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'.

Treat the Past as a passing Visitor, not a Permanent House Guest

When the past comes knocking, I have some choices to make. I can ignore the knock on the door, or I can open the door and face it, or I can open the door, invite the past in and ask it to live with me. Each response will have its own consequences good and bad.

Too often I have lived with the past as a permanent house guest. It has lived in my mind with memories and waking dreams that keep the pain of past traumas alive. In a way, I helped it feel at home in my head, by engaging it in conversation, I thought I would be able to 'understand' my past and find reasons why and why not. Instead, it became comfortable and made itself at home. So much so, that I missed a lot of my present, simply because looking after my 'house guest' left me emotionally exhausted and unable to engage with the here and now.

As I have worked through the Dialectical Behaviour Therapy programme, the importance of the Core Mindfulness Module has become central to my letting go of the past and its hold on my life. It doesn't mean, that suddenly I don't have to deal with flashbacks or disturbing dreams, but it does mean that I don't have to let the memories and emotions from the past spoil my present.

When I get the inevitable knock at the door and I know it's the past lurking outside, I open the door, I acknowledge that the familiar visitor is there again. No longer, do I have to invite the past in, to make itself comfortable in my head. 'You shall not pass'! Having acknowledged that it's visited again, I close the door on it and return to my life as it is - in the present.

Here is a simple explanation of the What and How skills of basic Mindfulness:

Learning to keep your mind in the moment….

Stop Your Mind Racing… (WHAT skills you use…)

Observe

* Just NOTICE the experience – Don’t react, don’t analyse
* Have a TEFLON MIND – let thoughts, feelings and experiences just pass through your mind – don’t focus on them or hold on to them, let them SLIP AWAY
* Keep your FOCUS – don’t get distracted by thoughts or sounds or sights that take your attention away from what you are doing right now.
* Be ALERT and aware of every thought, feeling and action that come to your mind.
* WATCH your thoughts coming and going. Notice each feeling – as they come and go like waves. Notice exactly what you are doing.
* Use your SENSES – when your focus slips use one of them to bring you back to the here and now – ‘Stop and Smell the Roses’'Wake up and smell the Coffee!'.

Describe

o When you notice something – Put WORDS to the EXPERIENCE eg in your mind say ‘I’m feeling sad’…. Or ‘my stomach muscles are tightening’… or ‘I’m thinking I can’t do this…or ‘I’m walking one step at a time…’
o PUT YOUR EXPERIENCE INTO WORDS – as if you were commentating on what is going on. Don’t analyse or criticise.

Participate

o COMPLETELY LOSE YOURSELF IN THE MOMENT – get involved in the here and now. For example, Don't just listen to the music, really enjoy it and when the urge comes over you, dance - madly, badly and with your whole body committed to the experience.
o GO WITH THE FLOW – dance to the music, sing along, whatever is needed in the here and now.
o Actively PRACTICE your new skills
(see previous post: http://bpdlifeinthemoment.blogspot.co.uk/2014/02/you-mean-i-have-to-keep-going-with-all.html)

‘Taking every thought captive….’ (HOW you use your skills….)

NON-JUDGEMENTALLY
• See but DON’T EVALUATE. Stick to the facts. Don’t think about ‘good’ and ‘bad’, or ‘should’ or ‘shouldn’t’
• UNGLUE YOUR OPINIONS FROM THE FACTS
• ACCEPT each moment as it is
• ACKNOWLEDGE both the helpful/wholesome around you and also acknowledge what is negative/harmful.
• DON’T JUDGE YOURSELF

ONE-MINDFULLY
• DO ONE THING AT A TIME – When you are eating: eat. When you are walking: walk.
• LET GO OF DISTRACTIONS – if your thoughts or feelings distract you from what you are doing, let them go and go back to what you were doing – and keep doing it again and again.
• CONCENTRATE YOUR MIND – don’t multi-task, if you find you are trying to do two things at once, stop and go back focus on doing one thing at a time.

EFFECTIVELY
• FOCUS ON WHAT WORKS – do what needs to be done in each situation.
• PLAY BY THE RULES – don’t cut your nose off to spite your face.
• BE AS SKILLFUL AS YOU CAN – in the situation you are actually in.
• BE AWARE OF WHAT YOUR OBJECTIVE IS – do what is necessary to achieve them
• LET GO OF ALL THE NEGATIVES THAT HURT YOU AND DON’T WORK IN THE SITUATION AS IT IS. 

Tell the past where to go and remember:

The Past is History
The Future is a Mystery
Right now is a gift, which is why it's called the Present.

Self Soothe Image...

I find it comforting to be among nature that feels so gigantic compared to me. I've always loved standing on the shore with wild, windswept waves lashing the sand. I enjoy the sense of dizziness from being surrounded by the sheer enormity of large mountains as I pass through and I have learned to love the solidity of trees - none more amazing than Redwoods - so reassuring to walk among living things that have been there thousands of years - and when I can't be there in person I love using great photos to imagine myself right in the middle of these wonderful forests....

Time to Talk

I sat in my car, dumbstruck, wondering whether to just continue on to work, or if there was suddenly some seismic shift in me since I set out for my assessment appointment that morning. I had been struggling with Mental Health issues which I thought were related to the stress of my job for the past year. My Manager was aware that I might be suffering from bouts of depression. This, though felt really different, somehow I didn't feel as free to talk about 'Complex Mental Health Issues' with my employer. Instinctively, I knew that a label was going to change everything. And this one had a lot of baggage attached - Borderline Personality Disorder (BPD).

Being a creature of habit, I continued on to work and debriefed my Manager, deciding that both she and I were the same people we were the day before. I also decided to trust in the good sense I respected in her as a colleague working with challenging people. I was right. Together we wondered about the label and what it actually meant in practical terms for my job and me as a person. It is hard to find a good Manager, but when you do, really appreciate them. So hurdle one was over, I had told my employer that not only did I have a Mental Health problem, but it was one that I really was only beginning to learn about.

Unfortunately, the procedures in place and the attitude of the Senior Managers in charge of my area were not as compassionate about my diagnosis as the person most responsible for my day to day work. Suddenly, from being supportive the shift in sickness procedures became a focus on whether or not I was a risk to my cases. This shows a shocking lack of understanding of mental illness in general and BPD in particular. Again and again, I was referred to Occupational Health with the same questions, was I safe to be left alone with violent offenders? What impact was I likely to have on my colleagues? Sounds ridiculous seeing it in black and white, given that I had worked happily and effectively for the same team for over five years. Amazing that suddenly, I was the risk to be assessed, rather be the assessor of risk which was one of my roles at the time. Finally, they decided that they needed to pay for a private Psychiatrist (somehow all the assessments and support being given to me by the NHS had become suspect as they were all emphasising that my risk to others was minimal!!) who fudged the issue by asking me my opinion!

In the end, a combination of this ongoing process every time I took a dip in mood and the worsening of my symptoms forced me to consider an offer of voluntary redundancy. I think this kind of treatment by employers goes on without challenge simply because the cost of standing up for yourself, along with dealing with your mental illness, is just too difficult to contemplate.

A diagnosis of mental illness is isolating. Suddenly, you're not sure who and what to tell. Every conversation becomes a risk. For me it has been painful at times to realise that some friendships which have lasted a long time, foundered when my problems had a definition and a way forward. Although there are problems with the diagnosis and the label, it opened up hope that I could overcome it with effective therapies. I've had various responses from 'Rubbish, you're just depressed'... (the fact that they can say, 'just' depressed alone, gives an idea of the misunderstanding out there of the impact of mental illness),to 'don't be ridiculous, you've got your own house, car, job'.... to 'but you're so normal!'. These responses show out and out ignorance of what mental illness is and who suffers from it.

More subtle were the responses which initially seemed supportive, but as time went on and they realised that not only was I seeing a CPN, monthly, seeing my GP monthly, but I was also expected to attend twice a week for treatment at my local Mental Health unit, they started to tell me that it was silly the amount of time being taken to 'help' me. After all I had managed for over thirty years without this level of intervention. I guess these reactions demonstrate how far I had managed to mask the worst of my symptoms from those around me. By the time I was diagnosed - no one in my life at the time was aware that I frequently self harmed and that on a daily basis, I thought about suicide. Frequently, I was so overwhelmed by negative emotion that I could not function outside a work situation. When that environment was removed from me, some of my symptoms were suddenly more evident to my friends.

