Bipolar 2 From Inside and Out

Posts tagged ‘coping mechanisms’

Releasing Old Ghosts

I don’t know what the proper term is (exorcise? banish? reject?), probably because I don’t believe in ghosts. What I do believe in are memories – persons and situations that haunt you, follow you, and inhabit your dreams.

I’ve had my share, especially of the dreams sort.

When I first got out of a truly destructive relationship, I was undiagnosed with bipolar disorder, medicated with valium (prescribed for temporomandibular joint syndrome) and self-medicated with wine. I was not in good shape.

For a long while, anything associated with that harrowing relationship, I shunned. Rex had like blue spruce trees. I avoided them. He had collected cobalt blue glassware. I could barely stand to look at them. He gave me heart-shaped boxes as gifts. I threw away every one I had, even the ones that were actually pretty and useful. He shamed me for my cooking. I gave it up. I gave up things I enjoyed, things that had been part of me. And I didn’t allow myself to explore things that Rex once loved.

He haunted me. I would have dreams in which I was going to meet him, where I was in a place I knew he might show up. I dreamed I was in his house, with cheerful parties going on around me as I panicked. I would have flashbacks to cruel things he had said, such as an obscene song he had written “in my honor.” Times when he said I had “betrayed his honor” for something as simple as cooking the wrong dish for a gathering. Plenty of others.

Now, it seems, the dreams have faded. I have reclaimed parts of my life I used to enjoy. I have banished things that were only his obsessions. The flashbacks are nearly gone.

What has helped me banish these destructive ghosts?

Time, of course, though you’d be surprised how many years it took. And it was gradual. He didn’t vanish from my brain like a puff of smoke. At times I still remembered music in particular – festivals and concerts we had been to together, the obscene song. (As I write this, they come bubbling up again.)

People. A few even from the time that the relationship was going on, who have helped me realize that I should not have been there, that I should not have gone through what I did, that I should have left sooner. I treasure these people. They saw me at my worst, knew me as I was recovering, and are still my friends today.

Other people – friends I had from long before Rex – have steadfastly remained in or reappeared in my life. I may have been bipolar and undiagnosed when I knew them, but these people stood by me, put up with my mood swings and odd behaviors. They have been part of my support system. And new friends, who have no association with those times, but who have had similar feelings and experiences.

Psychiatrists and therapists – also important parts of my support system for all these years. Ones who diagnosed my illness and medicated me properly so that I could deal with the issues that remained. Ones who helped me realize that I had some good memories from those times, that I could rebuild myself by retaining anything that I liked, that I had tools and techniques that I could develop and use to help me do that. I had done bargello needlework for Rex. I switched to cross-stitch. He called the kind of music I liked shit. I delved even further into it, reveled in it. Having developed a love of cats when I lived with him, I’ve never been without one again.

Love. One of the people I met during the next-to-last weekend of my time with Rex is now my husband. He has been with me through the dreams, the flashbacks, and the memories and has been the mainstay of my support system. And there are other people I love, and who have loved me back.

It seems strange that I was with Rex only a little over a year and it has taken me decades to work to this point where the memories have faded, the ghosts no longer haunt me, when it all seems like simply a bad time that has receded into, if not oblivion, at least only a clog that has slowly been removed from my psychological plumbing.

Now I know the right word. It’s time to flush those ghosts that plug up our mental and emotional systems.

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Reminders for New Year’s (and Beyond)

I’m not big on New Year’s resolutions. I can barely plan my day, let alone the whole year. And I’m also not big on making commitments I know I can’t or won’t keep.

Instead, I remind myself of certain behaviors I think I (maybe) can accomplish and refer to the list as often as needed. Here are a few suggestions that may be appropriate reminders for you as well.

You don’t have to drink alcohol at New Year’s Eve parties. Or ever, really. No one should try to pressure you into doing this, but if they do, simply saying, “No thanks,” should be enough. If the person is really pushy, you may have to ask, “Do you have soda or fruit juice?” You are not required to explain why you don’t want to drink alcohol, and you may want to forego attending parties that do not have such non-alcoholic alternatives in the future. You don’t have to attend parties at all, and “No, I can’t make it” is a perfectly reasonable response to an invitation. Or “Maybe next year.”

