many adventures in the process of “what to do after diagnosis”, exploring avenues of health in the mainstream as well as alternative health care available to me here on the West Coast of Canada.

Last week, I walked out on a 7-week day program, having had a first-hand experience of why CBT can have adverse effects on borderline patients; so, I’ll start by telling you about my experience with the (mainstream) mental health services here in British Columbia. journey of healing: part 2 will focus on the alternative sources of healing i have simultaneously been exploring.

This is a long post. I hope my experience can provide some information for anyone seeking help in the Cowichan Valley in the field of mental health. At the bottom is a listing of DBT offerings (which i have only been able to find) in Victoria, BC. For whatever it’s worth, this is what I experienced.

intake & diagnosis

Upon my arrival here in BC in June 2011, the Vancouver Island Health Authority (VIHA) of the Cowichan Valley began with excellent, holistic and compassionate service. My psychologist in my previous (remote) hometown wrote a letter about my condition and history, which my mother delivered directly to them. My care began with an appointment with an intake nurse at VIHA, who was thorough, open-minded, compassionate and holistic in her approach. She made several personal phone calls to my residence in those early weeks to see how I was doing and offer support in my transition. I then began sessions with a psychiatrist, who administered a thorough psychiatric evaluation and diagnosed me with bpd.

Initially, I felt quite heard and understood as I had never been before; and that the diagnosis was accurate, offered me hope of treatment, and a potential community of others who share my experience. I began reading every book I could get my hands on on the subject of bpd and mental illness in general, and spent numerous hours online sifting through and contributing to forums, blogging my experience and further researching bpd.

eat healthy, exercise regularly & see you in 2 weeks — really?

The psychiatrist however, only scheduled appointments with me every 2 – 3 weeks, which felt like a drop (lette) in the bucket. He took a very clinical approach that for me, skipped out entirely on validating my experience and giving me a sense of anchoring and confirmation of what I had been going through. He began minimizing what I had gone through, implying there was really nothing wrong with me, and interrupting me often in sharing what was going on for me. He seemed to focus solely on eating and sleeping well, exercising, and balancing the type of activities in my day.  When he went away on vacation, he decided I would be okay without an appointment for a month before I began VIHA’s 7-week day program for recovery and re-integration back into the “real world.”

I felt abandoned and invalidated by this; I was never able to get a straight answer as to whether or not he had been deliberately testing me to see if his diagnosis was accurate, and determine whether I was an inwards or outwards borderline.

I became quite distraught over this, so I phoned VIHA and managed to speak with a counselor there, who made an appointment to see me the next day, and got me into the 4-week day program, scheduled to begin the following week. This counselor has continued to hear me thoroughly and validate my feelings and experiences. She said that the psychiatrist doesn’t offer counseling, but is supposed to refer patients to a “case-worker” or counselor to work with me more in depth; that I had been put on a waiting list in order for this to happen, and had, in her opinion, simply had to wait too long in order to get in. The psychiatrist had neglected to mention that I was on such a waiting list.

Conclusion: I needed to speak up in order to get in sooner. The system has cracks to fall through.

more waiting, stop-and-start, and what’s this thing called DBT

I began the 4-week program, but as I hadn’t planned to begin for another month, I had too many other things going on in my schedule to keep it up; so I ended up attending only as I was able. The program was topical and academic, but I was assured by my counselor that the 7-week program was more in depth, and included “experiential” learning through the relationships with fellow participants and the instructors of the program.

I was unable to clarify what exactly the 4 and 7 week day programs were actually based on, but was told that they had been designed to treat people with mood disorders and limited, inflexible coping disorders that failed to meet the demands of normal life. VIHA had been offering these programs for several years with successful and positive results.

So, I continued to be seen by my new counselor once per week for the next month, with one delay due to an illness on her part and a pre-planned vacation. No substitute sessions were arranged, and I simply had to go without sessions for a couple of weeks, but I had my 12-step CoDA (Codependents Anonymous) program and although I was frustrated and mildly let-down again, my relationship with the counselor was strong enough for me to endure this period. During this time, I also discovered a bpd support group an hour drive away from me (Overwhelming Emotions Support Group). I attended one of their open meetings, and was cautioned that anything other than DBT (Dialectical Behavior Therapy) was likely to be based in CBT (Cognitive Behavioral Therapy); and that CBT is known to cause more damage than good in borderline patients. When I relayed this information to my therapist, she told me that the 7 week program was based in CBT, but had proven to be affective for all of their clients with depression, anxiety and bpd. Hmmm. There seemed to be a bit of a discrepancy here; but I thought, let’s just see if these people know what they’re talking about, and give the program a try. After all, it’s free, so why not?

trauma in the day program

So finally, in November, six months after my hospitalization, I began the 7 week program. The first week was okay, but exhausting – mostly an orientation to the program and time to “bond” with fellow participants. I was exhausted by so much unstructured “bonding” time, and I wasn’t wild about the mandatory tour of the gym or various non-profit organizations to volunteer with (I was already physically active and volunteering in my new community at this point); but I remained open to where the program would take me in the coming weeks.

After the first day of week two, I approached a facilitator to express a feeling of unrest over what the program called “check-ins.” The facilitator was brief and curt and instructed me to bring it up during check-in the next day. This was the second time I had approached a facilitator and felt unwelcome. I later learned from my counselor that facilitators of this program are instructed specifically not to engage in one-on-one (therapy? interaction? what is the difference?), and that this is a “research-based practice.” I don’t doubt that it is; but it seemed that either the research did not include me, or I was once again different, “unique,” strange, alone.

That night at home, I experienced an interaction with a family member that unearthed a very deep trauma for me. I was awake for most of the night, weeping and writing to process what I was feeling. I arrived at the program the next day obviously lacking in sleep, but also still in a deep state of honouring my grief. I was feeling unfelt, buried feelings and releasing them in the process. Yet, there was no place in the program for me to share what was going on for me, and this was another trigger. My experience of the so-called “check-ins” was that they were time for success stories only, so that the facilitators could use them as examples of how the principles being taught worked–some kind of positive re-enforcement I can only guess. I didn’t feel strong enough to voice my discomfort that morning, and instead shut down even more and stopped talking to anyone.

The first class after check-in was Changeways, looking at how changing (or “reframing”) our thoughts can change our emotions, which can change our actions. I didn’t want to change my thoughts or feelings; in fact, what I needed to do was the opposite – FEEL THEM and have them validated, CONFIRM the reality I had grown up with and eventually decide how to respond to it differently as an adult. I felt completely disconnected from the group, and a lifetime of shame and isolation for feeling things so deeply was brimming. My feelings were not appropriate in this situation; they were wrong, I was wrong, there was something wrong with me and my ability to perceive reality. I was deeply alone.

Part way through the Changeways class, during the break, a facilitator came up to me to tell me that my appointment with my counselor that day was canceled, again due to illness. Instead of recognizing and acknowledging that I was obviously not having a very good day already and that the news of this cancellation had the potential to cause even more distress, the facilitator seemed to be intentionally insensitive to this reality in the way she delivered the news to me. There was no compassion, no comfort, no support (eg. “Are you going to be okay? What’s going on for you today? Do you need to talk with someone?”).

In further shock, I simply said that I really didn’t feel like being there that day, which was true. The facilitator responded by saying that it was up to me, and that I could leave any time. So I left. By the time I reached my car outside, I was sobbing which would go on for the next hour. I didn’t feel safe in going home at that point, because of what had happened the night before, so I called a couple of CoDA people who weren’t home, and then called the local crisis line. The person listened and was compassionate as much as a complete stranger could be, and I was able to calm down a little bit. He asked if I wanted him to page a crisis nurse at the VIHA centre I was parked at, so that I could have some closure and reconciliation with someone there in person, and I agreed. So, an hour later, I was seen by a crisis nurse. Unfortunately, she had been trained to take the exact same stance as the facilitators of my program. She listened to a bit of my morning, and then asked me what I was going to do about it. How I was going to love myself that day. I went in to people-pleasing mode and responded that I was going to have some lunch and re-join my program that afternoon (this could perhaps also be described as dissociation). As if remembering her bedside manner training, she hurriedly and mechanically said, “Good, good for you” and proceeded to tell me, “We’re done.”

By this time, the “fuck you” in me was stepping in to get me angry, and the hell away from the mental health centre. I found a CoDA member at home, took my lunch over to her and was finally able to share and be heard. I began crying again, this time grieving the pain I had experienced that morning, and the lifetime of pain around the trauma of emotional avoidance and invalidation.

I decided for some reason that I would still try to rejoin the program, who were all out at their volunteer organizations, but I went to the wrong location, couldn’t call anyone ‘cause my phone was dead, and didn’t want to be late; so I eventually returned home that afternoon, feeling safer there having had my experience heard and validated.

My emotions felt somewhat stabilized, but the trauma began manifesting in my body as well; so, by that night, I found myself lying on the couch with a warm cloth over my eyes and all the lights turned off. The pain in my head was so intense I couldn’t open my eyes and I began to throw up. I knew without a doubt that this was a psychosomatic reaction to the events of the day.

resolution with counselor (a week later)

A couple days later (it was Friday), I phoned VIHA to see if my counselor was in, but was told she was still ill and to phone back on Monday. When I phoned on Monday, she was still ill, so I was asked if I wanted to speak with one of the group’s facilitators. I initially said no way hose, but then phoned back and decided to try it. But I got her voicemail, and she did not return my call that day. I had spent the weekend feeling reckless and exhausted and depressed and shut down, and extremely anxious over how this was going to resolve itself at VIHA. On Tuesday, my counselor phoned me to apparently “remind” me of my appointment with her that day, though I had no notion of this until then. I suspect that the facilitator who had notified me that last Wednesday that my appointment was cancelled was supposed to have told me of my rescheduled appointment had forgotten to do so.

