Tag: mentalisation based therapy

The wrong voices calling

The voices are very bad at the moment. My emotions are soaring and plummeting at the moment since my last group therapy and discharge on Friday. So it is not surprising the voices are worse. They often are when I’m emotional and stressed.

It’s as if now this stage of therapy is completed and I’m trying to hang on to the good and the real, the voices are getting louder (stronger?) trying to pull me back to the blackest darkness and terror where “reality” was my abuser’s words and threats. All morning I’ve heard her calling out to me. Sometimes just my name. Sometimes the things she’d say – mocking, detesting, making me an animal, less than human, threatening, confirming my evil and the terrible things that would happen (unless I gave in and gave her total control). I hear her. And it is terrifyingly real. It is totally outside, not an echo in my head. I turn towards the voice and dread grips me. It stays totally real to me even as I try to repeat my safety statement.

I am Ginny. I am 32 years old. Today is January 30th 2017. She is far away. I am safe now. I trust in God. …He created me for good not evil.

These aren’t the only voices I have but they are some of the most frightening and separate me most from reality. I don’t know how or if there is any way to stop or change the voices. If there is I haven’t found it in the therapy I’ve had so far. If I can’t change them can I lessen their power?

I try to remember,although the world created by my abuser was my reality – the only reality for 11 years and the most of it for another 14 or so – it is not the truth. The voice is not trying to do anything, or pulling me anywhere. It is a hallucination. It is a memory. It is not a person (now). A hallucination does not have a will or an aim. A hallucination is not physical so cannot pull or drag me. So why does it have power to cause me terror, to return me into the frightened child, to make it impossible to believe in my freedom or any goodness in me?

Several other people I’ve met who have personality disorders have shared having experiences of voices. In my 18 month MBT therapy, we talked about hearing voices in the group sessions. Sometimes for example, I’d share that I was struggling to stay present in the room because the voices were loud and scary and I was constantly being pulled away from reality. But in therapy we didn’t get to explore the experience of voices or how to cope with them, how they may interact with what you’re feeling and what is happening in reality, how they affect interactions… in therapy the focus was on using grounding techniques to move away from them and be present in the group and able to focus on others. Sometimes we talked a little about how the voices may affect our thoughts about ourselves and about others, for instance when we’re interacting with someone, leading to assumptions (they think I’m evil, the know I’m bad, that’s what the voices are saying) rather than curiosity about the other person’s thoughts.

However we didn’t talk about how to cope with them. We didn’t talk about their emotional effect on us, the way they pull us with them, the control they have even though it makes no sense, how they bring traumas right back, how what they tell us and make us feel is more gripping than our current experiences, if there is any way we can respond to lessen their power…

There is a place for using grounding techniques to cope and this is valuable. There is great worth in learning to be able to stay present for others here and now. Probably a value to staying present in the moment for ourselves. Yet I wish there were more than grounding techniques because there’s always next time the voices come. Their apparent power stays the same.

Perhaps I’ll look to see if there are any books that explore voices and how to cope. I’ve pretty much been told that the voices won’t go away but if I keep taking my medication, I won’t lose my grip on understanding they aren’t real. I feel I need to find more than that.

I would be very interested to hear about experiences of voices that anyone would like to share.

Ginny xxx

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Update long overdue!

It is a really hectic, up and down time at the moment and I’m much overdue posting. It has been hard to gather my words. I don’t make a habit of 2am posts – certainly not the best time of day for coherent writing – but I did not get to finish this earlier and it felt important to write before a big change coming up for me in the morning.

Belatedly, wishing you good things this New Year. I think I can just about say this since it’s still January! I’m praying that positive times and opportunities come for you and God’s blessings are shown to you to encourage you each day.

January is always a strange time, cold and empty in a way, after Christmas. Right now, so much seems unsettled, in the world, for my loved ones and in my personal life. I’ve written that before not long ago and of course it has not magically changed with the new year; if anything it seems all the more apparent. I’m trying to give generously of time and resources and friendship, for example to friends in need, and that’s how we encounter Christ in every day. But I’m feeling twisted apart inside because I come up against my limitations, what I cannot give and cannot resolve.  The family in my block, both of the partners seriously ill, whose Benefits have been suspended unresolved for weeks so they have no food, heating or electricity. My friend who has already suffered terribly and now faces more surgical procedures, my friend who has been homeless for almost a year and whose life may be in danger… to the thousands on thousands of people seeking asylum, the fear taking hold giving weight to insular policies that seem to offer protection but perhaps already spiral out of control. (The Mexico border “wall” seems to me to teetering somewhere between bizarre Divergent- trilogy-esque images and more than echoes of the Cold War era eastern block policies.)

I steer away from political issues in this blog but I think this turmoil hits ever closer to home. We hope that in times of hardship we come together and hold onto what matters most but I’m starting to think a certain level of hardship and fear brings only divisions. Then again, in my faith I believe somehow this must not be true because Jesus became Man to suffer and experience everything we suffer and go through. And He is all Love. Love came here, into the darkness and despair. Nothing changes Jesus. The despair and dark and hurt didn’t change Him, didn’t change love. So Love is here, Love suffers and struggles, but isn’t extinguished, so even in the hardest times, it’s love that remains – not division and conflict . I mustn’t lose sight of that.

This post has diverged somewhat from the update I originally planned. Probably to do with the fact that it’s 2am. I’m going to try to get back on track.

Since Christmas, I feel I have not been able to catch up at all. Usually, I have a big clear out, going through cupboards and drawers and so on and decluttering. I haven’t managed this at all. I’m frustrated with myself that I can’t keep on top of the housework at all. My emotions are bubbling over and have been for some time and I feel I have no resilience to cope with straightforward things. Saying that, maybe a lot is happening at the moment. I’m about to be discharged from the personality disorders community service I’ve had therapy in for the past 2 years. I’ve been trying to find support and things I can get in place for after my discharge. This has not been easy and actually it has been quite distressing because I have been promised a lot of treatment I haven’t had and I’m left with major mental health issues unadressed. On the positive side, I have made contact with a peer support worker and Recovery Coach who are going to help me short term and I think this will be really valuable. I have also signed up for some courses at a Recovery College, which I’ll post about (and explain) next week.

