Friday, October 31, 2008

Graciously Accepting Compliments

Yesterday near the end of my session Dr. X looked at me and explained he wanted to say something to me, but he wanted me to accept the compliment, and not reject it, or become self effacing about it. He really wanted me to try hard to accept and embrace what he was about to say. At this point I became extremely self-conscious and worried about what he was about to say.

At this moment, as I write, I am going to practice accepting praise at face value AND being proud of myself:

He began to express how much he like my blog. Not just that he went on in detail about what he like about it. I don't even remember what it was he said about it, because I was listening and it all seemed surreal. It seemed unlikely that someone like him, someone so important to me, someone so intelligent and well read would see so much value in what I write. I wish I could remember what he said, because after he said it I was flabbergasted. Yet, at the same time could not help but doubt the sincerity of such profoundly kind and elaborate praise.

I tried REALLY hard to just ACCEPT what he was saying, but I couldn't help let slip, "Are you serious? Do you really mean that?". He looked at me with a slight look of consternation that told me I had slipped up and done exactly what I had promised not to do. I was supposed to accept what he said, be proud of myself, and if I wanted to, say thank you.

I still find it hard to believe that he meant what he said, despite deep in my heart recognizing that he is not one to lie, or make things up. I wanted so badly for him to enjoy my writing, and it feels so important to me that he be interested in what I have to say, that it feels impossible that he would actually feel that way.

I was thinking yesterday why I would have such a reaction to praise about something I do, and something that means so much to me. I love writing in my blog. I find it intensely cathartic and challenging to write about the issues I do.

All I can think is that maybe I was projecting my Dad onto him. I try to please my father, to make him proud of me, yet no matter what I do I feel I never please him, or live up to what he wants, or expects, me to be. I am always a disappointment. My being depressed, and off work makes me disappoint him even more. I am trying hard to let that go, but I find the dynamic clings to me.

I think, because my blog is so important to me, I believe it became a contender for incurring disappointment in someone who matters to me. That is why I took in the compliment with a huge amount of doubt about its sincerity. My immediate thought was that the compliment was a gesture to placate me, to retrain me, to make me feel better during a therapy session where I was feeling so badly about myself.

My Dad called last night and asked me how my dog training was going. I told him about our first trip to the off-leash dog park, and how the despite all my hard work training my puppy to learn the words, "Come", "Sit", Heel" etc., the second my puppy saw another dog he was off like a flash and I may as well been a stranger. He tugged madly on the leash when I did manage to leash him, even though on the farm he happily walks with a loose leash at my side.

My Dad sounded so indignant. What the hell are you doing letting him off the leash? What did I tell you? That is when you need to use the long lead. He needs to be on a leash." Those words don't look too bad as I write them, but it was the tone in which they were delivered that said..."You are a fucking idiot, you never get anything right, I don't know why I even bother"

It is no wonder I get so angry with myself. I have internalized my father's dismay in who I have become, and who I was my whole life. I swear at myself; internally scream at myself, to, " just fucking get it together. Fucking change you idiot. You are such a loser. You don't get anything right. You just aren't doing the right things. You aren't trying hard enough. If you were you be better and back at work. You are disgusting."

Dr. X. explained that it is very difficult to get rid of those negative voices in my head, but I can bring more positive voices in to counter the negativity.

During the phone call I should have been thinking:

...Dad is just trying to help me. He does not realize that criticism from him cuts me to the bone. As a policeman, he spent his whole life barking commands and ordering people around. He does not understand how deliver a message softly. That's not his fault. He is a product of his life, just like me.

I need to not take his help as rejection. I need to accept what he is saying at face value. He is only trying to help me be a better dog owner, and he has the knowledge to do that.

Wow, I have worked really hard to teach my puppy manners and commands. He is however, still a puppy, and he has just recently been off the farm and into other environments. He becomes over stimulated and distracted by all the new things. I made a mistake. I have never had my own puppy before so I did not know better. I should have had him on a long lead. I know that now and will be better prepared the next time we go out. Dad was only trying to help me.

I feel like I will never learn these lessons. It is so painful to make the same mistakes over and over again. I would like to graciously accept Dr. X's compliments and believe he meant what he said. I feel flattered and very pleased with myself for all the effort I put into writing the things I do in my blog. Dr. X. you helped me feel even better about something I love to do. Thank you.

Thursday, October 30, 2008

Word Finding and Memory Problems

I am having so much difficulty with word finding and memory. I don't know if it is the depression or the medication. It's probably both. Whatever is causing it I am intensely frustrated, saddened and embarrassed by what I see is a continuing deterioration of my verbal intelligence, my ability to communicate and my memory; all aspects of myself that I highly value.

It seems like what words that used to flow out of me, without much thought are stranded somewhere in my brain. What used to take no time is now taking 10-20-30 seconds, and sometimes hours, or days to show up in my head. It is unpredictable what kinds of words I cannot find. Sometimes it is big words, sometimes it is everyday words like "pencil", or "palette", or "easel"

Here is an example of what happens:
Yesterday I was with a friend explaining how I really like this new show on t.v. called, "The Mentalist". I told her it is about this guy who used to be a "psychic" via trickery and observation. At some point early on, before the time in which the series is set, his wife and daughter are murdered by a serial killer. I can't remember if his chicanery led to the murders or not, but the murders lead him to a life change. He decides to use his powers of observation, and his ability to "read" people, for good and joins an investigative team with the California Bureau of Investigation.

The show is very... "insert word I can't find here"...and then I begin to fumble for the word. I know everything about the word, but its name. It means the show follows a pattern each week: A crime happens, the Bureau has a suspect, the mentalist does not believe that person caused the crime and, in a way that shows flippant disregard for the system, he shows everyone who the guilty party really is. The word I cannot find means "follows a pattern", or "plays out in a similar way", etc.

Neither of us could think of the word, so I bring this up in my appointment today and I STILL cannot think of the word despite knowing I know it, and that it is there, hidden somewhere in the folds of my brain.

It finally came to me when I was out with my puppy later in the morning. The show is "FORMULAIC". It may not seem like a big deal to some, but to me language is so important. The right word can often say more than a whole paragraph; as I believe I have proven in my above example. Also, it would not be a big deal if it weren't happening so often, and if it was not so noticeable to others. I feel like an idiot.

My memory is another problem (or part of the same problem?). I swear sometimes if you ask me what I did yesterday, or what day of the week it was, or when did I did a particular task...I just stare off into space, searching my brain. It feels similar to when your computer is really slow. Sometimes the answer eventually pops into my head, but sometimes it is as though I need to reboot. The memory is gone. So I end up saying I did such and such. I can't remember when, or I'm not sure which day, but I remember doing it.

Then sometimes I don't remember at all. This happens so much with television shows. I will start watching a show, my husband will say we have seen it. I will insist he may have, but I have not. Then suddenly, usually when the show is almost over, I begin to have the feeling I have seen it before and the memory of it pops into my head. Or alternately, I know I have seen a show I begin to watch, but I have absolutely no recall of what it is watching it again is like seeing it for the first time.

My husband gets so angry with me. He says I'm stoned all the time on my medication. He belittles my inability to remember. I feel awful, that I cannot remember, but I wish he would give me a break.

Dr. X. is going to help me in some fun ways, to see if I can improve my memory. Today he came up with some interesting ideas about how to help retain what I learn and learn in the first place. The task he gave me this week is to find a magazine I like and read a couple articles that interest me. I will then bring them to our appointment next week and we will have a conversation about the articles. I understand the point will be to exercise my memory.

Dr. X. has been so comforting the past few weeks. I find his faith in me and his, "together we can do it, we can help me make progress together" attitude inspiring, even when I am sitting across from him crying. He has a knack for really listening to me and understanding me. I am able to appreciate and value his help even in my darkest moments.

Oh yeah....and I'm supposed to take my vitamins EVERY day. I will if I remember..ha, ha!

Monday, October 27, 2008

Please Don't Make Me Go...

Once again it is Monday and I have a class to teach later this afternoon. I do not want to go. I want to stay home and do nothing. I want to be alone.

Each day I am scheduled to teach, (and sometimes for days before) I dread having to go. Each time I go teach I generally have a pretty good time. I really like my assistant and the people in the class are great. I don't know what it is.

