The Art of Connecting

I am preparing a talk to a group of Psychological Professionals talking about my story in the context of my journey through Mental Health Services. In considering the factors which have helped me most in my journey I have been reflecting on the central relationships along the way and the need to break out of the isolation of mental ill health and connecting with the world around me.

When the core building blocks of human relationships have been shattered by early experience of trauma where do we begin to rebuild trust, particularly within the restrictions of the realities of accessing Mental Health interventions? That is a message I want to communicate. Where to begin? People familiar with this Blog know that I have used the acronym CLANG for the five ways of well-being (Connect, Learn, Active, Notice, Give). That way I can truly call myself a 'Clanger'! I like this order as it begins with the C - Connect.

Connecting in relationship is at the core of our identities as humans. The truth about Trauma and its impact, is that while we survive it alone, there are few who can overcome it, effectively, alone. Healing requires relationship and, more importantly, relearning healthy relationship. ‘Most of us cannot carry these moments alone; and yet there are so few among us who will make peace with our despair.’ (Sarah Bessey – Out of Sorts) We cannot admit to our need of others if we do not admit to ourselves the extent of the burden we are carrying. When we remove judgement of ourselves for struggling with the effects of trauma and accept that the pain of despair is 'understandable' and 'human', we stop isolating ourselves from the rest of humanity and give ourselves permission to reconnect.

There is a complexity inherent in the destruction of relationship and connection caused by my early experiences of trauma. It follows then, that there needs to be complexity in the therapeutic approaches through which I make my way to healing. I wonder why group therapy is so often the central medium for some therapeutic approaches. I know within the NHS the answer is 'resources'. However, the argument can be made that those of us with experience of complex traumatic experiences 'cost' the NHS when time and resources are not appropriately allocated to helping us with this central issue of connection.

Healing takes time and commitment in relationship. Brene Brown says that we should only share with people who have earned the right to hear our story (The Gifts of Imperfection: Let go of Who You Think You're Supposed to be and Embrace Who You Are (2010)). Within the therapeutic relationship of many interventions, where is the time to earn that right?

The truth is that all of us relate to one another on a one to one basis. Groups are problematic to me, there are so many barriers to my engagement based on my experiences of relationships in the past. Social Media is a particularly difficult arena for connecting.
I believe this is because it is about quantity, rather than quality. How many mental health problems are related to or exacerbated by this medium for connection? The reality is that I have capacity for a few in-depth relationships and after that there are circles of intimacy emanating outwards from me at the centre of my social networks. Right on the outside are those I relate to only in groups, clubs, teams, churches, workplaces. There can be overlap between concentric circles of connection, naturally. On the whole I build trust in you when we spend time sharing moments that matter to both.

I have asked myself what it is about the DBT structure which helped most. The answer I think is that it offers a layered, complex approach which allows me to engage from my own experience with each element of the therapy. DBT groups work by introducing skills which then are taken up by me and applied to me to fit the life I want to live.

Our deepest relationships are those which are built, slowly over time. There are shared moments of trust. I need to learn the discipline of staying put, building or rebuilding friendships over time. In the past the fear of rejection, or even my anticipation of it, meant I would up sticks and run as fast and as far as I could the moment I felt myself beginning to rely on and (whisper it) trust in any relationship.

In the past I've written about rebuilding trust through animals. When every human relationship is laden with risk and reminds me of the pain of rejection and trauma from childhood, where do you begin rebuilding trust. I think that along with self-care for those of us suffering from PD diagnoses, connection provides the biggest challenge to recovery. Animals are wholly dependent, but they are entirely and completely non-judgemental and offer unconditional love. At a very basic level I can begin to connect with a living being who trusts me. At some point every year, within our group we discuss the fears about 'letting down' a pet. So we take it a step back and start by growing and caring for seeds. This may seem simplistic and reductionist, but if we truly do not believe 'we're worth it' we can begin to illustrate to ourselves the daily care of watering, feeding and spending time looking after a living thing. It becomes a reminder to do the same most fundamental things for ourselves in order to simply exist.

We are made for relationship and when we have our basic needs met through nourishment, sleep and hydration, we can start towards building a purpose for living. Here connection moves from a horizontal focus on those around us, to the bigger 360 degree, looking up and beyond our earthbound lives to finding a connection to something that is bigger than us and bigger than our struggles in life. For some of us, this is found in a faith in God, for others, in serving the needs of others, be it our families, or communities or even the wider world.

Connecting, ultimately says to the isolated 'you belong'.