My physical health is not going through a great patch just now. The cold always makes the pain worse so that’s part of the reason. I have had to give in to the fact I need a wheelchair sometimes now and I’m looking at getting a mobility scooter. At least this will help me be less isolated and take a little stress away perhaps, because I’ll be more able to take part in things outside my home, like my volunteer work.

Practically at home, I am going rapidly up the wall at the company who should be repairing my boiler. I have had problem upon problem since November and now have no heating or hot water. I feel they have handled the whole thing terribly (7 canceled appointments for a start, having to phone 6 times to arrange a very simple thing, and so on, then them accusing me falsely of missing appointments). Ggrrr!! I know this is just part of life but in the state I’m in at the moment, I can’t cope with this, and feel very frustrated with myself for that. My emotions explode out of all control. Then I get angry with myself because so many people are going through so much worse.

A close friend has serious housing issues as well as a huge number of health problems. I’m trying to be there and do what I can. Cook hot food and support him with form filling and trying to get him a support worker who could help. It is a little way I can try to help and use the knowledge I’ve gathered from my own housing issues in the past.

I’m going to stop here. Later this morning is my last group therapy session and this will be a really really hard lot of goodbyes. I’ve been writing thank-yous and goodbyes, some of the hardest cards I’ve ever had to write. I’m sure I’ll write more about this last session and ending therapy, in the coming days. At the moment I’m struggling to find the words. I’ve cried so much today.

Ginny xxx

 

 

In the cold

I hate how sporadic I am posting and reading at the moment. Again I’m sorry though I’ve already said that so many times I know.

I’m having a really low time. I’ve too many horrible feelings about the abuse and about the PD service that’s meant to be helping me. I have never felt so far from my dad in what I experienced as a child being abused and what he did not know, that I thought he did know; what he thought was actually going on. It is not his fault, it wasn’t then and isn’t now, but I can’t stand the distance – which means more doubt and fear and was it all because of me and have I invented everything through my madness. I have never felt so trapped by repeating patterns with the service -that I thought would help me and thought I could trust – of being misled, let down, tricked, brought to the very edge then when I’m in crisis they reject me, do nothing to help, say it’s nothing to do with them, send me away so I cope the only way I can at that point of utter pain, which at the moment, means overdose or knock myself out with sleeping tablets. It’s too much like how my abuser made me believe I needed her and she’d protect me but I never received her care, which paradoxically I did need, only her total control and the terror of her threats and certainty of my evil, so I believed. Now the cycle repeats with those I should be able to trust and ends in the same desperate pain.

Even in therapy group today I felt so so far from everyone else. An intruder. Something wrong with me. Disconnected. Just watching. Deeply hurting for everyone else and guilty for causing them hurt and anger too, but at the same time totally out in the cold; so much needing to be heard, but everything and everyone showing how at odds my experience is with theirs and what it should be.

Ginny xxx

A closing drawbridge and a silent cry: when it’s less safe

A closing drawbridge and a silent cry

Eating disorders and personality disorder

When it’s less safe, but I am no longer my abuser’s child

WARNING: this post contains mention of childhood abuse, discussion of my experience of anorexia and disordered eating and the purpose it served for me in my eating disordered thought processes.

When I started drafting this post, I didn’t actually intend it to form part of this series on eating disorders and personality disorder. I didn’t realise that it would be so much about my eating disorders, but it turns out that it is. I started writing tonight in preparation for my therapy group tomorrow. Last week, we were talking about feeling safe. In the discussion, I said that at some points during therapy (around the past 14 months so far), I’ve actually been less safe than when I was not in therapy. In hindsight, perhaps I should say, felt less safe. It has felt less safe. Despite this, I still feel therapy is a process I need and want to go through. Someone asked me a question about that, to which I struggled to verbalise the answer. I’ve thought on her question during the week. I’m not going to write what she said because I don’t want to break her confidentiality, but I wanted to share the reflection she has led me to about becoming more or less safe during therapy.

As soon as I tried to explain, the familiar eating disorder thought came into my mind – when I was anorexic it was safe. I know how sick and dangerous that thought is and how illogical, the physical destruction of my body having been so clear. Yet, there was a point not very long ago in therapy where I so desperately wanted my anorexia back, because it would have been safe, and not so much too much. With anorexia, I wasn’t too much and nothing was too much. (Except food, of course!) I was encased in a safe, protected place, and I felt nothing but its power, voice and drive. My emotions and my body made no more demands.

With anorexia I could be certain in the knowledge I was starving, punishing, weakening, enough to atone for what my abuser told me I was, enough to avoid the damnation I thought I otherwise deserved, enough to ensure I was not a threat. Enough to satisfy my abuser.  And even years after I had got away from her, I thought perhaps anorexia could take me back to that one time where it had seemed she wanted me, seemed through a child’s eyes that perhaps she loved me, the one time I wasn’t bad, where I was so weakened she took total control. That would be totally safe.

I was never cared for by her. Total control stood in for care instead. The closest thing to care and safety for me was my total self-destruction, total physical weakness, allowing her to take total control of me. My BMI was about 13. I was in unbearable pain in my back and legs. I could just barely walk with crutches and had to spend a lot of time in bed. She took control literally of my movements, my food, my use of the bathroom and toilet, my washing, my dressing and undressing, my weighing (any action that could have and should have been private, she invaded) my contact with other people (even the doctors who wanted to help me, whom she prevented me seeing most of the time). Telling me what I was thinking, telling me what I was doing to the family, telling me what to say, total control – but this total control was the only time that the terrible powers and terrible intentions she told me I had, seemed to cease. My body and my mind ceased to make demands and I succumbed to her totally. This was the only safe place. The rest of the time I lived in fear of what I would do to her or the family and of her terrible threats coming true.

