Routine - Bars of Protection or Restriction?

One of the most difficult things about completing a long period of intensive therapy is the loss of routine. I used to think I was quite a random person, I'm not sure that I come across as needing structure in my life, that I'm a spontaneous, carefree person - WRONG! I don't cope well with unpredictability in relationships or life.

I arrive routinely at least fifteen minutes early for most appointments, no matter how trivial. If I've made a commitment I will be there! I will do practice runs to new locations, either in real life or online through google street view (that has saved me so much time I love it!). Even informal arrangements have to be made and pinned down for me in good time. This helps me manage anxiety that has in the past led to panic attacks. So, it is hardly surprising that after nearly two years of intensive therapy and five years of having the same Care Co-ordinator a certain level of apprehension flooded me when contemplating final discharge.

For over a year I had two, weekly appointments around which to build my routines. This was more than enough to provide stability as the levels of exhaustion experienced by me just trying to get by meant that any more structured activity was unsustainable.

I have come to the end of a period of two months during which I have tried to transition from those routines to new ones around which to structure my day to day life. As well as changes to formal appointments, I had major changes to two friendships which were part of my care plan throughout my time in therapy. One friend moved away and another got a job. These things happen - it's life. The challenge becomes, when you don't have work to structure your routines, where do you begin?

What has helped me is to take an idea I first came across in the film 'About A Boy'. In it the feckless hero didn't need to work, but rather than be bored he divided his days into 'units' of time - 1 unit equals 30 mins. So, Breakfast and Coffee counts as two units. Haircut could extend to four units etc. I have adopted this attitude and have begun by trying to establish a daily structure. I know for some people with PD issues this sounds like madness - but it is very much part of my managing my life in order to maintain stability in my emotions. This is how I structure my day:

Before breakfast - quiet time, pray, take time to be mindful. 1 Unit (30 mins)

Breakfast & large pot of coffee 2 units

Walk Dog - 4 units

Lunch - 1 unit

Blog/Gym/Meet Friends 4 units

Dinner - 3 units

Relaxation - 6 units (Includes Self Soothe activities, take a bath, watch good tv and films, Wii Sports, read, listen to music)

The daily structure works for me because it has the flexibility to include meeting with other people as well as allowing me space and time to care for myself and my animals.

I have taken more time to establish a weekly routine because, along with my therapy appointments I also had two fixed times in each week when I would spend time with my Care Plan friends. Now, I have used my voluntary work and socialising to build a loose routine which can be changed depending on whether I feel like 'people' or not.

Monday - Evening Course

Tuesday - time to self

Wednesday - Women's group & spend afternoon with friend

Thursday - time to self/blogging/volunteering

Friday - Running Group - time to self

Saturday - time to self

Sunday - Church

You may notice there is a lot of time for myself - I enjoy my own company, but I need to ensure I make myself spend time with others. So, I have developed a balance of social and group activities that I can cope with. As long as I have space to myself and/or for writing then I feel my life is balanced. The amount of self space also allows me to build in more activities as and when I feel able.

I have found that, as I have recovered, I have been able to tolerate more social times than previously. Above all, if I can't keep to the routines, I don't just give up all together, I allow myself to have a Vacation (DBT Skill) and then begin the routine again at the next natural point. Usually the following day. For example, if Sunday at church has exhausted me, I give the dog a shorter walk on the Monday morning, take the afternoon to myself, so that I am better able to cope with the course on Monday evening.

Everyone is different, but, for me, structure and routine are essential elements of my long term recovery. It's also a good early warning sign that things may be going awry because both myself and my close friends can tell if I am struggling when the routines are disrupted for any length of time.

How do I know when that 'gut feeling' is just my body talking?

When I was sixteen one of my best friends had a boyfriend who could be euphemistically described as 'an interesting character'. He was an unfortunate soul, who seemed to attract disaster. On one occasion a riot spilled over from a neighbouring area where he lived in Belfast. The rioting hordes descended on his street and rioted along its length. One solitary car was severely vandalised - Geoff's.