You don’t have to make New Year’s resolutions per se. You can have New Year’s intentions, small goals you don’t have to announce to the world at large and that you don’t have to beat yourself up over if you don’t fulfill them. Instead of resolving to jog every day, intend to get out of doors once a week, even if it’s only to walk to the mailbox and back. Baby steps, after all.

I hate to use the word “should,” but you should keep track of your medications, reorder them if they’re getting low, and see your prescribing physician if the scripts are about to run out. That’s just common sense that’s necessary for your mental health, not a resolution. These days, you may even be able to arrange to have meds delivered.

Try to engage in a hobby once in a while. Say, once a month. It honestly doesn’t matter what the hobby is. Read a book, or even a short story or magazine article. Knit or crochet. Repot a plant. Water a plant. Do a crossword puzzle. Bake your favorite cookies, then eat them all yourself if you want to.

Keep comfort objects nearby. These can be anything that soothes you. A music playlist. A stuffed animal. A scented candle. A cozy blanket or sweater. A favorite warm beverage like cocoa or green tea. Don’t be embarrassed about using them to ground yourself. Most neurotypical people won’t even notice if you’re wearing a favorite sweater or have a scented candle lit.

You can connect with people online. This counts as interacting with people. Say happy birthday. Forward a funny meme. You don’t have to make it specific to your condition, but there are plenty of people on Facebook, for example, who have bipolar disorder or PTSD or an autoimmune disorder. You don’t even have to interact with them. You can join a group, then just sit back and see what others post there.

Avoid triggers, if you can. That judgmental aunt. Your creepy cousin. Your boastful neighbor. Again, you have the right to say no and not explain why. (It’s the not explaining that’s the hardest.) Don’t watch movies that you find upsetting, whether it’s Die Hard or Rudolph the Red-Nosed Reindeer (which many people don’t like because of the implicit bullying).

Write about how you feel, if you want to. It could be a mood journal, a regular journal, a letter that you will never mail, a poem. Don’t feel that you have to show it to anyone. Tear it up afterward, if you want to.

You don’t have to face the new year as a whole. If you must have resolutions, resolve to get through the next week or even the next day.

Make an appointment with your therapist. Many therapists are offering tele-visits these days, so it’s easier than ever just to touch base or to work through a problem, a trigger, or feeling overwhelmed.

In other words, do whatever you can to get you through the next day, week, month, or season. The year will take care of itself, whether you make resolutions or not.

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No, I’m Not Taking Bipolar Passively

It may look like I’m taking my disorder passively. I stay in bed a lot. I seldom leave my house. It’s true I don’t exercise or go out with friends or hike in the woods or volunteer at a charity or arrange spa days for myself or sleep under a weighted blanket. Those may be good, proactive things that people can do in terms of elevating mood and practicing self-care. But I don’t do any of those.

I do all the “required” things, like visiting my psychiatrist regularly and taking all my meds faithfully. But when it comes to more active practices, I fall far short of the “ideal.”

It may look like I’m passive, but in reality, fighting bipolar disorder is a constant struggle for me. It just mostly happens inside my head.

First, there’s tracking my moods. This takes an active awareness of my behaviors and what they may be telling me about my moods. If I find myself spending more money than usual, I may realize I’m drifting into hypomania. If I can’t laugh at jokes anymore, I may be headed towards depression. If I receive an unexpected bill and start to feel overwhelmed, I may be in line for an anxiety attack.

Even activities that seem ultimately passive or ordinary may require positive activity for me. Answering a phone call may take a lot of effort, even if I know it’s a friend calling. Going to the grocery, as mundane an activity as possible, can take a lot of effort on my part – getting out of bed, getting showered and dressed, going out of the house, choosing from the many options at the grocery, carrying my purchases indoors. These are actions that may not seem related to my mental health, but are. And I must struggle internally with doing them. It takes up psychic energy, not just physical.

