Long Term or Short Term Therapy

I woke up today embarrassed and stressed that I opened up so much in therapy yesterday. Still I stand by my decision to do so. It was important for me to share my feelings for many reasons. One of the big reasons is I have a sort of "magical thinking" that if I tell someone I care for them they will disappear, or the relationship will end. For this reason I avoid telling many people I care about how much I care for them. Yesterday was my brave attempt to believe that speaking my truth will not affect my relationship with Dr. X. Today I feel the fallout and fear of that decision, but I think sometimes I need to challenge these beliefs, despite feeling the terror of impending loss...

On another note:
In my post yesterday, cbtish said...
"Yes, good therapists recognize the feelings on both sides in a therapeutic relationship.But it has to be said that few good therapists now believe therapy lasting many years, or involving the kind of feelings you describe, is likely to have a positive outcome.So it frightens me, too, that you feel you depend on him so much.The thing is, support, kindness and compassion do not actually promote change — instead, they maintain the status quo. Therapy is meant to be about healing. Things actually happen. Tomorrow is different from yesterday."

I would like to discuss my feelings about the benefits for me, of long term, versus short term therapy.

First thank you cbtish for taking the time to comment. I always enjoy hearing other people's opinions. On some level I agree with cbtish. I think for some people, some of the time, short term Cognitive Behavioural Therapy (CBT) may be the most effective treatment. However, I think we need to be careful that our dogmatic beliefs about a particular therapy do not mean we blanket all people with the same kind of therapy, especially if there are times when it is clear that a particular type of treatment may not be what the patient needs in that moment.

I think for me, during the early years of my illness (17-25) when I had had only a few Major Depressive Episodes CBT worked well for me. By the time I was 25 I had been depressed several times at 25 I saw a Counsellor for 6 sessions of CBT and I remained well for approximately two years. It really helped me. The difference is that at that point my illness was less severe and I was able to do the activities I needed to do to help myself become well again.

However, there were a few things every therapist, counsellor, psychologist and the pdoc I saw before Dr. X missed, or misinformed me about, or neglected to inform me about:

1. That there are medications that can help people. Not a single counsellor/therapist discussed this with me. I discovered this on my own after reading a book about depression. Personally, I think it is negligent to encounter a patient like me, who has had numerous MDE's, and understand that for the most part each seems to last longer and become more severe, yet not inform the patient that medications help some people.


2. Until Dr. X every Counsellor/Therapist I saw was very rigid in the type of therapy they practiced. One believed in CBT, one believed in Eye Movement Desensitization and Reprocessing. (EMDR), another was Jungian, another Psychodynamic etc. I do not believe for me that a particular therapy is necessarily the best approach. My mood disorder is such that my mood cycles between complete inability to even get out bed sometimes, to highly agitated and anxious, to feeling disconnected from everything, to how I feel right now: extremely motivated, content and relaxed. When I am fatigued and extremely depressed short term CBT, or even the ideas of challenging negative thinking does not help me. I do not have the ability to do the actions I need to do to challenge my negative thinking or to change my behaviour. During these times I need supportive therapy. Therapy that helps me understand it is not my fault I am unable to change, or get better. I need help understanding that guilt about how I am is unproductive. I need to know I am cared for no matter how I feel.


3. I need different approaches in therapy depending on how my mood is, and what kind of cycle I am in. When anxious I need someone to help me relax, and learn relaxation techniques. I often also need medications to calm me down. When I am high I need someone who is familiar with CBT and can help me set goals and activate my life, because during these times I have the energy and power to change, when I am agitated and depressed I need to have a therapist who is not rattled by my intense suicidal thoughts, someone I know will listen and not judge me, someone who allows me to speak my truth, When I am severely depressed I need someone who understands and helps me learn to participate in activities outside my house; someone who knows I am struggling, but believes I can do things anyways. Sometimes, I just need someone I feel connected to; someone who I believe accepts and cares for me no matter what.


4. My depression has been treatment resistant believe it is unconscionable to treat a patient for 12-16 sessions, see they were not well still, and end therapy despite the patient remaoning ill. Basically this is what would have happened to me, and happened to me, numerous times. The therapists would treat me, I seemed a bit better, or even much better, but I continuously slipped back into depression. I did not need short term therapy. I needed (and need) long term support to change huge areas of my life, to learn how to make healthier decisions and choices, to learn what kinds of activities drive me forward and which hold me back. My lifestyle has had to change dramatically for me to survive and thrive with and in spite of having this illness. Dramatically changing ones life cannot be done in short term therapy. Personally, for me, I often see that small changes take a very long time. In long term therapy I am able to practice my changes and polish them. I am able to find who I truly am, who I want to be, and how I want to live my life. Before seeing Dr. X I was lead to almost every decision by fear; fear of ending up homeless, jobless, loveless. I am not certain I made any decisions based on what I wanted and enjoyed doing. Long term therapy has allowed me to work through my fear and work towards what stimulates me. I feel I am working towards having a life based on Joy.

I guess what I am saying is there is a time and a place for short term therapy, but to be dogmatic about either short term, or long term therapy is to miss an opportunity to really help a patient change the outline, or structure of their life to one that supports ongoing wellness and resiliency. Patients like me may need ongoing support indefinitely. If I discontinue therapy, it will not be with an eye towards never going back. If I need help again I will return. For me long term therapy, and different types of therapy within my sessions has been extraordinarily effective and helpful . I really believe it is the relationship between the patient and therapist that leads to lasting positive change.

Relationships, trust, and the ability to be truthful and open about all aspects of my life in order that I have the opportunity to address those aspects, can take a long time. The relationship between myself and Dr. X. is strong and I feel safe to make the changes I need to make. I am grateful I have a therapist who understands the psyche may take time to adapt, change, and grow. For me, long term therapy has led to a great deal of positive change; not just surface change, but change that is becoming embedded in my character. This is a great thing.

Walking into Walls

I have finally slept the past two nights. Thank goodness. My mood is still really high, maybe too high, as I keep catching myself talking and talking and talking. I need to listen more. I hate when I am interrupting and overwhelming people during a conversation. It is rude, but I cannot seem to stop talking. Every idea sends another to my brain and I am thrilled with the world. Unfortunately, my talkativeness is even annoying to me and I can see it is a bit too much for others. How do you explain what is going on inside your head and how you cannot seem to control your ideas or your voice from expressing all the ideas.

I love that I have energy though. I have been playing with my nieces and can actually keep up with them. When I am depressed I usually burnout and become overwhelmed pretty quickly. I adore them so much. It is good to thoroughly enjoy their energy and to have the same.

I am having a few other problems though. My hands are twitching. Either my whole hand, or sometimes just my fingers suddenly twitch, almost like a twitch when your reflexes are tapped. This morning I almost dropped my coffee a few times when I twitched.