Paradoxically, at other times my anorexia gave me something that was nevertheless mine. It was my anorexia and my body. I think I’ve written before how when she had me strip in front of the mirror, a fierce voice in my head said, this is my body and you will never touch me again, and I resolved to lose as much more weight as I could.

That determination and angry strength was unusual. It was more about cutting off. Later, I stayed as numbed and weakened as I could. Long after I was out of the anorexic weight range, physically safe, I continued to punish myself. Starving. Vomiting. Cutting. Overdose. On the outside, I could do what was required and expected. I achieved. I was together, doing what they required in terms of education and work. Again, that was safe, because I was doing what was required, my dangerous emotions were numbed, my atonement continued. Until I imploded. Everything went to pieces.

As everything fragmented, numb was no longer sure and safe. I desired the end and wanted to end my life. At the same time, my child voice that I had suppressed so successfully for so long, was screaming and desperately needed to be cared for. This was explosively dangerous. My abuser’s threats about what I was would come true; they’d be proved to be true for all to see. The evil in me would explode out of control, if I could no longer punish and weaken myself. I would cause unlimited hurt to others without even seeing it myself, but everyone else knowing the evil I was. I would never be cared for (ie in someone’s total control).

Straight away, the rejections began. (Again. Just as I’d been rejected when I had needs and sought help as a child – terrified what my abuser’s reaction would be; my father not knowing what was going on, so not protecting me.) I was not under my abuser’s control any more, but there was no care for me, no one to protect me, and the few people I trusted were not there for me. The pressures – I don’t know if consciously or not – piled on me made it very clear I am a disappointment, not good enough, not what they need me to be, that they will only accept me as long as I am moving in the direction they think I should be at the pace they have dictated.

I cannot silence the needs any more. Anger boiled out of control, hurt screamed. Going through therapy, the feelings intensified. There was no way back to the protection my eating disorder had given me. Now, when I write about how it worked and why I wanted my eating disorder back, I am horrified. I am horrified at the power my abuser had over me and how I allowed her to have it and how that made me feel safe.

I will never receive now the care I did not receive when I was a child being abused. I will never receive again the closest thing I knew to care, the total submission to another person and control by them. Terrible as that was, I feel as though I will never be sure, as I could for a brief time be then when I was totally dependent on her, that I am not the bad, evil thing I had been taught that I am.

With the loss of all my coping mechanisms, including stopping self-harming and stopping overdosing, as I have somehow by the grace of God managed not to do in the past few weeks, it does feel more dangerous. I don’t know how to find any reassurance, internal or external. My feelings, my emotions, experiences, feel so out of control and dangerous. I am no longer my abuser’s child. I am no longer what my family requires. I will never have the care and security I did not have as a child, nor will I have the safety unconditional acceptance would give, because I do not have that now that I’m no longer what they require. I don’t yet know how to exist without these things.

Part of me grieves for the loss of the eating disorder and mechanisms that kept me safe, because stupid and twisted as it sounds, they did at least protect me; despite the harm they caused, they protected me from ending my life, and though it was fairly illusory, they gave me the closest thing I had experienced to being cared for.

****

I should say that I think that another important part of the safety issue in therapy is coping between sessions with the emotions that have come up in sessions. Also, the impact that this disorder and the recovery process has across your life. Until very recently having the help of my support worker, I struggled badly with the social isolation that followed the loss of many important relationships, and the “domino effect” of all the material stability in my life falling away because of the financial problems caused by losing job after job and my erratic spending when I was out of control. Struggling with this at the same time as my emotions were going out of control anyway, my desperation for help increasing but being unheard by everyone I tried to get help from and had been led to believe I could trust, brought me very much too close to the edge. My support worker has greatly contributed to my safety now.

Ginny xxx

A very hard goodbye

This morning, one of the members of my MBT therapy group left, as it is the end of her time in therapy. It was her last group today. The MBT group is a “rolling group”. The group runs weekly, continously; members join (usually at least 2 people at a time) and are in the programme for 18 months, then leave. Usually, new members join to take their place and the group carries on. Sometimes new members join at other times. This means members start and leave at different times rather than a whole group doing a course together for 18 months and everyone finishing at the same time. Usually, at least 2 people would finish at the same time. It was a bit unusual that one person left alone today (someone else who would have left with them had to switch therapy groups earlier in the year).

It was a really emotional goodbye. I cried so much. A lot of us did. The depth of feeling at the point of saying goodbye was intense and in the group time passed much too quickly. At the start of therapy I would not have understood the depth of feeling for and attachment to another person that grows in group. She is a hugely kind person who has given so much more than I think she knows and I hope she does continue to know more of that good that’s in her.

I’ll write more later. Right now it feels very raw and surges of emotion are welling up out of the blue. It has been that way all week.

I need to get things done this afternoon because tomorrow I’m having a little fundraising coffee morning. It’s probably a good thing I have to be busy but I need to not push down my feelings totally either.

Ginny xxx

Bob and me and why couldn’t I say “no”?

WARNING: this post contains a passing mention of self-harm thoughts and a very brief generalised mention of abusive relationships

I’m sorry for this ramble that isn’t necessarily of interest to anyone. I really have to get this out and there’s nobody I can talk to. Kinda wish I could call someone but I don’t want to be totally needy and a burden on people.

It’s Friday tomorrow, which means group therapy. I’m really nervous. It’s the first group therapy for about 3 weeks following the summer therapy break. After the last therapy break (over Christmas) I found it hard to engage with the group again, stay present to mentalise and keep safe between sessions. The main reason I’m nervous this time is something that has happened between me and someone else in the group. Let’s call him Bob. I know that what happened is going to be talked about in group (because I talked it over in my 1:1 session earlier this week and my therapist told me it also needs to be discussed in group).

