Rapid cycling (without a bike) and how to get kicked out of DBT

So, I didn’t write a blog post last week.  It was a bit of a tough week, one way and another, so I just …. didn’t. Anyway, I’m back to full ranting power this week, so…

Over the last few days, I have been experiencing rapid mood cycling.  It is an utterly ridiculous and exhausting process.  I can go from genuinely cheerful, positive, energetic, joyful and optimistic to suicidal in the course of a few minutes.  Incidentally, BPD used to get mistaken for bi-polar because of this particular facet.  However, in BPD the mood swings are much more rapid and are usually in response to external events, which tends not to the case in bi-polar.  This creates a bit of a problem with blogging.  If I wrote during one of my ‘up’ phases you’d all think I had experienced an epiphany and was completely cured.  If I wrote during one of my down phases, you’d be calling the police.  I try to maintain an attitude to my moods along the lines of the adage about the weather in Sheffield…. “If you don’t like the weather………….wait.”

Anyway, I thought I might write a bit about Dialectical Behavioural Therapy (DBT) today.  It is a relatively new form of therapy, invented by a truly marvellous and inspirational woman called Marsha Linehan.  She is a professor of psychology and psychiatry and self-diagnosed BPD-er.  Her ideas about treatment and who can be helped are both radical and brave.  If you would like to read about her:

Marsha Linehan

DBT has only just come on line in Sheffield, so I am one of the first (and very privileged) people to be able to undertake it.  It is a highly structured form of therapy that focuses purely on the present and aims to reduce unwanted behaviours and feelings. The therapy involves a mixture of Zen-type mindfulness, increasing understanding and tolerance of emotions and improving communication skills.    Each week I attend a two hour group education session and have one hour of individual psychotherapy, where I perform chain analysis of an event that I found difficult to deal with.  In addition, I am expected to complete homework on a daily basis and sometimes have coaching telephone calls with my psychotherapist if we can fit them in.  I’m knackered!

Last week my psychotherapist said that she was finding it difficult to come up with a formulation that works for me.  In other words, DBT isn’t really working for me at the moment.  She and I need to find a different way forwards.  This might mean changing my formulation (ie what my goals are), or it might mean taking a vacation (the programme is American) from therapy for an indefinite period.  We did not reach a conclusion, and as she is on holiday this week, we must wait until next week to continue our discussions.  The problems are two-fold.  Firstly, DBT is largely focussed on reducing problem behaviours and I don’t really have any.  I don’t take drugs, I don’t drink to excess, I don’t self-harm or take part in risky or criminal behaviours, I don’t behave destructively towards my loved ones.  I’m a fucking model patient.  Unfortunately, I am still suicidal.  What do you do with that? The other problem is around stability.  You can only have DBT when you are stable and it may be that I am not currently stable enough to have the therapy.  So, I need to get better (enough) to have therapy………without therapy.  Catch-22.  If I sound bitter, I’m not.  I completely understand why this is the case, but unfortunately, it does not offer me a solution.  So, I’m a bit stuck right now.  Just to be clear, I want to continue with the DBT, but ultimately, it is not my choice…..

I also wanted to take this opportunity of talking about DBT to share a few hints and tips with you about what not to do in group education sessions:

1. Do not try and work film quotes (for example Lord of the Rings) into your answers.

2. Do not sit in a different seat each week purely to mess with the people who have OCD and anxiety. It’s not funny (apparently).

3. When someone shows the group the following graphic to help them understand emotions better do not respond by bursting out laughing and asking ‘which emotion is it that turns you into a Ninja Warrior?’

emotions

4. Try to not mutter ‘FFS’ under your breathe when the conversation about which type of milk we should have for the break time tea has gone on for more than ten minutes.

5. Definitely don’t suggest that an appropriate use for the ‘wheel of emotion’ (at the top of this post) is to stick a pencil in the middle of it and spin it round to decide on how you’re going to feel that day.

6. And finally, try not to giggle every single time the course leader says ‘and now we are going to do some role play’.

I know, I know, I’m being naughty, but you do need to find some fun in life.  I also know that if R~ was reading this blog (she doesn’t) she would tell me that I am responding to a situation that makes me feel uncomfortable and anxious by using flippancy and sarcasm as a defence.  R’s insight into my head makes her incredibly valuable friend, but also one that I occasionally want to punch in the face (only joking, love you really – just in case you are secretly reading this!).  And besides, I think I’m fucking hilarious…………

Until next time folks.

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