My Relationship Map

This is a tool I use in a course I run at our Church. It is used in the final session of five as a way to enable people to start to think about how much they are part of a community already. Some of you may be familiar with other relationship 'maps' such as the ripple effect with 'Me' at the centre and the people in my life in circles rippling outward depending on how close I feel to them. I have adapted that idea, along with the practicals of location to help people to identify where their nurturing relationships are as opposed to where their 'emotional blackholes' are ie the people who suck the emotional life out of them. It is a simple principle - how close are those who nurture me, geographically? Am I too close geographically to those who drain me? Does the location of those closest to me emotionally prevent me from building stronger relationships? etc.

When I use this tool I do not ask the members of the group to divulge any details of their relationships - it is designed as a tool to help someone to consider small changes they may want to make to their social lives to either manage damaging relationships or to encourage nurturing ones. It is a starting point and the only group discussion required is in general terms about practicalities of making and keeping contact with people who are important to us.

1) Take a sheet of A4 paper and divide it in two (landscape seems to work best) I tend to draw a line along the middle, some people fold the paper in half and make the fold the central line.

2) The central line represents ME, write this in the middle of the page.

3) On the left hand side of the line put the title EMOTION, on the right hand side, put the title LOCATION.

4) Now plot relationships along the left side of the line - the closer a person is to me emotionally, the closer to the central line I plot them. eg I am reasonably close to my University flat mate due to the length of time we have known one another. She has lived through most of my traumas without having rejected me or just let the friendship drop due to distance and time, so she is placed close to the ME line.

5) Once I have plotted relationships according to emotional closeness I then plot the right hand side of the line according to where they are in relation to me geographically eg my flat mate lives in a different part of the UK so is fairly distant from me geographically, so although she may be close to the central line on the emotion side I put her towards the extreme right hand edge of the page.

I plot as many friendships and relationships as I am able to, but focus on those who are important to me in terms of their impact on my life - for good or ill. Again, in the group I encourage people to use initial letters of names to avoid over sharing. The tool is most effective when left for individuals to reflect quietly on what they discover about their relationship networks.

It is not meant to be complicated, it is as simple as that. The important part of the exercise is in asking key questions about my relationships and how effective (or otherwise) they may be.

Some questions I have asked myself and the groups, are:

a) Is there any imbalance in the number of nurturing versus draining relationships in my life?

b) Are the people I am closest to near to me in terms of location ie am I able to encourage contact with these people easily?

c) Is there a lack of relationships that I consider close? What do I think has caused this? Are there any steps that I feel I am able to take to build new/renewed friendships that do not trigger negative emotions in me?

d) If I can't identify any close/nurturing relationships are there any relationships that I have identified as more distant that could become closer if I plan to build them?

e) Are there any relationships that are crossing boundaries and/or may be 'too close, too soon'? Do I need to put emotional distance into any of these relationships.

The questions about the map can be as challenging or easy as you want. What is important is to make a plan to change the things you may have identified that need changing. I usually give the groups I work with the homework of identifying one friend who is a positive relationship and aim to spend at least 30 mins in the following week with them doing something positive like going out for a meal or calling round for a coffee. For those recovering from mental illness, it can be a safe first step to rebuilding their confidence, socially. For those who fail to identify anyone they are close to, I encourage them to choose one person they would like to know better and do the same task of spending 30 mins in their company in the following week.

When it comes to relationships it is important to acknowledge that for most people with BPD the fear of rejection means that looking at the reality of our relationships can be extremely challenging. I do not ask people to look at all their friendships or relationships in one go. It is sometimes easier to begin with the least close emotionally first and then work towards those that are more significant as each person feels able.

One thing that repeating this exercise often has done for me is that I have been able to monitor the growth in the number and closeness of my friendships. It's lovely to be able to look back over the past three years and notice that I have been able to learn to trust people again. That's the thing, it takes time, and hard work, particularly when I fear rejection and am tempted to retreat to my previous ways of coping. What I need to keep telling myself is that, although I used to make friends easily, I often failed to sustain them long term. Now my focus is on 'building' relationships that I can rely on. Only time and steady, small contacts seem to work for me - that way I am not tempted to perform 'psychological striptease' in order to test friendships. In setting and keeping to my own boundaries, the friendships I now have are more secure and I feel less vulnerable - not least because few of my new friends know all about me and my past traumas. They just accept me as I am in the here and now.