There’s a rule that group members should not have contact outside the group. It’s accepted that chance meetings happen or that we may see each other when attending the same hospital or GP Surgery  or other places and we aren’t expected to ignore each other if this happens, but we are not supposed to arrange meetings. One reason for this is that we should not discuss what happens in group outside group where not all the members are present. In particular we should not talk about other group members and if group members felt they or their issues were being talked about, this could be very upsetting and damage trust between group members.

“Bob” and I sometimes bump into each other because we tend to head off in the same direction after group. We sometimes bump into each other in the supermarket or in town because sometimes we go to the same church. Small world and all that. At these times we’ve chatted and I never felt that was wrong. This has happened with other group members too; we’ve discussed it in group and everyone has felt that it’s okay when that happens. Some members live quite near to each other so it’s somewhat inevitable.

In early June, I talked a bit more to Bob whilst we were in the waiting room before group started, because he was going through some practical problems that I had also had experience of and I was glad to be able to suggest a couple of sources of support for him. Then Bob asked me to meet him for a drink. It was his birthday and I knew that he does not have any friends locally and had been through a rough time. Straight away I didn’t feel comfortable with this. It was breaking the group rule. It could be breaking other members’ trust. I felt this was different from all the previous times Bob and I had talked, because this wasn’t a question of bumping into each other or waiting in the same room together for appointments; it was going out of the way to arrange a meeting. I was straight away nervous about why he was asking me. Plus going for a drink with anyone is hard for me, especially someone I don’t really know very much. Crowded places and lots of unknowns are difficult for me, raising my anxiety. I didn’t want to say yes. But I was completely unable to say no. I knew he would feel hurt and rejected and upset. I would be being nasty and rude. There was just no way in my head I could say the “no” I wanted to.

[I’m scared…]

Instead, I agreed but gave the proviso that it definitely be a one-off, just for a drink because it was his birthday. I also said that I wanted to be very, very clear that this was as friends. I have a lot of issues of my own and I do not find relationships of any kind easy. I am not looking for anything more than friends and I would not be able to give to that kind of relationship what I would want to. I said I felt silly and awkward saying that but just to make sure there can’t be any confusion I wanted to say it outright. Bob said he totally understood that and he felt the same.

So we met for a drink one afternoon. Well, that was the agreement, I thought. Except that Bob made it dinner, one evening, at a restaurant. And he insisted on paying for me. And it wasn’t a one-off, because from there Bob contacted me more and more. He wanted to meet again and again. He told me more and more that he had been thinking about me and praying for me and that he thought I was a very special person. And every time, I didn’t want to. I wanted to say no. But I couldn’t. I didn’t. And we met again, then another time, then another.

[I’m so scared even writing this. I feel I can’t breathe. I’m twisted up inside. Why?]

I couldn’t say no but I hoped it would stop. I tried to say. I said I was worried for both of us – that we’d get worried about the other and not be able to tell anyone, that we’d share things that we really needed to talk about (in group or with our therapist) and we wouldn’t be able to, that I wanted to share our meeting with the group, that I didn’t think we needed to hide it, that I thought he was trusting me and thinking of me differently from everyone else in the group and that could be damaging, that he was sharing things with me and not with the group and that could be bad for him (and the group)… I said these things, I think. Yet I let them be quickly brushed aside. Bob wasn’t dismissive. He wasn’t typically pushy or crass. Somehow though, I let my concerns be put away by what he said in response and I didn’t follow them through.

It was evident he cared for me very much and thought well of me. A lot of it seemed to be true Christian care and prayer and friendship. However, I knew it went beyond that. If someone cares for me, it frightens me. Bob would say in group that he had been thinking about me and it scared me there too. I wasn’t the only person he’d say it about but he seemed to say it about me more than about others. I know I get scared about this kind of thing and it makes it hard to know (or hard to trust myself when I think I know) if the other person is caring about me in a normal way or if something is unusual.

Scared turned to terrified when he seemed to care for me obsessionally. It sounds wrong to say that. It sounds like he did something wrong. He didn’t hurt me. He didn’t force me. He did nothing wrong. That’s what makes this harder. He did nothing wrong and he is not a nasty person and he is a kind, caring, generous, Christian man. But his contact became more intense. Even how he looked at me. He’d watch me so intently. He’d comment on tiny things in my appearance and say he couldn’t get over them. He made a few comments that freaked me out, like that he couldn’t resist me if I had long hair, things about wanting cuddles, that I shouldn’t let my father know his age [Bob is substantially older than me but – what??!!]… I wanted to run. His texts got more frequent. Several times within an hour at the end. I knew I could not be what he thought I was and couldn’t give him what he needed.

In the end I was scared enough that he was obsessed with me that I stopped it. I checked out my feelings searching online to see if people can be obsessed with other people and if this happens in relationships, knowing the answer really but having to check out whether it is something bad and whether it can lead to worse – because I couldn’t trust myself. Partly because he really was being so “nice” and not doing anything wrong. As well, I was scared he was telling me things that he wasn’t telling the group. I was trying to encourage him to tell the therapists and tell the group. I knew too much about pressure he was under and danger he could be in and help he might need. I knew it wouldn’t be safe for either of us. I felt that whenever I ended it or whether I just let it carry on, I would end up letting him down and not being what he so much thought I was and he would get hurt and the longer it went on the worse it would be.

I couldn’t trust myself. I felt so strongly that there was a sexual or at least physical attraction undercurrent, that he was attracted to me, that he wanted more and wanted me to be something I never can be to him, that he was becoming what felt like obsessed with me. It is so obvious to me now and it scares me now and scared me then but for so long I couldn’t trust this instinct and end the relationship.

