Tuesday, 9 September 2014

Webs of Care

Since I started treatment I have come across requests from researchers for service users to take part in interviews about different aspects of the treatment received. Recently, I received one such request specifically looking at the discharge process from Dialectical Behaviour Therapy (DBT) and how I experienced it. It has made me reflect on my experience and consider questions such as, was this ending easier than previous endings in my life? How come I have found the removal of formal support easier to navigate than others I have spoken to?


On reflection there are a number of factors that have worked for me:

1) I had become very familiar with the Dialectical Behaviour Therapy model a couple of years before I was even diagnosed with Borderline Personality Disorder (BPD). After my diagnosis Marsha Linehan's theory that my symptoms had developed as a result of the confluence of biological and social factors actually made sense to me when I looked at my life story. This gave me confidence in the therapy when I was finally offered it. Because I had read Marsha Linehan's book behind the practice, I also understood the rationale of the skills training and one to one elements of the treatment.

2) From the beginning the message was consistent within the group and individual sessions that DBT would not and could not offer me a cure for my emotional distress. The first six months involved a process of me learning the skills to 'accept' the fact that I could not change the roots of my symptoms, but I could learn to manage the most damaging behaviours I had developed in an effort to survive my life. In addition I learned that I could also learn skills to help me manage the emotions behind the behaviours, no matter how distressing or painful they may feel.

3) Developing the ability to use DBT skills outside the group and one to one settings is a major objective of the therapy. So homework was central to the success of the therapy for me. I was shocked in talking to others with similar ages and symptoms who had undergone different therapies that their overwhelming feeling when approaching discharge was that of 'losing their family'. I have managed to build up a growing group of friends outside my therapy group so that, at discharge I did not fear that my whole social life was ending too.

4) Most significantly I recognise that throughout my life I have had strong webs of care. There have always been at least two or three significant relationships during periods of extreme crisis which have provided sufficient safety to prevent me from ever being admitted as an inpatient. This meant that I did not have this hurdle to overcome. If my place of safety becomes my default rather than a last resort, then my behaviours will centre frequently around accessing that place.

A Few Things to Consider about Weaving Webs of Care:

A) The isolation caused by mental illness means that at the worst of times we can be hanging by one slender spider thread. However, if you take time to observe spiders in nature, or in my lounge at the moment, that single thread is more than strong enough to hold the spider, no matter how high the ceiling. For me, many times in my life my single spider thread holding me up was a barely perceptible faith that I was held by a God who was capable of coping with my outbursts and emotional pain. In those times I didn't want any complexity to my relationships just a sense that something or someone was holding onto me. For a lot of BPD sufferers that one thread becomes a human relationship, either personal or professional.

B) At some point all therapeutic relationships need to end, if they are to effectively create independent functioning people. That means that the single central thread needs to be woven into a growing network of relationships. I started with two friends, one of whom had known me for over twenty years and, significantly, my pets. I could trust myself to look after my pets without being judged and my friends were close enough geographically to help me build routines - consistency takes time and repetition. In the beginning these relationships were practical and centred on meeting basic needs like walking the dog, making sure I was looking after myself and offering me meals. They didn't overwhelm me, but on more than one occasion they were able to step in when hospital admission might have been the only option and offered me a safe place and a bed for a couple of nights. These friendships were an essential part of my care plan and fitted together with the professional relationships I had.

C) As I developed DBT skills I was encouraged to look outward and to participate in the wider universe. By volunteering on a limited basis I developed a wider web of caring relationships and contributing to the needs of others. Apart from distracting me from my own distress this allowed me to enter relationships gradually rather than me launching myself at people and leaving myself psychological naked having given too much of myself away. By widening this circle of relationships I took pressure off the therapeutic and my central, close relationships. One mistake I had made in the past was putting my 'eggs in one basket' and investing all my emotional energy in one relationship. Inevitably, on both sides these relationships would implode with the pressure I placed on them. It takes a village to support me.

D) Usually, volunteering introduces you to wider communities. I became a part of a local community so there are webs of people who are acquaintances but who bring to me different gifts. Each relationship holds in it potential to either hurt or help, but because I no longer invest in all or nothing single relationships, if someone in the other layers of web hurts me, the stronger more central relationships that I have come to trust have the capacity to hold me, not simply because they are strong, but because I am also capable of using my DBT Interpersonal Skills to manage the normal ups and downs of friendship and caring relationships.

I have searched on-line for a web representation - my drawing is rubbish. This one crystallised for me how far I have come in developing networks of people who form my supportive relationships. It helps me cope with life and those people who would drain or hurt me - they will always be there, but they no longer have to have the power to drag me down. As I've grown stronger and started recovery I'm able to include some renewed friendships and family relationships that I can now manage and vice versa. It's a helpful exercise. Here are some things to consider as you fill it in or create your own web:


Ask yourself: 'Do I have a web of care?'

* If the answer is yes, put people into your web and show their importance and closeness to you by how near they are to you at the centre of the web.
* If the answer is no, ask yourself what is the single relationship that you are holding onto, it may not be human. Then honestly consider friendships that may have slipped - are they lost forever? Or could you get back in touch?

* If people scare you, consider swapping them for pets. My first pet was a hamster given to me by a friend at a time when a lot was going wrong - that wee chap really lifted me and gave me a focus outside of myself - a break from feeling emotional pain.

* If you have a good relationship with your CPN, Support Worker or Therapist talk to them about how you could find other webs of relationships to weave into your life. Taking advantage of the NHS Activity for Life programme has opened up the local leisure centre as a place where I can meet with people without any expectation of me emotionally. If I get to know people better (which takes time), then that's a bonus.

Above all remember, no matter how lucky you think others are with their partners or families and friends; it is still possible to be lonely in a crowd. Building quality rather than quantity takes time and not a little bravery.