The worse thing...you might find it funny if you were watching me...I am tipping into walls and walking into things. Yesterday I walked quite hard into a sign post while walking with my in-laws...embarrassing. Not sure if it is balance, or spaciness...Regardless, walking into sign posts is not good.

However, tipping and poor balance aside, I will take this good mood and all its energy and tippiness over sadness and lethargy any day. With the Joy comes an intense return of my love for music, movies, ideas and the company of others. I will enjoy this feeling now, and remember it if my mood sinks. I know now joy and happiness are within me. It is possible for me to feel happy again.

BZZZZZZZZZZZZ

To bed: 2:00am
Asleep: 2:30 am
Awake: 5:30am
Out of bed: 6:30am


I'm buzzing. Can't stop talking, singing, moving, dancing, and being generally too rambunctious. Anxious, agitated, energized. Feel good that I have so much energy and love life, but I feel scared about my agitation and how little I am sleeping. I know, if I don't sleep, I will crash. It always seems to happen that way. Please don't make me crash. Right now I feel like I have found the perfect mix of medicines. Please make that be so.

Soaring

I am really "over the top". I can see I'm going to fast, but I cannot slow down. It is strange, but in many ways I feel like myself again. I am ebullient, chatty, charismatic, and "on". I have tons of energy and feel really good. However, I can see I might be a little annoying too.

I am catching myself talking to loud, too fast, over speaking people, talkling on and on to people I don't even know (people on the ferry, at the store, etc.) ,interrupting, and too enthusiastic (yes, that is possible). I can see I need to back off a bit, but I try and then I do it again. I both hate and love this side of me...the bursting with stories is good, until I find myself dominating the conversation. My energetic self is good, until I find that energy turning into anxiety, irritability, or worse yet, agitation. My effervescent self is good until I overwhelm people with my thoughts and ideas. My energy to do things is good, until I plan a trillion things and manage to do none.

All in all, while I wish I were a bit calmer and quieter, but I certainly would rather be this way than my depressed self. Right now I want to LIVE. It has been a long time since I have felt up for more than a few days here and there.

I slept last night...I think because I took 1000mgs Tegretol and 100 mgs Trazadone, but now...at 12:14am I am wide awake and can't get to sleep. I have to get up early tomorrow too. Yikes. Here's hoping my energy will subside ASAP (for the night) and will return with the sunshine. (Well the fog actually...it is thick and solid right now...scary to drive in)

Mud on My Face...Literally!

(Do not be fooled by his cute silliness...he is a little devil)
I have become the dog owner I never wanted to be....argh! I went for a "nice leisurely walk" with a friend today. My lovely 55lb "puppy" tried to drag me all over the place. Since I have been taking him to the dog park, and trying to get him socialized with other dogs, he has began to be completely out of control.

I am not saying he isn't friendly, he is adorable and friendly to everyone and every dog he meets. He loves to frolic and run, and run and run (did I say run?) with all the other dogs...even the teeny weeny ones. We came across a 2.5lb teacup something or other puppy yesterday. The puppy could barely climb out of the deep, frozen shoe prints in the snow that still lays in the dog park yesterday. Not my cup 'o' tea, but a cute puppy nonetheless. The owner said it would grow to 5lbs as an adult. My cat is 3 times that size...too funny. My puppy played so gently with this tiny pup, so he is good with other dogs but...

...try to get him to come to me when he is out frolicking with his own kind...HA! It just is not happening. He is a social butterfly, flitting from dog to dog to dog. Yesterday I spent much of my time trying to "catch" him...he simply had no interest in me whatsoever. I felt like the kind of dog owner I would be annoyed by. He comes fine at home, but I really need to work on this when we are out.

Today when I was out with my friend he pulled and pulled on the leash. He almost pulled me over a few times. This is not good. How the hell will I manage to keep him beside me when he's 80 or 90lbs...which he will be. There was a boxer 3 months older than him at the park and Skookum at 7 months is bigger than that dog...a lot bigger.

I came home and took him for a walk around the farm, when suddenly the neighbours chow/lab cross showed up on the other side of one of the large drainage ditches. Skookum leapt across the ditch like a deer and took off after the neighbour's dog. Both of them jumped across and even bigger ditch between our properties and were running like antelope all over the neighbour's yard. I kept calling my dog, but it was as though he couldn't hear me. So I began climbing across the ditch and slipped and fell into the muddy, slimy ditch. I climbed out wet angry and covered from head to toe in mud.

Worst part is I recked my brand new glasses (yes this is my second pair in less than 2 months I have had recked) either directly by the dog, or indirectly while chasing the dog. My last pair were $180.00 glasses (which is bad enough). This second pair are graduated lenses and cost me $580.00 and now one of the lenses has two huge scratches across it....GRRRRRR!

Anyways, I climbed out of the ditch, dripping in mud and getting angrier by the second. Finally I was able to corner my dog on the neighbours deck and I began walking home out their driveway. I gave him a bit of a tug and spoke bruskly to him about my irritation. He looked up at me, and, as if to say..."F#$@ you!", he backed out of his collar and ran onto the busy road.

I thought I was going to be sick. I ran after him just in time to stop all the cars going both ways. Thank god no cars were there when he ran onto the road. People waited for me to coax him back to me and I managed to get the collar on again and head back home.

I am still freaked out by him going onto the road, because it is like a small highway this time of day, with cars bypassing the tunnel traffic by racing down our road. I need to take him to obedience lessons ASAP. I would have died if something happened to him. The broken glasses are nothing compared to how important he is to me.

I may not post over the next week as I have company visiting from Toronto (brother and sister-in law)...Hope everyone has a great week.

The Nightmare, Henri Fuseli 1741-1825

I actually slept last night. Thank god. I increased my Tegretol to 800mgs, took 125mgs of Trazadone and had a couple big martinis. I fell asleep within an hour of going to bed (12:30) and stayed asleep until close to 5am. I still feel wired for sound today, but I am very happy I slept.

I can't explain why sleeping is important to me when, although I wasn't sleeping, I had tons of energy. I guess there is some relief in knowing I got some sleep and in not spending all night trying to force and coax myself into sleep.

This whole experience is making me wonder how much I may need a mood stabilizer. I was trying to go off Tegretol because I thought maybe it was keeping my mood down; not allowing my antidepressant (Prozac) to lift my mood as much as I wanted. I also felt like maybe it was causing my fatigue.

Now, given my insomnia and hyperactive mood after I decreased Tegretol from 1000mg to 200mgs, I am rethinking whether it is wise to go off Tegretol. I guess I am afraid now that the Prozac is maybe lifting me too high on its own. Its not a good high either. There is so much energy behind my increase in mood that while I am "activated", or energized, I am also agitated and anxious. So much so that I do not think I can manage it much longer.

I will take 800mgs Tegretol again tonight and see if I can sleep with 100mgs Trazadone. Maybe if I get sleep for a few nights I will calm down. My brother-in-law and his wife are coming to visit next week. I have avoided them for a couple years now. Always opting out visiting them when my husband goes East to visit. I just get too stressed out trying to put on a face for everyone. It is exhausting.

My husband insists I spend time with them when they visit. I really do not want to be this high when I see them next week. They are really nice, but I'm sure they already think I am crazy. The last thing I need is to be speed talking, interrupting, agitated, irritable and anxious around them.

Unfortunately, we have to visit them away from our house. Travelling and staying away from my own bed is another stressor that contributes to my not sleeping well, and usually to a drop in mood. I am trying to go with the flow, but am really not looking forward to being away from home.

Vibrating

I wonder if you can sit on this thing? Imagine! Hmmm.

I was looking for a video of a song called "vibrating, by Robyn Hitchcock, but the only one online was really poor quality...so this is what you are stuck with...a woman on a vibrating exercise machine...funny though I am almost vibrating as much as she is...maybe I will lose weight? Do these things really work?

Picture a tall blonde bouncing off the walls and you are seeing me as I am right now. Ohh God...I am literally vibrating! (...get your minds out of the gutter;>) I slept a bit last night, but still far less than I need to and was awake much of the night despite having increased my Tegretol. By the middle of the night I had to take some Trazadone to try to help me sleep because I was tapping and singing and humming when I needed to sleep. The energy I have inside me is over the top. If I could bottle it and use it for electricity I might be able to power my whole house with it...for weeks.

I love having energy, but I am also feeling overwhelmed by the agitation/anxiety that my body seems full of. I cannot seem to stop moving and my heart is pounding and I'm breathing fast and shallow. It feels so physical. I have a really short fuse too and have been getting annoyed at people easily. I am so anxious my entire upper body is hard like a rock with all the tension I feel. I hate anxiety.

I think I will increase the Tegretol a bit more because I am wired and having a hard time focusing or concentrating on anything. I went to the Studio today to prep for my Printmaking class that begins Tuesday and staying on task was extremely difficult. Rather than do what I needed to do I found myself flitting about like a social butterfly and doing everything except what was required for me to be ready for Tuesday. I hope I calm down before my class starts.

I phoned my sister today to tell her about my singing lessons and within seconds she was saying "slow down, you are talking so fast I can't understand what you are saying". I was just excited about how my singing lessons went. I feel like a kid inside again. I haven't felt this much excitement about anything in a long while.

Ahhhhhhhhhhhhhhhhhhhh! "Calm blue ocean, Calm blue ocean, Calm blue ocean..." (that's my calming mantra).

Singing Lessons

Eva Cassidy - Somewhere Over the Rainbow

Just came home from my first singing lesson. It was not easy to either go, or to actually get myself to sing in front of someone, but I know this will be so good for me if I can manage not to run away with my tail between my legs.

First off....all day I have been BEYOND wired. I have so much energy inside me I feel like trying to contain it is creating a bomb. I am afraid I will explode any second. Because I am trying hard to be and appear 'normal' I am so tense inside and I can barely breathe.

This was the big problem I had in my singing lesson; not the fact that I didn't know how to breathe properly for singing, but I was so anxious...close to panic, that I kept FORGETTING to breathe. Since when did breathing become a non-automatic thing to do? God anxiety is brutal. I swear I feel like I have shoulders as stiff and hard as rocks and my lungs want to clamp shut on me.

Anxiety aside, and I am still extremely anxious 2.5 hours later, and was anxious the whole time, ...anxiety aside I am so glad I went.

The teacher is really into old Blues/Jazz songs and our tastes in Blues/Jazz are the same. She taught me some cool exercises to help my voice loosen up and get myself breathing properly, while at the same time practicing scales.

Oh yeah...in one of the exercises I get to howl, as loud as I can like a wolf. Start as high as I can and go as low as I can. How fitting is it that I get to howl given how much wolves figure in my anxiety and fears. Maybe now I get to talk back to them!!! Look out!

After that I went down to the music store, bought a couple Jazz music books and looked into taking piano lessons (eeeeeehhhhh!) (Loud high school girl scream of excitement!) I really, really want to do this. I love music so much. More than any art form in the world. I really want to sing, and learn to play the piano.

P.S. The video above is the rendition of "Somewhere Over the Rainbow" I am going to practice and learn with my new teacher. I am singing "Blue Moon too...it is beautiful.

Oh yeah...the best part:

My teacher said I have a "gorgeous voice" ..."powerful" (quotes), she said. She said my tone is great and my pitch is good...My range is good. It's a matter of learning to breathe and train what I already have going for me.

She really did go on about how much she liked my voice. I could tell she was being honest too by the way she kept telling me. She is thrilled to have a student who wanted to learn the kinds of songs she wants to teach...And I am thrilled she likes those songs. Fifteen minutes into the lesson she asked me if I wanted to join the choir she teaches on Wednesday nights at a big arts centre in town. I am going to do that after I take a few private lessons.

This is so good for me. I think next time will be easier as hopefully in two weeks I will have slowed down a bit. Dr. X said I am still having Valium withdrawal and that's why I am so agitated. Regardless, I am going to be afraid and do it anyways.

I Am a Song

Nina Simone, Love Me or Leave Me

If I were a a song (the music, as opposed to the words) right now...this is it.

That constant beat in the background and the flitty scales and the constant steady, speediness of the music, but also some of its airiness and lightness capture me perfectly.

Not sleeping...at all. Can't get to sleep for hours. Then when I fall asleep I am waking 15-20 minutes later and struggling to get back to sleep again. Rarely have I been sleeping more than an hour at a time.

I'd say my mood is up, insofar as I have more energy and feel intense desire to do things (not actually do them yet...but at least I want to). Unfortunately there is a measure of agitation, restlessness or speediness to how I am feeling. This is creating some mood lability in me.

I am frustrated with myself in terms of how I am struggling to "activate". I have to stop THINKING about what to do and JUST DO IT! Therapy is not going to help me if I don't actually do the things Dr. X and I discuss and decide upon. I need to take responsibility and will myself into action. I feel like I am wasting Dr. X's time by showing up and then not doing the work required to help myself.

