Group Therapy

You may have figured out through reading this blog that I’m not a huge fan of the different types of therapy (eg. Cognitive Behavioural Therapy). I think most of the exercises they make you do are stupid and I don’t think they have ever actually helped me. Not that they actually are stupid. Apparently they help a lot of people and if you’re one of them then that’s great for you, but I definitely am not. I’ve had many arguments with my therapist about it because she insists that they help most people and doesn’t want to believe that I am one of the few who do not benefit from it. Eventually she stopped trying to make me do them and now we just talk, which helps me so much more. In my last post I mentioned how some of the things she has said to me completely changed my perspective and helped to improve my life, and this is completely true. I benefit from her talking to me about any issues I’m having and giving me examples of what I could do instead of, for instance, freaking out.

All that being said, she convinced me to join a CBT group that she was starting for adults with ADHD. We had our first session the other night and the first question she asked each of us was what we wanted to get out of this group therapy. My response, “I don’t know.” And luckily she let me leave it at that or we would’ve been there for a while because I honestly have no idea what I expect to get from this group. I don’t have the highest opinion of CBT but my previous experience (which included attending group therapy twice) was for the depression, not ADHD. I’m not expecting much but I figure I might as well try it, can’t hurt right? The “exercises” probably won’t help me much but maybe something someone says will. That’s how it works with my therapist. There is one major problem though, the sessions are two hours long. Try getting a bunch of people with ADHD to sit still and pay attention for two hours when their meds are starting to wear off. I give her credit though, she brought “toys” that we can play around with during the session to help keep us engaged, and she encouraged doodling, which is what I did for the entire session. It helps a bit, but being seated for that long is still pretty brutal. Oh well, I'm sure we'll get through it somehow.   

Back At It

It’s been a long time since I’ve written anything, it started off as “writer’s block” and then I just kind of forgot about it. I’d like to start writing again though, to share my more recent struggles with ADHD and Bipolar and maybe help someone along the way.

Earlier this year I had a lot of trouble with anxiety and periods of emotional distress (basically just out of proportion reactions that had me sending intense emails to my therapist when something happened that stressed me out and made me anxious) but with a few medication and lifestyle adjustments we have been able to dull these down quite a bit. For the anxiety, my psychiatrist increased the dose of one of my antidepressants and had me go off caffeine (luckily for me I don’t get caffeine withdrawal) and since then I have been doing very well. I also received some “words of wisdom” from my therapist. Every time I was anxious about something she would ask me what was the worst thing that could happen and then get me to give her possible solutions if that did happen. After doing this for a few months she made me realise that no matter what happens, it’s not the end of the world and I will find a way to figure it all out and that has calmed me down quite a bit. I’m fairly chill and at ease nowadays, which is a very weird feeling for me. Reducing my anxiety has also helped a lot with the emotional distress because I don’t freak out about things anymore, but my therapist helped me as well. Initially she just had me try to distract myself when I was upset so that I could get through those periods relatively unscathed but then one day when I went to see her, we talked about my most recent distress period and she said what if you just didn’t freak out? What if you accepted that you were anxious or upset about something and then just let it go, moved on? And somehow that worked. The next time I was getting panicky I just let it go and all was good. Strange that that’s all it took but hey I’m not complaining.

On another note, my presentation skills have definitely improved. I used to get really nervous and I would be shaking while I was giving my talk but that barely happens now. I recently gave a talk and didn’t shake at all! I don’t know if the reduction in my anxiety helped with that or if it’s just that the more you give talks the more comfortable you are but I feel like it was a combination of both.

So overall, I’m doing pretty well these days, at least on the bipolar side of things. I still struggle a lot with the ADHD symptoms. The main problems are that I have a lot of trouble getting motivated to do work and that my brain goes dead around 3 pm. Now, I do tend to go in to work earlier than most people but I still wish I could work longer without my energy being drained or my brain shutting off. I guess that that’s my next goal for therapy. And maybe I would benefit from some more medication adjustments. I guess we’ll see. I’ll let you know how it goes.  

Mindfulness

       Every therapist I’ve been to has tried to get me on board with mindfulness, which is basically a type of meditation, but I’ve always been very resistant to it because there is no way I am going to sit and meditate or listen to zen recordings, etc. The therapist I have now initially tried to get me on board by introducing me to Acceptance and Commitment Therapy but I only lasted a couple of chapters. It doesn’t matter how much it will help, I am never going to sit and think of meadows or chew my food a hundred times trying to identify each individual flavour. That’s just not happening. However, she recently started me on Dialectical Behavioural Therapy which takes a very different approach and so far seems actually doable. Now, I have been seeing my current therapist for about 18 months and she has been through almost every type of therapy out there with me, all of which have failed miserably. I give them a shot but usually end up thinking that the exercises are stupid and ineffective so she was relatively surprised when she managed to finally find something that I was on board with. 