[I want so badly to cut. I won’t. I won’t. I am determined to sit with this and try to stay present to feel in group tomorrow and not numb everything down by self-harming.]

Though I was scared I don’t think he knew it. I don’t think he knew I was uncomfortable because I said nothing and pursued none of my objections. Actually, I was dishonest with him, in sharing time with him but actually wanting to get away whilst he thought we had a connection, or were sharing something important. I feel so guilty for that. But then, we did share something. We are both Christian and we spoke often of God and hope and mercy and that is something I cannot share so fully with many people. It’s something I don’t really talk about in group, not yet anyway, and it’s a different kind of conversation. Genuinely we did share that and it was good. It’s not black and white and I don’t blame him and he did not do anything bad or wrong.

I know a lot of my fear and my feelings came from triggers in our conversations and relationship which probably would not have been triggers to anyone else. To the next person perhaps it would have been easily passed off or nothing important. For me there were so many triggers to my emotions and behaviour that reminded me of when I was being abused. That sounds terrible to say. It makes it sound like he manipulated or took advantage of me. All he did was kind. Apart from me not wanting it and feeling we were deceiving people and feeling scared. He didn’t know. But it’s how I felt. I started behaving and thinking like I did in the abusive relationship. It’s why I couldn’t say no. It’s why my feelings totally disappeared for me in the sense that I dismissed them all and followed only what his feelings and his needs seemed to be. It’s why I couldn’t say no, couldn’t trust what I felt, wanted to run but it was utterly impossible to do anything about it. I fell into the same patterns of watching and silence and trying to get it right, perceive his needs and his emotions correctly, trying to save him and keep him from danger. His obsession with me and his need for me reminded me – in my emotions if not in facts – of the abuse too. When my abuser wasn’t threatening me she was attributing bizarre powers to me, largely perhaps stemming from her own delusions (or perhaps it was all part of the plan of the abuse), powers I did not have, powers that I was to have because I was born at a particular time because she had planned it for a reason; she’d watch me obsessionally and intently, she’d have me keep secrets… I ended up emotionally right back there when Bob talked about how good I am, how he thought about me, how important it was we shared these conversations separate from the group, how it should not be shared with anyone in group because that would get too complicated, when he so intensely contacted me and needed me.

When I did finally end it, I told the service because I was so afraid what Bob would do. I am not so arrogant that I think contact with me can matter that much to anyone, but I was sure that he’d interpret me ending our contact as total betrayal and breach of trust. I know those kind of feelings put him in danger, because of what he’s discussed with me both in group and outside. I didn’t want him to know I was scared, because of a particular thing he shared in group once. I thought for days about how to do it. I told the PD Service right away that I’d ended it and told them I thought he’d be in danger. If the service hadn’t been there and I hadn’t believed they could try to keep him safe, I would not have dared to end things.

I’m scared for group tomorrow. What’s going to happen. How it’s going to affect Bob when we have to talk about it. If I admit I wanted to stop the meetings, or that I had worries, it makes it sound like he forced me. He didn’t do anything to force me. So many times I could and should have said no. But I have to be honest. I’m scared how what’s happened will affect other people in the group and what they’ll feel. They may be hurt, they may feel betrayed, angry that rules have been broken and trust has been broken, they may think we were trying to do something in secret to exclude them. I think everyone will lose trust. I don’t know what Bob feels about it being discussed in group and I don’t really know what he feels about me having ended contact. I told him that I had told the service, but I don’t know what he feels really. I just feel so sure he feels totally betrayed. I’m scared he mightn’t come back to group. I’m mainly scared about him and about the rest of the group and how they’ll feel but I’m also scared how unable I was to act on my feelings and say no.

My head is imploding with all these feelings. Maybe I’ve really turned the proverbial molehill into a mountain but for some reason this whole situation is leading to really strong unbearable feelings for me. I’m fighting so so hard not to self-harm tonight. I’ve been trying self-soothing, trying to do creative things, trying to do practical things, hot drinks, texting a friend about something else, trying to take the focus away from the emotion and away from myself. Then I wrote this. In a minute I’m going to try a weird approach that just occurred to me – I’m feeling totally nervous and wound up so maybe if I watch a DVD that makes me just a little bit on edge and in suspense it’ll give another direction for the feelings and get some of them out. Not sure how that’ll go down and it’s just a thought that occurred to me, but here goes! A couple of episodes of Grimm should do nicely.

Ginny xxx

Really bad day

Well I probably shouldn’t say really bad. Nothing that bad has happened at all. It’s just how I’m feeling and it’s hard to stay with this.

I had my first 1:1 therapy yesterday for about a month because the PD Service took a 2 week break in therapy sessions for the summer and also I had missed one session shortly before the break. It’ll be the first group therapy since the break this Friday. It was a hard session. I was dealing with lots of strong uncomfortable feelings and a situation that’s very scary for me. I know we’re going to have to come back to it in group on Friday. I realised times when I experience the same thoughts and states as I did when I was being abused as a child and they come back at bizarre uncontrollable times.

Perhaps these feelings and what we went through yesterday have something to do with how today has been. Definitely… but I only just now made that link. Also yesterday afternoon I saw my support worker and we got through a lot  (finishing filing out a huge form for my assessment for a Benefit). Though this was great I was exhausted and in a weird state afterwards – cold and exhausted and sad and I don’t remember the rest of yesterday apart from that.

The pain has been awful too because I really overdid it physically over the weekend to travel to my friend’s and back, though I don’t regret for a minute going and the time with her and her family was precious. Today it took me until 11 to be able to stand more than a couple of minutes.

Then I went out for an appointment which was supposed to be for a referral scheme for physical therapy. About everything possible went wrong and I won’t bore you with it now but it was upsetting at discriminatory, turned out to be nothing like what I’d been led to expect and cost me a lot in terms of time, pain and anxiety for nothing.

