If therapy isn’t working, what’s next?
April 11, 2021 12:49 PM Subscribe
I’m having an extremely hard time grasping what my issue is, and how exactly to treat it. I feel like I’m not a person.
I have no strong relationships. Most of the time I feel sad, grey, blank, lonely, consistent emotional pain. I feel like I can never get enough attention to feel good. I eat healthy, exercise a lot, sleep fine, work an office job. I kind of have a few ‘friends’ but I don’t know that we actually enjoy each other’s company. I’ve been in therapy on-and-off since childhood (many different therapists over the years). Therapists regularly suggest that it’s not depression, and I’m inclined to agree because it does feel more complicated and sinister than that.
On SSRIs I felt even emptier and less like a person (which is the most painful feature of my problem). Bupropion made me very angry, no other effect, buspirone did nothing. I don’t like the concept of trying a ton of medications especially because it feels like my core issue is maybe that I just misunderstand how the world works? For example, I didn’t know you could be truly honest with therapists. Not one ever saw through my ‘lies’ about how great everything is. For a long time I believed I was lucky to have been born into my circumstances (which I now recognize were actually wildly abusive). It feels akin to (but how would I know?) growing up brainwashed by a cult. I was told in many ways throughout my childhood that no one would ever truly love me, I was ugly, annoying, a monster, difficult, etc.
I feel that what’s helped me more than anything is reading other peoples’ life stories and learning that my upbringing wasn’t normal. That knowledge improved my self esteem and helps me orient myself a bit better in that I realize not all people actively want to abuse me now, but just knowing this doesn’t help with the extremely painful gnawing hole in my chest.
I apparently don’t have object constancy, and I do feel like a very young child who really wants their parent, and I try to find my ‘parent’ in the people I date. Sometimes I find a partner who adores me and I always drive it into the ground because the attention is never enough for me. I used to date very emotionally unavailable people, but now I date emotionally available people and the problem is the same.
My last relationship fell apart because I looked for attention outside of our relationship (never feel like I get enough attention). I now understand that this is common in BPD and it’s what led to my diagnosis. I’ve been with my decent therapist for over a year, and just now they said it “sounds like BPD”. Despite having gone through so many therapists and sticking with this one twice weekly for a year, I’m looking again for another therapist and starting to feel like maybe there’s really no help for me. DBT sounds like a joke, honestly, and I feel like I've already been practicing all of the 'skills'. I’ve seen this community give wonderful advice, and hopefully something you say might resonate with me and point me to the light.
People say “be your own parent,” and I’ve tried to apply it for years but it's not working. How do you exactly validate your own feelings or whatever if you don't even feel like a person? I do ‘treat myself well’ but also it’s pretty hard to do when you don’t make much money. I meditate. I don’t do negative self-talk. I feel wary of volunteering because I feel like I'm pouring from an empty cup and I get resentful. I want friends and a partner, but my personality is so unusual and unstable that it’s not conducive to interacting with people. I want to be a person, but I don’t feel like one. Have you been here? What’s helped?
I have no strong relationships. Most of the time I feel sad, grey, blank, lonely, consistent emotional pain. I feel like I can never get enough attention to feel good. I eat healthy, exercise a lot, sleep fine, work an office job. I kind of have a few ‘friends’ but I don’t know that we actually enjoy each other’s company. I’ve been in therapy on-and-off since childhood (many different therapists over the years). Therapists regularly suggest that it’s not depression, and I’m inclined to agree because it does feel more complicated and sinister than that.
On SSRIs I felt even emptier and less like a person (which is the most painful feature of my problem). Bupropion made me very angry, no other effect, buspirone did nothing. I don’t like the concept of trying a ton of medications especially because it feels like my core issue is maybe that I just misunderstand how the world works? For example, I didn’t know you could be truly honest with therapists. Not one ever saw through my ‘lies’ about how great everything is. For a long time I believed I was lucky to have been born into my circumstances (which I now recognize were actually wildly abusive). It feels akin to (but how would I know?) growing up brainwashed by a cult. I was told in many ways throughout my childhood that no one would ever truly love me, I was ugly, annoying, a monster, difficult, etc.
I feel that what’s helped me more than anything is reading other peoples’ life stories and learning that my upbringing wasn’t normal. That knowledge improved my self esteem and helps me orient myself a bit better in that I realize not all people actively want to abuse me now, but just knowing this doesn’t help with the extremely painful gnawing hole in my chest.
I apparently don’t have object constancy, and I do feel like a very young child who really wants their parent, and I try to find my ‘parent’ in the people I date. Sometimes I find a partner who adores me and I always drive it into the ground because the attention is never enough for me. I used to date very emotionally unavailable people, but now I date emotionally available people and the problem is the same.
My last relationship fell apart because I looked for attention outside of our relationship (never feel like I get enough attention). I now understand that this is common in BPD and it’s what led to my diagnosis. I’ve been with my decent therapist for over a year, and just now they said it “sounds like BPD”. Despite having gone through so many therapists and sticking with this one twice weekly for a year, I’m looking again for another therapist and starting to feel like maybe there’s really no help for me. DBT sounds like a joke, honestly, and I feel like I've already been practicing all of the 'skills'. I’ve seen this community give wonderful advice, and hopefully something you say might resonate with me and point me to the light.
People say “be your own parent,” and I’ve tried to apply it for years but it's not working. How do you exactly validate your own feelings or whatever if you don't even feel like a person? I do ‘treat myself well’ but also it’s pretty hard to do when you don’t make much money. I meditate. I don’t do negative self-talk. I feel wary of volunteering because I feel like I'm pouring from an empty cup and I get resentful. I want friends and a partner, but my personality is so unusual and unstable that it’s not conducive to interacting with people. I want to be a person, but I don’t feel like one. Have you been here? What’s helped?