One day he announced to my friend that he was emigrating to Russia, as he believed this was the right thing to do. The thing was that he had never shown the remotest interest in that part of the world, never even mentioned it to anyone, let alone his girlfriend. In fact, Geoff had never even been abroad for a holiday before. Nor did he have any idea of purpose or job when he got there. As she explored his desire to emigrate to - not just visit - Russia, she asked him what made him think it was a good idea. 'My stomach' he answered. I actually admire the stickability of my friend as they lasted nearly two years in a relationship!

In some ways I am more like Geoff than I would like to think. How many times have I said to myself, this or that 'feels' right. Or how many times do people tell me to go 'with your gut feeling'. Instinct is a useful tool for navigating the big and small decisions of life. However, when you are emotionally dysregulated, knowing what is your gut and what is an extreme reaction due to unrecognised feelings becomes a real problem.

I have learned very late in life, that I am not always as good at reading people and situations as I think. This is not because I am unable to empathise or understand facial expressions, or read and respond to circumstances in the normal course of life. It is because, when my emotions are involved, I do not always recognise that I am interacting with them through the filter of whatever emotion is predominant in a given situation. Over the past week, I have believed that someone I value highly has started to hate me. This may seem dramatic, in fact many of my reactions to everyday ups and downs in friendships and relationships are seen by others as dramatic, theatrical even, because those on the outside are not privy to the power of the emotions evoked. So, when I have a disagreement, sometimes even just an exchange of views on the current economic situation, with a friend I can feel as if I have destroyed the relationship simply based on how my gut is guiding me to interpret what is going on.

I think the feelings that 'present' most often in my gut are anxiety, fear and anger. It is hardly surprising because these are the most difficult emotions for me to manage. They invariably involve physical sensations as part of the body's normal defence responses. This is fine if I am being chased by a lion or bear and need to escape and stay alive. This is not okay, when I am in the middle of a political discussion with a friend. The feelings are natural, but in context, they are out of place. This means that my body and mind are reacting to an unreal situation, but with very real threat responses.

For those observing me, my reactions appear over dramatic and long lasting, for me bringing my threat level back to normal takes effort and skill. This process is invisible to those around me and has resulted in my being dismissed, misunderstood, patronised and belittled in the past, thereby increasing the gut feeling of threat and keeping the cycle going.

In response to these experiences, I have developed some checks and balances to make sure that when I am tempted to rely on my gut feeling, alone, I am able to slow the process down and take stock. When I realised I was reacting to my friend in a negative way, I was able to ask another trusted friend if they thought I had damaged my other friendship. I also considered the information I had on the friend I feared 'hated' me. I considered the level of reaction - hate is an extreme - was I misinterpreting a lesser emotion in him such as distraction, preoccupation with other things going on? The DBT skills are aimed at restoring balance when emotions take over and throw me off kilter.

Wise Mind helps me to walk the mid line between trusting entirely in my 'gut feeling' which in certain circumstances can be so wrong it's funny (with hindsight) and a tendency I have had to dissociate myself from all emotions and become entirely rational. The latter resulted in me being emotionally numb for over ten years, the former resulted in some of my most explosive and unflattering moments ever.

If anxiety or anger are distorting my decision making or affecting my relationships because they are misplaced or out of proportion to the situation I try the following:

1) Quickly ask a trusted friend if the situation warrants my emotional response.
2) If I have a decision to make I use Pro's and Con's to ensure that any action I take is based on something other than how I am feeling in the moment. Don't make promises when you're happy, don't make decisions when you're angry.
3) Using Wise Mind I consider my experience of a person or situation - is what I think is happening in accordance with my previous experience of that person or situation? Has anything significant changed in the relationship or situation that would make my extreme emotions understandable? Can the reaction of the person or the situation itself be understood in a less traumatic way than I am currently seeing it?