Last night I was supposed to go to a pumpkin carving contest at the house of a friend of my husband. As it got closer and closer to the day we were to go I began having more and more anxiety about being stuck in a social gathering where I only knew my husband, and sort of knew (enough to say niceties and hellos), the host.

By yesterday morning I thought I was going to be sick I was so anxious about going to a function with so many (approx. 30) unknown people. What would I say? I knew I would end up an outsider, sitting outside the circle looking in. I knew I would "disappear" into an anxiety fuelled bubble.

That bubble appears to protect me from outside forces. I disappear. In disappearing I no longer need to try to connect with other, because I am no longer in the room. I am cutoff from every noise, sight, smell; everything that enters me via my senses. There is a peacefulness to disappearing, but my anxiety strengthens each time my bubble disappears, because I have no idea what I looked like to others, or how long I was gone.

No one ever seems to notice, or if they do they never say anything. I have to assume the bubble is an instantaneous process, lasting only a split second.

My husband asked me yesterday if I wanted to go. I felt immediate relief. Thank god he asked. "NO, no I don't want to go. I don't know anyone. What am I going to say to people. I really really don't want to go." He said, "you don't have to. I'm only going to stay for a while anyways." "Are you sure?", I asked feeling instantaneously feeling intensely guilty for backing out of yet another social situation I was supposed to sharing with my partner. "You will miss out on the opportunity to meet a lot of really nice new people", he replied.

I felt ashamed that I simply cannot manage those situations. "I'm sorry honey, but I really do not want to go. I prefer small intimate gatherings where I know everyone. I do not do well at large gatherings where I know no one". He just walked away accepting my mind was made up. He went by himself. I still feel guilty.

I have taken to sleeping most of the day in preparation for my afternoon classes. I am afraid I won't have any energy when I get there. Dr. X. asked me if I had ever fallen asleep in my morning class? even if I had not slept the night before. I get where this is going. No, I have never fallen asleep. "Maybe try and do something else in the hours leading up to the class and see what happens. I reply, "Okay, I will try".

It is 11:32am and I am feeling anxious about my class. The more anxious I feel, the more I don't want to go. The more I don't want to go, the more tired I become. I want to hide under the covers, avoid the class, but I know I will go teach it. It is a responsibility and a commitment I have made to the young adults in the class and to the Art Clubhouse occupational therapists. So I will go, but I really, really need a nap to deal with it.

Sunday, October 26, 2008

Sleep Deprivation and Mood

As part of a "Fatigue Busters" plan, a plan than entails removing anything from my life that is making me exhausted, listless tired etc., I am slowly (trying) to wean myself of Valium. I am not on a large dose, but have been taking benzodiazepines for a great deal of the time I have been in this Depressive Episode.

It may sound stupid to take a depressant when you are depressed, but a huge component of my depression, or something that makes my depression worse is anxiety. Valium really helps relieve me of much of my anxiety.

The problem is it comes with a price. Dr. X. uses the metaphor of a credit card. You use it upfront to get what you desire, but you always need to pay it back.

He's right. Going off Valium is always an ordeal for me. I managed to go from 15mgs to 10 mgs over a week and that seemed okay. I hadn't been sleeping well anyways, so never really noticed the difference. I am now taking it down to 7.5 mgs, which may not seem like much of a difference, but I pretty much haven't slept more than 2-3 hours a night since I started taking only 7.5mgs.

The not sleeping is bring on an unexpected side effect. One I know can happen with decreased sleep, but unexpected nonetheless. I feel my mood lifting a bit this morning. To the point that I bounced out of bed at 7:30, read the paper and then went for a walk in the blueberry field.

I saw the intense beauty of the flame coloured bushes enveloped in fog and encased in frost. I watched as the sun lifted the fog and the frost began to melt. In the field I saw the life force slowly returning to the crisp green grass.

I gazed in a dreamlike state as the warmth and melting frost began returning the quick to the blooms of the requisite dandelions strewn amongst the bushes, grasping for one last chance to bloom and turn to seed, thereby enabling them to release their parachuting progeny into the wind; ensuring a return of their children to life in the spring ahead.

I stared intently as the drifting, disappearing frost melted in conjunction with the rising sun. An unnatural parallel line appeared to be dividing the field in two: On one side the red leaves on the blueberry bushes appeared as flames, the richness of the red enhanced by the dampness left behind by the melted frost, the flaming red colour rising and racing across the frosted blueberry bushes.

On the other side of the line the leaves of the bushes stood at attention; cold, deathly silent, stiff, and ice encased. The red was hidden. Instead of flaming red the frosty army of bushes appeared pink because of the combined colours of red leaves and white frost.

As the moments passed the sun became warmer and more intense. Red flames roared faster and faster towards the pink army; an army that stood defenseless and silent in the face of the oncoming heat of the sun. The frost melting more quickly with the passing of time.

I raced home to get my camera, because I was awestruck and wanted to share the blueberry bushes joyous return to life. It felt like I was returning to life with each waking bush.

The moment had passed. My camera was too late. That moment is however, captured in my mind as a beautiful moment in a difficult life. If I were not here the moment, as I experienced it, would not have existed. I will remember those moments are worth living for.

Friday, October 24, 2008

The Value of a Powerful Therapeutic Alliance

I am falling deeper and deeper into depression; again. I feel so helpless as I feel myself falling farther and farther down. I went to my appointment with Dr. X yesterday, and all the way there I kept thinking: "I have had enough, I cannot take this anymore. I am quiting everything: medication, therapy, and if that doesn't work, life.

I sit down in my chair, across from Dr. X. and I feel an intense shame come across me. It is as though I feel not worthy to be in his company, to take up so much of his time, to have him see me for so long. I feel that same shame right now. How can I get so much help, and such good help, and still remain unwell?

I sit facing Dr. X. and I feel certain I must be exhausting to him. I must frustrate him so much. I cannot imagine how he manages to meet with me week after week, after week. How, after seeing me crash, seeing me unable to manage simple tasks, seeing me fail over and over again, how can he not be intensely frustrated, or in my mind even worse; how can he not have given up hope for my ever becoming well?

I manage to ask him if I frustrate him. He explains frustration is not the right word; sadness, a sadness that you would feel for a friend, or family member who remains chronically sick, that is closer to how he feels.

I feel touched by his saying that. No one except my Mom, when she was alive, has ever said that to me before. No one says they are saddened by my struggle to become well. My family mostly tries to make me believe that everyone has depressed days, shifting moods, anxiety, etc. That depression is normal. This makes me feel completely misunderstood. I am certain this state of mind is not "normal". They assure me I am strong and need to step out of this hole I am stuck in. Either that or they say "get a job", as thought that will fix me.

Even my Mom used to say I needed to accept my illness, get a job and I would become better. My husband says I am sick because I focus too much on my depression, am in therapy, and take antidepressants.

People without this illness have no concept of what it is like to struggle, and then often to even lose the ability to struggle. Life is hellish, empty, frightening, worthless, hopeless. I wake up everyday hoping today is the day, but most often I realize and know it will never end. It has been part of me for too long.

Sometimes I wake and think: " Today is the day this MDE will end". I have glimpses of joy, moments of laughter throughout the day, but after the moment ends it feels as thought the moment is mocking me; laughing at me, not with me, showing me a moment in time that will only ever be that: a moment, a split second of freedom, an infinitesimally small break in the darkness.

I sat in my appointment yesterday, ashamed of who I have become, wanting so badly for Dr. X. to know who I have the potential to be. In the moments we talk I believe he may know my real self. He may understand I am a better person than the one I have become. Actually he sounds like he accepts both of me: the sad one and the bright and joyful one. In fact, it appears he sees us as neither one or the other. It seems he sees the real me through the sadness. During the time I sit in that chair, across from Dr. X, I feel that the sad and joyful me are seen as one and the same.

I am not two people. It is not fake for me to be joyful for a few hours and barely able to move the rest of the day. Dr. X even says it is not a facade when I laugh gleefully at my puppy running and jumping for a Frisbee, and moments later feel sad. My sadness, and fatigue, and amotivation, my wanting to sleep all day are all symptoms. We will continue to work to address these. He seems confident that wellness is a possibility, that I will not be stuck in this hell forever, that we can, at the very least, help me lengthen and intensify the good moments.

I feel myself laugh when I think of my dog. He is bringing so much joy, and at least some fresh air and exercise into my life. He drags me out of bed, deserves a walk and play time. I am fully responsible for his care. Which at times seems overwhelming, but also is a responsibility that protects me and gives me energy.