Damn! I hit post when I meant to hit preview! To sum up, I want to say, hang in there. Your life is hard, it's going to suck for awhile probably, but there is the very real possibility that you'll make out and have an incredible, rich, rewarding life full of love, somewhere down the line. You can make it there. It's worth it to try. You are worth it. You can't see that, but it's absolutely f***ing true. I wish you all the best.
posted by WalkerWestridge at 1:55 PM on April 11, 2021 [19 favorites]
posted by WalkerWestridge at 1:55 PM on April 11, 2021 [19 favorites]
What is the reason you're looking for another therapist? That one seems like they had the point and you were with them for a year. Is it worth staying with them?
I was raised by a narcissist/pleaser pair, and yes when I am not in a relationship with someone I do not feel whole. I get very lonely at night even now, when I am in a good relationship. I don't think the quiet gnawing emptiness really goes away entirely. This is an existential thing that a lot of mediocre but popular writers have made careers out of describing, and you're really not alone in feeling it! What has helped me has been vigorous exercise, other tending to my body (massage and that kind of thing), keeping on top of monitoring feelings of HALT (hungry angry lonely tired), and going out and meeting enough terrible, dumb, gross people until I had met a few worthwhile people. The Lonely part of that HALT is important to combat.
What really helped is the realization that I am a genuinely energetic, cheerful, mostly happy person, even an extrovert. All my previous self images of being a tired, pained, quiet, solitary person were just reactions to attempt mentally and emotionally escaping perceived captivity with my family and schoolmates and my admittedly painful body. Once all the chronic bodily pain, attachment style woes, raised by cluster-B personality, dating people who are sad for me, stuff was partly out of the way (and still only partly), I found a person underneath who does a lot of things during the day and with good cheer.
My recommendation is to get yourself into a daily situation that makes you feel good on a spiritual level. No matter what it takes. You have to, simply, change whatever you need to. The last time I had to do this a few years ago, I had to blow up my entire life. I broke up with my misapprehended partner of 6-7 years, quit weed (at least for a good year or so..), moved neighborhoods, changed jobs multiple times, joined a gym, all within about 6 months. There was a month before this frantic period, when I was separated from my partner and job-searching and apartment-searching, when all I did was work, get super baked and binge Game of Thrones, and check those searches on the internet. It was like a sadness-and-junk-food cocoon from which I emerged like a butterfly, with a smoking crater where my heart used to be. But I'm realizing that the crater was always there! And some of it always will be.
Volunteering may not be the worst idea honestly. The important and useful thing about going out and meeting people, as someone who needs happiness and good attention from the rest of humanity, is that you are going to be disappointed. Why not be disappointed in a safe and predictable environment? When it's safe to do so and I can return to going out at night sometimes, I know I will meet some real dingdongs out there in world, people who I will genuinely regret giving my time and attention. And that's okay! It's just exposure therapy. You can volunteer, for example, and have experiences like serving food to scowling unhappy ungrateful people and getting yelled at. Then, you'll have survived an annoying moment and you can laugh about it later with your friends. Sometimes you have to like, recalibrate your notions of a bad time.
One of my mainstays is karaoke. I'm going to be very excited to go to my favorite dingy gay bar, suffer through some truly bad singing, and then put myself in front of everyone and blurt through a cheesy song, and get applause. Also, there's the chance to hear a stranger with a truly beautiful voice just being themselves in front of God and everybody. It feeds the ego beast, is a mix of fun and not-fun, and it's a socially acceptable pastime. If you can find some pastime like that, you'll feel more normal and human, before during and after the event, I guarantee it.
posted by panhopticon at 2:15 PM on April 11, 2021 [10 favorites]
I was raised by a narcissist/pleaser pair, and yes when I am not in a relationship with someone I do not feel whole. I get very lonely at night even now, when I am in a good relationship. I don't think the quiet gnawing emptiness really goes away entirely. This is an existential thing that a lot of mediocre but popular writers have made careers out of describing, and you're really not alone in feeling it! What has helped me has been vigorous exercise, other tending to my body (massage and that kind of thing), keeping on top of monitoring feelings of HALT (hungry angry lonely tired), and going out and meeting enough terrible, dumb, gross people until I had met a few worthwhile people. The Lonely part of that HALT is important to combat.
What really helped is the realization that I am a genuinely energetic, cheerful, mostly happy person, even an extrovert. All my previous self images of being a tired, pained, quiet, solitary person were just reactions to attempt mentally and emotionally escaping perceived captivity with my family and schoolmates and my admittedly painful body. Once all the chronic bodily pain, attachment style woes, raised by cluster-B personality, dating people who are sad for me, stuff was partly out of the way (and still only partly), I found a person underneath who does a lot of things during the day and with good cheer.
My recommendation is to get yourself into a daily situation that makes you feel good on a spiritual level. No matter what it takes. You have to, simply, change whatever you need to. The last time I had to do this a few years ago, I had to blow up my entire life. I broke up with my misapprehended partner of 6-7 years, quit weed (at least for a good year or so..), moved neighborhoods, changed jobs multiple times, joined a gym, all within about 6 months. There was a month before this frantic period, when I was separated from my partner and job-searching and apartment-searching, when all I did was work, get super baked and binge Game of Thrones, and check those searches on the internet. It was like a sadness-and-junk-food cocoon from which I emerged like a butterfly, with a smoking crater where my heart used to be. But I'm realizing that the crater was always there! And some of it always will be.