Things I want to do...and WILL do in the very near future:
1) Singing lessons (I am starting today....Yay!!!! (a bit scared, but excited too). I love to sing. My husband got me lessons for Christmas...best gift he ever got me!
2) Piano lessons. My whole life I have wanted to learn to play the piano. I have time now. I should just do it. Take lessons, practice, learn.
3) Swim or Exercise at the gym everyday....in the early morning.
4) Take an art class (I start one next week...a mixed media class)
5) Paint, paint, paint...draw, draw, draw.
6) Memorize some poetry

For some reason I see these things as "icing" and getting back to work as "cake". It feels indulgent and selfish, almost gluttinous and greedy, to do these things I like to do, when I should be doing what I am supposed to do. I feel like I should be spending more time contributing to society, not just doing everything I want to do. Does that make any sense?

Insomnia

The Last Psychiatrist (TLP) has written some an interesting post about "Treating Insomnia With Less". I am especially interested given my difficulties sleeping much of the time, and right now, almost all of the time.

Right now I am still wired, still not sleeping and still not tired. The past two nights, on top of my meds I have taken Muscle Relaxants and Advil as, when I was struggling to get to sleep two nights ago, after hours of laying there not sleeping, I somehow pulled a muscle in my neck/shoulder area by moving the wrong way.

I think in part I was so tense from being wired and not sleeping that my muscles tensed up so much I strained them. Anyways, at least last night and the night before I fell in and out of sleep here and there after about 2:00am. However, also woke up all night off and on and couldn't get back to sleep each time.

Anyways...to make a long story short...I am taking one of the medications TLP writes about (Doxepin), but at a bit higher dose than the 6mgs he is discussing. My first impression of the Doxepin when I began it last week ius that it is at least as useless as the 100 mgs Trazadone I was taking (which was not working either). My initial thought was maybe I need more Doxepin, but if I am reading TLP's post correctly, it appears less is more for Doxepine. Interesting.

Check out The Last Psychiatrist's Blog. It is always an interesting, thought provoking, and sometimes challenging site. Highly recommended.

It's Real

I take back what I said earlier about imagining how I was feeling yesterday. I am was not being neurotic yesterday. It is happening again today. I am speedy. My brain is moving faster than I can make my body act. I am flitting from one thing to another, not really getting anything done. Even now as I type my hands are shaky and cannot go as fast as my brain. I am getting speedier as the day goes on. I don't feel angry today though, just flighty, maybe annoyed, and a bit irritable.

Yesterday I whipped off two letters, one to my bank and one to a person, that were a bit harsh in tone. (The bank one was really snarky, which is unlike how I usually present myself, but may be like I am when irritable and speedy. Looking at it now I don't think I should have sent them, or would have sent them if I was feeling right.

My libido has returned full, full, full swing too (well maybe more than full swing)...that could be attributed to my new found sexual insight. It could also be that the Tegretol was dulling me.

Anyways...I guess what I am saying is I am speedy, which may, or may not be a bad thing. I am a bit concerned because I haven't slept for 3 days now and wasn't sleeping much before that the past while. You know how it is when you second guess how you are feeling? When you think maybe you are imagining you are going too high because you are afraid of flipping into a hypomania/mania. I should try to relax, because according to Dr. X I have nit been manic, but I guess I feel a bit out of control right now and have done a couple things that are not like me to do, and I feel so hyper I can't stop.

Not Sleeping

Clock reads: (approximate times)
10:15 pm To Bed

11:30 pm This
1:00 am is
1:45 am what
3:00 am it
4:00 am is
5:35 am like
5:50 (take dog out)
(sleep for a 15-20 minutes)
6:45 to
7:30 not
(sleep somewhere in between for a while)
8:45 sleep!

I was being a neurotic worrywort yesterday. I have more energy inside me and I am unused to that. It doesn't feel right because I'm usually so squashed down with fatigue. I am just going to "be". If I cannot sleep again tonight I will get up and write in my blog.

Arghhhhhhhhhhh! I feel so angry for NO reason.

Something is wrong. I feel so wired I am buzzing. My husband says I am talking fast and extremely irritable. He says I am talking over him and interrupting, being "pushy" and loud he says. I see it too. I feel out of control.

Yesterday I woke up and inside I felt like blowing up. I felt rage like I have not felt for a long time. The rage where I want to destroy the house or beat down all the bushes in the yard. I feel speedy inside; like I am FULL of adrenaline. It is not a good feeling. My heart is racing in my chest to the point that sometimes it is feeling like it is jumping, "buddle ump", or fluttering.

I feel confused and find myself pacing back and forth in the house...it seems like I am pacing in preparation to do something, but I always get into the room and forget why I went there and what was so urgent that I get there NOW.

This morning I woke with the same feeling: extreme anger, rage filled, irritable, cranky, speedy, get out of my way or I will run you over and keep going. I haven't been sleeping at all. Dr. X gave me a prescription for 10mg Doxepin to help me sleep. He says it can help with the later sleep cycles. So it helps people SATY asllep. Which has always been my big problem. Usually I fall asleep no problem. I just cannot stay asleep. Recently though that has changed too. I lay in bed awake for what seems like forever and cannot get to sleep, or stay asleep. It is getting worse.

I was taking 100 mg Trazadone and it was doing nothing. I don't think the doxepin is helping and even though the dose is small I think it is contributing to some of my feelings of strangeness in the morning. I feel buzzy, speedy, off kilter, tippy, unfocused...strange, fuzzy, a bit of a sleep med hangover even though I can't sleep? There is a feeling of depersonalization on some level...like I am not completely in my body. I am not me.

Previously, I thought maybe I was staying awake because the dog was on the bed, but last night I put the dog on the floor and realized it has probably been me keeping the dog awake, rather than him keeping me awake. He slept like the baby he is. I on the other hand rolled around and tried to sleep all night; catching snippets of sleep here and there only to find myself awake not long later. I was awake almost all night last night and the night before.

Maybe I am just not used to this much energy. I have been off Valium for about 3 - 4 weeks now and I am going off Tegretol (I am down to 400mgs from 1000mgs). Maybe the Prozac and Dexedrine is energizing me in a way it couldn't when I was on a mood stabilizer. That is the point of my going off the Tegretol and Valium, to energize me. Why is it when I get more energy I start worrying it is too much energy?

I think maybe because it doesn't feel like the good energy I have when I am well, or when I am even "high". It feels uncomfortable, obsessive, speedy and really irritating and negative. Arghhhhhhhhhhhh!

Guest Blogger - Observations on Habit

Today's blogpost is written by a friend of mine "Moana"(the ocean). She is witty, intelligent, caring, thoughtful and beautiful. Despite all these great attributes, she too struggles with longterm depression. She mentioned she was writing a piece about her habits, how they inform and maintain her depression, and how she might change those habits. It is a beautiful piece about her struggle to recover and overcome habits she feels feed her symptoms. I suggested I post it on my blog Enjoy!

