Friday, September 2, 2011

Lucid Analysis – Trials in Therapy

 I’ve been lax with my days in therapy. Yesterday was an odd day for me. I’ve been so overwhelmed with the amount of work I have to do the stress has been almost a physical weight slowing me down. Around 2p.m. yesterday my boss sent me an e-mail to see him at 4p.m. to go over a presentation I’m preparing and give me a 6 month performance evaluation.  I was instantly paralyzed, I could barely think, barely force myself to move. You would think the world was coming to an end, which I would have preferred, b/c seriously, zombies I can handle. For as busy and productive as I’ve been I could only imagine the awful things he could say; not productive enough, not good enough, too slow, why don’t I know everything yet. My brain whirred a thousand miles per hour while my heart seems to take forever to beat up in my throat. As it turned out it was more a handshake and congratulations I’ve been here 6 months. The only critique he had for me was that I should get out in the shop more. Done. It’s never as bad as I fear it will be. Never, and yet I can’t stop myself from thinking it. When I sat down in Therapists office I was still all locked up and tense from stress and could barely think of what to say. It took me almost 45 minutes to really be able to hold my end of a conversation.

Though it wasn’t much a problem. She talked for ages about studying psychology and things to be aware of. She was also very focused on reassuring me that this space was a safe space for me. It’s the developing the therapist/patient bond I think. I feel like I’m failing her here. Most people can probably come in and develop a trusting relationship real fast. I know I still hold parts of myself back. I’ve been in Protector mode for a while now, my walls and defenses have been very up. I am having a very hard time allowing anyone to be close to me. And rightly so I should not allow everyone close, but I recognize that there are people that do deserve my trust, like Roommate, and I even have a hard time letting her in and maintaining a connection. Therapist asked me what I was afraid of that makes me shut down that way. What causes me not to trust where cognitively I know I should? What instances can I recall where people have betrayed my trust. Of course the first people I thought of were those like Friend or Evil-Ex or the One I don’t talk about, but she said No, those are guys and the reasons I have for not trusting men are a different kind of mistrust. That stems from a different place. She wanted me to think to my female friends and understand where this may have stemmed from. I haven’t had much better luck with female friends than I have with male friends. All the petty instances of girls being catty and turning on me floated out of my head and I remember one friend that I was very close to when I was 12/13 years old. I remember very clearly that I had been suicidal, just understanding what cutting did for me, and needing friends that I could share my problems with. We’d been friends for ages, talked for hours every day, but when I let her in on the darker parts of my mind she drew away. We talked less and less and one day when I asked she told that she couldn’t be as close to me because I made her too sad. And who could blame her really? Too young to understand, too young for that kind of responsibility. But for me, I took a lesson from that. One that just compounded all the perfectionistic fodder that was already beaten into my brain. If I’m not perfect, people will leave. If I show the imperfections, I won’t be good enough. So I learned to hide myself away. When I was younger all the bottling turned to rage and exploded outward, now I turn it in. Therapist wants me to remember to step back. When a situation presents itself where I feel my defenses or walls coming up, try to recognize that this is occurring, and draw what comes to mind so that I can better visualize what I am feeling in relation to the reality of the situation.
She also said that when someone has such a strong Protector mode that it’s an indicator that one or both of the parents did not do enough to shield me from some kind of threat. I get angry thinking about this because my parents were never intentionally hurtful. My dad made us over achievers, he pushed me to the point of nervous breakdowns and suicide though I don’t think to this day he understands the level of stress he placed on me. Therapist believes that somewhere I feel like my mother let me down because she saw how hard I was being pushed but never tried to intervene. I don’t know if she could have though. She wasn’t around so much when I was growing up because she worked nights and slept during the day so I never really developed a strong bond with her. By the time I was old enough to express how I felt I had developed this mentality, this fear of failing. That I cannot be less than perfect or I will not be good enough for anyone. I cannot trust people to hold my best interest. I had no one to rely on but myself. I know my mom would read my diaries and I never trusted her after that, but it was even before. Maybe I was just an independent child, or suspicious in my nature, that I did not believe I could trust because all the things I wrote in my journals I wrote because I could not tell anyone else. I had already lost my ability to trust or maybe I never learned how to trust in the first place. Hm, I’m not sure. My memories are fuzzy if I have them at all. Something to think about for sure.

Homework: Create a timeline. Call my mom and talk to her. Talk about all the times growing up that we did things together, when we started doing craft type projects, major events in my life that she took part in, starting when I was very young. This will help me reform memories, see my mother’s perspective, and hopefully form a stronger bond between us.
The thought of this is daunting. Talking to my mom for any length of time is exhausting and often infuriating. Not for anything specific that she says persay but she always manages to make me feel like she’s asking too much. Information that I would gladly share freely with anyone else suddenly feels intrusive to tell to her. I recognize this and now it’s something to try to work past.