Volunteering may not be the worst idea honestly. The important and useful thing about going out and meeting people, as someone who needs happiness and good attention from the rest of humanity, is that you are going to be disappointed. Why not be disappointed in a safe and predictable environment? When it's safe to do so and I can return to going out at night sometimes, I know I will meet some real dingdongs out there in world, people who I will genuinely regret giving my time and attention. And that's okay! It's just exposure therapy. You can volunteer, for example, and have experiences like serving food to scowling unhappy ungrateful people and getting yelled at. Then, you'll have survived an annoying moment and you can laugh about it later with your friends. Sometimes you have to like, recalibrate your notions of a bad time.
One of my mainstays is karaoke. I'm going to be very excited to go to my favorite dingy gay bar, suffer through some truly bad singing, and then put myself in front of everyone and blurt through a cheesy song, and get applause. Also, there's the chance to hear a stranger with a truly beautiful voice just being themselves in front of God and everybody. It feeds the ego beast, is a mix of fun and not-fun, and it's a socially acceptable pastime. If you can find some pastime like that, you'll feel more normal and human, before during and after the event, I guarantee it.
posted by panhopticon at 2:15 PM on April 11, 2021 [10 favorites]
Best answer: Of all the therapists you've been through, have any of them been for-real actual trauma specialists? I'm pretty horrified that in your summary above the only acronym is BPD (a super-controversial dx, doubly so if you are a woman) and nothing about PTSD (Complex PTSD still isn't in the DSM, but it's on its way in and most trauma specialists are on board - it's useful for differentiating between long-term/ongoing/repetitive trauma versus an event-based or short-term originating experience), which would be the diagnosis to at least start differentiating from in the case of an abusive childhood.
With descriptors like "maybe not understanding how the world works", not feeling "like a person" (whether that is upper-case Depersonalization would be for a trauma and personality disorder specialist to explore with you), lack of object impermanence, plus the kind of emotional dysregulation that often results in BPD-like diagnoses, it just feels like you've not managed to connect with someone with the right credentials. (Certainly CBT or DBT general therapy isn't going to get at any of this stuff, though they might be used as an aspect of a treatment plan.) That may be because you hadn't been telling the truth, particularly about your childhood experiences?
It is also possible that you are on one or more axes of neurodivergence, which even outside of trauma (or, well, this is A trauma) can put you in a position of not feeling you understand how the world works as well as issues with object permanence. Even if you are a young adult who grew up in the age of (varying qualities of) school intervention, those services are still out of the reach of kids who don't have at least one parent strongly advocating, and in any case if you were perceived to be poor, non-white, and/or Otherable in some way.
All of this to say that you may not be an ideal patient for the average therapist. And as much as this gauntlet is daunting and expensive, that may mean you need to start with a psychiatrist in order to get the testing that gets you access to those specialists. Maybe you've done all this and just didn't want to get into it, hence the question "what comes after?" but if you haven't I would encourage you to try. Or maybe a two-pronged approach while you try to get access to the right kind of psychiatrist while simultaneously trying to find a qualified non-MD counseling therapist (you may want to look for someone with LCSW credentials or whatever your state calls someone with a counseling social work education) OR if you're really lucky there may be an entity in your area that provides team-based trauma treatment, which is a thing that has started popping up often in conjunction with a university/teaching hospital.
You might also raise the question to your current therapist, too, just to see if they have conceptualized a treatment plan that uses techniques from trauma methodologies or not, and if so why not. Make sure they know how you feel - maybe show them the parts of this question that describe how you feel and your background and make sure they've registered all those things.
posted by Lyn Never at 2:22 PM on April 11, 2021 [20 favorites]
With descriptors like "maybe not understanding how the world works", not feeling "like a person" (whether that is upper-case Depersonalization would be for a trauma and personality disorder specialist to explore with you), lack of object impermanence, plus the kind of emotional dysregulation that often results in BPD-like diagnoses, it just feels like you've not managed to connect with someone with the right credentials. (Certainly CBT or DBT general therapy isn't going to get at any of this stuff, though they might be used as an aspect of a treatment plan.) That may be because you hadn't been telling the truth, particularly about your childhood experiences?
It is also possible that you are on one or more axes of neurodivergence, which even outside of trauma (or, well, this is A trauma) can put you in a position of not feeling you understand how the world works as well as issues with object permanence. Even if you are a young adult who grew up in the age of (varying qualities of) school intervention, those services are still out of the reach of kids who don't have at least one parent strongly advocating, and in any case if you were perceived to be poor, non-white, and/or Otherable in some way.
All of this to say that you may not be an ideal patient for the average therapist. And as much as this gauntlet is daunting and expensive, that may mean you need to start with a psychiatrist in order to get the testing that gets you access to those specialists. Maybe you've done all this and just didn't want to get into it, hence the question "what comes after?" but if you haven't I would encourage you to try. Or maybe a two-pronged approach while you try to get access to the right kind of psychiatrist while simultaneously trying to find a qualified non-MD counseling therapist (you may want to look for someone with LCSW credentials or whatever your state calls someone with a counseling social work education) OR if you're really lucky there may be an entity in your area that provides team-based trauma treatment, which is a thing that has started popping up often in conjunction with a university/teaching hospital.