I Spent Christmas on my Own - By Choice

It is my guilty Christmas secret. This year I decided I wanted to spend Christmas Day on my own. I also didn't make it widely known - because suddenly other people feel obligated to invite me to join them in their 'family Christmas'. It's not that I am a Grinch or a Scrooge - I love so many things about Christmas - not least because of my faith which means for me there is more than just the surface hoo-ha about it. My main reason for spending one afternoon and evening on my own was in an effort to manage a period of time which has been triggering for me in the past. In this way I have been trying to be EFFECTIVE in using my DBT skills.

I have to admit managing this feat took a number of skills and no small amount of preparation and forethought, although I will admit not remotely anything akin to the stress inducing mayhem of trying to pack family baggage into one 24 hour intense time period.

1) I tried to manage my EXPECTATIONS. No matter how hard we try the whole of the media machine is ranged against us at this time of year, filling our screens and heads with images of warmly lit family bonhomie. Not least is the imagery of groaning tables with more food than is right for any small group to consider ramming down their throats. Most of my life, Christmas Day was the day when I felt I was given attention in tangible forms. When favourite relatives eased the gap between us and our parents. The problem for me was that just like so many coping strategies this one day did not erase the pain and confusion of all the other days spent with these people. There is a confusion for the child of the invalidating parents. Despite the ongoing lack of interest in our lives, there is a bond which is unbroken. At Christmas I lived in hope that the glow I created around tiny little traditions would magically last for the next year and transform my life and family. Inevitably, usually early in the day, my expectations were disappointed. My post Christmas crashes were epic. Because I had put so much pressure on the ability of one day to transform my life and remove all my emotional pain, the fact that nothing changed would bring sadness crashing in on my head. This year, I decided to recognise that Christmas is a season. We don't have to see all our friends and relatives on one manic day even if we need it to be at Christmas for practical reasons. So, I planned a series of events. Being part of a church at this time allowed me to PARTICIPATE in a number of really enjoyable events.

2) I considered how I could CONTRIBUTE to other's experience of Christmas. Feeling part of something is a great way to counteract the sense of failure I often feel when I am tempted to ruminate on failed relationships and friendships - and my own lack of current relationships. This year I was asked to help with the script of the Nativity at church and had a part which was absorbing, right up my street and needed a great costume. I really enjoyed channelling my inner Victoria Wood! It is interesting that this invitation to take part would not have happened if I had not taken smaller, manageable steps early in the year to contribute to drama in the church, as well as stepping in to run Sunday Club during the summer break. It was great to help out with the children's work, without feeling the pressure of responsibility. It also helped that I am up to date with my CRB (or whatever the letters are now) status. Preparation for Christmas then, has meant a continuation of the involvement I have tried to develop as part of my DBT ACCEPT skills.

3) I didn't try to pack my enjoyment of Christmas into just one day, I decided to be MINDFUL of all the small things I enjoy about the Christmas Season. I identified cinnamon and winter spices as the smell I wanted to focus on. I have returned to enjoying cooking and, latterly baking. I found the processes of preparing, baking then eating my produce allowed me to practice focusing on ONE THING AT A TIME. The effect of this aspect of mindfulness is to stop me thinking myself into either a state of anxiety or of unsustainable excitement, which is generally followed by an almighty crash in mood. I managed to bake some presents for some people who have helped me throughout this past year. I also spread out the events and socials I was involved in over the whole Christmas and New Year period. So, I started with the script and practices for the Nativity, the Nativity itself. I was invited out for coffees by a number of friends, some old, some I have made in the last year. For the first time in years I planned a Mulled Wine party, and enjoyed the preparation for it. I kept the numbers down and held it in the house of a good friend which was bigger than my own and therefore able to hold the gathering comfortably. I was assured that I am a good hostess and I was able to show off my newly developed baking skills - I even pulled off some of the lightest, yummiest mince pies EVER!! My Christmas season is not over, I and my brother looked at our diaries and have planned a lovely family 'chill' day on 2nd January - so we get to exchange presents and chill out at the end of the holidays too. New Year's Eve I usually lock myself away and hide because I find it harder than Christmas - this is when I feel the lack of an intimate relationship the most in the year. With some very good friends, I am planning a Cowboy evening to introduce their children to classic westerns - of course the menu will include beans.

4) On Christmas Day itself, I went to church which was packed and really enjoyable. Because of my preparations I didn't feel weird about all the children and families sitting in groups, leaving me to pick out the spare seat at the end of the rows. A couple of friends joined me and we all sat together in our own 'group'. A good friend who has been divorced for some time, was doing Christmas differently this year. She didn't fancy a big dinner with family so she spent the morning with her daughter's family and grandchildren opening presents. She then visited friends and family for the rest of the day - I was one of them. We laughed and ate cake and coffee for an hour, then she went to her next 'call'. Both of us made our own Christmas. Lots of friends and family phoned or texted with greetings. I was able to graze my way to my dinner in the evening. The menu was entirely my choice. I didn't have to rush to eat more chocolates than I wanted in case my favourites were swooped down upon by others.