Useful worksheet for decision making from @DBTPath

Ultimately, my gut feeling is only trusted by me when I have gone through this process. Taking the time to ask myself to notice and describe what is happening around me often changes the gut feeling anyway.

And what of Geoff? Well a couple of weeks after his stomach 'told' him to up sticks and move to Russia, he was admitted to hospital with an inflamed peptic ulcer. His stomach had been out of sorts simply because he was physically unwell. He didn't get to Russia after all. My friend broke up with him not long after.

Opposite Action - the Suck it and See DBT Skill

I've gone against the grain today. I don't often feel the urge or need to spontaneously embark upon household chores. However, today I was feeling low - have been struggling a lot for the past couple of weeks.

Of course, when things are going well I don't pay attention to all of the DBT skills. I become complacent, lazy even, and revert to a few well worn skills which risk me not challenging or changing my difficult emotions at all. We are, after all, creatures of habit. When the foundational maintenance skills of the Mindfulness and Emotion Regulation modules, have not succeeded in preventing me from swinging down or up, I need to bring out the 'big guns' of Distress Tolerance and Emotion Change.

Often I don't really fancy the idea of Opposite Action, for two reasons. One is that the painful emotion is what I have become accustomed to and so I fail to recognise that I don't need, or deserve, to feel this way. The second reason is that it requires action and effort. When I am battling difficult emotions I am often weary. What I fail to remember every time I feel like this is that when I do 'give it a go', by moving and changing my posture and intention, I actually give myself a break from the draining emotions. I know that I have been told that opposite action to how I'm feeling will result in me no longer feeling as bad as when I embarked on doing the opposite action. That's why I now call it the 'suck it and see' skill.

If I'm not getting anywhere by allowing the emotion to dictate how I am behaving, then maybe doing the opposite to what I feel like doing, is worth trying.

This is how I have found myself discovering the delight of bright sparkling windows in my south facing kitchen just as the sun breaks through some threatening clouds. Having achieved this small triumph, I continued to produce sparkling dishes, enjoying the feeling of cleared worktops for the first time in a number of days. This is a reminder that when I was at my lowest my house resembled the aftermath of a house ransacking, not unlike how the ravages of my emotions had left me internally. It is this reality which means for me that Opposite Action is particularly effective. If my environment can reflect my inner turmoil, working to improve it can help me to overcome the same turmoil.

This leads me on to another aspect of Opposite Action which reveals a vital element of DBT Mindfulness; Willingness. In the past, I have struggled to understand this beyond feeling when I was challenged about it during treatment, that it meant I was being 'contrary' or 'difficult'. I have since learned that it is much deeper than that. When I decide to engage with people and life around me, then I willingly engage myself in life itself. If I shut myself away because of fear, anxiety, anger, mistrust or whatever feeling is driving me at the time, then I am saying that I am not willing to engage with the world around me. This means that I fail to enjoy the positives of life, because I fail to engage with them, for fear that in engaging with the positives, I will have to face the painful and difficult.

Today I was in danger of allowing my low mood to prevent me from engaging positively with my life as it is, rather than how I wish it could be. In deciding that I had nothing to lose in trying to do some small chores, I managed to overcome my low mood, for a time. I also have learned that my moods do not need to dictate the direction of my days. If I can overcome a mood for a minute, then I can learn to overcome it for an hour, a day, perhaps, a week and eventually I hope I will find that my moods no longer control me, but I control my moods.

What is RADICAL About Acceptance?

One of the hardest things to do is to stand still. 'Traffic Lights' and 'Statues' are two childhood games based on the skills needed to do just that, physically. How much harder though is the emotional or psychological need to stop thinking and worrying about things that have either already happened or may never happen?

After years of constant striving to escape my internal struggles, I have found myself living through a hiatus lasting more than two years to date. During this time I have had to learn to be patient, to wait, without any assurance of 'having a plan'. Who said I had to always have a five year plan anyway? Acceptance has become a necessary skill.

