Being able to feel secure in my place in the world is vital to my ability to engage with the world around me. I cannot contribute to the communities I may want to be part of if I don't feel that I am accepted or, more accurately, acceptable to those around me. I will not be able to sustain relationships if I do not believe that I am worthy of that most basic of human needs - human contact and interaction. For most who suffer from BPD (Borderline Personality Disorder) a lack of basic self esteem underlies most self destructive behaviour. I will not care for myself, because I don't believe 'I'm worth it'.
One of the hardest things I was asked to do in DBT was to say 'I love myself so much'. It still hurts to even write that. I cannot say that I've reached a point where I'm able to say it with any level of belief. A lack of self love in the past evidenced itself in behaviours which often resulted in crisis in one or other area of my life. I would spend until my debts were so overwhelming they affected my physical and mental health. I neglected my physical health - I rarely went to the doctor, what was the point? I reasoned, it would be a waste of resources - because it's me.
No therapy in the here and now can undo the experiences and relationships in the past which have stolen any sense of self worth. Even the most loving relationship in the here and now cannot hope to permeate the depths of my sense of self loathing. A friend of mine who has gone through the adoption process told me about some of the training they received on expectations of the children's ability to absorb the effects of a loving home. During training they were told that the child is like a cup with a layer of cling film wrapped over the top. Pouring love into the child is like trying to pour liquid into the cup. It cannot get through. There is a certain acceptance of the reality of the impact of invalidating early environments.
I can relate to that image. I have been unable to understand or feel that I am loved, despite having some very high quality friendships. It is true that the hurtful, rejecting relationships have been the ones that I have gravitated towards over and over again. Again I return to the core belief that 'I am not worth' any better treatment. People wouldn't ask questions about why abused women and children don't seek help, if they truly understood the cumulative impact of experiences which reinforce again and again, that I am less than, that I am someone whose needs don't matter, that I am someone who can be used and abused at will and no one feels is worthy of rescue.
So, given that has been my experience of life, where do I begin with self compassion and self care?
1) Start with the simple things. I began to regulate my sleep. As I practised mindfulness I found that I was able to fall asleep and stay asleep easier. Under the DBT Emotional Regulation skills module, the PLEASE* skills give me a guide to what to do. Sleep is the S of the skill. I don't need to worry 'HOW' practising these skills affects my sense of self worth. I just have to try something different and see if that helps me feel better. P means take care of my physical ailments - so get myself to the doctor when I need to. I started by doing that, getting help with oft recurring migraines - they used to last 3-4 days, happen 1-2 times a month and resulted in me vomiting for at least 48 hours. Getting help with medication which prevents attacks as well as practising DBT skills means that I have only had 2 attacks in the last six months. It doesn't take a brain surgeon to work out that the impact on my emotional health of getting these under control has been immense.
2) Give it a go anyway. Even if I don't think I deserve it - by practising the non-judgemental aspect of mindfulness all I have to do is experience a bath, a walk in the sunshine, massaging hand cream into my hands, putting together an ace playlist for my ipod, watching a favourite TV series in the middle of the afternoon. It took me a long time to lose the guilt, but I kept 'acting' on my plans to treat myself. After nearly two years I am able to take stock of my needs and decide how to care for those needs in any given day. This of course needs to be balanced with using other times to care for others.
One of the difficulties of being introduced to DBT Skills in a group is that not every exercise or suggestion suits every member of the group. Having said that, if I am to find what works for me, I need to get over myself and give things a go. This is one aspect of DBT Willingness, which I understand better as a willingness to engage fully with the world and people around me. My therapist asked me to try saying 'I love myself so much' using Miss Piggy's voice (remember I enjoy drama - it was tailored for me as an exercise!). This made me less fearful of the emotional power of the words and has allowed me to keep trying to say it for real - as I have said earlier - still working at it.
3) Do what you can. Initially I found it difficult to look after my health by way of my diet. So much emotion was carried in my relationship with food. I have been obese for some time, but it was only when I had been out of therapy a number of months that I decided I was ready to do something about it. I needed to build up my ability in using other core skills such as mindfulness, long before I was ready to deal with my weight. Be realistic about what you can do. Care for yourself in basic ways such as sleep, enough water and regular meals before you try to tackle things you have used in the past to help you cope with your emotions, like smoking, overeating etc.
4) Accept any help on offer. Lack of self care results in avoiding asking for help from others OR it results in me becoming so ill that I have no option but to rely totally on others for my care. There is nothing more strengthening that being able to ask for help, knowing that I have made the decision and I know how such help fits in with my own plan of self care. Having decided that I needed to feel fitter I asked the GP about help with diet and exercise. I am so glad I did because I need additional support to keep going - in our area there is a Fit Squad which means that if you are suffering from Mental Health issues you can access three months individual support to improve fitness as well as a Food for Thought programme. I've lost over three stone and have ground to a halt - so I need to go back to my advisers and ask another boost of motivation to complete the transformation. Overall, by caring for myself I feel so much better physically and am able to enjoy activities a lot more. In addition because I am practising mindfulness, I am able to enjoy the changes.
The most important thing to remember when embarking on this journey of self care is not to blame yourself or mistaking self care for selfishness. It is not selfish to care for yourself and just because your parents or others have discounted you in the past, you do deserve to be able to enjoy good things. If you keep going with looking after your physical needs, then you will find your emotional needs easier to meet too.
* DBT PLEASE Skills can be remembered as follows:
"P L E A S E M A S T E R."
treat Physical illness
avoid mood-Altering drugs
build M A S T E R y
I have downloaded the Loving Kindness meditation from the UCLA website (http://marc.ucla.edu/body.cfm?id=22) This again is something which will feel painful if you are starting to work on self care, but over time allow yourself to keep going - non-judgement will be your friend.
I have found these tools on American website and have pinned them on my DBT Pinterest account. They are a good graphic representation giving some ideas about how to begin with self care: