Friday, October 28, 2011

Lucid Analysis – Trials in Therapy: The Relationship Issue

The Relationship Issue.
Right away Therapist said I looked centered and happy. She asked how things are with Tech Boy and all that. Good. Cute. We’re texting and talking all the time. I feel silly and cute (read: euphoric and high).  She asked me if I think this is on track to being a healthy relationship.
How would I know?
I’ve never had a healthy relationship. Surprise! Don’t look at me like that. That’s not saying they’ve all been bad, just not healthy. I dated a couple guys in college that were really great guys, but I felt no emotional attachment to them. For all intents and purposes the relationships were ‘normal’ but emotionally void b/c I was cut off from feeling (Boring-Ex can basically fall into this category as well except of course, that ended with me in the Psych ER). Unhealthy. My relationships with women were often more affectionately intense, but shorter lived as I would freak out at the speed of closeness. And then, there were the notable abusive messes that have hallmarked my existence. I fail at relationships. I think people are crazy for wanting to be involved with me. I actually TELL PEOPLE that I’m a terrible girlfriend and that they shouldn’t want to date me. I come with a disclaimer ß-------- This is a common phrase.
Or like this morning when Tech Boy and I were going out to my project site he was like… “You carry my equipment, drive me around, you’re just a generally good person ::insert cute smile::” To which my immediate response was to laugh that off and say “Clearly, you don’t know me that well”. I’ve tailored responses like that to sound joking, even though I mean it whole heartedly.
Therapist doesn’t see a bad person in me. She sees someone that has had a lot of bad things happen to them, but that doesn’t mean I am bad. I still feel bad. I feel like I’m going to destroy everything I touch. Which is awful because I want to touch things. I want to be touched.
Not literally. Don’t get too dirty on me there. Ok, maybe a little bit literal. Ok, a lot.
I mean I want to be with someone in a meaningful way. Therapist asked if I felt Tech Boy was someone that I felt I could share with? I want to be the kind of person that can be open and share myself with someone in a healthy way. But I have so much unhealthiness in my past. I told Therapist I’m not sure I can be open with Tech Boy (not just him, anyone). What right do I have to dump all that trauma on someone? How can I expect someone else to be ok with the things that have happened to me? That I’ve done to me? How can I expect someone to see all of this and not judge me and think I’m a terrible person? A damaged person?
I have to hide it all. It’s what I’ve always done. Eventually though, when people push to get closer and the walls begin to come down it all eventually comes out. Once my walls start to slip it’s hard for me to maintain that mask that I’ve kept in place for so long. It’s never quite the same.
The first thing people usually ask me is about my arms. For the first time I’m starting to dread this explanation. Therapist was like, well, maybe he won’t think they’re unusual. What? I don’t think she’s ever really taken a good look at my arms. I showed her and she had to admit it was pretty obvious. It’s not like Tech Boy hasn’t seen {some of} them. I don’t hide my scars, but it’s not the kind of thing people ask about in a professional setting so no one has ever brought it up. Then again, maybe I can assume that he’s noticed, and decided that it doesn’t matter, as he clearly has a thing for me.
Aside: When I say ‘clearly’, this didn’t stop me from freaking out about him not being able to see me last weekend because he broke his freaking ankle. I was actually paranoid that this was just an excuse to not see me at first. Yeah, I know. Don’t start.
Also, I don’t assume. And even if I did, I would ignore the assumption and think the worst anyways. I’m just going with it.
Coming back around to my point, I don’t need to unload all of my past at once. That should come slowly over time. I feel like I’m hiding who I am though and thereby not being honest. Bleh. I’ll figure it out.
So of course we ended up talking about Friend. I’m having a bizarre sort of mashup between Splitting and Abandonment here. I can’t let go of my friendship with Friend. I don’t want to. I can’t. I can’t even think about it. But he’s like a disembodied character to me. Every time I see him it’s like I’m seeing someone new that has all the characteristics of the last Friend I talked with. As soon as Tech Boy and I started getting close, my feelings snapped off for Friend (unless his wife is doing something to rub things in my face, then I just want nothing to do with them at all). I split from the love and hurt I felt to utterly neutral and not needing to be around him, or even talk to him anymore. I’m cancelling plans, changing dates, breaking my structures I built with him… in favor of something new. I still have a lot of anxiety about this, but it’s not for fear of his disapproval so much as for fear of breaking what’s familiar and fearing that I won’t be able to maintain that familiarity.
Therapist thinks I’ve done a remarkable job holding onto this friendship. What I went through with Friend and his wife was incredibly hurtful. She still thinks it was healing in many ways though. She asked me what kinds of things I want to remember from my relationship with Friend.
I couldn’t think of a single thing. I am completely blocked and dissociated from the feelings that I had. I only remember the bad, the hurt. I don’t even want to think about writing my letter to him. I don’t want to think about him like that. Split. I’m thinking about someone else now, I don’t want to think about what I felt before. What did I love about him? About us?
Homework: What positive things have I taken from my relationship with Friend?
She thinks this would be good for me to remember because I have such a hard time holding onto people. My lack of object permanency. I feel like I’m not a part of people’s lives if I am not in their immediate presence. If I can write down the things I valued about him, that I believe he valued about me, and relate that to how it is still displayed in our current friendship, maybe it will help me hold onto the idea of fluidity through time. It will also help me recognize the things that I want in a future relationship, that I should hold onto, and not allow myself to settle for things that don’t meet a healthier standard.
We’re really trying to work on forming new, healthy, relationships now. She’s very proud of me for taking all the safe risks I’ve been taking lately. She’s trying to caution me to think further into what it is that I want exactly, instead of just throwing myself into the moments.
Homework: What do I envision for a healthy relationship? (I remembered this week!)
I don’t even know. What do you think is part of a healthy relationship?