Throughout all of this I have made a conscious decision not to overspend. This is hard for me, because the only validation available to me as a child from my parents was in the form of material things. In the past one symptom of the emotional hangover from Christmas was debt which usually took me until April to clear. Through my baking and spending time with people I have learned a new way of feeling good about giving. Because I have spaced my time with people out, I have been able to be sociable from emotionally recharged batteries, rather than feeling completely drained by Christmas Eve.

POSTSCRIPT: I have found it interesting to see the discomfort of people who suddenly realise, 'Oh no, Alma's going to be on her on ON CHRISTMAS DAY!!' The thing is I live alone 365 days a year. I am lucky I have caring friends and my brother's family with whom I feel comfortable. Yet, for me there are many times when I feel alone. Weekends throughout the year are hard. It is so difficult in summer when I think 'I'd love to just pop out to the Lakes for the day', but it's not safe to do that on your own. I have learned to enjoy drinking a coffee on my own in a cafe. I am a long way, though from being able to go to the cinema or theatre or a restaurant on my own. How come the people who have invited me with such concern to 'join them and their family' for Christmas lunch never think to invite me at other times? I know that I am lucky to have the choice. I didn't mind my close friends who checked with me in the summer about my Christmas plans, I mean the folk on Christmas Eve who suddenly notice too late. Why should it matter to them simply because it is one 24 hour period? I am doing well socially, what about the other people who maybe didn't appear at any events over Christmas because it is too hard to be among people? They probably didn't even get the last minute, panic invite. Life is lived everyday, not just on Christmas!

My Christmas Self Soothe Habits

I once heard a famous musician state that he reckoned it took over 10,000 hours of practice to master a new skill. That means, not become a master of it, but to become proficient in it. That gives me pause to think when I expect perfection almost immediately when trying to learn new skills. Let me put it this way, 10,000 hours equates to 416 days - that's well over a full calendar year spent doing nothing but practice the new skill.

DBT Core Mindfulness is a simple skill to grasp hold of, but is hard to master. Most of the DBT skills are like that, some people find themselves doubting their effectiveness because of their simplicity. However the reality is that if I work at applying self soothing skills, for example, to my day to day life, then not only do I find them becoming a habit, I find that they begin to permeate my thinking.

If I apply the effort required to master any skill ie well over a year spent doing nothing but that skill, then I realise that the time spent in even the most intensive DBT therapy only gives me approximately 182 hours of practice. Of course those 182 hours assume that I have done nothing but practice mindfulness, say as a single skill. So what? Well it has brought home to me the fact that any hope of the DBT skills I have learned becoming effective in helping is dependent on how much effort and time I invest in developing and honing those skills in my day to day life. Seems obvious. Yet I continue to berate myself for feeling as if I don't deserve to enjoy life, or I feel as if I am a complete failure if my mind wanders when I am trying to be mindful, or if I find myself 'multi-tasking' and therefore not being as effective in a task. However, in real terms I have only been practising these skills for just over two years - in mastery terms I am well short of the 10,000 hours required to be merely competent and that's okay, because outside of being able to bend the laws of time and space I have no option but to live my life in a moment by moment stream.

Which brings me to Christmas - or rather my self soothe Christmas habits. Having used mindfulness and other DBT skills over the past year or so, for the first time in ages I feel as if I am awake to Christmas. Suddenly, I am more aware of how things are changing around me. In the past my experience of Christmas was masked by an emotional mesh over my senses which filtered out the more enjoyable aspects. Along with many others in society I have absorbed the lie that 'it's for the kids' or 'the most important thing is family'. Hardly any wonder that so many who don't have children in their families, or don't have perfect families (isn't that everyone?), or are isolated have a pervading sense of disappointment, from what is a two week, or if you take in advent, a four week season. More than any other time of year the pressure is on to either live in the future (THIS year we're going to....etc.) or the past ('remember when we used to do this, I always loved Christmas'). What a time to really focus on practising mindfulness.

I like to think about it as 'Mindfulness Max' - our senses have so much to be aware of and notice, that we can take our time and really focus on the here and now. Thoughts and memories bombard us from the future and past, derailing our mindful maintenance of moment by moment experience OR giving us the opportunity to build up our mindful skills.