You might also raise the question to your current therapist, too, just to see if they have conceptualized a treatment plan that uses techniques from trauma methodologies or not, and if so why not. Make sure they know how you feel - maybe show them the parts of this question that describe how you feel and your background and make sure they've registered all those things.
posted by Lyn Never at 2:22 PM on April 11, 2021 [20 favorites]
Best answer: Consider that you might have PTSD rather than BPD. Numbing, avoidance, "not feeling like person" can be symptoms of complex PTSD. You might want to ask your therapist about this, and if you look for a new therapist, seek one trained in therapy for those who have experience childhood trauma. Which you certainly have. I wish you the very best.
posted by KayQuestions at 3:12 PM on April 11, 2021 [6 favorites]
posted by KayQuestions at 3:12 PM on April 11, 2021 [6 favorites]
Best answer: It may be the quality of attention rather than the quantity. It also could be that you have trouble allowing yourself to experience the attention because it can be too uncontrolable (will it last? will they not like what they see? etc.)
These things are subtle. Nothing about you sounds BPD to me. Diagnoses are crude instruments. It doesn't sound like you feel any of your therapists understood you. Did they know you didn't feel understood? Saying you don't have object constancy is making your lack of trust which you come by honestly into a symptom--like it's your fault.
Some people "don't feel like a person" because they're neuroatypical. in a society that thinks everyone should be like some norm. Since you like reading others life stories, try some stories from the neurodivergent and see if you can relate.
posted by Obscure Reference at 3:56 PM on April 11, 2021 [4 favorites]
These things are subtle. Nothing about you sounds BPD to me. Diagnoses are crude instruments. It doesn't sound like you feel any of your therapists understood you. Did they know you didn't feel understood? Saying you don't have object constancy is making your lack of trust which you come by honestly into a symptom--like it's your fault.
Some people "don't feel like a person" because they're neuroatypical. in a society that thinks everyone should be like some norm. Since you like reading others life stories, try some stories from the neurodivergent and see if you can relate.
posted by Obscure Reference at 3:56 PM on April 11, 2021 [4 favorites]
I would wonder about complex PTSD with depersonalization. I would wonder about trying trauma therapy if you haven't yet. Specifically something like Somatic Experiencing, Sensorimotor Psychotherapy, or EMDR.
Therapy can work on what you're describing but talk Therapy often doesn't help much. This sounds like the results of a brain being primed for pain and unable to activate the pleasure/joy/play pathways. Trauma processing can help with that. MeMail me if you want help finding someone in your area that offers the kind of treatment I'm talking about.
posted by crunchy potato at 3:57 PM on April 11, 2021 [10 favorites]
Therapy can work on what you're describing but talk Therapy often doesn't help much. This sounds like the results of a brain being primed for pain and unable to activate the pleasure/joy/play pathways. Trauma processing can help with that. MeMail me if you want help finding someone in your area that offers the kind of treatment I'm talking about.
posted by crunchy potato at 3:57 PM on April 11, 2021 [10 favorites]
And if you want something free, "Crappy Childhood Fairy" has a website with a free "daily practice" and many free YouTube videos.
posted by crunchy potato at 3:58 PM on April 11, 2021 [8 favorites]
posted by crunchy potato at 3:58 PM on April 11, 2021 [8 favorites]
I have no idea if this would be a good fit for you, but have you considered volunteering at an animal shelter or fostering or adopting a pet? Dogs and cats are so giving and nonjudgmental and if you are up to the everyday routine of feeding and other tasks, an animal could help you feel like you are a complete person.
Hugs to you. Your path sounds hard, and please know that I’m rooting for you.
posted by computech_apolloniajames at 4:46 PM on April 11, 2021 [1 favorite]
Hugs to you. Your path sounds hard, and please know that I’m rooting for you.
posted by computech_apolloniajames at 4:46 PM on April 11, 2021 [1 favorite]
I'm a big fan of Internal Family Systems (IFS). It's a relational therapy designed to heal complex trauma. In IFS you have considerable agency: your therapist is more of a trusted guide and advisor than an authority figure. You're not "under their care," which I find mistrustful and patronizing, you're drawing on their expertise as you heal yourself. I have found IFS to be wonderfully affirming. If storytelling appeals, this is your ticket.
IFS is like having a round table with all the parts of yourself— literally. You learn to dialogue with and honor each aspect of your personality, even (especially!) the ugly painful ones. This in turn helps you revive and nourish the healthy core self that your childhood experiences taught you to squash. You know that empty gnawing void? Growing your identity is what fills it. As you unlock compassion and curiosity for yourself, you begin to bring these qualities into relationships with others. It is staggering work but it is so, so worth it.
Good reads on complex trauma:
"The Body Keeps The Score" by Bessel van der Kolk
"Complex PTSD: From Surviving to Thriving" by Pete Walker
"The Drama of the Gifted Child" and "The Body Never Lies" by Alice Miller
"Trauma and Recovery" by Judith Herman
"Waking the Tiger" by Peter Levine
Psst: You know that part of you that hides your blankness from therapists, from everyone around you? IFS believes that part is not only useful, but honorable and good. Because each part serves a vital role, if you can uncover what that role is, you can relieve the part's burdens and transform it. Dysfunction --> function.
I think somatic work could be really helpful, too. Anything that grounds you in your body.
posted by lloquat at 5:47 PM on April 11, 2021 [15 favorites]
IFS is like having a round table with all the parts of yourself— literally. You learn to dialogue with and honor each aspect of your personality, even (especially!) the ugly painful ones. This in turn helps you revive and nourish the healthy core self that your childhood experiences taught you to squash. You know that empty gnawing void? Growing your identity is what fills it. As you unlock compassion and curiosity for yourself, you begin to bring these qualities into relationships with others. It is staggering work but it is so, so worth it.