Thursday, October 27, 2011

Where do Broken Toys Come From? - Defectiveness/Shame

Let’s explore a new Schema today. It’s rather fitting as I’ve been mired in this all morning. I hate it.

Typical Presentation of the Schema
People with this schema believe that they are defective, flawed, inferior, bad, worthless, or unlovable. Consequently, they often experience chronic feelings of shame about who they are.
Defective. Flawed. Bad. Unlovable. This is me. I am all of these things. Despite the fact that everyone around me says otherwise, I KNOW this. Everyone else hasn’t lived with me my entire life, they don’t know all the bad things I’ve done, all the failures, all the shameful things. I remember it all, and I can’t forgive myself for it.  
What aspects of themselves do they view as defective? It could be almost any personal characteristic – they believe that they are too angry, too needy, too evil, too ugly, too lazy, too dumb, too boring, too strange, too overbearing, too fate, too thin, too tall, too short, or too weak. They might have unacceptable sexual or aggressive desires. Something in their very being feels defective: It is not something they do, but something they feel they are. They fear relationships with others because they dread the inevitable moment when their defectiveness will be exposed. At any moment, other people might suddenly see through them to the defectiveness at their core, and they will be filled with shame. This fear can apply to the private or public worlds: People with this schema feel defective in their intimate relationships or in the wider social world (or both).
This may be the origin of all the secret keeping, the hiding. I don’t want people to see the demons in me.
Typical behaviors of patients with this schema include devaluing themselves and allowing others to devalue them. These patients may allow others to mistreat or even verbally abuse them. They are often hypersensitive to criticism or rejection, and react very strongly, either by becoming sad and downcast or angry, depending upon whether they are surrendering to the schema or overcompensating for it. They secretly feel that they are to blame for their problems with other people. Often self-conscious, they tend to make a lot of comparisons between themselves and others. They feel insecure around other people, particularly those perceived as “not defective,” or those who might see through to their defectiveness. They may be jealous and competitive, especially in the area of their felt defectiveness, and sometimes view interpersonal interactions as a game of “one up, one down”. They often choose critical and rejecting partners, and may be critical of the people who love them.
I think this is common of abuse victims to blame themselves for the atrocities that have been visited upon us, not just people with BPD. An inner monologue that says there must be something wrong with me to have made me receptive to this tragedy. If I had done this, or if I hadn’t allowed that, or if I hadn’t decided, or if I hadn’t made the choice to…. A, B, C, D, wouldn’t have happened. It must be my fault. It’s not. It feels like it, but it’s not.
Can I tell you how often I compare myself to people around me that I perceive as having a better attributed/less flaws than me? Wanna guess? Come one, it’s not that hard. Did you say ‘constantly’? Congratulations! You win a glorious look into the depths of my imperfections! Kind of a shitty prize, I know.  
“I wouldn’t want to belong to a club that would have me as a member” ~ Groucho Marx
These people may avoid intimate relationships or social situations, because people might see their defects.
You know what I find insanely irritating love? When I voice my displeasure about one of my flaws and the immediate response I get is: Oh no one notices that but you. That I notice it is the problem! Who do you think I’m really trying to impress here? Me! That’s who. Ok, Therapist might say that I’m trying to impress my father, if I can hide all my flaws I can be worthy of his love. She may have a point. But I have another one… from my perspective my flaws and defects are glaring. I can’t imagine that other people don’t see them. I realize that most people probably don’t spend every second dissecting and obsessing over each little problem I have. My entire childhood I was involved in very competitive sports and activities, especially, gymnastics, dance and martial arts. Every move was monitored. Every aspect was judged. Every curve was on display. Critical eyes are everywhere, all the time. Mine just happen to be the worst of the group. But if I can catch the flaws first, then I can potentially do things so that others don’t see them. Unfortunately coupled with my dysmorphia I can become completely incapable of going out in public if something is bad. It’s debilitating. I hate it.  I get worked up into a panic about how bad or wrong or failed something is, I can’t stop thinking about it, I can’t imagine other people aren’t judging it, and I can’t bring myself to be in a position where someone else is going to be able to see. So I hide. I make up excuses, I cancel plans, I refuse to join the real world. Not until I’m fixed. It’s taken me a looooooong time, to make even the smallest progress on this. Right now I’m doing ok. I’m forcing myself to go out despite my inner judgments. I have a really hard time having fun, but I’m facing my fears and my flaws, and in the end, I’ve had many enjoyable evenings and encounters that I wouldn’t have been able to have had I hide myself away.
Goals of Treatment