Dr. X and I begin to talk about how we, as Dr. and patient, interact. He begins asking me questions I do not know how to answer. He asks me how my interaction with him differs from my interaction with a friend. I try to express how a friendship is a two way relationship and we have a one way relationship. I feel distanced from him by that separation; the him and me.. The game we play has rules and strict boundaries. The playing field looks different to each of us. We are playing entirely different games and I do not completely understand the rules. I only know there are strict boundaries that I need to guard.

I feel intensely uncomfortable asking him questions. I feel like it is not my place to question. That is how I was brought up. Call people Dr. Sir, or Cst.,Cpl, Sgt, Staff, or Inspector. They ask the questions. You answer them. I try to ask him questions like he seems to want, but I feel awkward and nosy. He insists I keep asking. I'm thinking it is a type of behavioural therapy. He wants me to see and believe he is a person like any other, that he cares about me, that I can ask him anything.

All I keep thinking is he must think I am a complete loser. I bet doctors make fun of people like me. Sit in their offices and laugh about how bizarre people like me are. Over coffee, having conversations that begin with: "You would not believe the patient I had today...". I feel scared people do not like me, make fun of me, are secretly talking about me behind my back.

At the same time I feel so disrespectful of Dr. X. for even thinking he might be like this. How rude. How unthoughtful am I to think this man, a man who has always been there for me, who is consistently caring and goes out of his way to help me, how can I even think he would be like that? I feel like I have hurt his feelings for even suggesting this might be possible.

I cannot, however stop worrying that he will give up on me, or that he is exhausted by me, or simply cannot take it anymore. It is always what happens. I wear people out. They leave me. I even used to ask my Mom, every time I spoke with her, if she loved me. As though her actions never screamed those words loud and clear. They always did, but something inside me felt I was unlovable.

My husband and I have been together 16 years and everyday I think he wants to leave. Everyday I ask him: 'Do you love me"? and everyday he answers yes, but I cannot believe anyone would love me, or care deeply and honestly for me. Not really.

This is what I need to work on in therapy. I need to learn to believe I am likable and worthy of people caring about me, and for me. This is where a powerful therapeutic alliance is intensely important. If I can work through my conflicting feelings about Dr. X., maybe I can reflect the behaviours and beliefs I learn onto the rest of the relationships in my life. Even if I am scared, what I do know, is that Dr. X is the safest person with whom I can to practice and relearn better personal and social skills.

Wednesday, October 22, 2008

Something is "Hinkey"

Anyone watch NCIS on TV? Abby, the forensics specialist/computer specialist has a line when something is array. She always says, "There's something hinkey going on". Translation something is strange or unusual about the circumstances.

Of my last 60 visitors a full 13/60 have googled "zebras" or something to do with zebras. That is a full 21% of the last 60 people who ended up on my blog...and they are different people, or at least visiting from different computers in different countries.

Something is "hinkey about that...anyone care to shed some light on why zebras on my blog are suddenly so popular?

Just curious.

Monday, October 20, 2008

Why Am I So Tired All the Time?

I feel so exhausted I can barely move. That includes my mind body and fingers typing this post. All I want to do is stay in bed, sleep; avoid life.

I get up no problem, but within a couple hours of am leaning towards a nap. If I crawl back into bed and cannot sleep I stare vacantly at the ceiling, or at the same section of the same tree outside my window. I feel hypnotized by these two things.

If I fall asleep, when I wake I literally cannot move. It is as if my body has remained unconscious while my eyes have opened up. The effort it takes to get out of bed is astronomical. In the late morning and all afternoon there are only three things that lift me out from under the covers for any length of time:

  1. My puppy...he needs a walk, or at least to go out and go to the washroom. Today twice I managed to drag myself out to walk him. I threw a ball for him, back and forth, back and forth. At least he was getting some exercise.
  2. Guilt...I feel immensely guilty about how sluggish I am and feel. The guilt pushes me to at least get up by 5 or 6 pm so my husband doesn't know how much I am in bed, and go on and on about how little I do.
  3. Responsibilities and commitments I have made to someone else; a visit with a friend, my classes today and tomorrow, my pdoc appt etc.

Even with the commitments/responsibilities....most of the time I feel more exhausted for having them. In my mind they weigh me down even more and require extra sleep to get through the activities. An example of this is are the days I teach my classes. My classes are almost making my exhaustion worse. When I have an afternoon class I plan to sleep for 2-3 hours beforehand, and after my morning class I fall asleep exhausted from all the effort I mustered for the class.

I feel like I am a snail that weighs a thousand lbs. Simply squirming slowly across the dirt feels like a monumental ordeal, and the weight of my shell makes it almost impossible to go anywhere, or do anything.

Friday, October 17, 2008

Ask Me a Question Part II

First Dr. X was my 9997th visitor. So close to the 10,000th. Wouldn't it have been mystical if he were the 10,000th visitor...yet there he sits three visits away. I wonder what he would ask if he could ask me any one question? Hmmmm?

I want to write, and I'm stuck for a topic, and my 10,000th visitor: Mr/Ms " Minneapolis, Minnesota. [who] started their visit at 12:09:56 pacific time (3:09:56 their time)and got to my blog by Googling "My Therapy Sessions" Did not or has not (yet) asked a question...the offer is still open...ask away.

So I thought I'd try to answer the 3 questions that were asked:

1) On Friday, October 17, 2008 11:08:00 AM Lola Snow from "Marine Snow" asked...

"If you woke up tomorrow and your life was perfect, what would have to change?"

Well...if it was perfect? Nothing! ...Sorry Lola I couldn't resist.

I will assume your question is an existential one, as in "what would I have to change to make my life perfect"? Is that what you are asking?

If so, that is a question to which I have been searching for the answers to for years. Today I said I was going to be honest in my answers. This will be hard, because I know I control some of the things that keep me down, but sometimes it is easier to live with the life you have, than make the changes you need to make.

a) I would have a job that I loved. One that required creativity and caring for others. A job that was stable and I was not alway afraid of losing, that did not change all the time, but that had change within it...i.e. one that required me to to think on my feet, utilized lots of different skills, was interesting in its variety and challenged me intellectually. I would work four days a week.

b) My husband would actively participate in marriage counselling with me. We would both work on completely overhauling how we communicate with each other. I would want to have sex again (I have completely lost my desire) and we would enjoy it at least a few times a week. On top of that I could actually manage to orgasm again. So, both my desire, and my ability to have enjoyable sex, would return. If my husband did not participate in counselling and work to help us change the way we communicate with each other I would divorce him.

c) I would not live in my old, falling down rented place. I would own my own home somewhere in Vancouver or east Richmond....just a small place with a yard. Nothing extravagant. All I want is a small home of my own that is not a a condominium. Unfortunately in this city, that dream is impossibly expensive. Maybe one day I can buy a lane home, or a carriage house. I need my own quiet space. I need a space I know is my own, where no one else (except my husband...who of course has gone to marriage counselling with me) has any power over my living situation.

d) I would swim everyday for at least 30 minutes (my perfect home would have a narrow 25" lap pool in the back yard)

e) I would WANT to live. I would not be plagued by depressive thoughts, or thoughts of suicide. I would no longer have all those thoughts of stabbing myself, or hanging myself, or shooting myself in the head, going through my brain over and over and over. I would give up the stash of medications I have hoarded for when I decide to kill myself.

f) I would not have any depression or anxiety symptoms. I would not have anxiety attacks, or panic attacks. I would not have any mood cycling. My mood would be level most of the time and my depression and anxiety would have disappeared. I would feel good like I did a couple years before this depressive episode and like I did in my last two years of university.

g) I would not stress out around others. I would look forward to going out to see others. It would be easy to go out with others. I'd stop feeling like I was in a bubble, or outside the circle at large social functions, or in stores and other places with lots of people.

h) I would not need a couple drinks every night. I would be able to drink socially like I did before; when I go out, never at home alone.

i) It would feel good and I would have the energy to do my housework. It would be enjoyable to cook dinner etc. It would feel good having a neat and tidy home.

j) I would enjoy gardening again.

k) My sisters and nieces would live closer to me.

l) My puppy would grow up to be well trained, behave like a saint, and be just as cute and cuddly as he is now.

m) I would have less things. No more clutter, or sentimental nic nacs. I would have a warm, yet calming zen like home...without all the accouterments of life I have gathered or been given over the years.

n) My Mom would be alive

o) I would make enough money to not worry about my bills or the things I need. If I made lots of money I would give away the amount I did not need to set up an art therapy foundation to help others with mental illnesses

p) I would spend at least 1 hour everyday creating art.

q) I would have an art studio in my house, where I could leave half done things up, and things I needed to create art were easily accessible at all times.

r) I would feel loved, cared for and wanted by those around me.

s) I would participate and join organizations that helped me feel a strong sense of community both culturally and spiritually with other people.

t) I would volunteer at least once a week

u) I would have season tickets to the Vancouver Symphony (and a companion who I didn't have to drag there to go with me each time)with me.

v) I would eat lots of veggies and take my vitamins. I might even become vegetarian again.

w) All my fatigue would disappear and I would sleep 8 hrs straight every night. I would have the energy I had during periods when I was not depressed.

and finally...
x) I would see Dr X once in a while because I enjoy his company, not because I need to see him. When I met with him we would have joyous discussions about all aspects of a good life, art, literature, intellectual ideas, friends, etc.