Expectations (Not Resolutions)

We all have them. We've all suffered from our own and others'. Many times they are too high for anyone to fulfil. Sometimes we most misjudge our own of ourselves. Expectations and their failure or perceived failure have caused me untold tears of disappointment and frustration. I am certain I am not alone - that expectation is bound to be met!

Misplaced and excessive expectations can cause increased distress and emotional pain at any time, but never more so than in our yearly build up to Christmas and New Year celebrations.

For the past few years I have abandoned the frankly masochistic practice of setting resolutions - why do we have to become abstemious and self denying, immediately assuming we can rid ourselves of all the behaviours which cause us untold misery over years at the stroke of midnight on the 31st of December each year? Was it Einstein who said that the definition of insanity is to keep doing the same thing, expecting a different result?

So, now I tend to adjust expectations - a bit like the Team GB Cycling Team - I now aim for 'marginal gains' making small adjustments to how I've been doing things over the past year. Looking back at my path on recovery I recognise that I have changed so many of my habits and behaviours and honestly I can say that I am in a better place this year than last. Doesn't mean that everything is hunky dory or that the past year hasn't had its battles or disappointments.

What expectations do I have for 2018?

1. For Myself. Setting unrealistic goals for myself has put unnecessary pressure on me over the years. Aspiration is all very well, but honestly, I believe that expecting myself to be perfect, to hold myself to a higher standard than I have for others has meant that a significant level of anxiety has been a constant in my life. So I need to adjust my expectations.

I am living with a condition (Emotionally Unstable Personality Disorder) which means that my emotional stability is constantly adjusting to changes in my circumstances, my body, my nutrition, the presence of other people, the absence of other people, making plans, too much work, too little work etc. This means that I quickly become exhausted if I do not 'give myself a break'. I have had to adjust my expectation that I can keep on going without any regard for my own emotional and physical needs. In the past this has led me to experience repeating cycles of recovery, giving out too much, for too long and ending up exhausted and unable to function.

I now recognise that helping others requires me to look after myself as much as I care for others. Part of the healing process is accepting that I need to be cared for in order to care for others. I cannot expect to feel connected to others by either keeping myself locked away so I do not become exhausted or becoming unreliable as a friend because I wear myself out by giving out when I have run out of emotional resources. The goals I set for myself will be helpful if I keep an eye on my limits, my realistic strengths and my need to care for myself as well as others.

2. For Others When feeling intense emotional distress it is easy to expect way too much of others. In particular, I have demanded of professionals and my friends the impossible. No human being can remove my past from me, no human being can undo the harm done to me. I think sometimes within a service which is free at the point of delivery, we have expectations of staff which are not humanly possible.

If I have waited nearly a year for a treatment, there is a sense in which I expect that on day one the therapist will wave a magic wand and all the emotional turmoil and sense of emptiness will disappear. In black and white that is clearly unfair, and if you presented me with this as an objective observation I would be shocked and deny it as an expectation. However, the reality is that sometimes my anger and frustration has been directed at those who are seeking to help me, simply because deep down my expectation is that they SHOULD be able to stop me from feeling so much pain. I have often created barriers and 'tests' which have become self fulfilling prophesies as I maintained my expectation and belief that 'No one can cope with me' and 'I am incapable of being loved and giving love'. Of course people give up when they are pushed to their limits and beyond. Unrealistic expectations result in the very rejection I always fear and, ironically, expect.

Adjusting my expectations means that the limits of the therapeutic relationship and friendship which maintain effective connection can provide a stable framework in which they can survive my emotional storms. Friends and therapists alike have their limits. I have no right to expect a friend to carry the burden of my past hurts or my present struggles. A friend is someone who walks alongside - no one - not even in the most intimate of relationships can actually live my pain for me. The therapist is there as a sounding board, not a whipping boy, as a guide, or coach. They are not a fount of all knowledge, nor are they able to 'prescribe' chemicals which can remove every painful emotion or memory. In a sense, because I have survived the actual events, the emotional pain and distress I continue to feel are the 'aftershocks'. I have the strength to deal with them, I do not have to inflict the same distress on my friends or my therapist in order for them to come alongside and help me cope in the here and now.

The most pervasive expectation I have had has been that of the 'perfect relationship'. If my loved one really understood and loved me, they would know at every moment exactly what is happening emotionally to me. They would be so entwined with me that they would be able to read my mind. Most destructive of all is the expectation that if my partner loves me 'enough' then all the pain and emptiness inside from my early experiences, coupled with my physiological make up would end. Man, what a burden to put on any relationship let alone any individual. Often, this impossible expectation is coupled with the twin one of myself, ie that no matter how self destructive to me, I will do anything to 'prove' my love. Sometimes, this toxic combination has resulted in abusive relationships which have perpetuated the destructive experiences of trauma in the past. Adjusting my expectations to taking responsibility for my own emotional balance allows me to enjoy connection and relationships which are not burdened by unrealistic expectations. Accepting that our shared humanity means we all have our limits allows greater honesty and more secure relationships.