I have had to accept a diagnosis that seemed to tell me there was something fundamentally wrong with who I am. I don't think this is what is intended by the professionals who work within the restraints of diagnosing emotionally sensitive people. I think this is because the condition I suffer from is too complex for simple labels. I have a good understanding of what it means to live with BPD (Borderline Personality Disorder), but it seems to be exceptionally difficult to make it understandable to those around me. What I have had to learn to do is to accept regardless of the label placed on it, I struggle with symptoms which mean that I am unable to sustain the levels of achievement I have aspired to all my life. Despite outward appearances to the contrary.

Seen simply I have achieved a lot. Three completed degree courses with the accompanying professional status conferred by them. Trained, qualified and experienced Teacher and Probation Officer. A former successful competitive swimmer. Since the age of 13 until the age of 45 I have had a job. I have even managed to work for considerable numbers of years in challenging careers. On the surface, I have been exceptionally successful within those professional spheres - until my emotional and psychological instability (undiagnosed for over forty years) would cause me to come to a sudden halt. What is not so obvious is the cycles of breakdown and recovery during which I have managed to achieve these things.

I am now learning, in my current period of recovery, to accept, that even though I am capable of achieving a reasonable level of responsibility and income from any job I take on, I need to consider sustainability, given my diagnosis. In other words I need to accept that I am limited not in terms of ability, but in terms of sustainability, if I keep trying to achieve to the extent of my abilities. Instead of stretching myself to my limits, I need to accept that I have to work well within them, if I am to be able to maintain any level of stability in my working life.

Above all, I need to accept that I struggle with things in life that most other people don't have to even consider. It has taken me some time to realise this.

I am an exceptionally determined person, I have needed to be. For a long time when I was introduced to the Radical Acceptance skills in DBT (Dialectical Behaviour Therapy) I believed that to accept the limits of my BPD was to stop fighting it - to give up - to surrender. Given what I have battled all my life, this felt like admitting defeat. However, my way of fighting clearly had not worked over a lifetime of trying. In using acceptance I have been able to stop putting my energy into trying to achieve things that were impossible for me to achieve.

Acceptance means admitting that there are things in life that I am powerless to change or affect. It may seem crystal clear in the cold light of day, that there is nothing I can do to change the past and there is nothing I can do to affect the outcome of the future. However, in my behaviour and what I call 'paralysis of thought', I spent most of my life trying to relive and undo the past, or trying to predict and control the future, in the process, spending any emotional assets I possessed so I was unable to enjoy the present.

What is so radical about this acceptance? I don't know what the clinical explanation of radical acceptance is, but I do know that this level of acceptance of reality is radical in terms of its impact on my mind and feelings. As with all the DBT skills I need to keep coming back again and again to remind myself to stop fighting in the old ways and to become more familiar with using my new skills.

I have been familiar with the story of Don Quixote and the idea of 'tilting at windmills' for a long time. It is only recently that I have realised most of my energies were taken up with battling against things that only I perceived as injustices as well as real, but unwinnable battles against wrongs done to me and others. In learning DBT skills I have been able to refresh my understanding of the Serenity Prayer. It reminds me to accept my limits and learn that life doesn't always have to involve strife to make me feel 'alive'. I can learn to give up battles against unbeatable foes, so that I can begin to enjoy winning the war against my emotions. I used to believe that it was good to struggle, because it showed I was still living - still 'kicking'.

'Kicking against the pricks' is a saying which comes from the fact that in Roman times some harnesses for horses contained sharp pointed pieces called goads or pricks, which were designed to keep the horses in line. When horses kicked against them too much they could cause themselves injury.

Wisdom, for me is knowing when battling, struggling and kicking against the difficulties of life is going cause me too much pain and injury. Acceptance is learning what is wise for me to put my energies into, so that life is less about struggle and more about meaning and purpose. If I can accept that it's ok sometimes to feel pain, it's ok sometimes to be sad, it's ok to be me and it's ok for the moment, not to do anything other than enjoy what can be enjoyed in the here and now, then I am somewhere along the road to living a radically different life to the one I lived before.