I’m scared how I reacted and how I felt after. I hate feeling angry and trapped and out of control. I hate feeling used, dismissed, laughed at, tricked, punished… I hate these thoughts and feelings even occurring. Not because of what they feel like in themselves but what they mean about me and the flashbacks and reexperiencing that comes with it. I hate how all the feelings and actions that stayed inside and stayed locked away into my… I don’t know how to name them because I don’t talk about them. My others, my “imaginary” people that are anything but imaginary, my others, that’s all I can say… they stayed safely in the worlds I made for them – the worlds I could escape to – but now they don’t. Now they’re here all the time. In every day.

The rest of the day again I can’t remember apart from that I picked up milk and a couple of things on the way home. I didn’t really even remember that til I saw the shopping bag on the floor. I’m terrified about this dissociating… the time that just disappears after I get the overwhelming emotions…sometimes before too… Then I’ve just been lying down too drained and tired to do anything, trying to do little things to ground me but I can’t concentrate. Everything hurts. Inside my head hurts too.

If this is feeling without self-harm, without overdosing, without starving and purging, it’s scary. It’s a scary place. I’m scared of what I am. Scared of how I’m acting. How I’m feeling. What I’m remembering – my feelings, as much as what was done to me. What I’ll do to people now. That my actions now are based on the trauma and abuse and who this means I am.

I’m scared, crying for no reason. Feels like I’m exhausted and in shock but there’s no good reason now. Can you feel shock years after an event?

Ginny xxx

 

All change…

Officially, my last day of work at the department store was yesterday, although as I am currently signed off sick, I was not actually in work. Last week I had my exit meeting with my manager (handing back my ID and keys etc) and said goodbye to my closest colleagues. I’ll be popping in again this week to say bye in person to a few people I was not able to see, and deliver some notes of thanks. They gave me a reed diffuser in a summery freesia scent, which is already providing a perfect calming aroma in my lounge, as well as a card wishing me well. I hope that I keep in touch, in particular with a few people from the department where I worked. We found a lot in common in the months I was there.

So it’s all change again now. I’m sad to leave. I’ll miss people – colleagues and some customers. I’ll miss the creativity. I’ll miss some aspects of the routine and order. I feel bad for having to go after I’d got to grips with things, received training and my colleagues and manager had put time in to show me what to do and support me into my role. They are all incredibly understanding and caring over my situation that has led me to need to leave and that helped me a lot; I still feel bad for leaving the team and leaving more work back on other people. I guess the good side of that is I must have had some confidence, in the end, that whilst I was there I did manage to do some good. Before I started this job I felt utterly useless, unable to trust that I could do any good because my previous employer seemed to find me so deficient. I see now that at the store I gained a tiny bit of confidence, as well as knowledge.

I’m amazingly anxious and I’m not quite sure why. I’m feeling it physically and feeling shaken and near crumbling and crying and really wishing someone could hold me and tell me it would be alright. I don’t know exactly what is causing this. I’m teetering on the edge of dissociating but I’m staying on this fragile edge instead of slipping over. On the edge are raw and exhausting emotions and I’m spinning and spiralling rather than falling into the safety in the hidden mist of dissociating. It’s painful. I’m trying to use my grounding techniques and self soothing and trying, if only in tiny moments, to avoid falling over that edge. Dissociating may be a relief but the pain it causes me afterwards, and others during, is even worse.

I’m trying to find the way through the next steps now that I will not be working for a while (on my GP’ s and support worker’s and others’ advice). I’m confused about all the forms I have to complete and assessments I have to go through. I’m scared of how they’ll judge me. Scared of whether I’ll manage financially. Scared of so many things that are making me feel trapped, not believed, going into the unknown…. I’m so thankful I have my support worker guiding me through, otherwise I’d implode and go back to shutting down and hurting myself out of fear and pain and flashbacks. I’m so thankful I’m not alone. I’m trying to find ways that this instance of having to leave work – because I’ve lost or head to leave more jobs than I can cope with counting, for the same reasons every time – is not yet another repeat of this cycle and is not only another failure, loss, or let down to those who have tried to help me. I’m trying to find ways I can make this different. I have therapy now. I have my doctors and support worker. I have a home. God willing I am soon going to have some more social interaction and a place to contribute something, in a mental health charity I’ve been referred to. These all count for a lot in stopping me going so deep over the edge and now I pray I can build something good from this place.

Ginny xxx

This is different, somehow

This is different, somehow

I’m feeling very very anxious today. My emotions have been shifting quickly in the last two weeks. Many of the emotions are familiar but some aren’t and the startling changes are raw and unexpected.  I feel so shaken and quickly exhausted. A substantial part is physical but a lot is emotional or mental too. Anxiety and hurt and pain but also thankfulness, feeling overwhelmed at goodness and expressions of love – from friends, for example – come suddenly and something is different. It sounds nonsensical because so much of my problem for a long time (and a big feature of BPD) is that my emotions have been so total, overwhelming, all-consuming, the only thing that seems to exist, the only thing I seem to be. Now I’m saying I’m feeling overwhelmed but it’s different. So, what’s different?

I can’t express it properly but since my therapy group two weeks ago things are shifting. I admitted in that group to strong and frightening feelings of anger and need and fear of the voices I hear that tell me I will do terrible, violent things; I admitted that since I have tried to stop self-harming I’m experiencing every feeling I so much wanted to cut off and control to keep other people safe from the evil I fear in me; I admitted how I detach and dissociate and how a lot of my needs and emotions, I only allow myself to feel through the pain of self-harm or in my escape (“imaginary”) world. I admitted I knew that  they would be horrified and disgusted at me and that I was disgusted at myself. Then something happened. The other group members weren’t disgusted or afraid of me.  Several people said that they hear the voices too and that they have similar feelings too. These three things stunned me – that they were not disgusted or afraid, that they hear the voices too, that they also have these feelings. This started to change things. It was more than a feeling of “oh thank goodness I’m not the only crazy one”. It started to mean that if these things are felt by other people too, experienced by other people too – other people who I trust and who are good and kind – then it is no longer something that means I’m evil inside or that I’m just all bad really and everyone else knows it or everyone else will be hurt because nobody could believe I was really so bad but they will find me out in the end, fulfilling my abuser’s threats.