Good reads on complex trauma:
"The Body Keeps The Score" by Bessel van der Kolk
"Complex PTSD: From Surviving to Thriving" by Pete Walker
"The Drama of the Gifted Child" and "The Body Never Lies" by Alice Miller
"Trauma and Recovery" by Judith Herman
"Waking the Tiger" by Peter Levine
Psst: You know that part of you that hides your blankness from therapists, from everyone around you? IFS believes that part is not only useful, but honorable and good. Because each part serves a vital role, if you can uncover what that role is, you can relieve the part's burdens and transform it. Dysfunction --> function.
I think somatic work could be really helpful, too. Anything that grounds you in your body.
posted by lloquat at 5:47 PM on April 11, 2021 [15 favorites]
I'm not a mental health professional, but many aspects of your situation (emotional numbness, isolation, feeling "ghostlike" or otherwise not like a real person) sound quite similar to my experience with the ongoing effects of repeated (i.e., complex) childhood trauma.
For me, CBT and DBT techniques were only useful up to a point. Eventually they hit a wall for me and became sources of frustration. I think that's because those methods are better at treating some of the effects of complex trauma (which for me manifested as social anxiety and depression), but CBT and DBT methods never touched at the causes, i.e. the trauma itself.
posted by cubeb at 5:48 PM on April 11, 2021 [4 favorites]
For me, CBT and DBT techniques were only useful up to a point. Eventually they hit a wall for me and became sources of frustration. I think that's because those methods are better at treating some of the effects of complex trauma (which for me manifested as social anxiety and depression), but CBT and DBT methods never touched at the causes, i.e. the trauma itself.
posted by cubeb at 5:48 PM on April 11, 2021 [4 favorites]
So, I usually avoid saying this because it comes off as elitist, and there are lots of amazing LCSW and LPCs doing great work, but in your case I really think it's safe to say credentials matter. Have you seen a clinical psychologist (PhD level) trained in trauma therapy? Because I think that has the potential to be genuinely helpful. DBT can be helpful for traumatized people who have developed maladaptive coping/relationship skills (I am of the opinion that BPD is just a specific manifestation of trauma). It will not actually address the trauma itself, though.
I really need to emphasize the trauma-trained part. Because it's easy to think every therapist is primed to deal with abusive childhoods and this is one hundred percent not the case. In my clinical psychology program, the way the classes are set up, only 50% of students get any training in trauma whatsoever because the trauma class is only offered every other cohort. And that's at the PhD level, where we get 5 years of training (vs master's level which is only 2). I think you may find that therapy with a trauma-trained licensed clinical psychologist may be a vastly different experience for you.
I get if you don't want to try again with therapy, though. The unfortunately reality is that a lot of therapy out there... just sucks. MeFi likes to say "go to therapy!" and I agree with them, but the process of finding a good therapist is so, so draining. I don't have life story books to recommend off the top of my head, but you may find some insight in Trauma and Recovery by Judith Lewis Herman. It's not directly related to your question, but if you also happen to have chronic health issues, Why Zebras Don't Get Ulcers by Robert Sapolsky may also be enlightening re: the connection to trauma, so I recommend that one a lot too. Overall, I think just researching and reading on trauma is likely to be more enlightening and helpful to you than looking into DBT or depression on their own.
And hey. The fact that you've tried so much, and so many times? That's good, hard work. I'm sorry it hasn't amounted to what you need--but the fact that you're still making the effort, in the face of everything you've experienced, is amazing. I just want to recognize that.
posted by brook horse at 5:53 PM on April 11, 2021 [19 favorites]
I really need to emphasize the trauma-trained part. Because it's easy to think every therapist is primed to deal with abusive childhoods and this is one hundred percent not the case. In my clinical psychology program, the way the classes are set up, only 50% of students get any training in trauma whatsoever because the trauma class is only offered every other cohort. And that's at the PhD level, where we get 5 years of training (vs master's level which is only 2). I think you may find that therapy with a trauma-trained licensed clinical psychologist may be a vastly different experience for you.
I get if you don't want to try again with therapy, though. The unfortunately reality is that a lot of therapy out there... just sucks. MeFi likes to say "go to therapy!" and I agree with them, but the process of finding a good therapist is so, so draining. I don't have life story books to recommend off the top of my head, but you may find some insight in Trauma and Recovery by Judith Lewis Herman. It's not directly related to your question, but if you also happen to have chronic health issues, Why Zebras Don't Get Ulcers by Robert Sapolsky may also be enlightening re: the connection to trauma, so I recommend that one a lot too. Overall, I think just researching and reading on trauma is likely to be more enlightening and helpful to you than looking into DBT or depression on their own.
And hey. The fact that you've tried so much, and so many times? That's good, hard work. I'm sorry it hasn't amounted to what you need--but the fact that you're still making the effort, in the face of everything you've experienced, is amazing. I just want to recognize that.
posted by brook horse at 5:53 PM on April 11, 2021 [19 favorites]
I now understand that this is common in BPD and it’s what led to my diagnosis. I’ve been with my decent therapist for over a year, and just now they said it “sounds like BPD”
A lot of people talk like BPD is part of the only cluster of personality disorders they've ever heard of (and if you are a woman, the only one, period.) There are, or used to be, others, and if I were you I would look into those others. on the off chance it sparks some new ideas, or even just new vocabulary for the same concepts. This is all somewhat outdated now regardless, but therapists do not check for new updates nightly like computers do, so what the hell.