       The main reason for starting me on this type of therapy was that I experience very extreme emotions and am incapable of calming myself down so I get desperate and turn to other people to talk me down. Unfortunately, most of them are just scared and overwhelmed by it (and probably not all that pleased either) so it ends up damaging the relationship. This type of therapy starts by teaching you distress tolerance, giving you ways to self-soothe when these emotions hit. In my opinion, this is way more effective than writing out your thoughts and trying to tell yourself they aren’t true. I haven’t experienced one of these episodes since I started this therapy so I don’t know how well it works for me but it just seems much more practical. It is also applicable to trying to fall asleep, something I often have trouble with, because falling asleep requires you to be able to self-soothe (apparently this is a skill I never learned). Anyway, I have now moved on to the next section of the workbook which is mindfulness and geesh why couldn’t all the other books be this straightforward?! Within the first two pages of the chapter I knew exactly what mindfulness entailed and how to practice it without meditating for an hour. Basically mindfulness is just being aware of the present moment, recognising when your attention wanders, and bringing your focus back to the current task. How difficult is that to explain? And you can practice it at any time: when you’re reading, watching TV, having a conversation, etc. As you continue to read they do give specific exercises you can do, some of which involve picturing meadows and clouds, but they are just options so if you aren’t into it you can just stick to the basics. Eventually all this practice is supposed to improve your concentration and reduce the time you spend worrying about future and past events, making you happier and less anxious, so we’ll see how that goes. For now I’m just glad that I don’t have to meditate every day.

Me? Immature?

       ADHD comes with a number of less than desirable qualities, most of which only really affect the person with the disorder. However, there are a few that make the general public not want to associate with us, for instance not understanding social rules. It has recently been brought to my attention that children with ADHD generally do not pick up on social niceties or appropriate and expected social behaviours and this leads to others seeing us as rude and immature. The social rules that most people just know are lost on us ADDers. How do they just know it? I have no idea, it’s not like they all took a course in social behaviour, but that’s exactly what a lot of people with ADHD need. This isn’t as much of a problem when you get diagnosed as a child because you are put in therapy or have special sessions in school where you are taught all the things that the rest of the world just picks up on. But when you’ve been diagnosed as an adult, who knows how different your life would have been had you known all these social rules.

       The reason I bring this up is because I recently had to contact someone to ask for a favour and I was told to make sure I asked nicely and included some chit-chat (I’m not sure whether I should read into the fact that I was expicitly told to include chit-chat regardless of whether or not it was required). My first thoughts were “What exactly is meant by chit-chat?” and then (once my therapist gave me some examples) “I have enough trouble coming up with things to say to people I know well, I have no idea what to say to someone I’ve only talked to a handful of times.” The ONLY thing that popped into my head was the weather, and that’s because I read on a website that is aimed at helping people with ADHD develop social skills that you should always be updated on the weather and the news so that you have something to fall back on during awkward silences (and yes I realise how pathetic it is that I have to go on websites to learn social rules but like I said, ADDers need a course on this). Now I never in a million years would have thought to add in some chit-chat at the beginning of my email, the way I see it is that if you don’t talk to the person regularly they’re going to know you want something so why not just come out and say it? Why do you have to dance around the subject first and waste everyone’s time? My therapist says that it’s just expected and that people like to be buttered up a bit before being asked for a favour (in order to entice me to partake in chit-chat, my therapist has equated it to foreplay, which I feel is way more important than chit-chat but anyway) which now has me concerned about how many times I may have come off as rude because I didn’t know to start off with some chit-chat, no examples come to mind but I’m sure it’s happened a number of times. Actually, one example does come to mind, when I email my therapist I always go straight into my problem, which is probably a little bit different than doing it with someone else but it’s probably still rude. I tried to ask her if it was rude but my emails to her aren’t being delivered at the moment so the answer is forthcoming…

       This whole discussion with my therapist about social behaviour and ADHD got me thinking about a number of other examples where I didn’t conform to social rules and probably came off as immature or inappropriate. Unfortunately, there is nothing I can do about it now, and I just have to hope that, like my bipolar behaviours, people will put it behind them and realise that I’m working on it. My therapist wants to start an ADHD group so that we can be socially awkward together (actually the point is for us to learn how to associate with the general public but that’s how I view it). I’m not big on group therapy but we’ll see, and then I always have my websites. You better watch out, before you know it I’ll be a pro chit-chatter and will be out-socialising all of you! Ok not really, but hopefully I’ll improve.          

Therapists

       Today my therapist had to cancel our appointment (and all her others) and I was slightly devastated, partially because I’ve been having a “I'm a worthless loser” week and partially because I actually kind of enjoy going to see her and I already think that I don’t get to see her enough. [The weirdest thing is that I had a dream last night that she cancelled my appointment, no lie. I should really try to hone in on that apparent psychic ability.] Now, I’m sure she had a very good reason for not going to work today but I still couldn’t help being a little angry because I needed her and she didn’t show up. It didn’t matter that she really has no responsibility to me whatsoever or that dealing with me is just what she gets paid to do, the emotional part of my brain didn’t want to hear it. This is where the relationship with your therapist gets a bit tricky. You want to like them and feel comfortable with them so that you'll talk to them and they can help you, but at the same time you have to realise that they’re not really your friend. Their job is not to be at your beck and call 24 hours a day. My therapist already goes beyond this for me so I have absolutely no right to be mad at her but sometimes it’s hard to get the rational part of your brain to communicate with the emotional part of your brain.