Since then, and even more since therapy group this week, I’m feeling my forbidden emotions, without doubt. Some connection is appearing that was not previously there. The void between my emotion and my ability to be present and think and speak is closing, somehow. Before, everything was either consuming emotion, leading to explosion, violence to myself; or to total dissociation, impulsivity and non-presence then utter horror and depression afterwards and memory loss; or thinking spiralling compulsive thoughts, being unable to connect to the emotion behind them that was just too frightening. Now somehow I am starting to pray and think in the emotion, experience its presence, experience its coming and going… it’s very raw but somehow it is different from how previously the emotion was my everything, my only reality, and the self-destruction (self-harm, overdose, starvation) was utter safety. My escape world of my other dissociated identities is encountering this world more and more, whereas previously they stayed safely separate, present with me much of the time, but not overlapping with my own consciousness, thoughts, feelings, needs…. Now I am feeling what previously “they” felt. That’s scary. That’s unknown. Also, that could be good.

I’m frustrated by how very inadequately I am able to explain what’s happening to me. It seems as if I could put it together better some of the anxiety I have might reduce. I know it isn’t a bad thing and that it’s very important but I am extremely shaken and high in anxiety and needing comforting, grounding things. I am going to find it a struggle the next 3 weeks or so, because there is a break in the therapy programme for the summer holiday time, meaning I don’t have any group therapy this coming week or the next and no 1:1 therapy until the second week of August. Right now I so need someone to work with through what’s happening. I have to try to dare to call the duty support team if I’m getting bad in the meantime. I have to take the step to trying to trust them again and this is as good a point as any, I guess. Perhaps it’s also good that I’ll have to try to cope without therapy. I know part of these changes is going to be learning to experience and emotion of my own without it being understood or accepted or cared about (and indeed without me being cared for) by anyone else. I’ll have to do that in these two weeks.

Ginny xxx

A much bigger loss than they realise

When I signed up to the programme of treatment I am in at the moment, it was to include weekly group MBT therapy, fortnightly individual therapy, monthly care coordination and support available from a duty team.

With no warning, monthly care coordination has been stopped and changed to quarterly. Having expected to see my care coordinator yesterday as we’d previously booked, this was cancelled and my next care coordination is not to be until the end of September, which will be about 4 months since my last appointment.

I could write a lot about how badly the actual communication of this decision has been handled. Actually I did but I deleted it. It probably doesn’t do anyone any good, not me or the service or anyone else, to shoot off into an angry tirade. I’ve been trying to process this through since we (ie all of us in the therapy programme) got letters telling us a few days ago. My emotions are pretty out of control and shooting to extremes at the moment independent of this which is making things harder – ironically, partly because there is so much going on all across my life and I can’t hold it all together; I could have really done with some help from my care coordinator. I’m trying not to just rant in anger here. However, I do think that some of my feelings are shared by other people in the programme and I do think this reduction in appointments is a much greater loss than the hospital realise. There is a huge gap in care here and it’s getting wider.

We weren’t involved in the decision. We were informed afterwards in an impersonal letter. We were informed that this would be best for us. There was nothing personal about the decision. Surely everyone’s needs in terms of care co-ordination may be different, at different times in their therapy, according to what’s going on in therapy, their health across the board, and all areas of their life? The approach being taken isn’t responsive. It’s just a blanket decision.

My views are certainly being influenced by what I observed and experienced when I worked in mental health services in the same mental health trust in which I’m now treated, but I wonder if the source of this reduction in appointments is actually largely to do with funding cuts and staff shortages? Conversations I’ve had with my care coordinator have given me more than an inkling that my suspicion is correct. If this is so, it would have hurt a lot less if this explanation had been given plainly, rather than it being couched in claims that the service think it’s better for us to have less coordination of our care.

Leaving this aside, nobody actually discussed the matter with us whilst deciding what would be best for us. We didn’t get to give any input about why care coordination is important for us, the help we need, the effect this withdrawal of support would have, what our needs are and how they might best be met. We committed to the therapy programme expecting one thing and now this has been changed. We’re expected to stick with the programme and commit to it but they are free to change it how they choose. This is by no means the first time this has happened and what we have trusted in has been changed or taken away. Support we desperately needed, which was insufficient anyway, has now been withdrawn further.

All these things combine to make us feel hurt and powerless and unheard by those we should be able to trust and undeserving of support. I posted yesterday about how when I discussed the changes on the phone with my care coordinator (after I’d chased several times for any explanation of how the decision was made and what’s happening in practice with my appointments going forward) he told me the service thinks this is the best way to challenge us to be more independent, and how much this hurt and how little the service we should be able to trust actually appreciate what we are facing.

Separate from the emotions this brought up, the withdrawal of these appointments doesn’t just affect the appointments themselves; by the very nature of what care coordination is meant to do, it will have an impact on our wellbeing across the board and I think this is where the proverbial baby well and truly has been thrown out with the bath water. It seems the clinicians who have made this decision do not realise what a loss this will incur.

First, on an immediate practical note, it will have a knock on effect on our therapy appointments. We have been told that the clinicians have decided it is most appropriate for us to get help in therapy appointments rather than care coordination. The focus of a care coordination appointment is utterly different from a mentalisation-based therapy appointment . Therapy appointments focus on emotions and interpersonal situations, looking in depth at particular relationships and specific interactions, our emotions and thoughts and our understanding of what is in our own and each others’ minds. It’s not so much about events and information and our circumstances as focussing in depth on our emotional experience and thought patterns. This is totally different from what is covered in care coordination – such as building a care plan, reviewing mental and physical health, looking at input that may be needed from other health professionals or support workers, looking at social and financial problems and stability, monitoring risk and safety issues, communicating with the range of professionals and others involved in someone’s care… the list goes on. If this is now to be squashed into the therapy appointments, either the time for therapeutic work will be greatly reduced or the problems we needed care coordination for won’t be addressed.