2) On Friday, October 17, 2008 11:11:00 AM deepblue from "Out of the Blue" asked:

"how do you afford/pay for your therapy?"

This is easy. I don't. In Canada we have nationalized health care. All doctors visits are covered by my province's medical insurance. I see my Psychiatrist for therapy, so the therapy is covered.

Having said that, before I met him I paid for therapy on my own for two years, once a week as psychologists are not covered. I really shored up how many times I went out for lunch and coffee etc. to save the $100.00 a week it cost. Also, on top of that I worked for a large corporation who allowed 6 free visits a year to a therapist...not great, but it helped. The only problem was I had to see psychologists covered by their plan, and I did not do well with any of them.

3) On Friday, October 17, 2008 11:55:00 AM Hannah from "Becoming Hannah" asked:

"Why you?"

I will answer this with a few different "voices":

a) The voice of reason: Depression, bipolar disorder and anxiety runs in my family. My maternal grandmother took antidepressants for years. My Mom was depressed for at least 10 years I can remember. My cousin has Bipolar Disorder and while undiagnosed, I am certain her Dad, my maternal uncle had bipolar disorder. It explains his bizarre, unpredictable and impulsive behaviour and his poor judgement.

My Dad has had a panic attack and I recently found out my paternal Grandma frequently had anxiety attacks. She also had an intensely hyperthymic temperament, the same way I feel better than most people when well.

My paternal Grandparents were alcoholics. I am pretty certain my Dad is too. Irritability, anger and a propensity towards emotional abuse and violence run in my paternal side as well. I was a worrisome child, and prone to insomnia, anxiety and dark thoughts from a very young age. It appears obvious I have a strong biological/genetic disposition to mental illness and alcoholism.

On top of that environmental factors made things more difficult for me. Our family moved almost every two years when my Dad was transferred with his job. So I was constantly in the mode of trying to please people, or trying to make new friends. As a coping strategy I tended to sever ties with those I left and form instant attachments to people in our new town. I always felt like an outsider.

My father was often away during my younger years as he was a police dog handler and was often called out for weeks at a time to search for people. He was emotionally abusive, distant and at times, a physically abusive father.

My parents divorce and how it proceeded in secret, how my Dad secretly remarried, how my Mom remained depressed for most of her life after my Dad left. This all affected me. I lost many friends to death in high school and was in a car accident where my best friend had a permanent head injury. That affected me.

With all that behind me it seems I was left unprepared and less resilient for all the regular sad and bad things that happen in everyone's lives. My depression and anxiety are not my fault. They are caused by a mix of environmental, genetic and biological factors.

b) The depressed voice: It is my fault I became this way. I had everything; a good job, a good family, (maybe my Dad was a bit harsh), but all in all my family cared for me. I just don't try hard enough. If I tried harder I would get better. I am too dependant on Dr. X. Maybe if I hated him I would get better so I would want to leave. Maybe I chooses to be this way? Maybe I stay this way because I get something out of it. Look I don't have to work, I can do whatever I want all day etc...but that's not true, because I am to depressed to do what I want and I want to work.

Well maybe I am being punished. Maybe I did bad things when I was young and I am paying penance for being a bad person. Maybe I deserve to feel this bad because I am a bad person. I think bad things about people. I hurt people. I don't deserve to be happy.

c) My Husband's voice: It's the medication and the help. If you hadn't tried medication you wouldn't be so sick. If Dr. X just refused to see you, you would get better. You will never get better while you have someone to help you (huh?). The day he cuts you off seeing him and off medication is the day you will start to feel better.

d) My Existential Voice: You continue to be depressed and anxious because you have intense death anxiety. Life is short, limited, it ends. You are not well because you are not living the life you want to live, you are not using what little time you have on this earth wisely. When you discover what it is you want and pursue that dream the depression will subside.

e) Dr. X's Voice (my interpretation): You have an illness that is caused by genetic, biological and environmental factors. Medication can help, but it will not be the only thing you need. You need to work hard to become well. To do all the things you can to feel better. I think he believes, like I do, that there is a strong existential angst component to my depression as well. He knows that finding and creating meaning in my life, and creating a purposeful life for myself are essential to my becoming well. They are not all I need, but they are a huge part of it.

Lola, Deepblue and Hannah:

Thanks for the questions. they really gave me both a lot to write about, but also a huge amount to think about and work on in therapy. Thanks.

My 10,000th Visitor

My 10,000th is someone who is from Minneapolis, Minnesota. They started their visit at 12:09:56 pacific time (3:09:56 their time)and got to my blog by Googling "My Therapy Sessions". Please, if you are interested, ask me a question. I will respond.

Ask Me a Question

Today I will have been visited 10,000 times. Wow. Seven visitors from now will be my 10,000th visitor. I offer that person to ask me anything and I will answer as truthfully as possible. The next few visitors can ask me a question and I will let you know which of you is the 10,000th.

Thursday, October 16, 2008

I Fear I Will Be Scrutinized

It is difficult to recreate the intricacies of a therapeutic moment, or moments when I come home, and sit down to write a post. Often, even within the therapeutic moment, it is difficult to describe, explain and sometimes, even bring up, what is going on inside my head. That is how I am feeling right now.

Dr. X. is so patient and understanding when I am trying to get things out. We have a long therapeutic history together, and on a huge level I trust him more than anyone on earth. Intellectually I know he is trustworthy. When it comes to an emotional level though, I have a difficult time trusting that anyone is who they appear to be.

His behaviour has always been consistently kind and compassionate. He has always appeared to care for me and not judge me in any way. In fact, I cannot think of a single time when, (factually vs. my paranoia) he was anything but supportive. I do not know why I cannot always believe he will not reject me, or does not secretly dislike me, or does not privately disrespect me, or think I'm a complete waste of space.

Most often I feel like my even thinking he would be like the person I worry he might be is disrespectful towards him on my part. He has never given me any indication he thinks anything but good thoughts about me. It is me who has difficulty believing; especially when I am really depressed.

I am using "belief "in the philosophical sense, where it is an unquestionable belief that leads to knowledge. An example might be believing the world to be round, allows you to take that next step and try to sail to the other side, whereupon a successful sailing, where you did not fall off the edge of the world leads to clear knowledge that, at the very least the world is not flat, and your belief it is round is closer to becoming knowledge.

This might be part of the problem. A patient can believe anything they want about their psychiatrist, but there is never any opportunity to have those beliefs turned into knowledge. You can never "know" your pdoc, you can only believe what you experience. To feel safe I need my beliefs backed up by knowledge.

The therapeutic alliance is such that the patient knows very little about the psychiatrist. In many ways this is a beautiful thing. For me it means Dr. X. can be anyone I need him to be at any given time. On another level it can be a frightening thing, especially if paranoia, or fear of rejection, or an intense need to be cared for, or valued, or not rejected are symptoms that flair up and become intense when I am depressed. Unfortunately, when I am really depressed, it makes sense that Dr. X. becomes the subject of my fears.