There is a perception of Mental Health problems as being something to be afraid of. I have begun to speak in public recently about mental health stigma and have been shocked that prejudice is found in all sorts of people from all walks of life. One of the responses is, 'but you can't have a complex mental health problem, you are not a violent person', which shows the need for real education about real people with real mental health issues. The fact is that you are more likely to be the victim of violent crime when you have a mental illness, than you are to be a perpetrator. As with many taboo subjects, headlines and media mask the truth and facts are neglected in exchange for selling more advertising, papers and programmes. I have found that this 'them' and 'us' gulf is best closed by speaking openly to people - when I'm well enough. I have also developed an upfront attitude to explaining why and where I can't cope with certain situations - 'I'm sorry being around people today is just too painful for me.' I no longer do things out of deference to other people, I am learning that when I am struggling with my emotions I need to care for myself, in the same way that I would care for myself if I had 'flu. And instead of making something up I let them know that I am unwell, just as I would with 'flu. After all both my BPD and the times when I have 'flu just tell me that I am a human being.

It is amazing that Mental Health is a subject that seems to be shrouded in mystery, something that is only discussed in hushed tones in corners. We may laugh at the older generations like my parents who refer to mental health problems as 'having trouble with your nerves'. But I'm not sure that modern attitudes are actually any more enlightened. They may have terms like depression and anxiety, but understanding has not developed any further than, 'why don't you get out and about, some fresh air and try to feel better!' Unless people actually HEAR what those of us with Mental Health issues say about how we are affected, then their understanding cannot develop any further. And if we are not engaging them in the conversation, then certainly no one is going to feel comfortable bringing up the subject.

The main thing I've found as I've spoken to different groups locally is that there are so many people out there who think they are the only ones who are struggling with mental health problems. The more we can talk to one another about the facts and reality of our illnesses and conditions, the more people will feel less isolated. Also hopefully the more people get to know individuals behind the diagnosis, the more they can see, that actually it's not 'them' and 'us', but it's any one of us who can be affected by Mental Health issues.

Acceptance is not Approval

Trigger warning: this blog deals with my personal journey through childhood trauma to forgiveness and may bring up some difficult issues - if this is likely to affect you please give this one a miss

"You know what your problem is? You've never learned to forgive."

For a start, when someone's opening gambit is to tell what your own problem is, you know the conversation is not going to be going anywhere positive. Secondly, the person speaking had never actually talked to me in sufficient depth to know if I had anything to forgive at all, let alone the real story. The reality is that I am learning to accept that I suffered physical, sexual, emotional and psychological abuse from a number of people in my childhood. Because it has been my journey, it has taken me a long time to accept that what I took to be a 'difficult childhood' actually was full of traumatic events. When you are the one living through and surviving trauma, then 'normality' very quickly becomes a distortion of other people's reality.

Forgiveness is a huge subject, for me it is central to my overcoming my past. However, no matter how I have found the process of forgiveness I don't believe that I can prescribe the 'how to' for anyone else, no matter how closely our stories may resemble one another. That is because I have learned that just as my experience of emotional and mental instability is unique to me, so my journey to forgiveness is equally unique.

I would say, though, that forgiveness is a crucial process on the road to recovery from trauma caused by other people's abuses. I do not believe forgiveness to be a single act (or determination) of the will, but it is a long and, often painful, process.

First, I have to acknowledge that I have been the victim of a wrong done to me by someone else. For me, that meant allowing that at the age of 4 or 5 I was not the author of my own physical and emotional scars. I have had to learn to view myself with compassion, often the same compassion I usually reserve for the pain of others. For some traumas this has taken me my whole lifetime, due to the depth and extent of the scarring.

It does not help to compare my wounds with those of others. I do not know what someone else has had to endure or is able to tolerate compared to me. I am not able to feel the physical pain of another person. In the same way with emotional scars and pain, I can never truly say 'I know exactly how you feel'. I may be able to say 'I think I can understand where you've been....' No one has lived my life, or survived what I have survived, so no one can know what I feel I need to forgive. It is only I who can decide who and what to forgive. And only I know when is the right time for me to forgive and 'let go'.

Second no one can decide what Justice means for me. For some, there is a need for retribution, for the validation of going through the full formal justice process. I am not able to tell another victim or survivor of abuse what Justice is for them, I only know what my need for justice is and whether I feel I need to go through a formal court process for me to feel I have achieved it.

A number of years ago I decided that I would not pursue any formal charges against those who had hurt me, because I did not have a need to protect any others at the time from abuse, and because to do so would have caused enormous hurt to others who mattered to me. I believe that there is a natural justice which has meant that I have been able - in time to leave Justice in other hands than my own. This sense of letting go has not been easy, there has been an ongoing process of recognising the wrong, acknowledging I have the power to choose which path to justice I follow and being prepared to leave the wrong doers to God/fate or natural justice, call it what you will.