3. For Life Life is tough. For everyone. When we are at our lowest we often assume, wrongly, that everyone else and everything else is experiencing a life that is so much more than our own. The reality is that most of life is boring when people are not dealing with crisis or enjoying high points. Often I have assumed that no one else is struggling to extent that I am. It is a symptom of emotional struggles that we fail to perceive the daily grind of most people. No one exists on mountaintops in terms of their life experience. Mountains stand out because the terrain around them is lower. The lives and experiences of others we think are better, stand out because of the relative 'normalness' of those around them. I do not know what other people's experience is of life, nor can I tell anyone else what a meaningful existence consists of. I can only decide that for myself. I cannot possibly compare myself or my feelings about life to another. There are too many variables in our comparative experiences. Nor do I have a right to judge another person for struggling, particularly if I expect that their life experience has been 'easier' than mine. I have no right to call another person's mountain a molehill. Accepting myself and the life I am living as unique to me, without comparing it that of others means that my expectations of my own life shift and don't suffer in comparison. This means that material and physical circumstances become less vital to my expectations of life.

If you are finding yourself under pressure at this time of year, ask yourself what you expect, or expected from the festive period? What do you expect of yourself and others going into a new year? Are your expectations for recovery/managing your mental health realistic? Do you expect too much from yourself and others? Do you ignore the limits of living in the real world? Are your expectations of medications/professionals/human relationships for your mental health realistic? Accept what cannot be changed, change what you can, within your own limits and maybe learn to enjoy what there is to be enjoyed, moment by moment. Resolutions sound so definite, expectations can be adjusted.

Nanny McPhee and the Therapeutic Relationship

"When you need me, but don't want me, then I'll stay. When you want me, but don't need me, then, I'll have to go" Or words to that effect. It has only just struck me that this quote from Nanny McPhee sums up the crux of the therapeutic relationship. I am into the second month since full discharge and have been reflecting on the transition from needing the support of services through wanting it more than needing it, to finally realising I no longer need the levels of intervention I have previously required.

I recently had an interesting discussion with a friend of mine who is also a service user. He now works as an Expert by Experience and told me about a psychologist colleague who had been arguing with him about the nature of the therapeutic relationship. She believed that such relationships should not be considered as friendships. My friend and I both profoundly disagreed with her. Boundaries and professional distance are essential to ensure the efficacy and the emotional health of both the practitioner and service user, naturally, that's a given. However, there is an emotional bond, or at least there has to be in order for 'unconditional positive regard' to have any hope of developing. If there is not an emotional trust, based on some aspects of friendship, then the relationship may well work to an extent, but, certainly in working with Borderline Personality Disorder, at least, a level of warmth is essential in order to bring about progress. Otherwise how can I learn what a positive relationship established with effective boundaries, but also warmth and compassion, looks like?

I guess it depends what you consider 'friendship' to be. I recognise in my friends different needs and different gifts to me from each one. Some meet my basic social needs. Some are based on shared interests and enthusiasms. A handful are deeply rooted in genuine affection and deep emotional bonds. As someone with BPD much of the therapy I received was focused on my relationships with my therapists. DBT as a therapy model, recognises this and builds in these relationships and working through the ups and downs as they develop to its methods of working.

I find it interesting that when Nanny McPhee first arrives into the chaos and mayhem of the unkempt and undisciplined children, she appears hideously ugly to them. I'm not saying that all therapists are ugly! However, it is a truism when discussing therapy that 'things get worse before they get better'. Part of this process is the setting of boundaries, and the inevitable challenging of behaviours which are generating real distress and pain on the part of the service user. So, in a way there are times when I may find it hard to 'like' my therapist, and vice versa. Such is the stuff of developing relationships of any ilk. If the relationship is allowed to continue and works in addressing the key characteristics of my emotional issues, then my perception of my therapist is likely to become more positive. So with Nanny McPhee, her warts and whiskers disappear, as genuine affection replaces her challenging discipline and the children blossom under her care.

I don't think friendship as an element of the therapeutic relationship need be a threat to the professional. It is a natural part of genuine positive regard and compassionate practice.

Whatever Happened to Gratitude?