[Written] January 5, 2009

by Moana

Observations on Habit

Some behaviours and habits seem harmless when pursued consciously, and not at the cost of other more positive behaviours or activities. These contrast with alcohol, drugs, cigarettes, lying, or cheating which have detrimental physical and social repercussions.

In the past I have used cutting my body with a razor or needle, over exercising, overeating, restrictive calorie regimes, drinking, and smoking as ways of coping with the uncomfortable feelings that are aroused around the control and ownership of my body and my sexuality. Now with the occasional exception of a cigarette and overeating I no longer use these first coping skills. Yet the negative feelings and confusing thoughts persist. How do I cope? Here I take for consideration that certain so called harmless pastimes may not be as benign as I have believed. They restrain me, keep me passive and ignorant and unengaged in my life. These are: overeating, tv watching, moodiness and oversleeping.

Why do these behaviours?

I do these behaviours to stop me from feeling strong emotions such as anger, hurt, sadness, fear and strangely - excited anticipation. These first began as my sexuality emerged as a girl and a teenager. I was afraid of this powerful force within me and my ability to attract men, including my father. I developed physically before other girls and had no idea what to do with this attention, especially from my father. He made me afraid of my sexuality by punishing me, frightening me, mocking me, isolating me from group activities, and ultimately molesting me. So I held back in fear.

This caused me to disconnect from myself, my body, a lack of engagement with myself and pulling back from wanting something out of life because I equated all wanting with sexual desire. It has made me satisfied with less because I feel I don’t deserve better. I don’t stand up to the fear by requiring more of myself.
As I engage in these habits I tell myself that it’s okay to do them because;
It’s just this once, I won’t do it again, I’ll behave better in the future, I deserve to feel bad, and I have lots of time to change.

Cognitive Distortions

The cognitive distortions that I am making are; no one will love me because I have needs so I am dirty so why should I try. I will always be rejected because the behaviours that I have used to mask my fears such as overeating have actually caused the fears I have to come about; too much overeating makes me fat "asexual" (but safe). Another way I avoid sexuality is to remain a child; docile, passive, manipulate able. As a child I am uninformed, I watch tv. Other peoples wishes are more important than mine. It is bad to have wants/needs/desires sexual and otherwise. To want something is to ask for what I deserve; respect and consideration.

I can address these thoughts by saying:

It’s okay to want or desire, it isn’t dirty, I didn’t do anything wrong by becoming a sexual being.
I have almost never been rejected or had poor results when I try hard
It’s okay for me to get my own way as everyone else is.

What true spiritual hungers are not being satisfied because of sleeping, tv watching, overeating and moodiness?

To make a contribution to the world
To express my full self
To know
To love and be loved

What alternative behaviours could I substitute that would replace these passive habits and allow me to fulfill my true wants as above?

Overeating: Recognising that the way I eat, quickly, unsatisfying food in front of the TV is NOT fulfilling any sensual desire. It just makes me fat and disconnected from my feelings.

• Replace with filling myself up with love or knowledge instead. Talking to people and learning. Acknowledging sensual pleasures other than eating.

TV Watching: Distracts me from true feelings and circumstances in my life. Stops me from spending time achieving the accomplishments that I crave. Mentally unstimualating. Entrenches passivity not debate. Pacifies me from developing what might be (adult) opinions that might be challenging to my family and others. Fills time that I could be making a contribution through meaningful work or expressing myself. Is a dilute form of knowledge. TV dulls me allows me to be absorbed in something that doesn’t give back to me.

• Replace with reading, going to cultural events, making music, making art, writing, (my desire to express myself). Prepare myself to say what my truth is – "This is how it is for me" ("like it or not…") Takes hours of time that I could spend loving and being loved. (If I could trust that that could happen; take a risk)

Oversleeping/Napping: When I feel strong emotions (including excitement), I go to bed to sleep it off, which dulls the feelings down. The fear or anxiety that I feel at expressing myself, through art, writing or conversation passes somewhat. I literally tire of the repetition of my unachieved ambitious thoughts. I seek to quell them by knocking them out. A lot of the mechanisms that lead to TV watching also apply here.

• Instead I could be expanding my experiences, becoming loving and knowing and expressive and as above with TV watching and overeating.

Moodiness: This is a hard one. I let my moods dictate what I will do with my day (and my life) rather than my ambitions, which frighten me (wants-desires=bad/dirty). I know I can accomplish things when I am not well, sometimes better than when I am, or at least under certain conditions.
The negative aspect of my moods keep me in a fearful childish dependant state. When I am moody I feel shame. I would like to have positive attention from achieving and being whole rather that the negative attention of pity and sorrow.

• Instead of giving into my moods I can use my words and language to express my truth – I am sad, fearful, upset, excited about…I can form my emotions into physical manifestations; art, writing, meditation, conversation etc instead of letting them fester inside me toxically for years.

Learning to Experience Sex Together

Warning:
May (or may not) contain explicit sexual content (depending on YOUR definition of "explicit";>} )

Well...hmmm, how do I say this...

I had a really great therapy appointment today. Though it was difficult to get out what I am about to describe, once it came out (no pun intended) Dr. X and I had a really great talk and he had some extremely helpful advice which I think may help others in similar situations.

Here goes:

We started talking about sex; both because sex has been a blessing for me many times as it really helps me relax and feel free, but also because my husband and I are having a bit of a problem with sex over the past year or two.

To begin at the beginning:

My husband and I have had great sex. I am adventurous and willing to explore. He has been a safe and trusted person to explore with.

Lately, over the past year or two our sex has fallen into a rut of doing the same things over and over. I need some variety. Part of the difficulty is that my husband likes his sex a bit rough. Which is fine by me SOMETIMES, but I don't want that all the time. He says he cannot orgasm with slow, or soft sex. (which I know is true).

I like really slow sex sometimes, sometimes I even like it, despite not orgasming. It feels intimate, caring, sublime. I like the "suggestion" of sex, the innuendo about what might happen. I guess a big part of sex for me it psychological...things like submission, letting go of control, role playing, romanticizing, voyeurism, exibitionism, psycological domination etc. I have always believed that sexual desire/preferences are a learned thing. What is learned can be "unlearned" or "relearned" if you are willing to try.

So...I brought this up with my husband. I suggested that maybe, if he practiced masturbating sensually, slowly, lightly; he may begin to desire that kind of sex and it may become more of a turn on than he thinks. I tried to be as compassionate and caring as possible when I brought it up, because I understand that one's sexuality and prowess can be a big thing for men (and women). I didn't want him to feel like I did not like what we do, only that I would like to explore other ways of being together.

He lost it. Told me never to talk to him about it again and that if he had softer, slower sex he would take hours to orgasm. It wasn't an option.