Sometimes my Feelings Change my Perceptions

'Sometimes you hear things that aren't being said. When you are right it makes you astute, when you are wrong it makes you....' I finished it for her 'paranoid!'. I have some excellent friendships. A vital element for my friends is that they are able to 'tell truth to Alma'. It helps me to see through the smokescreen created by the turmoil my emotions throw up for me at times.

I don't have issues with reading into people's words or actions when things are stable. However, if anything destabilises me or causes me to become emotionally sensitive, then the cycles and waves of difficult emotions are sustained by this tendency of mind to see things to prove my sense that I am under threat.

This is related to the fact that I tend to 'mind read' people as well. Usually, the feelings that most cause these difficulties are anger and anxiety. It is as if my thinking becomes bathed in the red warning light of hyper vigilance. Because people in the past have hurt me, that means that I can never trust the words and intentions of people in the here and now.

This is where I need to use a number of strategies.

1. First of all I need to be able to recognise that I might be maintaining my distress by constantly reigniting my anxiety or anger, because I keep circling round key events and conversations related to the triggered emotions.

2. To be able to control the thoughts, I need to stop the speed and power of the emotional waves. So, I use self soothing to bring my emotional temperature down to a manageable level. This is my self soothing kit: http://bpdlifeinthemoment.blogspot.co.uk/2013/11/my-self-soothe-kit-whats-in-yours.html

3. When I am able to manage the emotions through mindful breathing, I need to stop my thinking from returning again and again to minute details in the triggering events. I use my mindful visualisation of floating leaves or clouds to let go of distressing thoughts.

4. I try to use Wise Mind to question my perceptions. Is that really what happened? Am I reading into things that were said? If someone else had been there would their perception of what went on be different? Ultimately, it is useful to have trusted friends with whom I can test my reactions. Sometimes they confirm that I have not over reacted. Other times, they seek to reassure me that my feelings have distorted my perceptions of what went on. If possible, I have one or two friends who can check out with other people involved, sensitively what went on.

This is a learning process. When I become distressed in a situation or relationship, I am learning to withdraw and not react to what I perceive to be going on, until I have been able to manage my immediate emotional reaction. This is very important particularly when the emotion triggered is anger.

In the past, my reactions in some situations have appeared to others out of proportion. I have found their consequent attempts to appease me intensely patronising, as I could not see past my clouded perception of threat. I wonder if this goes some way to explaining some of the reactions from medical staff when I have become distressed and apparently uncontrollable?

It is as if a light has gone on in relation to some difficult experiences with medical professionals in the past. I have always felt that they were minimising my distress, when, in fact they could not possibly realise that my perception of the world around me was so threatening as to make my extreme fear understandable. Because I don't have a diagnosis which has as one of its main symptoms, psychosis, the idea of distorted perception of reality does not enter many people's reckoning. Including my own.

I am learning through recovery that I need to keep managing my condition. I am still absorbing the truth that I will never be totally 'cured' and so, I need to keep making use of the skills that have helped me in the past year or so. I am also continuing to explain, as I am able the impact of my condition on my day to day life. This process is helping me to become familiar with the things that bring me down, as well as practising the skills that help me bring stability back to my emotions.

In the Lion's Den

There are many lions to face in life. The challenges and difficulties that, if left unchecked, could devour me. The most fearsome of these for me and many with Borderline Personality Disorder (BPD) is the one called 'rejection' or, more accurately, 'fear of rejection'. Given that as a child my parents could ignore my needs and, my very presence, it is logical that, as an adult, I will have an almost unshakeable belief that there is something in me which causes people to ignore or reject me - out of hand, automatically, simply because I am me.

So, for me the very process of job hunting and applying for jobs feels like launching myself, bowed and bloody, into the den of the biggest, fiercest of all my lions.

