Tuesday, April 29, 2008

It is Gone.

I have lost my joy and all that is left is extreme fatigue, depression, apathy, grinding, tapping, clenching teeth and a desire to sleep all day long.

I just got back from a visit to my youngest sister's. I should have felt joyful and intense love, because I know I feel that about her and my nieces, but I felt nothing.

I found myself disappearing into my bubble...my description of when I dissociate. I feel like I am all of a sudden covered in a bubble that shuts out all the sounds and any kind of sensory perceptions. I stay in the bubble and then it suddenly disappears and I am back from wherever I was and the sounds and sights flood back into my head.

I had a few panic attacks this weekend at my sister's...almost fainting a couple times, getting that clammy I am disappearing and going to pass out feeling. I was so spacey most of the weekend that I was tripping and falling all the time. In fact, in one of my dissociative experiences I fell down my sister's stairs and really, really hurt myself. I landed on my behind and both my arms. I thought I broke my arm and was afraid to get up, because it felt almost exactly like when I broke my elbows...throbbing agonizing pain.

I finally managed to get up, but a few hours later I notice my arms were both covered in massive bruises. I have a monster sized bruise on my backside that is so black and huge it is frightening.
The next day I woke up and I was having a hard time using my right arm. It's okay now though, but it looks like someone beat me up.

I am so clutzy; always have been. I have broken so many bones and hurt myself accidentally so many times that it really does shock people how often I fall, break bones, get in accidents etc. I think it is because I disappear and the real world keeps on going.

I find it hard to visit my little sister, because she lives in the same town my mom lived in. God I miss my Mom. It feels like I have a huge empty hole in my heart where she used to sit. I seem to miss her even more this year than the first year after she passed away. My sister said the same thing. My Mom's Birthday is coming up soon, so that seems to trigger so much grief in me. To be honest, I still think I am in denial about her dying. It feels like I am just stuck in some horrible nightmare that I can't wake up out of. I wish it had been me and not her. She had so much to give the world; so much love, so much compassion, so much more to live for. I really do wish we could have switched places. I would give anything for that.

Friday, April 25, 2008

Medications, side effects and doubt I will ever find what I need

This post finds me frustrated beyond belief. Not only have my combination of medications seemed to have stopped working, they are causing me distress over and above their not working.

I started taking Tegretol (800mgs) about 6 months ago. I thought it helped somewhat with the lability of my mood. (Although in my appointments my pdoc used to ask me why I was telling him I was feeling better when I clearly was not???). I really felt a tiny helpful change.

So to augment that tiny lift we added Prozac, starting at 10mgs and now I'm taking 30mgs. Almost immediately (within two weeks) my mood lifted, but it also came with intensely annoying 4-8 bars of the same music playing over an over in my head and my teeth began tapping like mad.

So I tried Valium to calm that down and it seemed to help a bit, especially at night. The Valium also helped with my intense anxiety and alcohol cravings, so we added Valium to my nightly regime. The music has disappeared, as did my need for alcohol. Unfortunately as time went on the Prozac seemed to not work very well (from my perspective..if at all). Also, either it, or my returning depression began causing intense fatigue. I felt so tired I could not do anything. All SSRI's I had tried before did this same thing to me.

So we added Dexedrine to my mix to help with some energy and motivation. The day after i began it I got my old self back, and for 3 glorious weeks I felt like me again: motivated, action oriented, delighted to be alive, enthralled with everything I saw, social anxiety disappeared, I became my old self assured, bubbly and outgoing self.

Unfortunately the Dexedrine came with two price tags: It increased my teeth tapping problem tenfold. The teeth tapping became tapping, grinding, clenching, strange mouth movements like my lips kept pursing together. All this damaged my teeth and I had to get a guard to wear during the day, but it kept getting worse. The second problem with Dexedrine is that it quickly wore off. At first I started with regular release the next week I switched to a 10mg spansule (extended release) in the a.m., then the next week I added a 10mg spansule at noon, but by the end of that second week by 4pm the Dexedrine seemed to wear of and I became so exhausted I felt sick. By 4 or 5 that I had to nap until 7/7:30.

So now I am left with two options: Stop the Dexedrine for a while and hope that my teeth/moth movement problems are reduced and when I go back to the Dexedrine in a while it will help again, or stop the Prozac (as the initial cause of the teeth problems). Neither seems like a very good solution to me.