       It gets even harder when you start to think about the fact that it’s really a one-way relationship. You are completely dependent on them for your happiness and sanity but to them you’re just another patient. I’m not saying that they don’t care about their patients but you are still just a part of their job description, they see tons of people just like you every week. My therapist told me recently that I wasn’t a parasite, that by participating in our sessions I help her hone her counseling skills (as do her other patients), but in reality that’s just what we are. We go on and on about ourselves and our problems and we milk them for their skills and strategies without giving anything back. But I guess that provides the line between friend and therapist, although sometimes it can get a bit smudged. And plus, I’m sure seeing us finally happy at the end of it all is gratifying for them, this is what they chose to do for a living after all. So I guess I just need to work on getting myself to realise that it’s not personal, that this isn’t a friend who’s blowing you off, and hopefully I can hang in there until our next session.      

Stigma

     What’s the first thing that comes to mind when you hear the words “mentally ill”?  Most likely it’s people who wander the streets, clearly experiencing a break from reality, or who’s illness is so severe that they require institutionalisation, or even an incredibly dangerous criminal. The media has done a pretty good job of stereotyping psychiatric disorders. Let’s face it, the mentally ill people we see in movies go way beyond the average definition of crazy, every serial killer portrayed either has bipolar disorder or schizophrenia. And while in some cases these portrayals are accurate, there are many high-functioning mentally ill people out there, I myself am living proof (and my therapist assures me that I am not like the people wandering the streets). But even more importantly, the majority of these people don’t pose a danger to anyone (except maybe themselves). Lately mental health associations have been campaigning in an effort to make the public more aware of the realities of mental illness and to eliminate these stereotypes (something that is long overdue). Nonetheless, when I found out I had bipolar disorder I couldn’t help but worry about what people would think about me when they found out. Would they think I was crazy? Would they think that I wasn’t capable of the same things everyone else is? Would they think I should be locked up in a padded room? Ok, maybe this is a little extreme, but you get my point. Not everyone is going to think that there is nothing wrong with being mentally ill.

     Luckily for me, I’ve yet to encounter someone who has had an outwardly negative reaction to discovering that I have bipolar disorder, but I’m sure this won’t always be the case. Then again, everyone doesn’t need to know about it. Once my medications are stabilised and my condition is under control, there will be no need to tell anyone in order to explain my manic or depressive behaviours. The only problem is that recovery can take years. You get put on this drug and that, trying out higher and higher doses of each one, you have to deal with a myriad of side effects and spend countless hours in therapy. Unfortunately, I lack any ounce of patience. I like results. I like things to be done ASAP, not to be dragged on for months.  This poses a huge challenge for me in therapy because it doesn’t take days or weeks for this type of thing, it takes months or years and this frustrates me to no end. I like my therapist---okay I’m going to go off on a tangent here for a second:

It turns out that therapy doesn’t have to involve lying on a couch while someone writes down everything you say. I know eh? Who knew? Well ok, I was aware that most people don't have you lay down on a couch but until about eight months ago, therapy (and doctor visits) for me did involve someone writing down every word that came out of my mouth. Now I understand that taking notes is generally a good thing because it allows your therapist to remember what you talked about in your previous sessions but seriously, how is having someone write down your every word comforting? Your therapist’s office is supposed to be a safe place where you can talk openly but having someone transcribing my thoughts and feelings just makes me feel incredibly self-conscience and does not make me want to talk. Enter my new therapist. The first time I went to see her I was incredibly confused. She wasn’t holding a clipboard, she didn’t show any sign of wanting to write down what I said, she was just going to sit there and talk to me, have a (relatively) normal conversation with me and not make me feel like a mental case for having to go see her. Since then, she has become the only person in the mental health profession that I have ever trusted or been willing to talk to and a big part of it is that she doesn’t shove the different approaches down my throat like it’s a one-size-fits-all thing. If I think the exercises she gives me are stupid, I can tell her straight up and then we're done with it. Plus, like I said last time, she lets me email her between visits because it’s easier for me to talk to her that way. Anyway, she’s kind of awesome (hopefully she never reads this or I’ll never hear the end of it), and if you don’t like your therapist this much then get a new one, otherwise you’ll get nowhere, trust me. 

     Alright, where was I? Oh yeah, I like my therapist and I don’t mind going to see her, but it’s such a slow process. There’s nothing I can do about it though, I’m just going to have to deal. I have now completely segued and am not sure how to bring this back around to the point of this post but basically, the media makes life seriously difficult for people like me.  Hopefully this will change but in the meantime I’d like to get stabilised so that telling people is no longer a necessity.

Three posts in as many days, can you tell that I’m trying to avoid studying?