This is all the more important since the length of time for which one can be seen in the service is now strictly limited. The service was set up to be a lifelong service, recognising the fact that we may likely need help outside of particular therapy programmes across many years. Now this has been stopped and after we have completed a particular therapy course we are discharged whether or not we are coping or safe or recovered. When time is limited and so soon we will find ourselves alone again or at least without specialist support, whatever state we are in, it’s all the more important that whilst we are with the service we can get help pulled together across all the areas of our life that our mental health affects and that affect our mental health.

And these areas are broad.  Several of us in my therapy group, myself included, have multiple mental and physical health diagnoses. Most of us have many unmet needs at any one time.  Some of this is because of rules that you can only be seen in one service at one time. I’ve posted before on how unfair that can feel – for me one thing this rule means is I’m not allowed any help with my PTSD and trauma following the abuse I’ve been through, because I’m being seen in the PD Service. I know other people who were forced to choose between being treated for their life threatening eating disorder or their personality disorder. Multiple mental health diagnoses are often closely related but I, and I’m sure many others, have had big difficulties trying to find the way through the care and treatments they need and I’m regularly promised help that is then the next minute taken away. Someone needs to pull all this together and make sure communication happens and that help promised is actually delivered. It is too hard to do this on your own when you’re seriously ill and all too often you are bounced between different services, each telling you that another service is meeting your needs when actually nobody is.

Physical and mental ill health tend to cause disturbance and instability to a lot more than health. Just a few examples from my own experience – and all these are shared by other members of my therapy group – are losing your job, being made homeless or having to move from your secure home, having nowhere stable to live, having no money to meet essential expenses of food and rent and bills, falling into debt, trying to navigate the system to claim sickness benefits or help with housing costs whilst working part time – and being met by mistakes and delays at every turn and waiting weeks on end to receive any money, consequent trouble with utility companies, landlords, over or under payment of tax and Benefits, filling out form after form, having less and less contact with friends and having no resources (financial, or in terms of emotional strength) to keep in touch with the little positive things that can keep you well, relationship breakdowns, addiction, crises, losing control and ending up in trouble with the police or other involvement from emergency services… I could go on and on.

It just isn’t possible to sort out all of these things on your own especially when you’re struggling with the daily pain of the BPD itself. You desperately need someone to get you access to help and guidance, to be familiar at least to some extent with the systems you’re struggling through and to know what help is available and refer you there. This help has never come, for me, from the PD Service, and with so little care coordinator input going forward, it’ll be even scarcer.

Yes, a lot of these things are parts of everyday adult life but the fact is by the time most of us eventually get seen in a specialist service like mine, we have struggled without the help we need for years upon years and are very near the end of the road. (Potentially, very near ending our lives, or already having reached that point because there is nothing but pain, dark, utterly spent, utterly trapped, self disgust, I could go on…) Yes, we have to be able to function independently. But we are silently screaming how right now we can’t. We need help. We desperately need to be heard that we need help. Every time we have tried the very hardest we can and there’s yet another loss, obstacle, more and more piled on us, our risk increases and we are less and less able to be independent and more and more locked into our compulsions to overdose and self harm and try to numb and control the utter desperation and silence the painful scream for help inside us. If someone hears us, guides us, gets an understanding of what is happening across our lives, pulls the pieces together and gives some continuity, as our care coordinator could, then we can start to gain strength and start to find some kind of stability that might eventually allow us to heal.

I am incredibly fortunate that I have a support worker (from a local social service, not from the NHS) who is helping me with so many things that I’d have hoped my care coordinator and/or support workers from the PD Service would have done. The response from the PD Service was to brush me off saying everyone has to deal with these things and I did not qualify for any help and one appointment with a care worker who did not know anything about most of the areas in which I needed help. Thanks to my current support worker, I have not been evicted by my landlord, I have been helped to fill in the complex application forms for disability benefits, I have had support to go to assessment appointments, I have had help learning to budget, I have been able to access the correct advice and information from all the services involved (housing benefits, the council, the Jobcentre, disability services etc), I have someone on my side who understands the difficulty I’m going through at the moment in the police investigation into my abuser, and I have some social support which will help me use my time constructively to keep getting better and eventually learn how to get back into work.

In no way did the lack of recognition, lack of coordination and lack of support I received from the PD Service make me better or more able to function. In no way has having a support worker made me less independent or worse. I am now self harming much less and have not overdosed for weeks. I’m able gradually to do a little bit more and then more, because I have some sense of stability and safety and someone who believes me. With his support I’m not alone going through the things that distressed me to the extent that I couldn’t cope and could only hurt myself.

This support is desperately needed. It is very sad that it is so hard to find. Given that the therapy programme is so good, and I know it is such a privilege to be able to undertake it, it is sad that the support towards staying safe and being well and stable, is so lacking. It is much harder to grow and make use of the therapy from a place where you don’t feel safe or heard.

Perhaps I’m overreacting. Perhaps I’ve had an unusually bad experience with my care coordinator or when I’ve been in crisis. Perhaps I’m incredibly dependent. (Well, I think I definitely am.) Probably I should focus more on the fact I have the support I do. I know many services have much less support available. It just seems to me like a big and widening gap and that things could so easily be different.

If I recover enough to ever work or volunteer in this field, I’d like to work on trying to bring together patients’ access to the support that’s out there and bridge the gap of all the unmet needs that are stopping us from having a stable life whilst we’re working through our therapy programmes. I’m sure this would increase people’s security in their recovery.

Ginny xxx