Here I am with a combo of medications that seems to help somewhat to (periodically) quite a bit, but the side effects are such that periodically I will need to stop and the restart them. All I see is that my mood is going to be okay, bad, okay, bad, okay, bad forever. God I hate this illness. I hate the medications and I hate that nothing seems to consistently help me. Will I ever find a combination that really works?

Tuesday, April 22, 2008

Letter to My Sad Self From My Happy Self

Above is the card I choose for myself. It is from a series of cards Marcia Lippmann made from photographs she took of Buddha statues around the world. She also does a series of photographs of angel statues that are stunning. I choose this because despite how little and inconsequential I feel sometimes, like the flowers in this picture, I am a gift to someone, or some being...(I hope).

In my last post I wrote how, on the advice of Dr. X., in order to help myself when depressed, I wrote a letter to my sad self on a day where I was feeling really well. I have perused it so many times when I am unwell and it is definately a worthwhile exercise.

Inside the card and envelope I placed photos of my nieces, a ticket stub from when I went to hear the Dalai Lama speak, $60.00 (I said $50 before, but guess inflation hit me last time I dipped into it) so I could get out of the house and buy something I wanted, or pay for a massage or buy a book, or anything that helped me feel good. When I looked at it just now I realized I also placed a book of stamps in there...to mail a card to someone else. I always love handwriting and mailing cards the old fashioned way...it makes me feel good. I also folded up a whole newspaper page full of cryptic puzzles I like to do, and finally, included stickers my nieces gave me with their names and pictures on them.

If you want to write your own letter and tuck things into it the ideas are endless. Basically, place anything in with the letter that will make you smile, feel love, help you become distracted when you most need to be. What those things are is up to you...good luck.

Below is my letter to myself. If you click on the image of the letter below it will become bigger:

Monday, April 21, 2008

How Mood Stabilizers Feel and I want to Die

I thought I'd write a post to those of you who get to my blog by googling the above two topics. They seem to be common and maybe I can help you. Remember the following is based on my experiences only. I am a patient, not a Dr. and everyone experience these things differently. Please call your psychiatrist, or doctor if you are in distress. If you cannot get a hold of them and are feeling suicidal please call your crisis line and/or take yourself to the hospital. No one should have to cope with these things alone.

1) I Want to Die: (Please read this first)

I have felt this way this way too many times to count. You can find many posts on this blogsite where I have said this very thing. What has kept me here through 6.5 years of hellish severe treatment resistant major depression and twenty years of having major depressive episodes?

I'd say four things: My family, my psychiatrist, medication and some kind of resiliency inside me that clings to life even in my darkest moments.

Every time I think of suicide I am left with the thought about how, while it will be a release for me, it will forever impact those who love me. I have tried so many times to think of how I could die without impacting others, but after losing my Mom two years ago I know that is not possible.
Even if I did not have my family, I have a psychiatrist who does therapy with me once and for a long while twice, a week. He is intensely supportive, consistent, caring and available. I can speak to him about anything and every thing and trust he will help me. I tell him about my obsessive suicidal thoughts when I have them. Sometimes this is enough to relieve me of them if only for a while. I find sharing the thoughts and knowing he gets it to be helpful for me.

Some medications have helped me too...Epival, Valium (to reduce my anxiety, which sometimes leads to anxious, violent and agitated suicidal ideation).

Finally there is something inside me that never gives up, even in my darkest moments. Sometimes I just need to cling to the couch, or my pillow until I get through the thoughts and come out the other side alive.

My psychiatrist made a suggestion that has really helped. He told me to write a letter to my sad self on a day when I was feeling really good. So I bought a beautiful card and one day when I was feeling really well I wrote a point form note to my sad self about all the things that are good about me and my life. In the envelope I enclosed pictures of my family members and $50.

When I felt like suicide I open and read the note and look at the pictures. The $50 was an incentive to get myself out of the house and go buy something that made me feel good (a massage, or a new top, or a plant for the garden etc.) This really helps me.

I am not saying suicide is not your choice, because I believe ultimately we should all be free to make that choice. I am saying, it may be your choice right now, but you may not make that choice a few hours, days or weeks from now. If you commit suicide you will not be able to change your mind.

Please, if you are thinking of suicide, or planning to commit suicide, seek help. Call your doctor, call a friend, call the crisis line or go to emergency at the hospital.