though it really would have been helpful to speak with someone compassionate a little earlier (!), I survived the ordeal, and the resolution with my counselor was good. She agreed with me that the program is mostly based on CBT, was sincerely interested in hearing what I had experienced, and wanted to know how she and the team could prevent a similar experience in the future. At the moment, I am continuing my sessions with her, and exploring other healing options.

aftermath

Since leaving the program, I have realized how much that experience has set me back in my feeling of safety in the world. The core belief that was re-exacerbated was that the world is an unfriendly and uncompassionate place that will shame and isolate me for having my feelings. I must hide them and deal with them alone. There is something wrong with me for having them. It is not safe, appropriate or acceptable to be me. This has set me back in my daily energy and motivation, and caused my feelings of hopelessness and suicidality to resurface, though I am finding other means of healing, as I will discuss soon in another post.

I am doing okay, though still processing in particular the recurrence of not fitting in with the mainstream and my sadness and isolation over that. I have been pondering what mainstream is to me, and why it is important for me to gain some sort of acceptance there, aside from the fact that it is the mainstream system that can sign the papers for me to continue receiving financial assistance in this time of recovery.

in retrospect

I believe in VIHA staff’s collective and consistent statement that their programs and services are research based, and that everyone there has a sincere desire to help people, or they wouldn’t be there. I am also familiar with the dilemma that borderline therapists often encounter of how much to coddle borderlines — ie. that comforting our pain too much will simply perpetuate our dependency on others; yet disregarding it will re-open our initial wound of invalidation. And yet, this is exactly the dilemma that DBT has been designed to address. Also to the defence of VIHA however, and from everything I have been reading, DBT seems a very costly form of treatment to offer because of its high degree of individual therapy. So, I can appreciate efforts to adapt CBT to meet the needs of borderline patients; however, I did not feel that the 4 or 7 week day programs at VIHA were at all successful in doing so. On the contrary, I feel that the program had an overall negative effect on me. One major point of this failure is that I think borderlines, or anyone with invalidation or abandonment trauma, simply do need to have a much higher level of individual support than was presented to me. I think the program would benefit greatly with DBT training for its facilitators, so that they can be prepared and enabled to be more sensitive, open, receptive and supportive to individual communications from participants such as myself who who are there because of traumatic invalidation and/or abandonment (which is becoming my new definition for high-functioning internal bpd). I think facilitators just need to make some time to be open to these communications. I think that the stance of seemingly deliberate ignoring of what the patient might be feeling in the moment on the part of most of the workers at VIHA might be helpful for many or even for most, but extremely damaging to patients like me; and that adopting this stance as a general practice is therefore not a road I view to be effective for a mental health facility, given the increasing frequency of bpd diagnosis’.

In retrospect, the situation that morning is my deepest trigger in life and my original trauma – the trauma of invalidation and separateness for how I am feeling. I couldn’t have been triggered in a deeper way than the program facilitated. I had re-experienced my initial trauma of extreme invalidation and abandonment.

DBT PROGRAMS IN VICTORIA, BC:

South Island VIHA

I have also since been in touch with the South Island branch of VIHA, and learned that they do offer a limited program of DBT through their Urgent Short Term Assessment and Treatment (USTAT) division. What I know so far is that it’s a year long program; they have just closed intake for the next session, and they only communicate intake periods with facilities and professionals within their region (South Island), which is why their program was not offered to me as a resident of the Cowichan Valley. I spoke with a woman named Elizabeth there, who was compassionate and willing to investigate how I might be able to participate in the program regardless.

New Light Recovery Workshop

The Overwhelming Emotions Support Group I mentioned earlier also offer a peer-led 18-week DBT program called the New Light Recovery Workshop The program is free, by funding from the United Way, with intakes in the spring and fall of each year.

Thanks for reading, and as always, I welcome and enjoy your comments, questions and feedback.

Blessings be. HJ


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the concept of the high-functioning borderline

the mental health community in general is still in debate over the existence of bpd subtypes. Whatever the truth is doesn’t change my reality, but that doesn’t mean i won’t still follow the discussion, or participate in it however I can. What are your thoughts?

Article by Bon Dobbs on “mentalization” and “attachment” in BPD (The comments on this article are also very illuminating)

I will be making a longer post very soon about my experience in CBT and why i left the program. blessings, HJ

meandering (unknown)

meandering (unknown)

no one has managed to convey this aspect of identity confusion as well for me as the post that is linked below.

the image to the right also illustrates the phenomenon well; although it’s title implies that we are aimless, which actually couldn’t be more opposite to the truth, for me.

anyway, once again, I am relieved to recognize myself in another’s writing.

sometimes the best mirrors are in each other.

Constant career changes – the BPD unstable sense of self and identity.


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the fear

unknown image

unknown image

the fear that no one will ever know me as i really am.

i am too subtle, too complicated for anyone to ever figure out.

i fall off the planet at this thought, feeling condemned to isolation and hopelessness.


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inwards vs. outwards: no one is better, no one suffers more

I came across a bdp discussion forum last night discussing the notion of the Quiet (or Inwards) Borderline. A post there expressed disagreement with bdp subtypes, and criticism of the notion that Quiet Borderlines either a) Suffer more than “outwards” and / or b) Are somehow less ill or easier to deal with.

painting by tammera

painting by tammera

Some of my writings here on this blog might inspire similar reactions, as if I am demonizing outward bdp and making saints of inwards.

I don’t think it’s useful in any contemplations of bdp to compare levels of suffering — that is completely subjective, and impossible to ever really know or compare.

I think there are indeed many outcomes of the underlying patterns that define bdp, but those underlying patterns are the same in all of us, and we all suffer greatly with them.

Some of us turn our suffering inwards. In my case, it can be impossible for those around me to know what is going on for me until I become desperate enough to let it show; and in my case, I must decide to do so. Consequently, I often feel like I am a fraud, “dramatizing” my feelings in order to receive support that maybe i don’t deserve. Am I over-dramatizing or minimizing my experiences? It is a different reality in every day, or every moment at times. I feel the chronic aloneness, emptiness, self-doubt and fear of abandonment of any borderline; and my sense of confidence, status, personality and role in the world are as unstable. I am inconsistent in mood, energy and personality; which is often devastating to my relationships, and perpetuates my aloneness, self-doubt and abandonment fears in an endless cycle.

In my experience of being an inwards borderline, no one would say that I am a difficult person. I think what some might think (though they would never say it) is that they do sense something a little unsure or unstable, something i am hiding from them, and they therefore do not deem me trustworthy, and are not very comfortable around me. There is a sense of caution, like there is something dark and scary beneath the surface that is scarily subtle and ominous enough as to make people quietly and sneakily distance themselves from me. No one would think that I am mentally ill and may just require a little extra patience, support and encouragement; they just think i’m a little “off” and aren’t really drawn to get to know me too well. Some of my friends are probably saying this is a load of crap, but my recovery depends on my own ability to validate this experience I have, intentionally let it show and receive the treatment that I need around it. I have to choose and work at living more honestly in the world to escape the endless isolation that swallows me whole. It is the degree of this, the intensity to which i feel it, and my ability to hide it that qualify this a dangerous, precarious and pathological reality. The hardship of this outcome of bdp, and the common misconception on the parts of friends and mental health professionals, is the assumption that because I can control what I show, I cannot truly need treatment. This leads me to thinking that I am a fraud, until I read about others this way, and the term “quiet borderline.”

compassion painting

the heart of the matter of living

While the quiet borderline (in my experience) experiences subtle social isolation, invalidation and abandonment by the mental health profession for not being “ill” enough; the outward borderline, it seems to me, experiences overt social isolation and abandonment by the mental health profession for being “too ill to treat.”

Both borderline outcomes end up feeling the same thing–isolation, hopelessness and unworthiness. Both suffer. Both require and deserve radical acceptance, compassion and support. One is not “better” than the other; and one is not more treatable than the other.

Thanks for reading. Thanks for listening. Please comment!

Love, HJ


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BPD in France

It is refreshing to read something other than what I am beginning to call the “cliche” or “hollywood” version of BPD. I sometimes feel like some kind of a BPD fraud because i don’t have the angry outbursts and had begun to draw my own conclusions about (what I called) “internal” and “external” versions of BPD.

I’m not really sure who AAPEL is, other than its stated mission to support those with BPD and their loved ones; and, judging by the grammatical condition of this translation, I can assume that this is not written by a trained professional. None the less, I still feel relief that any organized body of bpd experience is making similar observations that help me (and maybe some of my readers) to not feel like a fraud any more.

I just don’t agree with the statement that the perception of friends and family is a criteria of mental illness; not with bpd anyway. I believe and understand how a person can be mentally ill without anyone suspecting it and how this is, in some ways, more painful and isolating.

The document is taken from the website of AAPEL (France):   http://www.aapel.org/bdp/BLsyntheseUS.html. The formatting below is clunky because i couldn’t get the bullets to publish correctly …

NOTE: I didn’t translate this, but I have made grammatical corrections to the translation that appears on the website above, for clarity, and have omitted some sections in what I am posting below. In red are the aspects I have not read or heard talked about outside of my own head before reading this.

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