'Should' - My Own Personal Dictator

I have lived under a dictatorship most of my life. Sometimes, especially in the early days I considered it a benign dictatorship. Sometimes, still it continues to be.

The problem for me is when 'should' is the only voice I listen to - when 'should' dictates my emotional responses to events and incidents that have already happened and I have no control over. I 'should' have done this, or that. I 'should' have said something different. I 'shouldn't' have even attempted to do this or that.

Worst of all is when my dictator tells me who I 'should' be - if I were a different person, if I could have a different life then I wouldn't be suffering. I 'shouldn't' even expect things to get any better - at least that's what this little dictator tells me when I try to improve my life and end up facing disappointments - of course things have gone wrong I 'shouldn't' have even tried to make my life better.

For too many years I have lived under the tyranny of Should. Making me do things I feel uncomfortable doing, ignoring my own needs to an extreme as I seek to prevent Should's assaults on my mind and emotions after I have attempted to do things to meet my own needs. Living in the state of Should meant that I was constantly on edge, even after I had completed tasks or meetings he would be there running through my head berating me for failing. In the end I was never at peace, always on the look out for ways that I had failed myself and others around me. Always with the expectation that I 'should' have done better. Never once asking if ANYONE COULD have done any differently.

The 'How' of mindfulness is something I often overlook in favour of the easier to practice 'what'- but 'non-judgemental' is exactly the ally I need to help me defeat the dictatorship of Should.

It helps me combat the messages about how fit I 'should' be, what weight I 'should' be, how successful I 'should' be. Non-judgemental helps me to silence 'Should' especially in the middle of trying to achieve things like taking part in social events, or trying out new skills to help me change so that I can make my life better. So rather than a constant stream of Should telling me what I'm doing wrong I try to let go of judging myself constantly: 'You should be more confident, you shouldn't talk to people, they'll think you're weird.' becomes, 'I'm going to speak to this person and focus on what is being said - there is no should or shouldn't, it's just called talking to people - it is what it is.'

The thing about dictators is that they tend to shout loud. I need to ensure that the opposition voice is as strong as Should. Unfortunately, I've given this dictator too much time and space in my head over the years. That means me telling him where to go when he pops up shouting the odds and ruining my experience of life in the here and now.

Of course, there are times when I need to do 'the right thing' by others around me. It's part of the social contract. Otherwise I risk replacing 'Should' with his odious cousin 'Me-Me-Me'. Perhaps what I need is to develop the skill of discernment: 'The act or process of exhibiting keen insight and good judgement'.

An essential part of good judgement is perspective. Being able to see things as they are. I have found that practising mindfulness has allowed me to take a step back from the constant ranting of Should. I can see that I need to ignore Should when he tells me that if I had acted differently the past would have changed. So what? I can't undo the past, it has happened, it is gone, it has no power to keep me away from living in the present. No amount of Should telling me off is going to change the past - so why give him headroom? Similarly, no amount of him telling me that I should be like another person is going to make me a different person, so why pretend that he has any power over that either? I am who I am, I have lived the life I've lived and I am where I am.

If I keep listening to Should and his insistence that I 'should' be this or that, or that I shouldn't have lived as I have lived, or that I should be somewhere else in life, then I am naturally going to make myself miserable. It is time for me to silence him and to focus on doing that which is natural to me, that which is effective in keeping me going in the here and now, and that which helps me to maintain a life worth living.

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.

My DBT House

This morning I have been preparing a session for my DBT Graduate Group which is due to meet on Tuesday. I found it on a website for counselling for children. I thought it would help our group as we try to set ourselves medium and long term goals. You see, for a group of people for whom identity is an issue which is central to our disorder, even being certain about who we are at any time is a struggle. So, we have been struggling as a group and as individuals to set any definite goals.

When I came across the DBT house, it didn't matter that it had been designed for children. As a former teacher and communicator I understand the effort which goes into engaging children in learning. Why do we inflict static learning on adults so often, powerpoint, anyone? Who said learning couldn't be fun for adults too?

First draw a house. It can be any style, but must have: a floor, a door, a roof, a chimney, 4 floors or levels and above the house a Billboard.

Now on your drawing write or draw the following:
1. On the floor (foundation) list the values you hold dear.
2. Along the walls write anything or anyone that supports you.
3. On the roof name the things or people that protect you.
4. On the chimney list ways that you ‘blow off steam’.
5. On the Billboard list the things you are most proud of.
6. On the door write the things you keep hidden from others.

Now draw the following on the levels of the house:
1. Level One: Behaviours you are trying to control or areas of your life you want to change.
2. Level Two: List or draw the emotions you want to express more, or more effectively.
3. Level Three: List all the things you are happy about or want to feel happy about.
4. List or draw what a life worth living would look like for you

It's a simple idea. One that actually builds on what has already been achieved. Despite what the storms and instability inherent in our experience of BPD tell us, we can only have survived if some basic essentials of identity have remained in place. Once again we are reminded that relying on our emotions and the thoughts driven by them are not reliable foundations on which to build our sense of self.

Instead, as I have worked my way through this exercise I have recognised that I do have some very strongly held values: kindness, compassion, a belief in justice. I have also learned that rather than being abandoned by every friend I have ever made, I have maintained some key relationships that have survived the ups and downs of my life. I am essentially likeable - that is what a fact based assessment of my relationships tells me. My feelings no longer drive my life, I am free to set myself small goals to help me achieve a more balanced way of living. More than anything, this exercise encourages me to see my recovery as a work in progress, one which is positively building a 'life worth living'.