The basic goal of treatment is to increase the patient’s sense of self-esteem. Patients who have healed this schema believe that they are worthy of love and respect. Their feelings of defectiveness were either mistaken or greatly exaggerated: Either the trait is not really a defect, or it is a limitation that is far less important than it feels to them. Furthermore, the patient is often able to correct the “defect”. But, even if patients cannot correct it, it does not negate their value as human beings. It is the nature of human beings to be flawed and imperfect. We can love each other anyway.
Patients who have healed this schema are more at ease around other people. They feel much less vulnerable and exposed, and are more willing to enter relationships. They are no longer so prone to feelings of self-consciousness when other people pay attention to them. These patients regard other people as less judgmental and more accepting, and put human flaws into a realistic perspective. Becoming more open with people, they stop keeping so many secrets and trying to hide so many parts of themselves, and can maintain a sense of their own value, even when others criticize or reject them. They accept compliments more naturally and no longer allow other people to treat them badly. Less defensive, they are less perfectionistic about themselves and other people, and choose partners who love them and treat them well. In summary, they no longer exhibit behaviors that surrender to, avoid, or overcompensate for their Defectiveness/Shame schema.
Obviously I am not healed form this schema. Secrets. I keep a lot of secrets. I have a big one currently but no, I won’t share. The only way to keep a secret is to not let anyone know. Not even one person.
Accepting compliments is funny though. This is something I’ve worked into my outer mask pretty seamlessly. I learned a long time ago that people don’t want to hear you put yourself down. Refusing compliments comes across as ungrateful. The best thing to do is just say ‘thank you’, or ‘I’m flattered’ and move on. Often I think people are lying to me to get something from me. Or sometimes I can see that they actually believe the compliment they are giving me. Just because they believe it doesn’t make it true for me.
Strategies Emphasized in Treatment
Behavior strategies – particularly exposure – are important to treatment, especially for avoidant patients. As long as patients with Defectiveness schemas avoid intimate human contact, their feelings of defectiveness remain intact. Patients work on entering interpersonal situations that hold the potential to enhance their lives. Behavior strategies can also help patients correct some legitimate flaws (i.e. improve sense of dress style, learn social skills). In addition, patients work on choosing significant others who are supportive rather than critical. They try to select partners who love and accept them.
This is something I’m actively working on. Forcing myself to go out and interact with people even when I would prefer to hide. My flaws are glaring at the moment, but I still try to get out. And you know what? The world hasn’t ended yet! Crazy. I know. I may spend most of the evening fighting my self-consciousness but in between my criticisms and ruminations, shockingly, I also find a little laughter and good conversation.
Behaviorally patients also learn to stop overreacting to criticism. They learn that, when someone gives them a valid criticism, the appropriate response is to accept the criticism and try to change themselves; when someone gives them a criticism that is not valid, the appropriate response is simply to state their point of view to the other person and affirm internally that the criticism is false. It is not appropriate to attach the other person; it is not necessary to response in kind or to fight to prove the other person wrong. Patients learn to set limits with hypercritical people and stop tolerating maltreatment. Patients also work on self-disclosing more too significant others who they trust. The more they can share themselves and still be accepted, the more they will be able to overcome the schema. Finally patients work on decreasing compensatory behaviors. They stop trying to overcompensate for their inner sense of defectiveness by appearing perfect, achieving excessively, demeaning others, or competing for status.
I don’t overreact OUT so much anymore. I certainly used to. I’d rage and scream and lash out when I thought someone was criticizing me. I’m quieter now. I overreact IN. The thoughts that I need to punish myself for not being perfect are terribly hard to drown out. It’s that nagging voice in the back of my mind that says, how can someone love you if you’re not perfect? If they can see your flaws, they’ll know. They’ll leave.  
Special Problems with This Schema
Many patients who have this schema are unaware of it. A lot of patients are avoiding or overcompensating for the pain of this schema, rather than feeling that pain. Patients with narcissistic personality disorder are an example of a group with a high probability of having the Defectiveness schema and a low probability of being aware of it. Narcissistic patients often get caught up in competing with or denigrating the therapist rather than working on change.
Patients with a Defectiveness schema might hold back information about themselves because they are embarrassed. A long time may pass before these patients are willing to share fully their memories, desires, thoughts, and feelings.
This schema is difficult to change. The earlier and more sever the criticism and rejection from parents, the more difficult it is to heal.
I’ve lived most of my life being unaware of this. Of course now I am aware, but I still find myself avoiding or overcompensating for my problems. My Therapist is constantly reaffirming my positive attributes in hopes that I will eventually internalize that I do have good aspects of myself. I understand what she’s doing, but I’m not there yet. I’m still struggling with understanding that I can be flawed, and that’s ok.

