Making therapy sessions better

Sometimes I leave therapy feeling worse than how I felt before it. But sometimes, therapy is really helpful, and I leave feeling heard, validated, hopeful, and knowing what to do when things get bad again.

So, I’ve been trying to think of what makes some therapy sessions better than others.

I think a big part of it is making sure I actually say the things I want to in session. If I don’t, I leave feeling disappointed in myself, frustrated with my therapist, and invalidated. This can spiral and I can start to feel hopeless and think “no one can help me,” “no one likes me,” “I’ll never get better.” Those are all-or-nothing thoughts and aren’t true.

I’m not entirely sure what the solution to this is, because sometimes I don’t know that I really wanted to say something until after I’ve left and realized I haven’t said it. It sometimes just takes me a while to get my thoughts in order.

It also takes me a while to remember stuff. My therapist will ask what was going on on x day before y, and I have no clue. I think this is partially because I dissociate, which interferes with memory somehow (I don’t know the specifics), and partially because I avoid thinking about bad stuff because it upsets me. Dissociation is essentially avoidance, so these are kind of the same thing at their core.

I guess a solution to this could be for both me and my therapist to be patient with myself during session and wait for my thoughts to come and for me to be able to say them.

I could also spend time before session thinking about what I want to talk about. Sometimes I write things I want to talk about on sticky notes and bring them to therapy. That is helpful, but I have to make sure that I do actually say the things I have written down. To do that, I have to overcome any shame or embarrassment and not feel too afraid of saying them (if they’re about upsetting things or trauma reminders).

Sometimes it’s helpful when I say, “I wanted to say something, but now I don’t,” and my therapist helps me through what’s getting in the way of me saying it, whether those emotions are justified or not, whether I need to do some grounding before talking about something hard, etc. So I guess in general it’s good to be open in therapy as much as you can.

It’s also good when I journal before going to therapy because then I know what’s actually going on and have already given it some thought. Writing things down generally helps me. Plus, if I’m avoiding saying something, I could just hand it to my therapist to read instead of trying and failing to say it out loud, or I could email it.

I’m working on it. 🙂

My relationship with death

(In case it isn’t obvious already, this is about death, and it’s dark.)

We’re in a close relationship, death and I, but it’s a rocky one.

I saw you, death, for the first time when I was in 5th grade. I had heard about you before. I had heard what you had done to my grandpa, to my friend’s dog, to many others. But I hadn’t been present to see you in the same room.

In 5th grade, I saw you come and take my grandmother away. I saw her heart rate fall, fall, fall, until it got to levels at which she was surely unconscious, and we took the monitor off her finger.

I understood that it was her time. I loved her, but it was a peaceful way to go.

Then, the summer between 9th and 10th grade, you noticed me. Before, we were just strangers in the same room. Now you introduced yourself to me. You showed me my life. I saw it flash before my eyes. It was a good life, one I was proud of. You told me it was enough. You told me to come with you. You showed me peace and beauty, the calm in the eye of the storm. You took my breath away. I said okay. I didn’t have a choice, but I said okay anyway.

But you decided not to take me then. I don’t know why. Maybe it was fate. Maybe it was God, if he exists, thinking I deserved to live longer, that there was some plan for me. Maybe it was physics, just the way things moved in that moment, and my luck of being where I was. Maybe it was that I was wearing a seatbelt. Maybe it was that I wasn’t too tall. I’ll never know why.

You turned away from me and looked at my dad. He was too tall for the car. The physics did not work in his favor. I saw and heard horrible things. For maybe five minutes, I thought you had taken him. I imagined the rest of my life without him. I regretted not loving him more. I hated you, death. You caused pain, misery, and sadness.

And yet you didn’t take him away from me, either. It was an amazing gift, one that I struggle to be thankful for today, but it really was.

Time passed. You stayed in my mind. The image of peace stayed in my mind. The horrors stayed in my mind. For better or worse, you and I were linked together.

Later, when things were too much to bear, you knocked on my door. I invited you in. At some point, we must have started dating. I thought about you often. I fantasized about you, “Death + Me” written in a heart. I wanted to be with you, but at the same time you repulsed me. I hadn’t forgotten the accident. I hadn’t forgiven you for that. But the peace was so tempting.

I kept our relationship hidden. I didn’t tell friends, family, teachers, even my therapist, what you meant to me.