2) How does a mood stabilizer feel?

I believe Aristotle was the first to say "Knowledge is power" (although Sir Francis Bacon also said it, but much later)...sometimes though, it is difficult to discern the difference between "knowledge" and "information".

They are two completely different things. There is tons of "information" about mood stabilizers out there. You could read forever about all the scary side effects...but remember:

You may NEVER experience those side effects!!

The drug companies are supposed to list all the major side effects that people have experienced (information), but until you try a particular medication you will have no idea whether you will have even a single side effect (knowledge). The information about possible side effects for the mood stabilizer I take, (Tegretol/Carbamazepine), would be enough to frighten even the most brave (or desperate) patient...I have had ZERO side effects from it.

Remember different people have different reactions to these medications. I have no idea why, but things I can't manage at even minute doses I have friends who are on HUGE doses who are feeling much, much better. Here is my experiences:

Lithium: I was so scared to try Lithium. I thought it would mean I was really insane (I am...ha, ha), or much sicker than I thought I was. I felt stigmatized by even the suggestion that I try it. I avoided trying it for 4 years. Then I tried it out of desperation.

At 1200mgs...Surprise, surprise...I felt almost instantaneously better and I had hardly any side effects, and no significant side effects. I had to pee more. That was the side effect. Unfortunately, it did not seem to work after I became sick with a really bad 4-week long cold/flu. I seem to remember my lithium levels going too high two weeks into being sick, causing extreme fatigue, which may have contributed to my being sick for so long. I lowered to 900mgs didn't help and then up to 1050mgs and I felt fatigued again and it didn't help my mood. I really wanted Lithium to work, because I felt comfortable with having so few side effects. Lowered to

Divalproex Sodium (brand names: Epival, Depakote): (tried 900-1200mgs) Epival quickly slowed down and lowered my intense feelings of rage and helped lower my anxiety. My mood still cycled, but the intense BAD energy dissipated and my thoughts of suicide slowed down. Unfortunately it came with side effects I could not manage. In the beginning my hair began falling out in clumps (I took 200micrograms Selenium a day with Zinc and this slowed down and eventually stopped). The big problem I had was trouble with my memory and attention. I would walk into a room and forget why I went there. I did memory tests with my pdoc and it was clear I was having difficulties. Still I remained on it until I got through and intensely bad period in my depression. It really helped the agitated energy inside me and was worth the side effects.

Lamotrigine 200mg: Tried twice. Once after 8 sessions ECT(2004). The ECT time my mood seemed to lift for a while. I seemed to become almost hypomanic like when I took it after ECT (could have been the ECT?). I had balance problems both times, but two weeks after ECT I was extremely high and running all over the place on the ice at a curling event. I fell a broke both elbows. Three weeks later I fell fell again off a curb into traffic, then fell a couple more times. Dr. X suspected it was causing balance problems, Tried 200mg again Jan/Feb 2007 with Lithium...nothing.

Gabapentin...might as well have taken sugar pills.

Carbamazepine (Tegretol): Since August/07 I have been taking this at doses of 600-900mgs/day in the p.m. I have ABSOLUTELY no side effects. I believe it slowly is helping my moods cycle less often, though I still cycle and I have been severely depressed on it until the past few weeks I really think it has slowed the lability of my moods...I cry less even when depressed, I can function a bit better even when depressed. I am taking it now with Prozac, Valium and Dexedrine, and I think it is helping me sleep better than before (Although I still go through long periods of insomnia like right now).

I haven't discussed my experience with antipsychotics as mood stabilizers. I know many people who take high doses of these and swear they help them. I could barely function on even low doses. I guess this supports the idea that we are all so unique in what does and does not help us and how we react to different medications.

I guess what I would like to get across in this post is that there is so much misinformation about mood stabilizers out there. If you read an article saying they will impact you negatively, you can easily find another that states the opposite. I have learned to both trust my psychiatrist to guide me through my medication trials, but never blindly. I still research what he suggests and we make the decision together about what I will try.

Being an active participant in my therapy, asking questions, working together with my doctor, and having a therapeutic relationship with my psychiatrist where I both trust my doctor's knowledge and his support is the way I make decisions about what medications I will take to try to help myself. I hope everyone has the opportunity for this type of an experience.