So...I have not had very much sex over the last while because I want some variety. I want to have sex the way I want it sometimes too. I do not want all the sex I get to achieve orgasm to be through mutual masturbation, or oral sex at the beginning of our sex act and always end in really rough sex for him. It makes me feel like we are "doing" sex to each other, me first, then him. I want sex to be both of us experiencing sex together.

Dr. X. and I discussed this. A long time ago he suggested I be the change I want to see. This helped for a long time. I began providing the types of sex acts I like. My husband and I began experiencing each other like we never had before. It was great advice and opened our relationship up to all sorts of exciting things.

This time though I have tried and tried to slow it down, to do things more softly, more slowly etc, but it always ends up getting rough. Dr. X said that Masters and Johnson suggested that couples make time for sexual acts that do not lead to orgasm (massage, masturbation with no orgasm...just the build up to one, and touching that is below the sex/orgasm "thresh hold" that the couple is used to). He said (I am paraphrasing)... if I offer to touch my husband very softly, with no intent to orgasm, but rather an intent for intimacy...he's sure to be pleased with the result, regardless of their not being "closure" of the act.

I think that is true. I bet if , out of the blue, I offered to fellate, or masturbate my husband softly, even if there was no orgasm he would like how it feels. If we did that for a while we may achieve what I want, without my husband even recognizing I am helping him change.

When I left my session today I felt really good about Dr. X helping me talk about this. I marvel at his ability to talk so frankly, and help me so frankly talk, about things I have a hard time bringing up with almost anyone. It seems to me he is able to draw things out of me in a way that makes me comfortable opening up. What a gift he has as a therapist.

The proof of how comfortable he made me feel about the topic, is that I have actually chosen to write, and actually written about, sex. A topic I was having a difficult time getting out of my mouth this morning while with him.

A Lesson to Challenge Negative Thinking

My regular readers will know the angst I feel about not working. I struggle to understand my pdoc's claim that "I am working". I think he means working towards getting better. Not sure.

My definition of working is much more narrow. To me "working" is employment. Today I am going with a friend for an orientation at an employment agency that helps people with mental illness find work. I am freaking out right now. My last experience of this was when I met the lovely women who said I was "bizarre" (well at least my questionnaire answers were).

I am stressed because I don't think I am ready for work, but I want to have a job. I am stressed because I feel okay and then I feel awful. Somehow, someway I NEED to get working. I feel so guilty when I see there are people much more ill than me working. I feel like I am not trying hard enough.

Anyways, the stress is being brought on by the prospect of looking for work and how the orientation might lead to that. I will write when I come back and let you know if the stress subsides; if I can challenge the fear and do it anyways.

A Prison Guard/Warden

This is in response to Harriet's comment on my last post. In the comment she says,

"I know exactly how inept these tests can be - my 16 year old daughter recently took a test to see what careers she would be best at. The results were so surprising and it was obvious that she didn't understand the questions".

I had to laugh because I ran into a similar problem in first year university. I went to the university's counselling department because I was feeling extremely depressed; having suicidal thoughts, and obsessing about dying, low mood, fatigue, eating and sleeping all the time.

I met with the counsellor and after listening to me for a short while she said it was clear that the reason I was feeling down is that I lacked direction in my life. I did not know what I wanted and that was making me sad.

It sounded completely reasonable to me. They were right I did have extraordinary difficulties making choices, decisions and deciding what to do with my life. They said I needed career counselling. I went to a career counselling session and did all the tests that would help me decide what to do. When the tests came back the counsellor invited me to meet with her.

She told me that the tests were very clear that the only kind of job I would be good at was to become a prison guard, or a prison warden. I just sat there in disbelief. First of all I do not believe in prison. I think it does not help anyone, or rehabilitate anyone. Secondly, the last thing in the world I could see me doing was either of these jobs. I am extremely sensitive. I could not see how my personality could possibly fit into such a difficult and brutal environment. It made no sense to me.

Looking back I think I now understand why the tests came out as they did. I was a few months into a Major Depressive Episode (MDE). When I am depressed my thinking becomes very black and white. Things are right or they are wrong. There are good choices and bad choices. The world is extremely structured in terms of what I should do or should not do. I am intensely indecisive, but my guilt tells me what is right and wrong.

My theory is that while in a MDE my questionairre choices would have been extremely rigid, thus leading the interpreter to believe I wanted such a rigid structure. What they missed is that the rigid structure is needed BECAUSE I am depressed. The counselling department missed that aspect of my being. I know of another person who had almost the exact same experience. I hope today, with school counsellors having a deeper recognition of depressive symptoms, my vocational aptitude results would be different.

I am not sure why my most recent vocational aptitude results seemed to place me more accurately in profession I am interested in; much more accurately than the depression and anxiety tests portion of the tests. Perhaps it is a matter of my having experienced more kinds of careers throughout the years. Maybe I had a better understanding of what I liked to do than when I did vocational tests more than 20 years ago.

The vocational tests I did a couple years ago seemed quite accurate to me. Those tests resulted in three of the top ten career choices recommending I be a teacher, counsellor, psychologist. I can't remember the rest, but I am a teacher of sorts and have been for a long time. I love to teach. If I were completely well for an extended period of time, and if I felt confident I would remain well, I would love to study to become a counsellor or psychologist.

The big thing that stops me is the fear that I am so messed up I couldn't possibly help others without hurting them. Some part of me wants to believe that the possibility is there that I will become well, and if I do, I could be good at listening and understanding others; on helping others feel better about themselves, on helping others get through difficult times, etc. I hope one day I am at least well enough for that to be a possibility.

Semantics and Tests for Depression

In the comments section of a previous post , "Subjectivity and Objectivity of Symptoms", Anonymous (E) commented, "Aside from cognitive tests, there are tests also designed to measure affect (mood), motivation, feelings of hopelessness." This triggered a remembrance of times when I have done written tests for depression and anxiety and why I believe they may not be accurate in terms of assessing how depressed or anxious a person is.

I cannot remember all the tests all I have done, but I know I have taken the Beck Depression test, and I believe the anxiety test, along with numerous others. I believe these tests only reflects how the person doing them understands the question. Unless I, as a patient, interpret the question exactly as the person giving me the test the tester and the patient are talking about completely different things.

I have experienced a very good example of how the meaning of a question sullies the outcome, unless the 'tester' and 'testee' are understanding the meaning of the question in the same way:

A few years ago I went to a vocational testing facility for people with mental illnesses. I took a number of tests for both my mental health and my vocational interests. When the results came in the psychologist testing me wrote a summary of the results. Her summary started with the words, The results of [aqua's] tests are bizarre and unlikely...".

I remember very little about anything else written in the report because I was so distraught at being dismissed and being told that my results were "bizarre and unlikely. I was intensely upset and hurt, because I had answered the questions as carefully and as honestly as I could. I sat across from the psychologist and I asked her, "what EXACTLY about my answers made you say my results were bizarre and unlikely?"