We’d break up. I’d swear we were never getting back together. I’d write lists of why I wanted to stay living. I’d plan things to look forward to. I’d make checklists to follow during the times when you tempted me, so that I wouldn’t give in.

I’d go without seeing you for a while. I would try to forget. But somehow you still called to me, especially in my dark moments, especially in flashbacks, especially when I was alone.

At some point I started becoming more open about our relationship. I wrote about it in my journal. I alluded to it with my friends. I confessed to my therapist when she asked me point blank. A few months later, my therapist and I told my parents about my relationship with you. They didn’t really understand. But they loved me and wanted to support me. They wanted to help me move beyond you. At the time, I wanted to be done with you, too.

You were my guilty pleasure, death, a secret kept hidden, but also a monster haunting me. You keep proposing. You keep wanting to run away together and get married. I keep saying no. But I’ve gotten so close to saying yes.

You always ask in my weakest moments. When I’m feeling better, I hate how close I came to giving in to you.

Death, I know you will take me eventually. Subconsciously, I expect that it will be soon, but I think that’s just because the horrors you left me with make me expect to die. You’ve never left me completely. You still feel close.

In the times I’m feeling well, I don’t want to be with you. You offer peace, but it’s mixed with pain for others. You offer peace, but it’s too soon. I have plans. I have dreams. I have relationships besides the one with you. I can find peace in ways other than what you offer.

I wish I could break up with you permanently. I wish that when you finally do come, it will be many, many years from now, after a full, satisfying, joyful, loving life. I hope when you do come, I’ll be sad to leave.

For now, I am working on healing from my relationship with you.

Wanting to be my friends’ therapist

Recently I’ve been struggling with an urge to act like a therapist towards my friends who are emotionally unwell. I am not a therapist.

And I am certainly not their therapist. But, I can relate to many of the issues they struggle with. I know (some of) the issues well and know ways that I have overcome them or ways that other friends have overcome them. I am also a friend. I enjoy spending time with, appreciate, care about, and want the best for my friends. So I want to help them, and feel like I am able to help them, but…

A therapy relationship is different from a friendship. People aren’t always ready to be pushed or analyzed—they’re just saying random things, and even if the things they say are concerning, people just want to go about their day and not be bothered, corrected, or dragged into painful memories. I wouldn’t want to push that on someone, and I don’t want to act like I’m superior to anyone.

I also don’t want to constantly push advice on people, even if I think it could really help them and it comes from a place of good intent. I very rarely say, “you should…” because I know from personal experience and from hearing many people’s experiences that “should”s can be annoying and unhelpful and make people feel worse. But I do say things like, “When I’m feeling x, I find that y really helps me z” and “What if you did x?” I don’t think saying these things is harmful if I don’t say them that frequently (I think they’re probably helpful and appreciated), but if I’m saying them a lot, I wonder if it starts to get annoying.

Now that I’m thinking about it, I guess one of the main ways I interfere is to try to change my friends’ negative beliefs. I have one friend that consistently says things about how she’s lazy, she has no friends, she’s a bad influence on other people, people don’t want her around, she’s failing, etc. I feel really sad when I hear her say these things because I firmly believe they’re not true and that that’s just her depression talking. It makes me really sad that she truly sees herself this way.  I sometimes try to argue back and say that I disagree, and we can agree to disagree, or I try to remind her that I am her friend, x is her friend, and she was really worried about that last test but ended up doing well so maybe this one won’t be as bad as she expects, and Halloween is coming up so that’s something to look forward to, etc. I don’t know if I’m actually being helpful though. I suppose I could ask… asking would be a good thing to do but would require courage and finding the right time and wording it correctly.

I just want to fix all my friends’ problems.

Another part of my problem is that I’m not entirely sure how to have a close friendship without it being a therapeutic relationship. My relationship with my therapist that I’ve had for a few years was my first real place I shared a lot of things I had kept inside me for years. I feel like when I make close friendships now, they’re modeled on that relationship – I ask questions and listen similarly to how my therapist would. (Not the same way, though; I’m my own person) And the people I feel closest to are the people I talk about my mental health with.

Most of my closest friends also have mental health issues.

I’m not really sure where I’m going with writing this. I’m also not sure what to do about this in general. I’m not even sure if it’s a problem or not.

I guess the part that’s a problem for me is that I feel more distant from my friends when I’m acting more therapist-y because I feel like I’m less “on their level,” even though I am.

I also want to be friends in a way that doesn’t have to do with mental health. I guess I do this sometimes when we watch movies or go to events or cook together or talk about what makes soup soup (it was a hilarious discussion).