Schema Therapy: A Practitioner's Guide [Paperback]Jeffrey E. Young (Author), Janet S. Klosko (Author), Marjorie E. Weishaar

Wednesday, October 26, 2011

Notable Milestones!

Hello Everyone! Today I'm extremely busy at work (read: no time to blog for real) but I've been meaning to mention a couple things for days now and keep getting busy and forgetful. I hit some blog milestones recently!

First: I passed my 300th post! I don't know about you, but I'm pretty excited about that. I probably have a full length novel of blog posts collected here. Which, is pretty  much the point.

Last ( Or maybe Next): My followers have been growing steadily and I passed the 100 follower mark =) This makes me very happy. Most of you lurk out there instead of leaving a little comment love which is cool. ::smiles::

I feel like I should do something celebratory but I'm not sure what. I'm open to suggestions. Though I think for now I'll just open the forum up to hear whatever questions, opinions, comments, random musing or drunken ramblings you may want to throw my way. Be it about BPD or yanno, anything, like what the name of my first dog was ( It was Raider btw).  Either in the comments or you can e-mail me ( ) whatever you like and I'll share questions and answers at some point (keeping your ID anonymous if you so desire).  

Regardless, I love hearing from everyone that e-mails me and shares a few words or long stories. Sometimes it takes me a minute to write back but I always try.

So let's hear what you have to say!

Tuesday, October 25, 2011

New day, new disorder: Emotional Deprivation Disorder

Fill her up!
I’ve discovered a new disorder! Is it just me or does everything have a disorder these days? Anyways, it’s called Emotional Deprivation Disorder.

Emotional Deprivation Disorder is a syndrome which results from a lack of authentic affirmation and emotional strengthening in one's life. A person may have been criticized, ignored, neglected, abused, or emotionally rejected by primary caregivers early in life, resulting in that individual’s stunted emotional growth. ‘Unaffirmed’ persons are incapable of developing into emotionally mature adults until they receive authentic affirmation from another person. Maturity is reached when there is a harmonious relationship between a person’s body, mind, emotions and spiritual soul under the guidance of their reason and will.
Some signs and symptoms include:
Insufficiently Developed Emotional Life

Abnormal Rapport
o Incapable of establishing normal, mature contact with others
o Feels lonely and uncomfortable in social settings
o Capable of a willed rapport but not an emotional investment in relationships

o Childhood level of emotional development
o Feels like a child or and infant and others must focus their attention on the individual just as an adult would focus on a young child.
o Incapable of emotional surrender to a spouse