Friday, April 18, 2008

I Am Cycling Downwards...Again

These past three or four weeks I really thought my pdoc and I had hit upon the magic mixture for my depression. For the first time in years I felt like myself for a few weeks. This week that all began to disintegrate once again.

I went to my pdoc appointment today and I felt like I just didn't want to talk. I feel frustrated, annoyed, irritable about the loss of my creativity, high mood, and recently rediscovered feelings of self esteem. All week I have become increasingly fatigued; feeling so tired by 4-4:30 pm that I feel sick I am so tired.

I have been crawling into bed at 4:30 or 5 and sleeping until 7 or 7:30. When I get up I feel less tired, but my mood is still low. The I have not been able to sleep during the night. I am awake, asleep, awake, asleep, awake, asleep...all night long.

Dr. X. suggested I try napping for only 1/2 hour around 4:30 and then get up and go for a brisk walk around the farm. I told him I would try, but today I set my alarm and when it was time to get up I shut it off...I just couldn't get out of bed. I felt like I was made of unmoveable stone.

He also explained to me that I need to try eating small amounts of food throughout the day. In the last 3 weeks I have eaten very little, because when I am well it is like I forget to eat...the rest of life becomes to exciting. I've lost 6-7 pounds, which to me is a good thing, but Dr. X. says nutrients provided in regular eating of food can affect mood.

I did not have the energy, or the motivation before to cook dinner...I have really not been eating well for quite a while, and then when I felt good I didn't want to waste my time cooking. I would say I was eating okay though. I had a bowl of granola/muslix at about 10:30a.m. and then around 7:30pm I made myself a yogurt, blueberry, mango, banana and blueberry juice smoothie. At least I'm getting some fruit. Sometimes I'd eat a couple eggs too.

Anyways, the other thing I am going to try to do (on Dr. X's advice) is actually two things: keep painting even if my creativity seems to have disappeared. He says to keep doing the things that make me feel good when well, even if they are hard to do, or I don't feel like it. Secondly, give myself permission to slow down and ride out the low cycle. He expressed that he knows these are both easier said than done. I appreciate that he gets that.

All in all my mood is lower, but no where near as low as it sometimes goes, so I'm hoping I can get a hold on it before it really crashes. I hate the unpredictability of my mood.

Wednesday, April 16, 2008

Therapy and Boundaries

This is to address a couple comments on my last post. It also addresses things I have thought about, wondered about in therapy, things that made me stopped doing things I really enjoyed doing, because I beacame afraid I may be perceived as crossing boundaries.

In my previous post "Co-Blogging Re-visited and a Therapeutic Epiphany", both Dr. Shock and Jcat encouraged me to to continue towards trying a co-blog with my pdoc, in spite of some reservations about this being a means of avoiding the person to person communication issues I have, or a way of overstepping the therapeutic boundaries.

I agree with Dr. Shock when he says not to generalize another therapy's belief onto my relationship and therapy with my pdoc. That was a powerful comment and really made me think. I believe my pdoc and I have a really good and mutually respectful therapeutic alliance. I am not one to try to cross boundaries. In fact my crossing boundaries might signify a breakthrough in my therapy, because I am always so conscientious about doing the "right" thing, about not ever making a mistake, or taking a chance.

I, like Jcat, find it easier to express myself clearly in writing. Like her I have wondered about, and was careful to not cross anything I felt was a boundary.

I used periodically send cards to my pdoc , just to say thanks. I never saw this as stepping over a line, or "acting out". I saw it as, and meant it to be, a symbol of kindness, caring, and to let him know that even though my mood never seemed to get better, I valued his seeing me. Of course one could look for a subtext here: I was fearing abandonment because I felt I was an incredible burden on Dr X. because I was so unwell and not making any progress. I sent the cards to let him know I wanted to continue trying, that I found him helpful and that I really wanted to keep seeing him. That is all true, but the cards were more like a thank you for his consistently being there when I needed someone.

I live on a flower farm, and I used to sometimes bring flowers to my appts for Dr. K. I stopped doing it because I felt really self -conscious that maybe that was crossing a boundary. Flowers seemed too personal, even though there were thousands of them growing all around me, and I found joy in giving them away. It is a shame I felt wierd about bringing some to Dr. X, because the act of choosing the flowers, arranging the bouquet, and the joy of giving a beautiful gift heartfelt gift to him. actually inspired me, the giver.