It’s also a problem for me because I stress about my friends not doing well, and I worry about whether I’m acting wrong and what I can do better.

And, this could also be a problem for my friends if I’m making them feel worse.

So… something to think more about later 🙂

I’m doing better

For the first time in a while, I am feeling solidly okay.

• Sirens aren’t a trigger for me anymore. I go to school in the city, and this was a huge problem for me last year. I would get caught in flashback-y/dissociative states for a few hours as a result of hearing the unremitting sirens just outside my window.
• Brains aren’t a trigger for me anymore. We look at lots of pictures of brains in my psychology class, and I am not alarmed and do not associate them with traumatic memories anymore (at least not unless I consciously prompt myself to think of the connection, like now).
• I’ve been having fewer nightmares. I haven’t had a really bad nightmare, one where I wake up in a panic attack, in a while. The few nightmares that I have had haven’t been that bad.
• I don’t feel as dependent on my therapist(s); I don’t feel as much of a need for a therapist. I think this is because I have formed other close relationships in my life where I feel comfortable talking about things similar to those that I talk about in therapy. What I want most from therapy right now is to do the trauma work (which keeps getting put off, because I didn’t have enough time left at the program I did over the summer to do the trauma work then, and then when I got a new therapist I had to get used to her, and I was overwhelmed at the start of the school year and thought I couldn’t handle anything extra until school settled down). As kind, sensitive, caring, and wonderful as my friends are, I know they don’t have the knowledge or experience (or time) to help me work through my trauma. So I still need therapy for that.
• I haven’t self harmed in a while… maybe a month? I think the past few times I have self harmed have each been about a month apart. I’d say that’s pretty good! I used to self harm a lot, maybe a few times a week, although I didn’t think of it as self harm at the time.
• I’m getting better at asking for things!
• I’m being more vulnerable with friends, gradually, slowly.
• My college feels like a real home now. Last year, my home home (place where I grew up and my family still lives) felt like my real home, and I missed it a lot. It was a better place than college. In contrast, this year, my college home is better than my family’s home. My suite there is my home, and my suitemates are my family. When I go back to my family’s home, I miss my suitemates. My suite is a much more supportive environment than my family’s home, and I feel more comfortable being vulnerable and being myself there. And my friends are there. And we’re at similar places in our lives and studying similar things, so it’s much easier to relate and get along. If I squint, I almost feel like I’ve lived here my whole life. In my suite, we have a kitchen and lots of people who love to cook. Sometimes my suitemates make food and share it because they have extra, so I sometimes wake up and am offered freshly made crepes, or come home from a long day and someone says I can have the caramel apples in their fridge. It’s really lovely.
• I declared my major! This has a lot of benefits. a) It enabled me to drop a hard, stressful class that I don’t need for this major. b) I can stop worrying about what to major in, which I had been worrying about a fair amount for at least half a year. c) I can plan out what classes to take in the rest of my time at college. d) I can see a future for myself that looks at least a little enjoyable. I am more hopeful. 🙂
• I’m doing my homework regularly.
• I ask questions more in class and am developing relationships with professors.
• I’m getting better at knowing what I need. Sometimes I need to express myself, sometimes I need validation, sometimes I need someone to know something, sometimes I need a hug, sometimes I need distraction, sometimes I need help grounding or need help checking the facts, sometimes I need a broader perspective. I am still working on this but have gotten a lot better at identifying what would help in a situation and taking steps to get it.

Using a safety behavior is like cheating on a test

I had an interesting dream last night that made me realize some things.

In the dream, my little sister was caught cheating on a test. Before taking the test, she had to fill out a form with her name, education level, employment, etc. (remember this was a dream, so it was a little weird). She made up a person, Avery Perkins, MD–an older, more educated woman–in order to seem smarter and get a better grade.

She took the test under this persona and got a B+. She had been hoping for an A+, but it was still better than the B- she got last time.

Now, her teacher had looked up this Dr. Avery Perkins my sister claimed to be and found that no doctor existed with that name. She knew that my sister had made up a fake person.

The teacher (who reminded me of my therapist) came over to my sister and told her that Dr. Avery Perkins doesn’t exist. She told my sister she was cheating. She looked at my sister with a serious, sad expression, and asked, “Do you understand why we don’t want you doing this?”