Today we reviewed my schedule. I did not do very well. In fact the things I really feel NEED changing did not get done at all. This led to the following paraphrased and (very) abridged recap of our discussion:

Me: I hardly did anything this week.
Dr X: You made up the schedule and came prepared with another schedule for this week
Me: Well, I haven't even filled the new schedule in yet and I didn't dust, or drop off the laundry, or cook dinners...yadda, yadda, yadda...I am so disgusting. If you saw how messy and dirty my house was you would be disgusted.
Dr. X. I challenge you to take pictures of your messy house and bring them to show me in our next session.
Me: (inside feeling absolutely mortified by the thought of doing that.) There is absolutely no way I could do that.
Dr. X: Why do you say that?
Me: (inside thinking a hugely complex set of ideas...I'm disgusting, it would destroy any semblance of "normality" I have tried to maintain with Dr. X, I would completely destroy any image of "togetherness", or likability I have left with him, etc.) I am afraid you would not like me, or would disrespect me.
Dr. X: Maybe this is an important behavioural exercise. You keep thinking I will not like you for your messy home. Showing me your home and seeing your worst fears be mistaken would be a good exercise.

This is when I began to fear my whole good relationship with Dr. X. was just imagined. I knew nothing about the man except what I see in our sessions. I imagined him having a beautiful and immaculate home. I imagined how disgusting my home would appear to him. I believed if I showed him my home he would be disgusted with me. I believed that I had worked so hard to be "likeable" and pictures of my house would destroy all I had worked so hard for.

It became obvious to me that showing Dr X. my house would lead to him disrespecting me, seeing how truly lazy and unorganized I really was, and that inevitably it would lead to his rejection of me as a person he valued.

I understand that taking the pictures and "joyfully" sharing my messy house with Dr X. could be good behavioural therapy, but what if it backfires and he really is disgusted in me?

Please note: I understand this trust issue is my problem, and that Dr. X. has never indicated in any way that what I fear would take place, but the fear is so powerful I feel sickened that I even tell him this stuff.

I just saw(seconds ago) this very fitting video...

Wednesday, October 15, 2008

How Long Should I Remain in Therapy?

In my the comments section of my previous post "Consciously Challenge My Thoughts" Kara asks:

..."how often and for how long have you met with Dr. X? I ask because I've been seeing my counselor weekly since beginning of January. And it's not that I "want" to stop; actually I'm a bit fearful because it's become a's in my routine..."

The short answer is I have been seeing Dr. X once a week for almost exactly 7 years. At least a couple years of that time (off and on) I saw him twice a week. Kara's question, and the subsequent worries attached to it, often swirl around in my head

I despise myself for feeling like I need the help. I rail against myself for feeling too dependent. I see it as a sign of weakness that every week I look forward to having 50 minutes of time with someone I care about, and someone I feel I can be free around.

I even think I am a bad person for caring about, thinking about, and actually "wanting" to see my psychiatrists. What kind of person wants to see there psychiatrist? Like in Kara's comment I often think I am habitualized to our meetings, too attached; that wanting to go to a psychiatric appointment each week is somehow a sign I should break the bond.

Dr. X and I have talked about my feeling this way numerous times. Before my Mom passed away she wanted to meet him, because she too feared I was too dependant on him. When she came to my appointment she asked him about this directly.

His response was (paraphrased): "In fact I encourage a type of maternal dependence. The type of dependence that allows the patient to feel supported, so they can eventually go out on their own". An example he gave me one time was (and he assured me the example was not meant to be paternal)...the example was that of a parent teaching a child to ride a bike. The child has to feel safe and feel they are completely supported and cared for before the child will feel safe telling the parent to let go of the bike.

For three of the 4 years before my Mom met Dr. X. she kept telling me how concerned she was about my dependency on him. The day we all met together; as we walked out of his office, she expressed an intense feeling of relief and told me she now felt confident I was both in good hands and in the right hands. She told me it was an immense relief to know I had Dr,. X to help after she passed away, and to know that he would continue to help me.

My Mom always loved, encouraged, supported and helped direct us. Even when she was depressed she was supportive, kind and loving. Now that Mom has passed away, I really miss her maternal love and support.

My Dad was a different story. I know he loved us, but he was unpredictable in his anger. He scared the hell out of me when he was mad and I never knew when that was going to be. He controlled me with fear, derision, dismissal and shame. For some reason his model stuck with me and looms large within, and runs through, my life.

His model of parenting led to my fear of authority figures; so much so that almost every day I worked, despite being constantly rated in my work performance as an employee who exceeds expectations, everyday I was afraid I would be fired, let go, or punished for making mistakes. The things I remember from work are the times I received negative feedback. I find it difficult to remember the feedback that was positive. I really need help relearning life in a safe environment.

Dr. X.'s support and unconditional regard is so similar to my Mom's when she was alive and well. I used to think I relied on my Mom too much, and she was family. It makes sense that I feel that way with Dr. X.

More and more I am starting to see that my depression as a chronic, lifelong illness. I will never be "cured". I have to live within the parametres of having a chronic illness, in the way that a person with heart problems, or diabetes, or MS must live within the parametres of their illnesses' symptoms, and with an eye towards reducing the symptoms as much as possible, but also accepting that they have whatever illness they have, and symptoms will come and go.

The previous paragraph is not meant to sound morose or hopeless. It is a way towards peace with myself. The more I FIGHT my illness, the less the symptoms seem to recede. If I can accept my life is different now than before I had so many Major Depressive Episodes, then maybe I can at least try to excel with my limitations.

Maybe I won't ever have a job like I had before. Maybe I am relegated to doing sporadic volunteering when I am well enough to do so. That is painful for me to even contemplate, but ironically the way up, might be to let the downs happen, and accept they create limitations.

A few days ago I began reading Peter Kramer's book, "Against Depression". If I am reading it correctly (and I easily could be misunderstanding as I am having a hard time reading it) in it he surmises that people with depression do not simply need the symptoms of their depression taken care of (the depressive mood, suicidality, amotivation, fatigue, i.e. the psychiatric "markers" of depression). Peter Kramer seems to be saying that ridding a person of the symptoms that psychiatrists have defined as "depressive symptoms" may not be enough.

The person who is depressed may need to review and rebuild their entire "personality"; how they manage rejection, their ability to socialize, their perfectionism, their ability to accept and go with change, and so on.

If Kramer is right, and on some level I suspect he is, then therapy for a chronically depressed person would be expected to last a long time, and would probably be required periodically throughout a person's life. Even if a person's MDE symptoms seem to completely disappear, therapy may be needed to help the person successfully get through and manage life's changes and blips.

So Kara, in the scheme of things, I am saying you have been in therapy a relatively short period of time. It is up to you to determine if you feel comfortable with, and have confidence in, your therapist and the the value of the therapy you do together. I personally believe in quality over quantity.

I also believe there is evidence that supports long term therapies (both medication and psychotherapy). From what I have read, if your depression is chronic, or you have had more than one or two MDE's in your life, long term support can be really helpful and is probably crucial, given the more depressive episodes one has, the more likely one is to have another MDE inthe future. I believe the statistics show a person who has had three MDE's has a 90% chance of having another in the future. To me that indicates the value of taking a proactive approach towards staving off any indicators of depression and hopefully managing to be in the 10% whose deression does not return

For me, I am beginning to believe the "habit" of therapy might be a good coping strategy and a good habit to form; like cuddling your puppy throughout the day, or singing to your nieces and nephews, or enjoying a walk in the sun. Just because you habitually like doing does not mean it is wrong.

Sorry Dr. may be stuck with me for a while;>)

Thursday, October 09, 2008

Consciously Challenge My Thoughts

My appt with Dr. X, was okay today. I didn't want to go, which is unusual. I'm so tired and feel so beaten down and dejected that it feels embarrassing to share how lame I am with him.
He challenged me on that one when I told him I was lame.

Dr. X: Why do you say that?
Me: Because I do nothing. I think I should be working.
Dr. X: You are working.
Me: (feeling annoyed) I volunteer for 5 hours a week. That's not working. That's lame.

At this point I recognized the pointlessness of continuing the conversation, because I know he's never going to agree I am lame, even if he believes it to be the case. He is going to continue to say I am working, that it is valuable work, and it is work to be proud of. I'm right the conversation keeps heading in that direction. I don't believe him anymore than I did at the beginning.

However, we begin to talk about my setting up a schedule, a formalized structure to help me actually complete some of the tasks I want to do, but cannot seem to actually do...a structure to become less "lame".

