Reflections on Therapy Part 2

After my second hospitalization and after I was placed on medical leave, I started seeing a new therapist (we'll call him James). James was well versed in DBT (dialectical behavioral therapy) which is the gold standard for borderline personality disorder. Everyone, including me, seemed to think I had BPD but it didn't explain my psychotic symptoms. By this point I had been put on anti psychotics and several other medications..

James was a great listener.  I was really suffering after the disintegration of the relationship with my best friend. James was trying to make me see that dwelling was only making me miserable.  “If that lamp was disturbing your peace of mind,  would you tell me to get rid of it?” he asked “Yes” I deadpanned “but Derrick is not a lamp”

Everyday I filled out a diary card ranking my emotions and if I had self harmed or indulged in substances. For a good chunk of my life I had self medicated (usually with alcohol,  sometimes with pot) but I was sober now so I turned back to self mutilation. There was even an incident at work where I cut myself with a box cutter. 

DBT is built on four pillars: interpersonal effectiveness, mindfulness, emotional regulation and distress tolerance. I had problems with the last two particularly distress tolerance. My first instinct was either to numb or self harm. With James I learned techniques (like cold showers with all your clothes on, face baths and holding ice cubes to change your body’s temperature) as alternatives. 

James also placed me in a substance abuse group even though I had my alcohol abuse under control (my sobriety date is for Fourth of July 2016). One girl had recently gotten out of jail for heroin use. She took me to a narcotics anonymous meeting in a local church so I could see what it was like.  

When the summer ended I returned to school for my junior year.  But there were signs that had gone unnoticed.  Clues we missed.  A month into college I attempted suicide and was placed in a psychiatric ward back home.  When I got out I saw James. I felt I had disappointed him.  But he and the hospital agreed 100%. It wasn't a personality disorder.  I was bipolar type 1 and I immediately got pumped with medications.  

I didn't tell James about the day the voices told me to kill myself until much later.  Then I told him about lying in my room wondering if I would actually die.  I told him how badly the staff in the emergency treated telling me to “shut up” I told him how utterly alone and scared I was with no one comforting me through my mental and physical anguish. James listened then said “You know,  I think that's the first time you told me what happened that day”

I also went back to group therapy but it was a different group this time. James asked each of us to take a session and lead it educating people with a hobby. One woman taught optimal photography mentioning different components like lighting, angles and contrasts. She showed us an app we could use on our phone and James let us use his printer to print out some of our attempts and take them home with us. Another woman showed us gardening. James brought soil and pots and seeds and me, who had never made anything grow, planted a vine I named Amy that I took home where she thrived and wrapped a vine so long it climbed up the window and wrapped itself around it. I led the group in different poetry activities and I could see they were really engaged in it. There was no checking phones. Everyone wanted to write at least one poem plus the group we did at the end (an exercise I had picked up in the hospital). James thought I did such a good time he had me do it for the teenage group. 

I spent about three to four more years in therapy before James decided I had “graduated”. I would still see my psychiatrist (whom I had replaced with an adult psychiatrist and then replaced again after borderline malpractice) for meds and talk therapy. Being out of therapy was weird (I had been in therapy most of my life) but I felt very independent and strong. However, much as I desired this, it wouldn’t last.