My sister said no, and the teacher continued, “If you cheat on a test or impersonate someone else and get a good grade, you assume that the good grade came because you cheated. You think that in order to get a good grade, you must pretend you are someone else. Getting a good grade when you cheat positively reinforces cheating. So you cheat more.

“The problem with this is that you never learn what happens when you don’t cheat. You don’t learn that you would have gotten the same grade if you had written your own name on the test. You don’t learn that you can take a test and be successful without anyone’s help. You don’t learn that you can do it.

“Cheating is a safety behavior. You use it as a crutch to get through the test. You rely on it. What are you avoiding? What are you afraid of?”

My sister said she didn’t know.

The teacher offered, “Are you afraid of failing? Are you afraid of disappointing your parents? Are you afraid of not being as good as you thought you were?”

My sister again said she didn’t know.

The teacher said, in a manner much like my therapist, “Well, I don’t have all day. I have other students to take care of. I want you to think about this and what cheating is doing for you.

“You’ll only learn that you can do it without cheating when you try it and see what happens. Maybe some things you thought would happen aren’t very likely to happen, or, when other things do happen, they’re not as bad as you thought.”

And she walked away and left me with my sister.

I like this dream because, as good dreams do, my subconscious uses metaphors to explain things to my consciousness. If I only try to face scary situations as Dr. Avery Perkins, using my safety behaviors, how will I ever know that I can face them?

My therapist has been talking to me a lot about exposure to the things I am afraid of and avoid. I’ve been noticing what my safety behaviors are when I do things that scare me.

A safety behavior is something that distances you from something you think would be too scary to face without it. Safety behaviors include avoiding something entirely (e.g. not going to a party out of fear of judgement), escaping from it when you’re confronted with it (e.g. leaving a party early), and avoiding in subtler ways (e.g. attending the party but not talking to anyone because you’re on your phone all the time).

I have a lot of safety behaviors. I carry around survival gear with me. I use google maps even when I know where I’m going. When I’m in the car, I physically brace myself for impact. I announce, “bump,” out loud before we drive over a bump. (I was in a bad car accident.) These are just a few. More obvious behaviors are that I never learned to drive on the highway, and I avoid going on trips with my family (I try to say no or get out of them).

I’ve been trying out mini exposures recently. I wiped up some blood (which was a big deal for me!), but I noticed that when I did it, I was sure to have lots of napkin in between me and the blood, and I washed my hands right away. So, to continue the exposure, next time I would try to do it without those safety behaviors.

I also told a couple friends that I was in a bad car accident, something I definitely avoid talking about. My safety behavior in that situation was that I laughed through the whole thing. I couldn’t keep a straight face, even though I was talking about something serious. I wasn’t fully experiencing the emotions that talking about it brought up. I was also very jumpy and tried to end the conversation as soon as I started it. I’m not sure how much control I have over the laughter, but maybe next time I’ll be more serious.

I’ve also been doing exposures to vulnerability with my parents. I try to share something vulnerable that I would normally avoid, like how I’m really doing. My biggest safety behavior there is avoiding eye contact at all costs. I also avoid eye contact when I’m telling my therapist something I’m uncomfortable with, and she has to remind me, “I’m over here, look over here at me,” and “If you don’t see my face, you won’t know that I’m not judging you or thinking you’re weird.”

My dream made me realize more deeply what I already knew logically, that I have to try the things I’m scared of without my safety behaviors, just as I am and no one else, in order to learn that they are safe and I can do it on my own.

Things I’ve learned about myself

I’ve done three weeks of my treatment program now. I have at least one more week in the program, maybe more, depending on what I decide to do. I have learned a lot of new skills and ways of behaving, but I have also learned a lot about myself!

I have learned:

• Dissociation: I dissociate a lot. I know I am beginning to dissociate when I lose track of what is going on, ask “what?”, feel like my legs are disappearing, feel confused, have trouble moving, and have trouble focusing my eyes on things.
• Minimizing: I minimize my problems a lot. I say, “Eh, I’m just having a bad day, but it’s okay,” when really I am experiencing intense fear, shame, sadness, and anger and have very strong urges to engage in my target behaviors (self harm, suicidal ideation, etc.). This interferes with asking for help because I think my problems are “not bad enough” to deserve help. But they are.
• Self-validation: It is hard for me to validate myself. I tell myself that I “shouldn’t” be feeling emotions, and I try to block them out. It is hard to be understanding and kind to myself and to acknowledge that there are very valid reasons I feel the way I do. I may be overreacting to a situation, but I am overreacting for reasons that make sense, given my life.
  • Before my therapist left for her vacation, I told her to be safe on her trip and that I was scared that she was going to die. It was hard to say that, and especially hard to say it without prefacing it with, “This is weird, but…” After some talking, I was eventually able to validate myself by saying, “It makes sense that I am scared of this because it has happened before.” My family and I nearly died on a trip once. That doesn’t at all mean that my therapist is going to die when she goes on this trip, but it is valid for me to feel that way.
  • All emotions are valid! The specific emotion, intensity, and duration may not fit the situation, but it is still valid to feel that way.
  • Maybe I look to therapists, friends, and the internet for validation so often because it is hard for me to give myself validation, yet I still need it.
  • Purposefully reminding myself of my trauma (looking at my scars, going through old papers, finding triggering things), even though it upsets me, also serves the function of validating that something bad did happen to me and that it was real.
• Judgements: I judge my feelings and thoughts a lot. Now that I think about it, this could be the reason I minimize and invalidate myself. I say out loud or in my head, “This is stupid,” “This is weird,” “I’m so weird,” “Shut up,” “It doesn’t matter,” “It’s nothing,” “It’s weird; don’t say it,” etc. I am working on being more nonjudgemental and only stating the facts, not my judgements of them. For example, “I notice that I am feeling scared. I notice that I am having an urge to run away. I notice that I feel my heart pounding.”
• Abnormal behavior: I am learning what is normal and not normal behavior for a teenager.
  • Making plans to run away from home is not normal.
  • Staying up to 1 am and sleeping in to 9, or 11 or 12, is normal for a teenager.
  • Staying in bed or in my room for five hours after a nightmare is not normal.
  • Being afraid of going to sleep and as a result doing everything I can to put off going to sleep for hours is not normal.
  • Having feelings of wanting to die every day is not normal.
  • Having panic attacks every day is not normal.
• Avoidance: I avoid a lot of reminders of my trauma, and I have many methods of avoiding them. I have a list of triggers with over 50 items. I avoid looking at said list. I refuse to share it with my current therapist. I don’t look at pictures we have in our house that remind me of the trauma. I tune out of conversations that only indirectly remind me of it. I limit the places I go. I barely watch movies or read books because I’ve been upset so many times by them. I limit the classes I take in school to avoid topics where memories might be brought up. I clamp down on thoughts of the trauma, when I have them, and I very, very rarely talk about what actually happened (even just the basics).
  • I also avoid thinking about how I am feeling. In DBT, I have to fill out a “diary card” every day with my symptoms, emotions, target behaviors, etc. When I show it to my therapist, I flip it over, push it to the side, and try not to talk about it. It is hard for me to think back and explain what was happening when x on my diary card occurred because I bury it so deep.
  • This isn’t something I’ve learned about myself but something I’ve learned in general. Avoidance is okay in the short term but a problem in the long term. Avoidance is okay when it prevents me from engaging in target behaviors. In exposure, I will gradually stop avoiding, but it will be done in safe ways. 
• Relationships: I am scared of pushing people away and losing relationships. I genuinely don’t understand why certain people don’t hate me by now.
  • I had several close friendships end abruptly in my childhood. This could be why I feel like this.
• Self-hatred: I have feelings of self-hatred and worthlessness, and think I don’t deserve kindness, compliments, or good friends.
• Wanting to be a therapist: It is common for people who struggle with mental health issues to want to study psychology and become therapists. I am not weird for secretly wanting to be a therapist or to take psychology courses, even though I’m currently studying a totally different field. It’s okay for my interests to change.
• Diagnoses: I don’t actually know what diagnoses I have, and I’m not sure if I want to ask. I know for sure that I have Post-Traumatic Stress Disorder and that I have had (but maybe don’t at the moment? not sure) Major Depressive Disorder. Other illnesses I think I have or have had at some point (but I could very well be wrong because I am definitely not qualified to diagnose myself) are Social Anxiety Disorder, Obsessive Compulsive Disorder, Hypochondria (health anxiety), Generalized Anxiety Disorder, Seasonal Affective Disorder, Pre-Mentrual Dysphoric Disorder, Borderline Personality Disorder, and Panic Disorder.

I am learning so much! It makes me sad to realize how badly I’m actually doing, but I think that that’s necessary in order to actually address my problems and recover.

What is something you know about yourself?

(here is Things I’ve learned about myself, part 2)