This seems to me like a good plan...but only if he makes me accountable in our next session. I need some "work like" formal structure to get things done. I need deadlines and expectations. I really, really need some external motivation.
He agrees to ask me about my activities completed to plan in our next session. I know, if there is no follow through I will let this whole plan disappear. I cannot keep it up without feedback and accountability. That is me. I work well when there are people expecting things from me.

So Dr X and I set up an action plan for this week. We also discussed how my negative thoughts get in the way of me doing things, and that I need to prepare for them before I do the activity.

I came home and I set up the schedule we discussed on a more formal paper that I can stick on the wall or fridge, or somewhere prominent. I also created a worksheet to write out the tasks I find difficult, why and to actively challenge them. I also added a couple questions about "perceived" difficulty/fear/enjoyment before the task, and then the same questions rated after I complete the scheduled task.

The whole exercise of setting up a formalized action plan to address my symptoms feels reassuring. It is a concrete way for me to address my amotivation and fatigue. I feel scared that I won't be able to stick to the plan, but I feel much more hopeful that there is something I can do to try to change my life.
Here is my schedule for this week and a copy of one of my "Thought Challenge" worksheets. Maybe they will be useful to someone else: (click on the documents to enlarge) I will fill in "Thought Challenge" worksheets about my grocery shopping fears, my teaching classes, cleaning the house, cooking dinner and especially challenges for my automatic thoughts when I try to sleep or nap. This seems to be when the deluge of negative thoughts about myself happen the most.
I will fill in the sheets later, because right now his is cutting into my scheduled: "Puppy Time"
Thanks Dr. X.

Wednesday, October 08, 2008

Helpless and Hopeless

(aqua, study in charcoal of a poppy/2005)

That helpless/hopeless feeling is setting in again. That sense that I am falling deeper and deeper into depression again and no matter what I do, or how much I struggle I remain intensely fatigued, depressed, apathetic, dissociative/depersonalized, confused, isolating and unable to sleep.

I want to hide out, in bed, in my back room with the curtains closed. I am so angry at myself for being this way. When my thoughts turn to angry depression I begin visualizing about ways and places and times to hang myself, suffocate myself...die. I feel like my life will never get back on track.

It takes all my energy to get going in the morning, even to take the dog for a short walk, or to write this post, and those are things I usually like to do. Everything seems like a chore: a dreaded chore. The real chores, housework, cooking etc. ,simply are not getting done and it is making me feel intensely guilty for not contributing to the running of our household, and my husband increasingly hostile towards my "laziness".

On top of feeling helpless/hopeless I had that same feeling of dread I had last week as I headed to teach my Youth Art Class Monday night. I tried to sleep all day in preparation for it, but just lay there awake wishing I didn't have to go. At 2: 00ish I dragged myself out of bed and went to class. When it began I felt myself becoming more social than I expected. At the same time I also felt it was harder than usual to do.

When I woke up Tuesday morning I wanted so badly to not go teach my drawing class that morning. I felt I just couldn't do it anymore. I feel overwhelmed with two classes and a puppy to look after. However, I pushed myself, because I committed to teach the class.

On my way to class, despite my exhaustion, apathy, and depression; I also felt an intense sense of ennui. That made me begin to thinking maybe I need to do more, not less, stimulating, "scheduled/regular", work like things everyday. Maybe my husband is right. Maybe I should get back to work.

If I am at home all I feel I can do is lay down,sleep, or watch t.v. If I am doing something work like at least, for a while, I get a sense of accomplishment, and my mood lifts while involved and distracted.

The problem is I cannot even manage to do what I want and/or need to do: like keep my house clean, cook, grocery shop, do household chores and even paint like I want to. How do I work more when I can't manage the little I do now?

I feel extremely frustrated by my lack of stability, by my not working, and by my not contributing. These all feed my bad mood and anger. I know that. I know I need to do more, but how?

Sunday, October 05, 2008

He Lives With Me. Why Can't He Get It?

I feel so angry at my husband right now. Not just my husband, but some of my friends too. The final "straw" that made this camels back break came from comments my husband made last night. While I had been able to let some of our friends comments go, it finally set me off when the person who sees me struggle everyday vocalized the same ignorant beliefs.

We went out last week and when one of our friends asked me how I was doing I told them the truth; that while I was feeling better than I had been I was still struggling with mood swings, fatigue and depression. He proceeded to lecture me on how everyone has mood swings, no one's mood stays the same and everyone gets tired. I hear this kind of response so often that I have really tried to learn to let it go.

I commented that I believed most people did not have the extensive mood swing I had, and that I didn't believe most people struggled with the depth of depression I do and then tried to move the conversation on.

I honestly feel like screaming when someone suggests what I am struggling against is a normal human occurrence. It negates how much pain I feel and the depth of my difficulties. It is dismissive.

I am pretty certain "normal" (I use that word loosely) people do not want to sleep all day, kill themselves on a regular basis, become absolutely exhausted after two or three hours of volunteer work, feel so tired that shopping for food and cooking anything, even Kraft Dinner, seems an impossible task. I am pretty sure most people don't feel so tired they feel sick.

I know when I am well I do not feel like one thing a day: meeting a friend for lunch, painting for a couple hours, or participating in a short class, is the only thing, (besides sleeping and watching t.v.), I can manage that day. I have had periods of "normality" and I had a zest for life, loved cooking, i didn't have time to sleep, because I had too many things I wanted to do.

Anyways...Argh! A few weeks ago a well off friend had made a proposal to my husband to purchase a resort on a remote island and have my husband run it. Part of the proposal was to have me involved working in the restaurant, or something like that. At the time I told my husband it sounded exciting for him, but that given my mental health I was not able to work yet and also, I needed to keep doing the things here that seemed to be helping me (Art, Teaching Art, Participating in the Art Clubhouse etc.). I told him to do it and I would come visit on a regular basis. (It is an 8 month a year operation). He seemed to to be okay with that and to understand.

Last night on the way home from a friends I asked him if the proposal was going through and he said the people who owned it would be willing to pay me more than I receive on disability. I just looked at my husband...Huh?...and explained (why the hell do I have to explain this) I am not on disability because I do not want to work. I am on disability because I am too sick to work. Do you not understand that if I was able to work I would be the first to be out there looking for a job?

I felt angry at our friend too. I felt like they must think I'm simply sitting here watching the money come in when I could be working. I can't even express how angry I felt about that, but especially about my husband thinking the same thing.

He started telling me I would never get well unless I started to work. I think the rage came from within because I struggle so hard with my not working. I looked at my husband and asked him what he saw me able to do during the day. Did he really think I was able to work given my mood lability and my inability to do hardly anything without feeling like I'm going to collapse?

My husband just kept saying if I worked all that would disappear. Fuck! I wanted to kill him (figuratively). He began to blame the whole falling through of the resort deal on me. That if I worked there he would do it, but because I'm making money doing nothing I was not willing to help him. He wasn't going to accept the deal unless I agreed to work there too. So the weight of his future lays in my hands and is suddenly my responsibility.

I live with this man. I expect that he sees how much I struggle. Maybe he is in complete denial that I need the help I receive. He kept saying over and over:

"As long as you receive help from Dr. X, as long as you receive disability money, as long as you get will never get better. I can't wait for the day Dr. X. won't see you anymore. I can't wait for your disability to be cut off. You will never get better until Dr. X kicks you out of therapy. No ones mood is perfect . Everyone's mood goes up and down. You will never have a perfect mood....[etc.]"

I went to bed enraged and so angry that he thinks I'm not trying to get better, and that he thinks the things that help me keep me sick. As I write this I am becoming enraged all over again. I don't even know how to explain to him how his view is mistaken, wrong, dismissive of how hard I try and extremely hurtful. I am so mad I don't even want to talk to him, or be with him anymore.

If he has been with me/lived with me for the last 16 or 17 years and he can't notice this last few years is not me, he obviously pays no attention to how hard I am trying. He obviously is missing the fact that I sleep much of the day, feel depressed much of the time, want to die part of the time still and that I am not ready to work even minimal part-time, let alone full-time, at ANY job.