When I was saying Ms. Fuller gave me food for thought, it was that she reminded me of some of the things I used to do, and stopped doing, because of my fear of crossing boundaries. There is obviously something there, because I rarely bring flowers in, or send cards anymore, because I feel uncomfortable for some reason, though I'm not sure why.

I was also thinking she has a point about how it is really important for me to learn to speak what I seem so easily to write. Despite that I feel I really have been able to speak up many times, because I write.

I think writing directly to my pdoc, about my experience in therapy, as long as we have an agreement that his portion takes place within the therapeutic hour, will only enhance my already great experience in therapy with Dr.X. I will remain conscientious of the boundaries between us; they are as important to me as they are to him. I am looking forward to trying a private co-blog with my pdoc.

Sunday, April 13, 2008

Co-Blogging Re-visited and a Therapeutic Epiphany

I had such an incredible therapy session on Friday. I feel like I am really making huge steps forward recently. What was so great about my session?

First, I felt so unbelievably supported during the session, something that I often feel, but, when I am severely depressed, I have a difficult time maintaining the feeling when I leave Dr. X's office. Suspicion begins sneaking into me that the support isn't 100% genuine, or real, or I heard wrong, or it is based on some kind of sneaky way to get me to change. Of course, none of that has to do with anything my pdoc does. It is some strange component of my depressed mood.

In my last session I felt able to ask really direct questions about how supportive Dr. X was of my understanding of my treatment plan. I asked him all the questions that fill my mind with guilt and despair about my understanding of what it means to work and to be well enough to work.

He so clearly supported all aspects of my understanding of our recovery plan, that I feel so much more at ease about my being on the right path now. I feel like I AM working, I AM doing what is not only best for me, but what is best for the people I volunteer to help, and for society in general. I feel like what I am doing now is the ethical thing to do.

Wow! The session was a huge relief for me. It probably helps that I feel less depressed right now and am able to absorb the lesson.

About a co-blog...I discussed it with Dr. X. He seemed to think it was an interesting idea. I sensed some trepidation on his part, but he said we could try it. One thing he mentioned was that he would not be able to read the blog throughout the week, which I had already addressed in my proposal. I also believe boundaries need to be really clear between the two of us. I told him to think about it until next session and we can discuss it again. I have been busy trying to test how private and secure a co-blog can be. It seems like you can make them so only the two of us can view and write in it. I am still checking that out.

I do have a few more concerns about a co-blog than I did before. The worry was brought on by a post I read on a blog called Jung at Heart". In her post titled, "Therapeutic Space Revisited" , Jungian Therapist Cheryl Fuller comments about the idea of writing in therapy as opposed to face to face communication. Here is an excerpt from that post:

"For the purists, a letter from a patient between sessions is an instance of acting out and they would not read it but rather place it on the table and wait for the patient to talk about it. And it is acting out, because it is an extra-therapeutic contact, a kind of effort to gain more time and attention from the therapist outside of the boundaries of their time together, and it is writing rather than putting the feelings into words and speaking them in the session. But that it is acting out does not mean it is useless, meaningless or bad; what it does is signal the presence of unresolved feelings or or need." [I find this interesting, because I have in the past sent Dr. X. cards, and it makes me think of why I do that]
"The actual words of the letter may indeed impart thoughts or ideas not expressed in session but it is what drives the desire to write them rather than say them that is probably of greater importance. And dealing with the fear/resistance to expressing those feelings and thoughts directly is a big part of what depth psychotherapy is about." [(my bold)...I have wondered about this in the past...this reinforces that wonder...?]
So back to the idea of co-blogging --
I have to wonder if, like writing a letter or sharing a journal, this isn't at base a way to sidestep the heart of the matter -- that it takes time and effort to work through our defenses and resistances and to do so in the presence of another human being". (Cheryl Fuller, Jung At Heart")
Ms. Fuller really got me thinking about why I want to write, as opposed to talk. I have mentioned some things in my previous posts: My difficulty thinking clearly as I am often intensely emotional in my sessions...it is like my brain shuts down, I find it easier to express myself clearly when I write, Sometimes the medications that I take make it difficult for me to find the right words to describe what I am feeling...in writing I can think for the correct phrase or word, and most important, Usually I am writing in my blog to clarify to myself what happened during my session and how I could use what happened to make my next session better, more open, more honest...a sort of practice session for my next session.
Ms. Fuller is right in many ways though. There are some things I probably should be able to express in my sessions that I am unable to. For example if there is conflict in my session (honestly, by conflict I mean me misunderstanding something) I have a really hard time addressing that in the moment. When I have it has been really helpful. Usually I write about it and try to figure out how to address it the next session.
Also, if I am feeling intensely suicidal, I am afraid to address this in my session for fear I will not be able to make my own decision about what to do about it. I am afraid my freedom to choose will be taken away. So often I do not say anything, until the next session when the intensity of the feelings have dissipated.
Anyways, "Jung at Heart" gave me things to think about and I found her comments very interesting. I will address some of these ideas in my next therapy session.