Reactions Around Others
o May be fearful in nature or courageous and energetic
o More fearful people tend to become discouraged or depressed
o More courageous and energetic persons can become more aggressive

Uncertainty & Insecurity

Fear or anxiety
o Can be in the form of a generalized anxiety
o Fear of hurting someone else’s feelings
o Fear of hurting others or contaminating them (e.g. with germs or a cold)
o Need for frequent reassurance

Feels incapable of coping with life
o Worry that they’ll be put in a situation they can’t handle
o Can be easily discouraged or depressed
o May pretend to be in control in order to mask inner feelings and fearfulness

Hesitation and Indecisiveness
o Difficulty in making decisions
o Easily changes mind

o Overly sensitive to the judgments of others, criticism or slights
o Easily hurt or embarrassed

Need to Please Others
o Pleases others in order to protect self from criticism or rejection and gain approval of others
o Easily taken advantage of or exploited
o Fear of asking for favors or services needed

o Worried about what other people think
o Self-doubt and need for reassurance

o Do not dare to say “no” for fear of rejection

Inferiority and Inadequacy

Feel Unloved
o Believe that no one could possibly love them
o Feel devoid of all feelings of love
o Believe they are incapable of loving others or God
o Suspicious of any token of affection – continually doubt sincerity of others

Physical Appearance
o May have feelings of inadequacy due to physical appearance

Feelings of Intellectual Incompetence
o May have difficult completing projects
o Repeated failure or fear of failure

Show Signs of Disintegration in New Circumstances
o Fear of new situations and challenges
o Difficulty coping with new job, landlord, moving, etc.

Sense Impairments
o Undeveloped or underdeveloped senses (touch, taste, sight, smell)
o Lack of order, disorganization
o Fatigue

Further symptoms found in some individuals with emotional deprivation disorder:

o Deep feelings of guilt
o Kleptomania
o Need to collect and hoard useless things
o Paranoid condition
Essentially, it’s BPD Light without the wild mood swings, anger, impulsivity and penchant for self-harm and suicidal tendencies.

The cure? Simple! All you need is affirmation. Just find one person who can be your personal source of unconditional love and will provide all your emotional strengthening!


I’m sure there’s more to it than that, like say, years of therapy. Affirmation Therapy in fact.
“Affirmation therapy involves the therapist’s affective, not effective, presence with a client—in other words, it is a way of “being” with a person as opposed to “doing” something for him or her. Affirmation therapy can be formally described as a way of being affectively present to another human person in a therapeutic relationship in which the therapist reveals to the client his or her intrinsic goodness and worth.”
Essentially the therapist will be your source of unconditional love in a therapeutic relationship.
I don’t know. My experience with people makes it very difficult to believe that there are people out there that can genuinely love you without really knowing you…. Especially when you’re paying them to love you. It’s like emotional prostitution. This has always been an issue of mine regarding therapy actually. The idea that a complete stranger can generally care about your issues and problems without having any emotional investment in you. You can pay someone to listen, but you can’t pay someone to care. Though to be true, it has been my experience that given time a therapist can and will develop a genuine investment in their patients. A genuine investment based on the very reason they went into the profession in the first place…. A desire to help people. I know my therapist cares about me. I know she thinks about me when I’m gone, though I can’t help but feel that her connection to me is stronger than my connection to her. This isn’t her fault though, it’s my own attachment issues at play. She hasn’t given up on me though and that is exactly the kind of support I need.

My question with this Affirmation Therapy is… How much emotional support can you really expect a therapist to give? To listen, to help you work through your issues, to guide and provide the tools you need in order to learn to deal with your own life… sure. But unconditional love? Maybe they’re like the Grand Master Zen Buddhists of the therapy world.

Personally I would have a really hard time accepting this as genuine. But to each their own I suppose. Hell, if you’re in a place where you can openly accept the unconditional love of a therapist you’re probably a leg up on my stubby little bipeds of emotional stuntedness.

Monday, October 24, 2011

Stop Starving Yourself - Emotional Deprivation

Well it’s Monday again. Seems pretty inevitable doesn’t it? I’m actually in a pretty good mood this morning… good, bordering on hypomanic good haha. Anyways. I hope you all enjoyed my Guest Post last week. This week I’ll be getting back into my more in depth look into the schemas.