Saturday, October 04, 2008

It's Not Always Perfect: Sometimes That's Why it Helps

I recognize that there are many many people in therapy who are really struggling, either with their therapist and/or with their continuing, and maybe worsening mental illness, in spite of therapy and medication. I was looking back at my recent posts and I can see that my therapeutic alliance with Dr. X. might seem perfect, or completely seamless to people who have only fairly recently been reading my posts. I want my readers to understand that I have struggled with difficulties in therapy too. It has take a long time for me to feel as safe as I do with Dr. X

It is true, I am, and have been since I began seeing Dr. X, extremely confident that he is the right Pdoc/therapist for me. This is not to say I have never had difficulties with him in therapy. There have been many times in the past where I have entered, departed from, or have been in sessions, where I feel incredibly scared, or abandoned, hurt and once, even punished. Therapy is often an extraordinarily difficult process to participate in.

I entered therapy because I was extremely and increasingly depressed. That depression; its causes, it continuation, and its increasingly worsening hold on my life, brought tons of baggage into the therapy room. That room had two people in it: myself and Dr. X. Any room full of that many difficult behavioural and thought patterns carries the potential for lots of conflict. For me, I do not believe that good therapy is free of conflict.

What I do believe is that in good therapy, when conflict happens, both the patient and therapist feel safe addressing the issues that cause or contribute to feelings of conflict. I am not suggesting it is easy, or that I always feel safe addressing issues as they happen.

Often, within the session, I am feeling angry, or hurt, or rejected, or simply feel I made an idiot of myself. At the time I am simply unable to garner the courage to speak up, or address how I am feeling about something I feel is happening within the session.

Sometimes, I am able to address my fears during the session. I remember one time I was late for my appointment. I am never late. I waited in the waiting room, and 5 , 6, 7, 8, 9 and 10 minutes went by and Dr. X never came to get me. At about the 5 minute mark I began thinking he was punishing me, by the time 10 minutes had gone by I was sure he was teaching me a lesson.

Finally I got the courage to go up to the receptionist and ask if she could get him. He came out, and immediately I knew my mind had been getting the worst of me. However, it was important for me to say something, both because I was angry and hurt for 10 minutes, and also so we could make a plan if I am late again. Addressing the anger and hurt in a calm and safe environment, with a therapist who listened and understood became a learning opportunity and a therapeutic alliance building exercise.

Some of my readers may not have been reading my blog for very long. To ensure everyone that I have conflicts with my therapist too, and that the relationship blips happen within even the strongest of therapeutic alliances; I thought I would share some links to previous posts that express some of the difficulties I have had within my patient/therapist relationship.

The key when reading each of them is that every single time there was a conflict I forced myself to talk with Dr. X. about it. Sometimes it took a few sessions before I felt safe to bring it up. Sometimes I could not even say the words, so I printed up my blog post and let him read it, and sometimes I addressed my feelings in the moment.

The important thing is I never let conflicts go unaddressed. Why would I? The conflicts I have with Dr. X. are always reflections of feelings and conflicts I have outside the therapeutic hour. Addressing fear, shame, anger, depression and anxiety about something that happened between myself and Dr. X helps me work out those feelings when I later have them with someone else.

The following are links to posts, and short excerpts from those posts, to give you an idea of what the post is about. I am hoping others in therapy might see that conflict in therapy can sometimes be used to gather great insight into yourself, others and your behavioural patterns in other relationships.

That said, I do not believe all conflict within therapy is good. My experience has been that trust and mutual respect between therapist and patient needs to be strong, and in place, in order for the conflicts to be healthy learning experiences.

I learned more from the following therapeutic moments than any other moments I have had:

1) "Opening Up Too Much"

"I just got back from my therapy session. I have mixed feelings about how it went and how much I opened myself up to Dr. X..."

2) "Do I Tell My Pdoc the Truth?"

"...The truth I am afraid to tell is how deceptive I have been in regards to my dog's prescriptions. I have been amassing very large amounts of two types of heart medications and a very large, and definitely lethal dosage, of Phenobarbital My dog does need these meds, but I have been getting the pharmacist to give me all his refills at once under the guise that I do not want to pay the dispensing fee for monthly doses.That is not the truth. I want to use the medicine to commit suicide..."

3) "Is it a Love Hurt Thing?"

"...Today I went and saw my pdoc again and he says he thinks I should go off all medication for a while and really work on my relationship with my husband and other non-medication things (like exercise, eating well etc.) ...

...I lost it...I feel so ashamed of how I reacted...

...I felt like my pdoc was taking my husband's side and my family's side..."

4) "You Won't Die From Not Sleeping!" (About being 'taken off' benzodiazepines when I did not feel ready...this post actually led to a really good discussion and a lot of support from my pdoc this past I try to come off them again. This time I feel safer and more confident I will get help if I need it)

"...All I want is to sleep, but I asked my pdoc what to do and he said he did not want to take all this energy away from me. I was hoping he would give me something to help me sleep...Why can't I ask more directly?

"...He said he did not want to sedate me when I finally was feeling more energetic. He wants me to look at it and use it in a positive way, because I have been so depressed for such a long time with no break in my mood. He said, he doesn't want me to feel like he is not supporting me, or dismissing how difficult not sleeping is, by saying that, but he wants me to really try to use this time to push forward..."

5) "Preparing For my Therapy Session Tomorrow"

"...I don't know why, but I feel it is not my place to ask Dr. X. to reveal some of these maybe I can do it on paper..."

(About things I was unable to talk about or open up about in therapy)

6) "A Fine Line"

"...I just need help and I'm not one to take myself to the hospital, or call my I cry, and I cry and all I want is a way out."

(About my inability to tell Dr. K how suicidal I feel, or to reach out)

7) "Prepare to be Cut Off"

"I went into my session today feeling really good, despite not having slept more than a couple hours last night and not much the past week or so.

...Then I do not know what happened, but all sorts of negative thoughts started to creep into my session..."

8) "Truthtelling in Therapy" (I sometimes print off things that are really difficult to say and hand them, or read them to Dr. X)

"I feel so ashamed and guilty about how I behave. While I believe absolute honesty in therapy is extremely important to, (and maybe the cornerstone of), successful therapy, I still hold back and find it hard to explain the bad things I do to myself..."

9 ) "Judge and Jury" (about my projecting my Dad onto Dr. X and its affect on the therapeutic relationship)

"... I felt so stressed out and scared in my therapy session today. I have been severely depressed (even more so than usual)and have been feeling really paranoid about being abandoned...both physically and emotionally, by Dr. X, by my family, by my friends, basically by everyone..."

10) And Then the Door Slams Shut"

"...Ahhhhhhhhhh! I want to scream. Four days ago I was going on and on about trust and how I am feeling safer and closer to my pdoc and now I am totally obsessing about how I think my pdoc is not being straight up with me..."
how I was able to talk to Dr. X about my feeling dumped

11) "Blind-Sided"

"...I do not think he is being honest with me. I think he saw an out and took it as quickly as he could. I feel totally let down...and angry that when I am so severely depressed, (but finally had the courage to ask for him to change his schedule to meet a need of mine), I got shot down in flames..."

12) "Freed Up" (about my addressing how I felt "Blind-Sided")

"...I am so proud of myself today. I was brave in my session today and brought up how I left the session in shock...wondering how, when I was brave enough to ask for a change to accommodate my needs, I left feeling like I had been dumped like a hot potato..."

You know that song by REM..."Everybody Hurts" It is really important to speak up and try to understand and work things out if you feel hurt happening in therapy. I swear speaking up with Dr X. has led to some of the biggest therapeutic epiphanies I have ever had.

Friday, October 03, 2008

"Happy" Anniversary

It has been seven years today since I first met with my pdoc, Dr. X. Despite all the psychic pain, anger, intense depression and anxiety I have endured over the past seven years I believe October 3, 2001 was the luckiest day of my life.

Before I wrote in my blog I consistently kept journals, in much the same way that I post here. Unfortunately I did not start a journal until a month or so after meeting Dr. X. I thought it would be interesting to look back to that first meeting.

My appointment was supposed to be a consultation to provide medication information to my family doctor as my depression had not reacted to two different medications, a CBT learning group, or a 3 month stint in group therapy and numerous attempts at therapy, the latest had been an unsuccessful two years in therapy. Dr. X was a mood disorders specialist.

I do not remember much about that first appointment. What I do remember is incredible fear as I waited in the waiting room. I had never seen a psychiatrist before (except in a group environment). I was terrified that I was going meet an authoritarian man, whose job it was to judge, diagnose, spit me out and send on my unmerry way afterwards. I thought I would end up one more sad statistic, unable to survive the increasingly despondent feelings I was feeling.