Wednesday, April 09, 2008

The Blog as Therapy

This post was inspired by a comment made by Dr Shock on my recent post titled: "Letting People In" .

I found his comment very thought provoking. He said: "...what is interesting is how can a blog help besides "getting it of your chest", what are the therapeutic factors. Another important topic is how can a therapist use the blog for the therapy. Especially when doing a more psychodynamic psychotherapy. For cognitive therapy [CBT] with housework it is relatively easy, you can monitor the progress but with more psychodynamic therapy based on psychoanalytic principles such as transference and counter transference and defense mechanisms it is difficult to use the blog together with the therapeutic sessions."

I was intrigued for a few reasons. I agree that a blog, shared with a therapist, for CBT, would be fairly straight forward. In a CBT situation the blog could be used as a documentation and reference for the activities, goals the patient is accomplishing.

I am not 100% sure I understand what Dr. Shock was referring to when he said " but with more psychodynamic therapy based on psychoanalytic principles such as transference and counter transference and defense mechanisms it is difficult to use the blog together with the therapeutic sessions", but if I understand his comment correctly, I think I believe the opposite . I believe a blog is an incredible way for the patient to clearly layout their defense mechanisms and for the Psychiatrist to have a much more in depth and detailed view of his/her patient's transference. If the blog is two way; one written by both the patient and the pdoc, I could see tremendous value for the therapist to also recognize their countertransference more clearly.

I am very interested, and in fact believe I have been utilizing my blog, more and more to enhance my therapy experience. Second to that my hope is that those who read my blog will see how I struggle and work through different difficulties in therapy; how I depend upon a safe therapeutic experience, a consistent and trustworthy psychiatrist, to both ensure, and allow me to be completely open and honest in therapy. I believe that is the cornerstone of good therapy. If I am not safe to say anything and everything, then I cannot work through the things I have the most difficulty with.

Here are some of my ideas/experiences/hopes for using my blog as therapy:

My experience thus far:
My blog has always been a means by which I both prepare for my therapy sessions and debrief myself AFTER my therapy sessions. This debrief allows me to absorb what I have learned in therapy; to retain the lesson.

My thoughts about my therapy sessions are often much more intense after I leave the session. In the 50 minute session I am so focused on interacting that I find it difficult to clearly reflect on the dynamics happening between Dr. X. and I, or around a specific subject. I often feel so emotional I cannot think straight. While in a highly emotional state I become reactive instead of reflective. To me, what happens between Dr. X. and I; the feelings while we discuss something, my reactions to him etc. are like a microcosm of my feelings and reactions to people in the outside world. Our interactions replicate difficulties in my life. This is super important for me to recognize and work through. My blog assists me with this.

Ideas to enhance my experience and my therapy via a blog:

I have some ideas about how to use a blog to enhance my therapy sessions even further, with each idea I have pros an cons I need to consider:

Idea #1: Keep my current blog and use it IN therapy sessions.

I was thinking of asking Dr. X. if we could together spend the first 10 minutes of my sessions reviewing my weekly blog postings. The next 40 minutes could be spent reviewing what was read/discussed:


  • I wouldn't forget to tell Dr. X things like I do now
  • He would have a really clear record of what I'm thinking/feeling
  • I often find it easier to write about a topic, rather than bring it up in therapy. I often use my blog as practice to get brave enough to open up and tell the truth, or explain how I really feel.
  • My feelings, thoughts, experiences etc. are clearly laid out,
  • I could list any medications side effects (I always forget to tell him things),
  • I could clearly list any interpersonal difficulties, successes etc.
  • I could make a simple list of discussion topics,
  • If he wanted, he would have access to the information later( he takes notes, but if he missed something he thinks might be important, the information is there).
  • I could express in clear details what I wanted to achieve in my session (I often get side tracked)
  • I believe he would see transference, projection issues etc. even more clearly than he may already...because sometimes I am more shy or embarrassed to say things in person.