1. SIGHTS - There is no way this aspect of Christmas can escape anyone. One of the real pleasures of the dark days of winter is the appearance of coloured lights in windows and in shops. Even the sight of a bright pink Christmas theme in a garden centre was a pure joy to behold, if only sharing the joke with some friends that it did indeed look as if Barbie had thrown up all over the place! The reason the lights hold such delight for me is because it is such a contrast to the drab winter world outside my window.

Even when I couldn't manage to do any real Christmas decorations in my home, I tried to have a couple of candles. If that is all you can manage to cope with I encourage you to light one, turn off the electronics, for as long as you can cope with it, and watch the flicker of the flame. As with all mindfulness exercises, if you notice thoughts or painful memories, just bring yourself back to simply describing WHAT you see in front of you - what colours are there in the candle? How does the flame move? Flames in candles or fireplaces are fascinating and soothing, especially when we sync our breathing to them.

2. SOUNDS - I don't mean the brash music that blares out incessantly, I mean the sounds of winter outside. I was amazed last week when walking down a ginnel (that's an 'alley' in northern lands) I heard what sounded like hundreds of birds really close to me. I realised when I stopped and looked closely at the hedge beside me that flocks of tiny bluetits and sparrows were chirping away in the middle of a stormy winter day. I have also discovered the soothing tones of Pentatonix - they are an a capella group who have brought some fresh sounds to some very familiar Christmas songs - they don't sound remotely dirge like. The lack of over produced brass and orchestration we have grown used to in our Christmas music is so restful to me. Equally, some Christmas cheesy classics have the familiarity of old friends or comfy slippers.

3. TASTES - at Christmas we can wage all out war on our taste buds - assaulting them with sugar and fat. This year I have rediscovered my love of cooking and baking. I am planning to reinstate my Mulled Wine party - the smells of mulled wine is matched by its soothing taste - a must have for Christmas. Along with the flavour of cloves I love the taste of cinnammon, I enjoy mince pies, short shortcrust pastry and...brussel sprouts! And why not? I have noticed that it is taking me so much longer to eat my meals - I used to be a 'bolter', now I have learned to savour most meals - not only has it helped me to regain my love of cooking, it has also improved my digestion.

4. SMELLS - these are closely allied to taste. Because of this, I think smell can be problematic in that it can evoke so many memories. Because Christmas is about tradition most of our food will have a history. For me making a menu change means that I can truly create a break with the past - this year I am doing a traditional roast beef dinner. I am learning that traditions are only valuable when they help me to enjoy the season. If I am diverted to the past then maybe the tradition needs to be replaced with a new one.

5. TOUCH - this can be a problem for those of us who live alone, or who are not in an intimate relationship. For me, touch has meant beginning with the safety of my dog and cat. Initially the cat was good for me, as he didn't overwhelm me with demands for affection. Dogs are different, dogs need you, they want to be close to and they constantly present themselves to you for strokes and cuddles - at least my dog does! Another thing I have learned to really enjoy is trips to my hairdresser. I have developed a friendship with my hairdresser - it is a positive relationship and one that I trust. I have learned to indulge myself when going for a hairdo. It takes between two and three hours, depending on how laissez faire I'm feeling about my 'do'. I am plied with coffee, trashy mags, gossip, laughs and most soothing of all: the head massage! I know and trust the staff well enough to be able to just close my eyes and focus on the experience of having the tension massaged out of my scalp - it feels safe and offers me human touch without any agenda, hidden or otherwise!

If I am tempted to wander into wishing, or hoping, or regretting about the future or the past, my task becomes to shift the focus of my senses so that they tell me about the here and now. It's okay, I still have 9,680 hours to go before I master that skill.

Small Things

When your mind and body are wracked with emotional pain, it is so difficult to do the most simple routine things. Few people who have never experienced mental illness, understand the physical impact of such struggles. When you manage to do small things, don't belittle them or discount them, Celebrate them, it has cost you and is a real achievement. The Black Dog Tribe have shared this cartoon which sums it up nicely:

When it hurts to get up and about remember the following:

1) Be kind to yourself - you would give others a break if you saw them in the same situation.
2) Be realistic about what you can do safely
3) Celebrate the small things
4) Try to enjoy the sense of achievement

Life Post DBT therapy - self help or no help?