One of the traditional ways to feel you are a real person is perceive that other people are real - to feel, as well as to know. That is one function of a therapist for people in your situation, and it is the opposite of the function of a therapist for many other people.
you describe having a particular role-relation you crave, and casting one person after another in a role. To do this, the individual person cannot be as important to you as what they do for you. (not an insult, just an attempt to paraphrase what you've written: "I apparently don’t have object constancy, and I do feel like a very young child who really wants their parent, and I try to find my ‘parent’ in the people I date." ) If you are able to become attached to a person as a person, not for the role they fill - because real people who can be loved change roles the time, are not constant archetypes, are not always parent-figures even to their own children - you may be able to feel yourself a person too. because if the object of your care isn't interchangeable or anonymous, isn't reducible to a role or a function, neither can you be. It may not be good to get too much of your identity from somebody else, but knowing you are yourself because you love X is better than knowing you are somebody because X loves you. this isn't everything, but it's something.
anyway, a lot of therapists work really hard at being a role, not a person, and will consciously consider themselves stand-ins for important figures in your life. This may be helpful for patients who don't notice larger patterns until they are pointed out. But you know your patterns and have a the opposite trouble. It may be that therapy isn't the way out for you because therapists do all have a stable role they cannot ethically dismantle. but maybe a simple change of therapeutic perspective will be enough to start something.
this all boils down to: you seem to be having trouble establishing yourself as a successful author of affections but you have been expending your energies trying to earn them from other people. the wrong direction. you have found people who would "adore" you but you do not say that you have found many people whom you yourself adore and want to look after. mistrust of your own affections or disbelief that your own love for others is as important as theirs for you is common in people with miserable childhoods of all sorts.
forgive the tweeness but in the story of the velveteen rabbit you are the human child, but you have been trying to find the solution proper to the stuffed rabbit and it will never work because you are already real. loving is more important than being loved.
posted by queenofbithynia at 6:39 PM on April 11, 2021 [14 favorites]
A lot of people talk like BPD is part of the only cluster of personality disorders they've ever heard of (and if you are a woman, the only one, period.) There are, or used to be, others, and if I were you I would look into those others. on the off chance it sparks some new ideas, or even just new vocabulary for the same concepts. This is all somewhat outdated now regardless, but therapists do not check for new updates nightly like computers do, so what the hell.
One of the traditional ways to feel you are a real person is perceive that other people are real - to feel, as well as to know. That is one function of a therapist for people in your situation, and it is the opposite of the function of a therapist for many other people.
you describe having a particular role-relation you crave, and casting one person after another in a role. To do this, the individual person cannot be as important to you as what they do for you. (not an insult, just an attempt to paraphrase what you've written: "I apparently don’t have object constancy, and I do feel like a very young child who really wants their parent, and I try to find my ‘parent’ in the people I date." ) If you are able to become attached to a person as a person, not for the role they fill - because real people who can be loved change roles the time, are not constant archetypes, are not always parent-figures even to their own children - you may be able to feel yourself a person too. because if the object of your care isn't interchangeable or anonymous, isn't reducible to a role or a function, neither can you be. It may not be good to get too much of your identity from somebody else, but knowing you are yourself because you love X is better than knowing you are somebody because X loves you. this isn't everything, but it's something.
anyway, a lot of therapists work really hard at being a role, not a person, and will consciously consider themselves stand-ins for important figures in your life. This may be helpful for patients who don't notice larger patterns until they are pointed out. But you know your patterns and have a the opposite trouble. It may be that therapy isn't the way out for you because therapists do all have a stable role they cannot ethically dismantle. but maybe a simple change of therapeutic perspective will be enough to start something.
this all boils down to: you seem to be having trouble establishing yourself as a successful author of affections but you have been expending your energies trying to earn them from other people. the wrong direction. you have found people who would "adore" you but you do not say that you have found many people whom you yourself adore and want to look after. mistrust of your own affections or disbelief that your own love for others is as important as theirs for you is common in people with miserable childhoods of all sorts.
forgive the tweeness but in the story of the velveteen rabbit you are the human child, but you have been trying to find the solution proper to the stuffed rabbit and it will never work because you are already real. loving is more important than being loved.
posted by queenofbithynia at 6:39 PM on April 11, 2021 [14 favorites]
Sorry for my typos above, I have a broken hand. I second brook horse above: if therapy isn't working you may need a therapist with more training, like a PhD level psychologist. For medicine, you may need an MD who specializes in psychopharmacology. Getting yourself to these more highly trained professionals may result in a more accurate diagnosis, and more effective medication. For example, in my reading I see that for complex PTSD buspirone can be effective, but sometimes only at higher doses than is standard.
You are suffering. You are asking what to do if therapy is not working. You are seeking another therapist. It may be helpful to seek a higher level of care.
posted by KayQuestions at 9:29 PM on April 11, 2021
You are suffering. You are asking what to do if therapy is not working. You are seeking another therapist. It may be helpful to seek a higher level of care.
posted by KayQuestions at 9:29 PM on April 11, 2021
Best answer: My opinion is going to differ slightly so take what you want, it is an opinion.
First depersonalization is awful. I suffered from it for years. And therapists are bad at it. There are no medications that are proven to treat depersonalization. None, so don't bother with psychiatry unless you are looking for other benefits (decrease in anxiety symptoms, decrease with difficulty sleeping whatever, but disassociative symptoms ultimately aren't studied enough and there's just nothing on the market for them).
Depersonalization is this nightmare of reconnecting to yourself and it's hard. I had to start litterally building me as an adult. Keeping journals about what makes me human, opinions, desires whatever. I also had an eating disorder so i started with food. Do i like x or y more? Do I like x or z more? As i still can't answer favorite questions usually (what's your favorite blank is this awful question for me). I begged my therapist to do a body trace with me (basically just teaching tracing an outline of myself on paper) because I super wasn't convienced i was real and i saw it on a tv show once. It actually was a extremly helpful excersize, but my therapist was like uhh, i have no idea what I'm doing. Ymmv. But yeah, depersonalization has all been any slowly connecting me to myself. Noticing my feelings when they are happening and not after. Finding clothes that feel comfortable. Finding a hair style i like. Establishing things that interest me. Hobbies.