  • Privacy (from my employer, my insurance company etc.)
  • Ethics on his part in terms of what he keeps in his files about me
  • Boundaries would have to be really clear with me. I.e. I would not expect him to read my blog on his own time. It would be part of our therapy sessions

Idea # 2: Start a new Co-blog

This idea was inspired by an Irvin Yalom story about how, after each therapy session, he and a patient wrote a brief synopsis about each of their experiences, learnings, understandings etc. in that session. They then shared what they wrote at the beginning of the next session. It was intriguing how each picked different components of the session as meaningful. It seemed like a really interesting way for a patient to learn to fully understand their behaviours and experiences from a third part perspective.

I thought maybe Dr. X. and I could set-up a private blog; with the two of us as co-bloggers. Maybe we could shorten our sessions to 30 minutes and then each of us would be responsible for utilizing 20 minutes sometime during the week for each of us to blog about the experience. At the beginning of each session we would debrief what was blogged by each of us.


  • I often leave my sessions and think, what was Dr. X. trying to tell me,
  • What did I miss?,
  • I'm not quite sure I understood what we talked about.
  • Maybe Dr. X. experiences that too.
  • It would be a great way to remember and/or clarify lessons, ideas, sharings, understanding, misunderstanding etc. etc.


  • Privacy...I checked out to see if you can set these blogs to a private setting. It appears you can, but I need to find out if private blogs are "googleable", if they are really safe to be 100% open about EVERYTHING, like in therapy.
  • Unsure how the Canadian medical system would view and reimburse Dr. X. for this type of therapy. I would not do this if he couldn't be reimbursed the same as he is now. (I have heard of a new system being introduce in Canada whereby Drs can communicate online with patients on a patient pay per contact basis)
  • A co-blog would be really cool and groundbreaking for others to view therapy sessions in progress...I can imagine it as a really interesting teaching tool for psychiatrists and therapists in training, and for patients in therapy themselves, but privacy in therapy is really a huge part of why I (and I assume many others) are able to discuss certain things.

Idea # 3: Co- Blog as a means of identifying transference/countertransference/defense mechanisms etc.

I think the co-blog would provide the perfect opportunity to address some of these psychodynamic issues.


  • You would have to really trust your therapist/pdoc, as there would be no deniability about what was said...it is written down for each of you to see.
  • I see tons of defense mechanisms on my part when I both write and read my blog. My current blog has been a wealth of information for myself, and, if I remember to bring it up, for my pdoc while we discuss these in therapy.
  • Conscious and unconscious thoughts, of both patients and Drs/therapist may become more evident when they are seen on the page.
  • Dreams are there to review and analyze more clearly (I am a great believer in my dreams telling me things, so this is important to me).
  • Feelings could be clearly written about, there for posterity and further discussion and clearer understanding
  • What you write would open doors to both the therapists and the patient's perspectives. What Irvin Yalom discovered was that what he thought was intensely important to his patient was often not the case at all. Often what mattered to the patient, what inspired the patient was some aspect of Dr/patient the relationship that came out in therapy; a gesture of kindness, or respect; a moment where the patient felt really understood.
  • Identifying these could really have the potential to add value to therapy and really move the patient's therapy forward.
  • Alternately, it could also really help therapists identify what really makes a difference to their patients.


  • Privacy...again...for this type of therapy to help it has to be very clear that what is said remains between Dr. and patient.
  • If there was not an intense sense of trust between the patient and therapist difficulties might arise in what was written (although with the trust I have with Dr. X., even though I am afraid sometimes, I think I would feel safe and secure in this type of therapy)

Monday, April 07, 2008


This is my latest painting. I finished it 5 minutes ago. It is titled, "Unravelled". As always it is full of symbolism.

She is me, but she isn't. She is dreamlike and is about to defy gravity. Before she hits the sea and rocks below, before she reaches the depths of madness and death, she will lift out of the fall. The shroud she has been wrapped in is becoming unravelled and as the fabric unravels, as she unravels her shroud is becoming wing like.

I was thinking of Icarus and his inevitable fall when he tried to reach the sun with wax wings. However another symbol developed as I began to paint, that of an angel protecting me and saving me from Icarus's impending death on the rocks below.