Along with Simba, in the Lion King I proudly shouted 'Hah, I laugh in the face of rejection' as I recently launched myself into the once familiar process of CV writing and application letter preparation. I seem to do this well as I manage to get myself to interview stage quite often, and this is where I meet another of my lions. Hope. If job hunting ends at the application stage, then this smaller, possibly more sinister lion remains sleeping peacefully in the background. However, the period leading up to interview always results in him awaking and growing in stature.

A little something about me. My stuggles with depression and BPD aside, I am an eternal optimist. Hence, year after year, I would put all my efforts into constructing the perfect Christmas, overspending wildly in an effort to reconstruct my dysfunctional family into my version of the 'The Waltons'. So when it comes to any little shred of encouragement ie an invitation to attend interview for a hoped for job, I will become my optimistic twin sister, who has absolute self belief. Sham. All this does is build me up for a fall. Then again, I need to be able to summon from somewhere the wherewithal to keep job hunting and moving forward somehow. I guess this may be one of my flawed coping mechanisms, although I suspect I am not altogether different from most people. I mean if you can't see yourself in the role you're applying for, then how can you possibly sell it to any prospective employer?

So far, so average. The problem for me lies not in this side of the application process, but in the emotional fall out from such investment when I am unsuccessful. Apart from natural disappointment, the million and one hurts from all the rejections of my life add up to make for one massive cold, wet, Trout in the kisser! Along with mental tiredness and disappointment following the delivery of the bad news, the rejection lion roars out his 'told you so's'. I am reduced to a quivering wreck before him. Of course he's right, every time I try to move forward, I am bound to fail simply because that's what has always happened. I mean who would want to employ me, I am after all 'unemployable'. Along with this crushing sense of self defeat, I am also assailed by the roars of derision from Rejection and his pal, Hope, 'ha, fooled you into believing that you could be valued.' Again, the overwhelming realisation that of course there's no point in my ever trying to get a job, because no one wants to have me around them, full stop, let alone working for them.

There I am on the floor of the lions' den, with Rejection and Hope (or as he has now become), his alter ego, Despair, circling me, licking their lips. I have a choice at this point, I can either allow all the missiles coming from the ghosts of my past looking on with glee to keep me down, or I can stand up and face the lions.

It's either this or give up on ever finding an occupation which can provide me with an adequate income. There are enough obstacles to my satisfying any prospective employer, given my history of mental health, without me having to overcome my own emotional and historical 'lions'as well.

This is where my reasonably newly acquired DBT Skills need to be used in earnest. I need to manage my emotional distress, because it is not nice, after all when someone doesn't choose me for a job I obviously had thought I wanted. I need to acknowledge the disappointment and hurt, that's natural and understandable. I need to make myself control the negative thoughts that are my natural default - thought diffusion exercises help with this (Mindfulness). This is where my determination and fight need to begin, otherwise I have no hope of ever re-entering the workplace. I need to learn to validate myself, unlike other rejections a work rejection is not personal - hard when I am in the thick of it to grasp hold of, but I need to remind myself that my skills were not what they wanted. It is not me as a human being who has been rejected. This, again is hard for me, as most of my sense of validation in the past came from being a high achiever in work environments. I could manage my emotions when my mind was allowed to focus on the task in hand. At the moment in my life, I don't need to be validated as a person - I have people who love me who do that. So far so very DBT, reality is that I have to repeat the use of my skills over and over as waves of self condemnation wash over me, followed closely by cycles of anxiety about my future and my ability to provide for myself.

Right now, in between the crash of the waves, I am aware that I'm no longer in the lion's den. I have begun to stumble from the grasp of my lions. The emotional waves that are crashing on me, resemble the sound waves from their roars of derision. I need to grab hold of my bottle of lemonade, and prepare myself for the next time. There is no point in me feeling sorry for myself. Yes, I've had a lot to overcome, yes it feels as if I am due some good fortune, but that's not life as it is. For me to constantly expect that life should be fair, is the real definition of insanity. After all, I just wasn't right for THIS job.