Thursday, September 1, 2011

Get a Grip: Coping Mechanisms

As I mentioned yesterday there are three basic responses to any kind of threat; Fight, Flight, or Freeze. Or in this case: Overcompensation, Avoidance, Surrender. But what do we consider a threat? In this context a threat is any emotional frustration that triggers a schema response; the frustration of one of those core emotional needs or the fear of the intense emotions that a situation inspires. The coping mechanisms that arise from this may have once been appropriate, say in childhood, but later on in life they become maladaptive when they perpetuate the schema even when circumstances have changed and there are better, healthier ways of dealing with a situation.
So what happens when you deal with a schema in these ways?
Schema Surrender – When someone surrenders to a schema, they yield to it. They don’t try to fight or avoid it and accept the schema as true so that they feel the emotional pain directly. They act in ways that confirm the schema. “When they encounter schema triggers, their emotional responses are disproportionate, and they experience their emotions fully and consciously. Behaviorally, they choose partners who are most likely to treat them as the “offending parent” did.”
Schema Avoidance – This happens when a person tries to arrange their lives so that the schema is never activated.  They attempt to live without awareness, as though the schema does not exist. They avoid thinking about the schema. They block thoughts and images that are likely to trigger it: When such thoughts or images loom, they distract themselves or put them out of their minds. They avoid feeling the schema. When feelings do surface they push them down on instinct, maybe by drinking excessively, doing drugs, having promiscuous sex, overeating, compulsively cleaning or in some other fully immersive way. People that engage this kind of coping mechanism often appear completely normal because they avoid anything and everything that will put them out of their comfort zone.
Schema Overcompensation – To overcompensate for a schema, it is fought against by thinking, feeling, behaving and relating as though the opposite of the schema were true.  A person may try to be as different as possible from who they were when the schema was acquired. For example, if they felt worthless as children, then as adults they try to be perfect OR if they were subjugated as children, then as adults they defy everyone OR if they were controlled as children, as adults they control others or reject all forms of influence ( < ----- this is often me, I reject all forms of influence even if I ask for it). Faced with a situation that triggers a schema someone who overcompensates with counterattack.
Overcompensation isn’t entirely unhealthy. It sort of starts off on the right track to fight back against the schema but it overshoots the mark so instead of being able to heal the problem is perpetuated from a different angle. Overcompensation develops because it offers an alternative to the pain of the schema. It is a means of escape from the sense of helplessness and vulnerability that a person felt growing up.

So what determines which coping style you develop? Most likely it’s your inborn temperament. Temperament probably plays a bigger role in determining coping styles than determining schemas which are more often a result of the environment. For example, someone with a naturally passive temperament is likely to surrender to their schemas while someone with a more aggressive temperament is likely to overcompensate. But like most things, it’s rarely so simple. Especially for someone with a Borderline Personality Disorder who may run the gamut on a huge array of these schema types. I absolutely cope with different schemas in different ways. Hell, sometimes I cope with the same schema in different ways.  For example, I had a very strict and over structured childhood so with Subjugation I overcompensate by rebelling against authority or any norm in general. But in Defectiveness/Shame I engage all three coping styles by putting myself down, avoiding expressing my true thoughts and feelings and letting others get close, and/or criticize and reject other people while hiding my own flaws, depending on the situation.  
Tomorrow or Monday I’ll give examples of each coping style as it corresponds to each of the maladaptive schema types. Side by side it’s easier to get an idea of how these correlate.

Wednesday, August 31, 2011

Stop the Cycle – Perpetuation

I feel like I’ve been away for so long! Sort of like I’m rediscovering electricity and all the useful e-lec-tronic-al type stuff that goes with it. Internet included. I’ve been almost anxious having anything to do with getting on-line and connecting to anyone and anything.  It’s felt safer to curl up on my couch, away from all media and people, and hide in my books. I’m not even connecting with my previous patterns and structure. I need my routines but everything is just a hair off. Arg. Plus I’ve been majorly, majorly swamped at work so everything feels overwhelming and disconnected to me right now, but in a super busy and productive way.  Anyways…..

Now that we know what each of the different maladaptive Schemas are we can begin to recognize how they are displayed. Perpetuation of a schema is everything someone does that keeps that schema going. All the thoughts, all the feelings, all the behaviors that keep you stuck in a rut and reinforce these things that ultimately you really want to heal from. Threes. We’re going in groups of threes today.

Three primary mechanisms that perpetuate these schemas:

1. Cognitive distortions: An individual misperceives situations in such a manner that the schema is reinforced, accentuating information that confirms the schema and minimizes or denies information that contradicts the schemas.  Essentially the emotions connected to a specific schema are blocked.
2. Self-Defeating Life Patterns: Unconsciously a person may select and remain in situations and relationships that trigger and perpetuate a schema while avoiding relationships that are likely to heal it instead.
                “Destructive thought they might be, schemas provide patients with feelings of security and predictability. Patients resist giving up schemas because the schemas are central to their sense of identity. It is disrupting to give up a schema. The whole world tilts. In this light, resistance to therapy is a form of self-preservation, an attempt to hold onto a sense of control and inner coherence.”
3. Coping Styles …. Which we’ll get into next. Maladaptive coping styles and responses develop early to help a person adapt, to not experience the level of intensity or overwhelming emotions that these schemas represent. In this way a person behaviors are not part of the schema, but they are a part of the coping response.    The schema itself is the thing that motivates the need to cope and the behavior that results from it.