Echoing trauma therapists only. I usually use an EMDR certification as a quick did somebody go out of their
way to learn extra stuff about trauma as a screen when looking for somebody.
Now, regarding the BPD. It sounds like you do have very specific actions and reactions that pop up during relationships that fit the BPD pattern, and DBT is good at giving tools to just... Not act on that pattern. It is ultimately a emotional regulation toolkit, and absolutely nothing more. It's not necessiarly useful for all the stuff surrounding and foundational trauma work (like feeling like a person, object permanence) but is a way to learn how to stop acting out patterns when you have super strong feelings. But DBT and disassocative stuff really don't go together, because people who tend to feel more flat, unreal see the exercises as pointless and are usually over regulated not under to begin with. You might find that most of the time you over regulate, so you are really looking at at trauma activation in a relationship context only, where as BPD tends to have disregulation across many parts of their life effecting coworking relationships, friendships and others like therapeutic relationships. If you don't care until you care too much, that might be more disassociative and less BPD. But, if this l the push pull of relationship feelings is super strong for you and overwhelming DBT might be useful tools for those moments.
Most BPD therapists do have some understanding of trauma (it is well known that people who suffer from BPD have significant backgrounds in trauma), but the approach is more about some foundational skills to keep with a therapist long enough to do longer term work than actually doing the long term work I think. So that you are able to stick with a therapist long enough (i think a year is long enough) then feel free to move to a therapist that specializes is in something else.
In terms of disassociation, I really liked reading The Stranger in the Mirror by Marlene Steinberg. This does a great job and I think it is really useful in explaining what is going on and found it very useful to be able to describe what was going on with me.
posted by AlexiaSky at 12:20 AM on April 12, 2021 [10 favorites]
First depersonalization is awful. I suffered from it for years. And therapists are bad at it. There are no medications that are proven to treat depersonalization. None, so don't bother with psychiatry unless you are looking for other benefits (decrease in anxiety symptoms, decrease with difficulty sleeping whatever, but disassociative symptoms ultimately aren't studied enough and there's just nothing on the market for them).
Depersonalization is this nightmare of reconnecting to yourself and it's hard. I had to start litterally building me as an adult. Keeping journals about what makes me human, opinions, desires whatever. I also had an eating disorder so i started with food. Do i like x or y more? Do I like x or z more? As i still can't answer favorite questions usually (what's your favorite blank is this awful question for me). I begged my therapist to do a body trace with me (basically just teaching tracing an outline of myself on paper) because I super wasn't convienced i was real and i saw it on a tv show once. It actually was a extremly helpful excersize, but my therapist was like uhh, i have no idea what I'm doing. Ymmv. But yeah, depersonalization has all been any slowly connecting me to myself. Noticing my feelings when they are happening and not after. Finding clothes that feel comfortable. Finding a hair style i like. Establishing things that interest me. Hobbies.
Echoing trauma therapists only. I usually use an EMDR certification as a quick did somebody go out of their
way to learn extra stuff about trauma as a screen when looking for somebody.
Now, regarding the BPD. It sounds like you do have very specific actions and reactions that pop up during relationships that fit the BPD pattern, and DBT is good at giving tools to just... Not act on that pattern. It is ultimately a emotional regulation toolkit, and absolutely nothing more. It's not necessiarly useful for all the stuff surrounding and foundational trauma work (like feeling like a person, object permanence) but is a way to learn how to stop acting out patterns when you have super strong feelings. But DBT and disassocative stuff really don't go together, because people who tend to feel more flat, unreal see the exercises as pointless and are usually over regulated not under to begin with. You might find that most of the time you over regulate, so you are really looking at at trauma activation in a relationship context only, where as BPD tends to have disregulation across many parts of their life effecting coworking relationships, friendships and others like therapeutic relationships. If you don't care until you care too much, that might be more disassociative and less BPD. But, if this l the push pull of relationship feelings is super strong for you and overwhelming DBT might be useful tools for those moments.
Most BPD therapists do have some understanding of trauma (it is well known that people who suffer from BPD have significant backgrounds in trauma), but the approach is more about some foundational skills to keep with a therapist long enough to do longer term work than actually doing the long term work I think. So that you are able to stick with a therapist long enough (i think a year is long enough) then feel free to move to a therapist that specializes is in something else.
In terms of disassociation, I really liked reading The Stranger in the Mirror by Marlene Steinberg. This does a great job and I think it is really useful in explaining what is going on and found it very useful to be able to describe what was going on with me.
posted by AlexiaSky at 12:20 AM on April 12, 2021 [10 favorites]
To piggyback on what AlexiaSky wrote, have you considered RODBT instead of standard DBT? I agree that your problem sounds more like loneliness from over-regulation than it sounds like under-regulation, and it’s not uncommon for overcontrolled people to be misdiagnosed with BPD. Regular DBT is practicing the wrong skills if that’s the case; RODBT conversely is more about practicing openness and social connection, and was designed for overcontrolled folks. Might be worth looking into.
posted by en forme de poire at 5:53 AM on April 12, 2021 [2 favorites]
posted by en forme de poire at 5:53 AM on April 12, 2021 [2 favorites]
Best answer: It sounds like growing up, you got a lot of negativity and anger thrown your way, which has led you to seek love and guidance. It's no surprise that you seek out people to be a parent, or feel like their attention is never enough - it's because you have a lifelong deficit.