This is how the conversation went:

Her: When the test asked you about personalities you answered, "I feel like I have more than one personality" That is unlikely.

Me: I do have more than one personality. There's sad aqua, exhilarated aqua, intensely angry aqua, anxious aqua etc.. When I switch into one of those moods it feels like my personality switches because when I am sad I avoid people, become unsociable, want to sleep all day. When I am high I am highly social, bubble and have tons of energy. I become a different person.

Her: That is not your personality.

Me:There was no description in the test about what a personality is or is not. I am a lay person, not a psychologist. How am I supposed to understand what the question intended to mean?

Her:Well, in another question we asked about suicidal thoughts. The choices were: "I don't think about dying, I think about dying, I wish I would die, I want to die". You said "I want to die". You have never attempted suicide so this answer is unlikely.

Me:I read the question and I thought carefully about how I feel. I have intense suicidal ideation. When I am having those thoughts it feels like I want to die. Why else am I having the thoughts? The thoughts are propelling me towards dying. I cannot understand they are only thoughts. It feels like "I want to die". I have been having those thoughts all the time. So, given I have the thoughts all the time, and that while I am having the thoughts I believe I want to die...I choose "I want to die"

The conversation just went downhill from there with her refusing to understand, or acknowledge that basically, how I answer the question, and how she perceives the answer, comes down to semantics. Unless her and I MEAN the same thing when we interpret and read the question, the test is useless. It tells her nothing about me and how I am feeling.

In order for the test to be accurate she would have to sit down and ask me what I meant when I chose: " I feel like I have more than one personality", or "I want to die". Then she would have to TRANSLATE my choices into her meaning.

This has happened to me before. My interpretation of these tests is different from their intent. Personally I prefer, and believe, the way Dr. X interviewed me when I first met him is much better at picking up the truth and the subtleties of my mood and my other mental health difficulties.

The first time we met he asked me questions. I answered them, and he asked me more questions to ensure he fully understood what I was saying. He actively listened to me. The way he "interviewed" me felt more like a conversation. It did not feel rote like so many of these interviews. It felt natural and I felt like he was really listening to me.

Maybe for some people the tests work, but I think for some of us, our true feelings get lost in the different ways we interpret the questions and give our answer, as compared what the questions and answers mean to the psychiatrist/psychologist performing the tests.

How To Become Up to $5000.00 Richer Each Year

Canadian Disability Tax Credit and Registered Disability Savings Plan:

This is an information post for any Canadians who are currently on Canadian Gov't Disability Income programs, or Provincial Disability Income programs:

Previously, if you did not have a higher income, eg. were receiving disability from both an employer and CPP, it did not appear worth a person's while to apply for the yearly Disability Tax Credit of $6890.00, as you would not have the income to write it off against.

However, this year (2009) the Government has something called a "Disability Savings Plan". To qualify for it you need to qualify for the Disability Tax Credit.

Why would I want to qualify for the Registered Disability Savings Plan?:

It allows anyone (family , friends, etc. to contribute to an account where all money in the account is tax free until the money is withdrawn.

This will allow your savings to increase at a faster rate.

No annual limit to the amount you can invest (is a lifetime limit of $200,00.00), so it is better than an RRSP (for most of us)...given we probably don't have $200,000 room to contribute in our RRSP), because if you receive an inheritance, or larger sum of money you can invest a larger amount than with an RRSP.

There is a disability savings grant (Government meets or exceeds your deposit amount based on how much you save) of up to 3500.00/year for those who are beneficiaries in an RDSP. (people deposit money, and depending on your family net income and how much you invested over the year, you can receive up to 3500.00 from the federal government.

Government Website:

"The government will contribute, in the form of Canada Disability Savings Grants, funds equivalent to 100% to 300% of RDSP contributions, up to a maximum of $3,500 depending on the net income of the beneficiary's family"

Translation:
(because whoever they hire to write government documents makes no sense at all):

• You can receive up to a $3500.00/year
• The maximum annual is $3,500 for families with net incomes of less than $75,770

Beneficiary's Family Net income Less than or equal to $75,769: (from BMO Website)

• On the first $500 [deposited into your account the gov't will give you a grant of] $ 1,500: $3 for every $1 contributed [maximum grant of 1500.00]
  
• On the next $1,000: $2 for every $1 contributed [Maximum grant of $2,000]

Beneficiary's Family's Net Income Greater than $75,769*, or no income info with CRA:

• On the first $1,000 $1 for every $1contributed [up to a maximum of] $1,000
• This means the gov't will give you up to $3500 grant depending on how much you make and invest each year, or as BMO puts is:

"The amount of the grant depends on both the beneficiary’s family net income and the amount of each plan deposit. Contributions to an RDSP may qualify for payments from the CDSG, up to a lifetime maximum of $70,000 per beneficiary. The maximum annual CDSG is $3,500 for families with net incomes of less than $75,770"

• So if the beneficiary's family has a net income of $75769.00 or less, and saves $1500.00 a year, the government will give you a grant of $3500.00

All of a sudden you will have $5000.00 saved that is tax free until you take it out.

• If the beneficiary's family has a net income of $75769.00 or more, and saves $1000.00 a year, the government will give you a grant of $1000.00/year

All of a sudden you will have $2000.00 saved that is tax free until you take it out.

***And if your income is to low for you to save any money you may qualify for the

Canada Disability Savings Bond : (From BMO's Website)

• Lower-income families may qualify for payments from the CDSB program without having to make a contribution to an RDSP, up to a lifetime maximum of $20,000.
  
• The maximum annual CDSB is $1,000. This applies to families with net income below $21,288.*
  
• Canada Disability Savings Bond payments are prorated for families with higher incomes. This applies to net incomes greater than $21,287, but less than $37,885.*
  
• The maximum annual CDSB is $1,000. This applies to families with net income below $21,288.*

Below is the application for the Disability Tax Credit (Form T2201):

• You and your pdoc need to fill this out.
  
• You need to qualify for this to qualify for this in order to qualify for either the disability savings bond, or the Disability Savings Bond
  
• I have also posted a couple links about the Disability Savings Plan

Info your pdoc may need...People with mental illnesses never used to qualify for the Disability Tax Credit. This has changed recently and the criteria are a bit different for mental health disabilities:

• http://www.disabilitytaxcredit.com/news.php

The application form (Form T2201):

• http://www.cra-arc.gc.ca/E/pub/tg/rc4064/rc4064-07e.pdf

Govt Disability Savings Plan info:

• http://www.bccpd.bc.ca/rdsp.htm (BC Coalition for People with Disabilities)



• http://www.cra-arc.gc.ca/gncy/bdgt/2007/rdsp-eng.html (Fedral Gov't info)



• http://www4.bmo.com/investments/0,4629,35649_62551912,00.html (BMO info)

Good Luck Saving!