What’s more, everyone uses different coping styles for different situations. Different people will use different coping styles for the same situations. Hell, over time, the same person may eventually come to use different coping styles for a situation they’ve been in before but learned to adapt accordingly. The schema itself is not changing, but the means of coping and the behaviors might change.
“Almost all patients who have characterological disorders repeat negative patterns from their childhoods in self-defeating ways. Chronically and pervasively, they engage in thoughts, emotions, behaviors, and means of relation that perpetuate their schemas.”
Hence, schema healing is the ultimate goal. This involves diminishing; the intensity of memories connected to maladaptive schemas, the emotional charge, the strength of the sensations that are felt, and the maladaptive cognitions. Not only that, but it also involves behavior change.  Once you learn to recognize the maladaptive methods that you’re utilizing, you begin to replace these with more adaptive patterns of behavior.
While we all may cope differently there are three basic responses to any kind of threat: Fight, Flight, or Freeze. Or in this case: Overcompensation, Avoidance, Surrender…..

Tuesday, August 30, 2011

And the Medication-Go-Round Continues: Pristiq

Hello Everyone! Well I survived the Hurricane. Not unexpected. The storm wasn’t really so bad. I woke up with half a tree in front of my front door and we were without power for 3 days but generally speaking we were well prepared. Mostly the whole thing was just very, very inconvenient. I know a lot of people in our area still don’t have power so we’re fortunate in that ours is turned on already. Personally I think if we’re going to have major weather events they should at least occur during the work week so it doesn’t screw with my time off but that’s just me. Oh well. Back to the real world!
I’m apparently starting a new drug. I’ve been off the Abilify and medication free for about a month now. On the anger punching side my mood swings have actually been alright but I’ve been swinging pretty low from my depression on the other side. As soon as I stopped taking the Abilify I felt my energy jump right back up to where it usually is and I’m actively functional again. Even really getting back into the swing of my exercise routine! I went and saw Psychiatrist on Thursday. I hadn’t planned on going back on medication but like so many things in my life I made a split second decision. Sitting there I was afraid that I would lose something if I didn’t try something new. Maybe the approval of my psych. Idk. Logically I know I started going to my psych because I hate always feeling like this, but everything we’ve tried so far has only been a detriment so I’m incredibly weary of new things. Especially anti-psychotics.
Mood stabilizers aren’t really what I need since they only seem to “stabilize” my good moods and not my depression. I find that to be rather unfair. This time we’re just going to try and treat my depression with something totally new. Pristiq. Pristiq/Desvenlafaxine is in a class of medications called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). It works by increasing the amounts of serotonin and norepinephrine, natural substances in the brain that help maintain mental balance.

I have a question. Who the hell names these thing? Seriously?
She allayed my usual concerns and said there has been no reported weight gain or sexual side effects (I don’t really believe this) and the norepinephrine aspect actually gives people a motivational boost so I shouldn’t have any fatigue either. Yay! So what side effects might there be?
-         loss of appetite  <----- We can hope
-         dry mouth
- dizziness
- extreme tiredness <----- Hmmm, watching out for this
- unusual dreams <------ Probably my favorite aspect of anti-depressants
- yawning
- sweating
-uncontrollable shaking of a part of the body
- pain, burning, numbness, or tingling in part of the body
- enlarged pupils (black circles in the centers of the eyes)
- blurred vision
- changes in sexual deesire or ability
- difficulty urniating

And the more serious CALL YOUR DOCTOR IMMEDIATELY ones:

-         rash
- hives
- swelling
- difficult breathing
- fast heartbeat
- cough
- chest pain
- fever
- coma (loss of consciousness for a period of time) <---- Seriously?!?
- seizures
- hallucinations (seeing things or hearing voices that do not exist)
- fever, sweating, confusion, fast or irregular heartbeat, and severe muscle stiffness
- unusual bleeding or bruising
- nosebleeds
- small red or purple dots on the skin
- nausea
- vomiting
- diarrhea
- headache
- difficulty concentrating
- memory problems
- confusion
- weakness
- problems with coordination
- increased falls
- fainting

Seriously. This is all very ridiculous. The list isn’t as long as for the Abilify but there’s still a hell of a lot to look out for. She did say headaches and nausea were typical for the first week or two. That should be fun.
While I’m at it I’m going to quit smoking. Not that I smoke much at all but still, I’m determined. It’s an  ugly, awful habit. I really hate it but I get addicted to habits and repetitive motions and patterns easily so it’s hard for me to give up things once I’ve established them somewhere in my life. Drinking too. I need to stop entirely. I’ve been drinking more and more lately from all the stress I’ve been dealing with and this just isn’t healthy. In the past I’ve tried to just focus on fixing one thing at a time but that doesn’t seem to work so well, so this time I’m going to throw all in and see if I can’t fix it all at once. Here goes nothing.   

I’ll keep you updated.
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