'Yes, it's so rare to receive thanks from people, that a bunch of flowers, one time, made our team cry.' I was sitting with some friends, sheltering from the rain during a good old British BBQ. I had started the conversation because I had been taken aback by a comment from an NHS Manager, who was asking me to tell him about my recent experiences in Mental Health Services. I mentioned one or two issues that had happened during my five years in the local area, but overall I expressed my profound gratitude to my Care Co-ordinator, my DBT Therapist and my GP practice. His response was such shock, that he stopped me in the middle of my story to tell me that such positive stories of treatment are unusual. It was then it occurred to me, it wasn't the first time I had come across this shock at gratitude when talking to healthcare professionals. My friend at the BBQ is an OT working in Palliative Care, she confirmed that thank you cards, etc are exceptionally rare.

As we discussed whether or not we give thank you cards or small gifts to people helping us, we came to the conclusion that as a profession, Teachers do really well from thank you gifts, compared with other public service professions. I know this from my own time in teaching. Teenagers, in particular, are very good at saying 'Thanks' (at least to anyone outside their immediate family who they feel helps them) and I still have so many cards and thank notes from my students. The chocolates and flowers are long gone. I was a Secondary Teacher for only five years.

When I completed my DBT skills group I gave the team a large box of chocolates to share and a thank you card. I did the same for my one to one therapist and for my Care Co-ordinator. I have always given Christmas chocolates or biscuits to my GP and continued this with my Care Co-ordinator and Therapists. When I was finally discharged from Services in July I gave my Care Co-ordinator a small gift and some chocolates. After a relationship both of us had committed to for over four years, not saying 'thanks', to me would have been unthinkable. Yet, once again, she told me it was so rare to even get a thank you card from Service Users.

To me it is not just polite and good manners, although it is. It actually acknowledges that we were all committed to helping me manage my condition. I wouldn't have learned my skills, or managed the ups and downs of the last four years without these people. I give gifts to my friends. The relationships we have with those who care for us are equally as important, for the time we need services. That is why discharge is such a painful process. Especially if it is effective, both sides have invested emotionally as well as in terms of time and effort. I expect to be praised for the progress I make in managing my condition, why shouldn't my Care Co-ordinator expect to be praised and thanked for her part in that process? We absolutely know when things go wrong, we are willing to let anyone who will listen know about it. However, when things are going well with our treatment, I think sometimes it is easy to slip into the 'They're only doing what they're paid to do' view of good practice.

I think there is a wider principle that affects us in our therapeutic relationships. Gratitude generally has fallen out of favour in our society. In the US customers are better at complaining directly for bad service. In the UK, we think we are less forthright, but any time spent on any social media, or bus, will tell you that we are no slouches in the complaining department. Another of my friends told me she recently felt she should phone customer services at TESCO to tell them that she really felt their online service was a godsend. She spoke to a call centre worker, who did a double take, then thanked her for her comments. Later on that day, she received a phone call from the Supervisor who was checking she had made the call. Again, she was told that gratitude was so rare.

Don't get me wrong, I think pointing out when things are wrong in the service we receive, is important so that others don't suffer from poor service. We need to be able to know when things are going wrong in order to fix them. How often, though, do we feedback when we have received good or excellent service? It is all very well for services to speak to one another about 'best practice' but in operation, what does best practice look like?

When I read on social media the many stories of those who experience lack of people skills, lack of compassion and lack of professionalism in the care they have received, it makes me more grateful for the good experiences I have had.

I was brought up to show gratitude. We never went visiting, or for a meal without bringing something for our hosts. I witnessed my parents buy gifts for staff in hospitals that were thoughtful, hand creams, chocolates, things to be shared among teams. We gave Christmas bonuses (or boxes) to the milkman, paper boy etc. And we always gave soap or chocolates to our teachers.

I wonder if it is a practice that is dying out. I do know that when I was at the beginning of my battles with BPD and Depression I was not emotionally equipped to think about the people around me, I was too busy just struggling to get by. But today, I have made such progress that when I am able to look back and recognise how far I have come, I am also able to acknowledge the part that the healthcare professionals involved have played in my recovery. Why wouldn't I say 'Thank you'? My whole life has changed, with their help.

The NHS is under attack from all sides. When I look at the alternatives I realise that, whilst there are problems and services that are performing below par, overall I am grateful that I have been able to access five years of intensive treatment without a huge debt burden to worry about. The NHS means that I can access physical health services that enable me to manage my emotional health more effectively, again, without having to worry about finding the money to access this help. I want to be able to highlight the good practice and positive relationships I have experienced in my relationships with healthcare professionals. If you haven't done so in a while, look at your therapeutic relationships and try saying 'thanks' when things are going right. It may just reinforce best practice.