Emotional Deprivation
Typical Presentation of the Schema
This is probably the most common schema treated even though patients frequently do not recognize that they have it. People with this schema often enter treatment feeling lonely, bitter, and depressed, but usually don’t know why; or they present with vague or unclear symptoms that later prove to be related to the Emotional Deprivation schema. These people do not expect others – including the therapist – to nurture, understand, or protect them. They feel emotionally deprived, and may feel that they do not get enough affection and warmth, attention, or deep emotions expressed. They may feel that no one is there who can give them strength and guidance. Such patients may feel misunderstood and alone in the world. They may feel cheated of love, invisible, or empty.
As mentioned before, there are three types of deprivation:
1.      Deprivation of Nurturance: in which patients feel that no one is there to hold them, pay attention to them, and give them physical affection, such as touch and holding.
2.      Deprivation of Empathy: in which they feel that no one is there who really listens or tries to understand who they are and how they feel.
3.      Deprivation of Protection: In which they feel that no one is there to protect and guide them (even though they are often giving others a lot of protection and guidance - This is often related to the Self-Sacrifice schema.)
I feel all three of these almost constantly. Even when I’m surrounded by people I know and that I (cognitively) ‘know’ care for me, I feel alone; emotionally separate. I believe I’m too different to relate to, too weird to be inoffensive, too new to have any real connection… and what’s more, I can’t actually allow people to see that I need these things because it will undermine my strength.
Typical behaviors exhibited by people with the schema include not asking significant others for what they need emotionally; not expressing a desire for love or comfort; focusing on asking the other person questions but saying little about oneself; acting stronger than one feels underneath; and in other ways reinforcing the deprivation by acting as though they do not have emotional needs. Because these patients do not expect emotional support, they do not ask for it; consequently, usually they do not get it.
Hugs do a body good
I think it’s important to add that, yes, this is typical, but it’s typical because we often don’t even know what it is we should be asking for. How do you ask someone to show that they love you when you’re not sure what it looks like when someone does offer you this? I always act stronger. I don’t think this is all an act though. I am strong. I’ve been through a lot. I’ve build up my base, my core, and my defenses. I’ve learned how to take care of myself. I do have a lot of strength. However, because I don’t want people to find the cracks in my armor, find the weak points that are more vulnerable (because in the back of my mind it’s only a matter of time before these points are attacked) I refuse to let people know that there’s something I’m missing emotionally. I definitely see this problem of needing something, but by not allowing others to see that I need it, kind of self-sabotaging my ability to be open and receptive to the thing that it is I need.
Another tendency is choosing significant others who cannot or do not want to give emotionally. They often choose people who are cold, aloof, self-centered, or needy, and therefore likely to deprive them emotionally. Other, more avoidant, people become loners. They avoid intimate relationships because they do not expect to get anything from them anyways. Either they stay in very distant relationships or avoid relationships entirely.
::laughs:: I’m the queen of choosing emotionally unavailable significant others. Abusive narcissists, married men, polyamorous women…. Bluntly… people that will always have someone else as a priority. I tend to alternate between wanting to try, and that expectation that I won’t get anything from people anyways and spend long periods being actually alone.
People who overcompensate for emotional deprivation tend to be overly demanding and become angry when their needs are not met. These patients are sometimes narcissistic: Because they were both indulged and deprived as children, they have developed strong feelings of entitlement to get their needs met. They believe they must be adamant in their demands to get anything at all. A minority of patients with the Emotional Deprivation schema were indulged in other ways as children: They were spoiled materially, not required to follow normal rules of behavior, or adored for some talent or give, but they were not given genuine love (this is often associated with people with Narcissistic Personality Disorder because often people with Borderline PD were not given enough attention when they were young).
Another tendency in a small percentage of people with this schema is to be overly needy. Some people express so many needs so intensely that they come across as clinging or helpless, even histrionic (Histrionic Personality Disorder). They may have many physical complaints – psychosomatic symptoms – with the secondary gain of getting people to pay attention o them and take care of them (although this f unction is almost always outside their awareness).
Goals in Treatment
One major goal of treatment is to help patients become aware of their emotional needs. It may feel so natural to them to have their emotional needs go unmet that they are not even aware that something is wrong. Another goal is to help patients accept that their emotional needs are natural and right. Every child needs nurturance, empathy, and protection, and, as adults, we still need these things.  If patients can learn how to choose appropriate people and then ask for what they need in appropriate ways, then other people will give to them emotionally. It is not that other people are inherently depriving; it’s that people with this schema have learned behaviors that either lead them to choose people who cannot give, or dis courage people who can give from meeting their needs.