Instead the man I met was soft spoken, quiet and curious; kind and welcoming. I immediately felt comfortable telling him all kinds of incredibly personal things. He never rushed me; never made any judgements about any of the behaviours I described. Quite the opposite, he encouraged a sense that their was nothing unacceptable about my behaviours except the fact that I was in pain and being hurt by how I felt.

At the end of the session, rather than send me away and abandon me to the same treatments I had been struggling with for years, he asked if I would like to see him for therapy. Thank you Dr. X. for reaching out when I really needed someone like you to help me.

At the time I was having intense suicidal ideation. I often take the ferry to Vancouver Island because my whole family lives in various towns/cities over there. Something about the ferry triggers obbsessive suicidal thoughts. While n it I often feel compelled to jump overboard.

That night the thoughts were flying at me: I would slip quietly off the ferry into the thick black water. It was nightime and no one would notice me in the dark. No one would find me. I'd swim to see if I could make it to shore; searching for a sign that told me I was supposed to be here. Istead I pulled out my journal and wrote about what I would miss if I left this world.

It was one of my first journal entries after one of my earlier appointments . I believe I would not have even considered these things, or written them rather than jump, without Dr. X's support.

The things wrote I would miss are simple things that reflect who I am. I thought I would share my short, yet important list with you:
  1. My family
  2. That cool breeze that sweeps across your skin when you are really hot
  3. The smell of the ocean-when the smell is the strongest at low tide
  4. The feeling of the wind against my face when I ride my bike
  5. The feeling of being emerged in water that is not too cool or too warm
  6. Floating in that same water
  7. The flowers in the garden: the giant purple clematic. the lilies, the sunflowers and peonies; all of them

I find it interesting that the same water I had just been thinking of dying in, became one of the things I would miss the most. (except the water here is pretty damn cold..tiny detail:) I would still miss these things, but would add to the list,
8. Dr. X.
9. My friends
10. My dog
11. My newfound love for creating art, especially painting

Dr. X. thanks for being there for me every single time I needed you. It means so much to me. I am a better person for having met you.

Thursday, October 02, 2008

Processes in Therapy That Help Me

The process of therapy is always fascinating and somehow mystical and magical to me. I went in to my session today feeling really low, guilty, withdrawn, angry at myself for allowing the depression to sink into me again, and for doing things that I know in my logical mind affect my mood. I also still felt very tired. Within about half an hour I felt like a huge load had been lifted off my shoulders. I felt completely different at the end of my appointment than I did at the beginning. Sometimes I feel that all I need is to sit in a room with my pdoc and life becomes less difficult. There are however, obective actions/activities/discussions that take place during my therapy that are of this world, practical and very helpful to me.

As I left I began thinking about what happened in my session that facilitated such an immediate and obvious change for me. I thought of a few things, many of which happen on a regular basis in my appointments, because Dr. X is very consistently non-judgemental about any information he requests, or I provide.

Here's a list of things that helped me this session:

1) Dr. X. has the calmest demeanor of anyone I know. This is where the magic comes in. Just being in the room with him calms me and puts me at ease. Even if I have a preconceived notion that I have done something "wrong" and I have been worrying about it; the minute I sit down and we begin to talk my shame, or fear begins to dissipate.

2) I say "wrong" because it is only me thinking that (or at least vocalizing that:) Dr. X. alerts me to my self-talk, and, without being annoying, quietly helps me see that using pejorative terms when describing things I do makes me feel worse.

Note: I say "without being annoying", because I would get really irritated if it was a constant barrage of CBT lingo and techniques being tossed at me...I see some merit in Aaron Beck's Cognitive Behavioural Theories, but I find his books and his "CBT is the holy grail of therapy" attitudes really annoying. When a person is severely depressed the theories require energy and a "stick-to-it-iveness that are impossible to garner, let alone maintain.

3) Dr. X. asks me the questions I'd rather not talk about. This point may sound strange, but I need him to ask me about some things because I feel shame around them, and they are impacting me, and I need help. For example my drinking. He asked me today about my drinking and immediately I feel sheepish and sensitive.

I feel that way, because I know my slope is getting slipperier. I have gone from 1oz to 2 oz. to 3oz. of vodka/day in a fairly short period. It is not tough for me to see I need to get a hold of it NOW, before 3 become 4 and 5 and so on. I have insight. The problem is, for some reason if it becomes a "don't ask, don't tell" situation I will keep increasing my alcohol intake. I need Dr. X. to ask me. There is something about him asking me that makes me feel a sense of responsibility to rein in my alcohol consumption.

Again, this is some kind of magical/mystical aspect of therapy. He never, ever says anything that makes me feel bad about my alcohol usage. In fact, he is extraordinarily tactful, thoughtful and caring when asking, even when I have been regularly drinking larger amounts of alcohol. He understands that I do it to "help" myself, but he also, gently helps me see that the effect I am seeking (freedom, release, relaxation etc.), might actually end up being the opposite...fatigue and and its companion insomnia.

4) At the end of my session he told me he has been reading my blog, and that he liked it. I immediately played down the value of my blog...even though inside I really do like it too. I like writing. I enjoy the connections I have made with other fellow bloggers. I enjoy the challenge of coming up with something I think others might be interested in etc. I felt really happy that he has been reading my blog. However, I never said any of that. I negated the value of my blog.

We talked about my tendency to put myself down when someone compliments me. The talk was helpful and I sensed he really did enjoy reading what I write. That both made me feel good and made me able to tell you (the readers) that someone I care about enjoys reading what I write(...there!!... that is an exercise in being proud of myself and sharing that pride).

5) We discussed, and decided together, to make some medication changes to try and address my fatigue. I love that he respects and allows room for decision making based on what he thinks might help, but also based on my wishes and what I think might help too. I feel like we are a team and that he is working with me. Trying to make some medication changes made me feel more hopeful than when I went in. So our joint decisions were to:

  • Cut my alcohol in half...and savour the 1/2 that I drink
  • Cut my Valium down from 15mgs to 10 mgs this week...I'm the one who wants to go off it this fast...I really have a hard time with slow.

Dr. X also interjected here that if I cannot do manage to lower the dose of Valium, to not be afraid to tell him. He said he would help me and the amount I am taking is small, so he is not concerned about that. Most important he reinforced that I not be afraid to ask for the Valium if I feel I really need it. This really made my plan to lower my dose seem safer. When he said that I felt comforted knowing he wasn't going to just cut me off and not help me.

  • Increase Tegretol from 800 to 1000 mgs (might help me decrease alcohol/Valium and still manage to sleep
  • Increase my Prozac from 40mgs to 60mgs (because I am wondering if the fatigue is a depression symptom, vs. caused by the medicine. (my idea)

Anyways...I felt much better by the time I was ready to leave my appointment, because I felt very valued, listened to and cared for in my appointment. Unfortunately I feel myself fading right now, so I'm going to have a nap, but maybe I will set my alarm for 3 and try to wake up and paint for an hour or so before dinner.

Wednesday, October 01, 2008

"You Are getting Sleepier..."

God I am so tired. I feel sick I'm so tired. I'm feeling, not just tired...depressed, apathetic, and amotivated. All I want to do is hide out under the covers.

I get up in the morning, without much trouble, though my puppy is waking me at night. I am trying to just get out of bed in the a.m when he want out, which is 7:30 or so. I am okay for a few hours and then, where I used to wait for 4pm to show up so I could have a nap, now I am waiting for 2 or 3 pm. I just feel like collapsing then.

Yesterday it was 1:30 by the time I got home from my drawing class and took my puppy for a walk. On the walk I thought he got stung by a wasp on his foot, so we came in from the field. We both fell asleep for about an hour and then I woke to him rubbing his face. I looked at him and his eyes were so swollen they were almost shut. I started to panic because I have two sisters who swell up and go into anaphylactic shock if stung by a bee; meaning they keep epipens (adrenaline? needles) with them at all times.

(Here is the poor swollen guy)

Images of my puppy suffocating were going through my mind. I called the vet and they said to give him Benadryl (which I actually had, because my other dog had reactions to bees) I just needed to know how much to give a puppy. After the Benadryl the swelling slowed down and stopped and in a 6 or 7 hours it went down to almost normal. It freaked me out though and I put him in bed with me so I could feel him breathing. When he stopped swelling we both slept until almost 5pm.