The Robinson Crusoe Effect

When I was young I used to enjoy television on a Saturday morning and one of my favourites was an old black and white dubbed version of Robinson Crusoe. Apart from the ace title music I loved the story of a man who was on an island and was desperate to get off it. My child’s view was that, of course Robinson’s efforts were all about getting off the island and back to society. However, when I studied the original novel at University I realised that Robinson’s story was much more complex than that. After many years he had adapted to life on the island until the thought of rescue in the end became something that was bittersweet.

Life with a mental illness has been described in many different ways and one which resonates with me was from Sylvia Plath, the American poet. In an autobiographical novel describing her lowest points in her late teens and early twenties she described her life with Mental Illness as being like life inside The Bell Jar. I have related to this on many occasions, as sometimes it feels as if I have been trapped in a vacuum sealed glass jar; others could see me, but I had no way of making them hear me. At times the best way I could find to describe this was that I was 'inside my own head, screaming'. If you have felt the isolation brought by depression and other mental illnesses you may relate to this sense of being cut off from the rest of humanity.

Like Robinson Crusoe, depending on how long you may have struggled with mental illness, you may find yourself feeling in two minds about ending the isolation. On the one hand, emotional distress is exhausting and there is little energy to cope with others. On the other hand, remaining isolated from others only confirms some of the more negative thoughts about yourself and stop you from receiving emotional energy from others.

For me life on the island of Mental Illness was painful, but ultimately, I was 'safe' from humanity. Basically most of my emotional and psychological wounds were the result of the actions of others. This along with the combination of my biological predisposition has meant that I have battled psychological maelstroms all my life. When I was diagnosed and offered 'shelter' in MH services, I was able to find some respite from the dangers of relationships. I have been quite happy not engaging to any emotional depth with anyone over the past nearly fourteen years, since the last traumatic breakdown of a relationship. Being 'in treatment' has meant that I have had a focus on managing my BPD and it was a convenient excuse to ignore the need to engage with anyone outside my therapy bubble. Except, I have reached a point where I feel strong enough to manage relationships. I don't trust everyone yet, 'In God I trust, all others have some way to go to prove themselves...' But I have let some people in and it's been ok. I know I am healing because I can say I am fond of certain people and look forward to their company. I still enjoy my times of solitude, but I am no longer in danger of going for weeks at a time with no human contact. I would say that I have learned that in order to cope positively with my relationships and friendships I know I will continue to need those times on my own to recharge my emotional batteries - people I think will continue to tire me.

I have now been given a date for my final discharge from Mental Health services. I know that it is testament to the journey I am completing (at least this stage). I am happy that there is equilibrium in my life. It's not perfect. I still react emotionally in situations that other people take in their stride. I continue to battle some of the demons from my past. I have developed new skills and rather than my BPD (Borderline Personality Disorder) controlling me, I am feeling that I can ride it's storms and maintain a level of stability which will allow me to step off my island and sail back to 'the mainland'. However, I am aware that I have been sheltered on my island, I have had safe places and people to whom I can speak to about my ongoing battles with my emotional extremes. I am at the point on my journey to recovery where I can see the docks looming into view and will face the prospect of walking the gangplank back to the life I was ripped from about five years ago. It's a scary thought.

However, I'm not going back to the same country. Anymore than Robinson Crusoe would recognise the world that awaited him back in England, following his many years on the island, the place I left behind no longer exists. Many of the friends I had then have fallen by the wayside. Some gave up on me, some have considered me 'lost at sea' and others just haven't been that interested in maintaining relationships in general. There are other friends, though who have strengthened the friendships with me because we have weathered the storms together. They have patiently waited for me to return from my desert island. These relationships rather than the therapeutic relationships are what will sustain me through my recovery.

I still face the pain of the final separation from people who have been really important to me, who have helped me, who have been privy to the most intimate details of my heart and soul. That's not an easy transition to make. In the past I have moved on too quickly, I have not allowed myself time to grieve friendships and relationships. The process of leaving services is yet another opportunity to learn a new way of doing things. Of allowing myself to feel grief and know that I can live with it. What is different about these therapeutic relationships is they have been honest, straightforward and have delivered what was promised. When we have had issues I have felt confident enough to be honest about the impact of mistakes on me - what has been refreshing is the level of self confidence in my CPN and therapist which has meant that they could own mistakes and we could work through the implications together.

My journey out of services has above all, been well planned. This ending has not taken me by surprise, and though I can acknowledge that it will be a difficult transition, I know I am ready to return to life after the island.