I have within me the foolishness to strive for the sun, wrought by my intense upswings in mood, and the sadness to send me crashing to earth. While painting this I was believing that somewhere there is a middle ground; a place where though I may soar, or I may fall, it is a safe place.

Dr. X and I have spoken about that place in the past. I think I am now ready to explore and accept the idea that safety is not what I used to think it was. The idea that I need to embrace my new, intensely personal, and unexpected way of being. That may be the only thing I have control over in terms of embracing and saving myself.

Friday, April 04, 2008

This is Fascinating

I've posted 2 posts today. My therapy focused post is below this one.

I came across this video and I found it so fascinating I wanted to share it with you. In many ways Ms. Bolte Taylor's experience reminded me of when I read and wrote about Aldous Huxley's book, "The Doors of Perception", in my other blog, Aqua's Quest.

In so many ways her experience of the right hemisphere of her brain slowly taking over, reminds me of when I feel at my highest, when I am almost hypomanic. Life becomes intensely fascinating, colours intensify, I feel completely at one with the universe. Other parts of her description sound like exactly how I feel when I dissociate, or when I experience depersonalization...that feeling like you have completely disconnected from the outside world. Like you are outside your body looking in. It is a very interesting video.

Here's the website's description and the link:

"Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened -- as she felt her brain functions slip away one by one, speech, movement, understanding -- she studied and remembered every moment. This is a powerful story about how our brains define us and connect us to the world and to one another." (TED talks)


Self Esteem, Guilt and the Definition of Work

My appointment felt difficult in the beginning, but I really felt cared for and understood as it progressed. The past few days I have felt my mood slipping, along with my energy. I have really been fighting against both, but have had to nap for at least a couple hours in the late afternoon, early evening the past few days.

I got my period yesterday, which makes some of the slip make sense, because the two to three days before I menstruate I always feel absolutely exhausted...like I can hardly move. I get confused and really clumsy; tripping, bumping into thing and especially dropping things. Yesterday I poured myself a glass of water and promptly let it slip out of my hand. Water went everywhere. Immediately afterwards I realized I was getting my period. So maybe my dip in mood, my increased irritability and my fatigue can be explained by that. I hope so.

Today I talked to Dr. X about my paintings and the dynamics of shame, fear of judgement and embarrassment I felt around showing them to him. I also expressed how I felt like a little girl seeking approval when I showed him. I wanted him to be as excited as me, then afterwards I just felt like that was so childish and lame. He said everyone wants approval from others. I asked him: "Do you?", thinking he doesn't strike me as someone who feels the need for approval. His answer, "Yes I do" came so quick and was so sincerely spoken I really believe him.

Funny, I always think of him as a rebel, or a maverick. He seems to challenge the status quo and seems so much like I WANT to be; good at what he does AND confident in his approach, even if he is unsure of the outcome. He strikes me as a person who, while not dogmatic about which approach is right to achieve a specific outcome, is very confident in his approach towards his job. So confident that he is not afraid to say I do not know. To be like that you need self esteem and the freedom inside yourself to let your ego go and know your self, your core values and the beliefs about yourself, will remain intact even when you are being challenged by others. I do not feel that.

I feel that any challenge to my ability to achieve an outcome, or about the way I approach a task, or about the outcome of the task, is a defacement of my self. In the face of negative feedback I do not have the self esteem to stand up and say I am right, my work is valuable, my approach will work, and to follow through on my convictions.

One example of this is my approach to trying to get back to "work". My definition of work is so narrow and defined by my past, by my peers, by my insurance company, I would suggest by society in general: Work is a job you do in return for a regular paycheck.

Dr. X. seems to define what I am doing now to help myself as work: my volunteering, my painting, my artwork, my taking art classes, my helping others at the Art clubhouse, these things he calls work that is no less valuable than my definition. In fact I sense he believes, for me, it is MORE valuable than my own marred, achieving other's expectations filled, and guilt driven definition.

He said some people leave work on disability from a workplace that subjectively is unhealthy. These people will leave and find it helps them because, maybe for the first time in their lives, they begin to live a life that is meaningful and healthy. From what he said I think I fit into that category, but the glitch is I feel guilty about being reimbursed by my insurance for leaving a subjectively unhealthy job to now be doing things that are really healthy for me and getting paid by the very organization that was unhealthy for me?

It is all so very confusing