Since being discharged from Mental Health Services in the summer, my work as a Church Mental Health volunteer has exposed me to responses to impending discharge that are different from my own. Again and again, I have encountered an expressed need to continue in a 'safe', supported environment. Usually, this has resulted in people seeking to develop and/or join peer support groups. For those who have gone through hospitalisation and intensive group therapy, there is a shared experience and understanding of certain conditions which makes peer support highly desirable. I myself have found the online peer support available through twitter and blogs to be invaluable in my ongoing DBT practice.

Certain websites have been a real help too, by providing encouragement, advice and practice from other DBT graduates. In particular, dbtselfhelp.com is an excellent resource. I have found the following article about 'The Self Help Myth' has challenged a number of assumptions I have made about the need for ongoing contact with 'peers' following graduation from the main DBT programme: http://www.dbtselfhelp.com/html/the_self_help_myth.html The article presents an interesting discussion of both the problems and solutions to the self help conundrum:

"When we first presented this idea [of a Peer Led Graduate Group] to Marsha Linehan, she told us right away that it wouldn't work because of the nature of BPD (or people with similar types of diagnosis'). People with BPD have trouble with boundary confusion as well as inappropriate behaviors when triggered by stories similar to their own and have the tendency to be addicted to crisis. We balked at this response, certain that we could make it work anyway if all the participants were focused on a goal.

But Marsha was correct. The boundaries required for leadership were outside the skill set of group members. Triggering behavior often required professional intervention. Plus, when feelings were hurt or when someone felt panic, we were unable to provide the kind of validation offered by professionals. In a peer-led situation without training it was unrealistic to ask our leaders to rise above their own lives and issues in order to exert control of the group. We even tried creating a set of rules and circumstances and guidelines that groups would have to follow. But truly, the nature of the diagnosis is ill-suited to a peer-led environment."

Helpfully, DBT participants in the USA have had a number of years to develop thinking and experience about DBT so they have tried, failed and tried again to find a way forward. It is encouraging that the same website has followed the progress of different post DBT groups in the USA which seem to be having more success. However, nearly all have had the active participation of Mental Health professionals.

My attitude to peer support has been different to some. Because I belong to a strong faith community outside of the therapeutic setting, the main aim of my development of skills, has been to allow me to build a strong social network in 'the real world'. I found the protective environment of services to be a haven to which I could retreat when I was struggling to learn and practise the DBT skills when they were new to me. For some time now, I have felt it's time to move outside of that 'safe zone'.

For me, it was crucial to keep my focus on what a 'meaningful life' looked like. That included being able to build and maintain relationships that were not dependent on a shared experience of mental illness. Although, I know that most of my new friends have had a willingness to learn about my condition and the skills that help me manage it, so I have learned that some other people outside Mental Health services, are prepared to accept me as I am. Some of my former friends have never been able to reconcile themselves to the reality of my ongoing emotional and psychological struggles and I have had to accept that they are lost to me. That has allowed me to practice the DBT skill of Radical Acceptance.

If my therapy and recovery only work in helping me develop relationships with people who struggle with the same diagnosis, or with the people who work in those settings, then that is not allowing me to develop a balanced social life. I think that this issue is shared across all mental health conditions. Stigma and the fear of rejection, naturally mean that people will gravitate to 'safe' places and people. Unfortunately, the structure of services in the past has kept people in a cycle of discharge, relapse and return to 'safe' therapeutic settings. Perhaps, this goes some way to explaining the revolving door experience of people with BPD.

Having said that, there is a need for a stepped progression from group therapy towards life after discharge. Peer support clearly has a part to play in that progress. I think that peer support works if it keeps me focused on the positive practice of my DBT skills. If I can 'recharge' my mindfulness batteries ready to return to the world outside. If I am encouraged by my peers to keep developing the skills which will enhance my life and help me to build a 'life worth living'.

These concerns were foremost in my mind when I wrote a short five week programme for our church. Finally, working alongside the Vicar we developed a series of workshops aimed at helping people coming out of Mental Health services, to integrate into the community. It is not designed to be an ongoing support group, but can help by introducing people with similar experiences, although mostly a range of diagnoses from Bipolar Disorder to Anxiety and Depression. I have found that initially people were disappointed that it wasn't a 'support group', but in the last year that we have been running it, group members have developed positive friendships within the groups which have continued after they have completed the course. In addition a number have been happy to introduce others to the course and have themselves ended up helping me to run public events, such as our Suicide Awareness Day in November.

I know some people reading this will disagree with this approach. Everyone's experience is different. The pace of recovery and progress out of services varies according to each person's experience. I don't legislate for anyone else, but, for me, the growing sense of confidence in my day to day DBT practice as well as my growing social life is a testament to the fact that moving out of my safe zone has been positive for me.