Tallahassee, Florida Come on Down!

Reader from Tallahassee, Florida - You are the 15000th Visitor to my blog. Welcome. I have a hard time understanding my stats pages. but it looks like you entered my blog from the "A Psycho-Therapist With Bipolar" (Annie) Blog at 9:32:32 am PacificTime (12:32:32 your time).
You visited for about 10 minutes. It appears you are the only recent reader from Tallahassee.

If you would like to ask a question, or suggest a topic to write about...put a note in the comment section below this post and I will write about whatever you want me to.

Actually, I am feeling uninspired. If anyone else wants to suggest a topic, ask about my perspective or my experience with something: Ask away. I will answer Tallahassee's question/or topic as soon as I get it and anyone else's question/topic as I feel motivated.

Fear and Desire

First, before anyone reads this I want everyone to recognize that while I periodically have feelings of love/lust and always care for Dr. X; I believe these are reflections of the difficulties I have with romance, connection and lust in my "real" (i.e. outside therapy) life.

This topic is very difficult for me to write about, but I also believe it is very important to dissect and address the feelings I experience.

While I respect and care deeply for Dr. X as a person and psychiatrist; I feel he is an extraordinary human being...I do not REALLY love Dr. X. I don't really even know him. (It feels kind of sad to say that)

I see him an hour a week and we talk about me. He has strict boundaries and I definitely respect those boundaries. In fact, I am probably more cautious of the boundaries than most Drs, because Dr. X is extremely valuable as a psychiatrist to me. I have no trouble recognizing I am transferring love onto him, rather than feeling love for him. I believe this is a common occurrence in therapy. I also believe gaining insight into my feelings, and why I have those feelings, for my therapist can help me.

The reason I brought the love/lust/caring thing with Dr. X. is not because I wanted him to know how I feel about him...I think he could have guessed that. I am not very transparent. The reason I brought the topic up is I believe it reflects and shows me difficulties and patterns and relationships in my life that need changing. I believe in acknowledging my feelings I have the opportunity to open up at a deeper level than I have ever been able to in therapy. I also believe this needs to happen before I can set about making changes to the relationships I am having trouble with. I think the love I feel for Dr. X. is a reflection of the love and connection I am missing in my "real" life (vs. life in therapy).

I thought it might be helpful to brainstorm some of the real life connections/disconnections that lead me to desire the love of my pdoc. By writing them here I will have a list of things to discuss and work on in therapy.

I came upon a very powerful statement about transference the other day. I have turned it into a question for myself:

What are the feelings the patient has towards the therapist? Examine the feelings the patient has and how they relate to unconscious motivations, desires and fears.
Conscious/Unconscious Motivations that Lead to My Feelings:

• I feel listened to. How could I not feel attracted to someone who listens carefully to what I say; someone who listens not only to what is being said, but also wants to uncover what is not being said. In my real life love relationship I feel unheard, undervalued, and ignored.


• I feel safe. I feel I can say pretty much anything with Dr. X. He never gets mad at me, never yells at me, never challenges my opinion in an angry way. My spouse always seems angry at me.


• I feel cared for. by Dr. X. He is always thoughtful, kind and compassionate. In my real life love relationship I feel the target of a huge amount of anger and frustration. I feel like my husband goes out of his way to avoid me. Much of the time I feel lonely when with him.

Conscious/Unconscious Desires that Propel My Feelings:

• I desire the love of a kind man. Dr. X is like this, always. I recognize it is his job to be this way, but I have NEVER encountered a man like this...ever. It would be hard not to have feelings for someone who, every time you see them, is kind, and thoughtful.
  I used to enjoy casual encounters. On some level I miss the excitement and newness of casual sex. I get bored in my sex life. Dr. X is a powerful "taboo". This excites me. It is the IDEA of a prohibited encounter that excites me.


• I desire a man/woman who wants to spend time with me and who shows me that. I feel wanted (as in I don't feel rejected) in therapy. I often feel rejected by my husband in many areas of our relationship. He calls me greedy for wanting too much sex, or ignores me when we are together, or is angry at me all the time.


• Dr. X seems to enjoy many of the cultural things I do (music, art, intellectual pursuits etc). My husband could care less. It is a chore to get him to participate in cultural events. I feel like we have little in common. I would love a partner who liked to do some of the same things as me.


• Dr. X never seems uncomfortable with my sexuality. Rather he normalizes the desires I have that may seem out of bounds to some. My husband is good like this too. He is really open minded...but he gets jealous. I like to flirt sometimes. It feels like harmless fun to me because I never have the intention to take my flirtation to the next level. I am just flirting as a form of fantasy. I get angry when my husband wants me to stop being a sexual being with anyone but him. I don't mean my having sex with others...though I miss that...I mean innuendo and flirtation, just for the fun of it


• I love a man who is an authority figure. Dr. X is this to me...though we have tried and tried to help me lose that feeling. Part of my sexual psyche craves someone in control, someone who knows what to do, someone who has power over me, someone who "forces" me to do things I do not want to do., etc. I have created a fantasy world where people in my life, other than my husband are doing this for me. I recognize both that Dr. X is not like this with me. He really has tried and tried to help me feel like an equal, but something about how close I feel to him makes me want him to be. This is a weird pattern of behaviour in that, on some level, it reflects my feelings towards my father. He was intensely controlling and my feelings of having an authority figure "force" me to do something, or tell me what to do are holdovers from both my childhood and from how my dad still treats me. I suppose, given my father's authoritative behaviour I always have had a difficult time making decisions for myself. I have an ingrained need to be given the answer, the activity, the way of being. This has slipped over into my sexual fantasy life.

Conscious/Unconscious Fears that Lead to My Feelings:

• I am afraid I am unlovable and cannot love. I feel like I have never been loved by a partner. Likewise, I have never felt "love" for any partner. I care about them, lust after them, am obsessed with them, excited by them etc., but I don't think I have ever truly loved or felt loved. I am not sure why. I think I am so scared I will be rejected that I neglect to allow myself to feel and show love.


• I am afraid my marriage is a sham. I fear I have spent from 27 to 43 (16 years) trying to hold together, repair and survive a marriage that was not meant to be. I am terrified that my husband stays with me just because he doesn't want to hurt me. I am scared we both stay together because the other choice is too difficult to decide and take action towards.


• I am afraid I have become old, depressed and unattractive. On some level, my desire for an "other" reflects my fear I will never be interesting, or desired by anyone else.


• I fear dying and not having experienced true love. Or having missed out on opportunities to exchange an intense and everlasting bond with someone else.