I have not been able to confront any of my abusers directly and therefore, there has been no restorative process of them asking and then me choosing to forgive them. Rarely, are victims offered this opportunity, simply because of the complexities involved in the relationships between perpetrator and victim. Forgiveness, then becomes an important part of my healing process, which allows me take control and without any reference to the perpetrator, to be able to choose to forgive. This has been necessary in some instances as I have decided to maintain some kind of relationship with some who have abused me. In this process, there has had to be a radical acceptance of the fact that often those who are closest to us, may never be able to acknowledge the wrong they have done to us. Therefore, for me to move forward I have to recognise that I am the one who is capable of recognising the situation as it is and either accept it or change it. Ironically, I have found that in accepting that I can forgive without seeking retribution or justice, I have also changed my attitude to the relationships involved and therefore I have allowed myself to move forward in my own emotional healing.

The most important thing for me to say is that acceptance is not approval. Just because I accept that I was a victim, and that my abusers will never acknowledge the wrong they did to me, does not mean that my forgiveness is some form of tacit approval of the actions which caused the wounds.

Rather, I have accepted that I cannot change the past, I have accepted that there is an inner strength which has been a result of surviving my past and finally, and most importantly I have accepted that those who have hurt me, as well as the wounds from the past do not have to keep me chained up for the rest of my life. Ultimately, forgiveness and acceptance of the past frees me to enjoy the strength of character my life's journey has created in me and to stop those from the past from continuing to hurt me in the present. I am free to be myself, with all my colourful complexity, in the here and now.

Ten Tips for a Mindful Home

10 Tips for a Mindful Home

1. Wake with the sun – there is no purer light than what we see when we open our eyes first thing in the morning

2. Sit – Just be Mindful of you, your surroundings, forget the distractions of intrusive thoughts

3. Make your Bed – The state of your bed is the state of your head. Take care of your surroundings.

4. Empty the Laundry Basket – Do the laundry without resentment or commentary – focus on what you are doing, be aware as you deal with different fabrics. Use your sense of touch and smell.

5. Wash your bowl – Rinse away self-importance and clean up your own mess. If you leave it undone , it will get STICKY and longer than 24 hours will be CRUSTY!

6. Set a Timer – If you’re distracted by the weight of what’s undone, set a kitchen timer and, like a monk in a monastery, devote yourself wholeheartedly to the task at hand until the bell rings.

7. Rake the Leaves (vacuum the dog hair) – Rake, weed, sweep. You’ll never finish for good, but there is satisfaction in the job itself.

8. Eat when Hungry – Be aware of how full you feel as you eat. When you feel full, stop.

9. Let the Darkness Come – Set a curfew on the internet and TV. Discover the balance between daylight and darkness, work and rest.

10. Sleep when tired

You mean, I have to keep going with all this Mindfulness business?

When I finished my main DBT skills group it took me some time to realise that all the benefits I had gained wouldn't magically remain without some effort on my part. It's a shocker, but no treatment for long term mental health problems will help without considerable effort from me. It's not as if I wasn't warned - we had 'homework' every week and we had one to one sessions every week to help us make the skills relevant to our real lives. So why did I think that magically, the symptoms I had suffered for over thirty years would just disappear, without some significant effort on my side?

And yet, I have found myself surprised when my negative soundtrack reawakens inside my head and I lose the balance of 'wise mind' as 'emotion mind' rears its ugly head. With a start I realise, hey 'you haven't been using your mindfulness to keep on track.' Now if I weren't being mindful, that statement would be accompanied by a hefty dose of judgement. However, just because I have lapsed a bit, doesn't mean I haven't made progress or that I should even consider giving up. Life is full of ups and downs, trial and error, failure and success. The most important thing is that I have NOTICED that I'm slipping back. Falling down is not the end of the story, I can get up again and get back on the DBT horse. It would be a waste of all the effort, all the learning to live with difficult emotions, all the pleasure I have learned to find again in life, if I just give up on the things which have helped me recover so far.

So, yes, I do have to keep going with all the DBT skills. They do help me, I know this because it is obvious when I'm not using them to manage my BPD symptoms. Full recovery will take time and effort, and practice, practice, practice. After all, I had over 30 years to hone those unhelpful emotional and cognitive habits.