Everyone's already mentioned PTSD and CPTSD (which I agree with) as well as family systems.
1. I'll add into some family systems information by suggesting Jerry Wise who is a family systems coach and has a lot of videos and workshops.
2. Looking into attachment theory. Take the quiz on Personal Development School and watch corresponding videos on the YouTube channel.
3. If you want to read stories that may resonate with you, reddit has a CPTSD subreddit which even has its own bookclub.
I wouldn't suggest any volunteering until you feel comfortable. It can be challenging for people who have had trauma/childhood trauma because of codependency. You may end up giving so much of yourself up, you become resentful.
posted by Ms. Moonlight at 11:32 AM on April 12, 2021 [2 favorites]
Everyone's already mentioned PTSD and CPTSD (which I agree with) as well as family systems.
1. I'll add into some family systems information by suggesting Jerry Wise who is a family systems coach and has a lot of videos and workshops.
2. Looking into attachment theory. Take the quiz on Personal Development School and watch corresponding videos on the YouTube channel.
3. If you want to read stories that may resonate with you, reddit has a CPTSD subreddit which even has its own bookclub.
I wouldn't suggest any volunteering until you feel comfortable. It can be challenging for people who have had trauma/childhood trauma because of codependency. You may end up giving so much of yourself up, you become resentful.
posted by Ms. Moonlight at 11:32 AM on April 12, 2021 [2 favorites]
I lack the expertise of everyone upthread, but wanted to offer something on your question about being your own parent. And apologies if you already know this, so it doesn't help answer your specific question/issue there. But I understand the idea to be to treat yourself the way you wish your parents had treated you in your formative years (or how you wish they would have treated you, if we're talking about a specific situation happening now, when you're an adult). I struggled with this, and my therapist told me to imagine my kid had come to me with the same issues I'm having now and the same feelings that stem from them. Where I might be unsympathetic to my own thoughts, and overly self-critical, with my kid I'd be much more likely to come from a place of love, to focus narrowly on reassuring him what he's experiencing is normal, on helping him look at it from multiple perspectives, on telling him I'm sorry he's dealing with it -- the verbal version of a big hug, sort of. I don't know whether you have anyone towards whom you might have feelings like that, and I don't know that it will work in your situation, which is different from mine, but that's a way to explain it and a thing to potentially try; it could be a piece of the solution, if not the answer to everything.
posted by troywestfield at 11:46 AM on April 13, 2021 [2 favorites]
posted by troywestfield at 11:46 AM on April 13, 2021 [2 favorites]
I want to emphasize trauma focused treatment. I did a lot of the outcome focused stuff with my therapist who eventually went and got EMDR certified because those of us who are hyperintellectual and disassociated and depersonalised can just get stuck and never deal with the trauma using our words. I did EMDR and it was immensely helpful.
And part of that was seeing baby-me as someone who did the best she could. There was one specific situation that I did the most incredible and brave boundary setting and I was only eight! It didn't fix that trauma at the time, but being able to go back and immerse myself in it sucked horribly but also made me connect with that brave and broken little girl I was in a way I never had. And I can bring elements of that to other kinds of trauma and memories.
Realising my disassociation was extreme also helped. I tracked it for a while, and worked on what it means for my life. It's not always bad! Having a disassociative disorder doesn't mean you've got alters and all that either. But recognising that often my grey or blank periods are literally my brain turning itself off and back on helped me work through why it was happening, and ways I can prevent and recognise it, THEN how to address it in the moment.
posted by geek anachronism at 11:09 PM on April 13, 2021 [1 favorite]
And part of that was seeing baby-me as someone who did the best she could. There was one specific situation that I did the most incredible and brave boundary setting and I was only eight! It didn't fix that trauma at the time, but being able to go back and immerse myself in it sucked horribly but also made me connect with that brave and broken little girl I was in a way I never had. And I can bring elements of that to other kinds of trauma and memories.
Realising my disassociation was extreme also helped. I tracked it for a while, and worked on what it means for my life. It's not always bad! Having a disassociative disorder doesn't mean you've got alters and all that either. But recognising that often my grey or blank periods are literally my brain turning itself off and back on helped me work through why it was happening, and ways I can prevent and recognise it, THEN how to address it in the moment.
posted by geek anachronism at 11:09 PM on April 13, 2021 [1 favorite]
This thread is closed to new comments.
The sentence gradually changed the way I approached relationships. Instead of focusing on what I could get out of them, my number one priority was to give to the other person. Give trust, give love, give the benefit of the doubt etc. Basically everything that had never been given to me. It took lots of trust to become even a little bit good at giving. It did not come naturally. Once I finally was able to give I eventually found a stable relationship and that has made the world an entirely different place. For the first time in my life I actually have a family (we don't have kids it's just me and him, but we are each other's only real family).
People who grew up with even one decent parent will never understand what it is like to be born into the world with absolutely no one on your side. As a human being you are biologically driven to find love before all else, this is a fact proven by science. I'm sure a lot of people will take issue with what I'm saying here, but I'm telling you, what's going to give you peace is finding a family, whatever that family looks like to you.
To be clear, what I'm saying is, you probably have some years in front of you to get through. You may feel this way for a long time. Personally I found it easier to live with by just accepting that I was broken. I didn't break me, someone else did, but I was well and truly broken nonetheless. Accepting it allowed me to concentrate on moving forward as a broken person instead of aimlessly wishing life was different (I'm not saying that's what you are doing)
posted by WalkerWestridge at 1:47 PM on April 11, 2021 [65 favorites]