This is definitely something I need to work on, am working on. It’s not easy. Often it feels like prying open steel reinforced vault doors with your bare hands. One inch at a time. But even slowly, things do eventually begin to budge.
Strategies Emphasized in Treatment
Many patients never realized they were missing something, even though they had s symptoms of missing something. Patients need to get in touch with their Lonely Child part and recognize that this is connected to the problem. It’s important to find a safe way to express their anger and pain to the depriving parent. Listing all their unmet emotional needs in childhood and what they wish the parent had done to meet each need is important to recognize.
Cognitively it is important to change the exaggerated sense that significant others are acting selfishly or depriving them on purpose (if this isn’t the case). To counter the “black or white” thinking that fuels overreactions, the patient learns to discriminate gradations of deprivation – to see a continuum rather than just two opposing poles – Even though other people set limits on what they give, they still care about the patient.
This is something I have a really hard time with. I usually either feel like someone cares about me completely in the moment, or doesn’t remember me at all… and therefore doesn’t care about me. If I’m not in their presence I can’t even really understand how they remember me, let alone continue to care for me. And if they aren’t able to give as much in return as I am willing to give to them, then to me it seems like they must not really care that much at all. I’m working on seeing those ‘grey’ areas; the in between shades where people can care, even if they have other things going on and cannot be focused on me exclusively.
I’ve found it to be a really helpful (though occasionally painful) exercise to think about my parents, or significant others, and write down the things that they didn’t do, or did wrong, and how I wish things had gone, or what I think I really needed.
Behaviorally, this helps people learn to choose nurturing partners (because it enables you to recognize the patterns you need to avoid in people) and friends. It becomes possible to ask partners to meet emotional needs in appropriate ways and accept nurturance from significant others. Patients learn to stop avoiding intimacy. They stop responding with excessive anger to mild levels of deprivation and withdrawing or isolating when they feel neglected by others. It’s important for the person to learn that people have limitations and to tolerate some (normal!) level of deprivation, while appreciating the nurturing that can be provided.
Special Problems with this Schema
The most common problem is that people with this schema are so frequently unaware of it. Even though Emotional Deprivation is one of the three most common schemas, people often do not know that they have it. Because they never got their emotional needs met, patients often do not even realize that they have unmet emotional needs. Thus, helping patients make a connection between their depression, loneliness, or physical symptoms on the one hand, and the absence of nurturing, empathy, and protection on the other is very important.
People with this schema often negate the validity of their emotional needs. They deny that their needs are important or worthwhile, or they believe that strong people do not have needs. They consider it bad or weak to ask others to meet their needs and have trouble accepting that there is a Lonely Child inside them who want love and connection, both from the therapist and from significant others in the outside world.
This is me.  Underlined for emphasis, maybe with a couple dozen exclamation marks at the end. It’s an interesting juxtaposition that I have going on. Here on my blog, I am very vocal of my feelings and problems, you see my inner turmoil pretty clearly. In the real world, you would never know. I hide all of this. Growing up I was told to stifle and get over any upsetting feelings and emotions. The time when I really could have used emotional comfort I was told to repress and not express these needs. I learned to bury them, hide them. These things made me weak, and bad. I still feel like this. I don’t know how to ask for emotional support. I believe that if I do others will judge me, and think I’m weak, undermine my ability to take care of myself and manage the important aspects that I value. I can’t figure out what is ok to ask of others, if in fact, it’s ok to ask others for anything. Coupled with the fact that I need it so badly, the frustration bubbling below my calm exterior is maddening. I’m always at odds with how I feel… and how I feel I need to present myself.
Similarly, people with this schema may believe that significant others should know what they need, and that they should not have to ask. All of these beliefs work against the patient’s ability to ask others to meet his or her needs. These patients need to learn that it is human to have needs, and healthy to ask others to meet them. It is human nature to be emotionally vulnerable. What we aim for in life is a balance between strength and vulnerability, so that sometimes we are strong and other times we are vulnerable. To only have one side – to only be strong – is to be not fully human and to deny a core part of ourselves.

This is so important to remember. I, we, want to be whole people. Whole, healthy, people. It’s ok to be vulnerable sometimes with people that it is safe to be vulnerable with. Being vulnerable doesn’t mean that you are not strong. It just means that you are human.

Sunday, October 23, 2011

Quotes from the Borderline

“Take care that when you dispose of the demons, you do not dispose of what is best in you.”

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