And what about seeing my psychiatrist and taking my meds? These, though they may seem minimal, are not passive actions either. As with grocery shopping, I must convince myself – even force myself – to keep track of my appointments and show up at them bathed and clothed. I must monitor how much of my meds I have left and pick up refills. (Or order home delivery for meds and groceries, if possible.)

When even the smallest efforts seem to take too much, well, effort, trying to accomplish them is at heart a mental battle – to think of what needs doing, convince myself I need to do it, plan for it, prepare myself to do it, attempt to do it, and, if I fail, try again later.

Lying in bed may seem the ultimate in passivity, but there can be a constant, very real struggle going on. On one hand, there’s trying to get to sleep and stay asleep. On the other hand is the struggle to get out of bed and do something – anything. Even if my struggles aren’t successful, that doesn’t mean that I am passive. They can be exhausting (though not enough to sleep). They can require tremendous mental effort, which is sometimes more difficult than the active kind for a person with a mental disorder.

So, no, I am not taking bipolar passively. I am fighting to get through it, to conquer it, to keep it at bay, to not let it win. Giving up would be the ultimate passivity, and I’m not going to allow myself to do that. I will continue struggling with my disorder as best I can, determined to do all I can to meet it actively, with intention, and with repeated efforts if necessary. And not beating myself up when I find myself being reactive rather than proactive. It’s important for me to remember that I’m doing the best I can with what I have. And that I dare not be truly passive when it comes to my mental disorder, lest it take over again.

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Why CBT Isn’t for Me

It’s been suggested more than once that CBT, or Cognitive Behavioral Therapy, might help me with some of my problems, including “depression, anxiety disorders, marital problems, and severe mental illness” (bipolar disorder, in my case), according to the American Psychological Association (APA). And I understand that it’s helped a lot of people, including some in my position, with some of the same problems I have. If it works for you, that’s great. I’m not saying that no one should ever use it or that it’s a rotten form of therapy.

I, however, dislike the premise of CBT and have never felt comfortable trying it. Here’s why.

One of the basic tenets of CBT is that the client’s thinking is faulty and the therapist helps the client to discover how and where. Then they work together to pinpoint the faulty thinking and replace it with healthy behaviors, or at least less destructive ones.

Again, according to the APA, “CBT treatment usually involves efforts to change thinking patterns” and examine “what is going on in the person’s current life, rather than what has led up to their difficulties.”

When I first got into therapy with the counselor who has helped me the most, what I needed was not someone to convince me that my thoughts were faulty. I had worked hard to reclaim my memories, validate them, and recognize that they really were damaging events. I would resist any attempt to undo that work by invalidating those memories, and my attempts to understand them, as “faulty.”

Despite all the times it has betrayed me, I think my brain is the most powerful weapon I have in moving forward, but that does not include denying the past or brushing it aside in favor of what the APA calls “learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.” Evaluating the memories and the thinking associated with them is a large part of what has helped me most, but calling them “distortions” would not be helpful. I needed to reclaim those memories and understand the feelings, accept them for what they were and how they changed my life, and then go on to rebuilding a new life – not one free from those memories and feelings, but one that validates them as part of my lived experience.

The methods used in CBT discomfort me as well. The idea of “homework assignments” and role-playing my future interactions does not appeal to me. I have gotten on much better with good ol’ talk therapy (and medications) than I believe I could with body relaxation and mind-calming techniques.

My problem largely involves confronting my memories and not denying them or downplaying them, but learning how to live despite having them in my past. It does me no good to deny a train-wreck as “faulty thinking” or to dismiss it as part of my past. Owning it as part of my past and realizing what it did to me is much more helpful. Validating my feelings and reclaiming my memories, then moving beyond them, is what I need. My therapist has helped me do that, without ever once suggesting that my thought patterns are faulty. We’ve worked on coping skills, sure – but never based on the premise that my past doesn’t affect my present or future.

CBT is also said (by NAMI, the National Alliance on Mental Illness) to be a short-term process (which I’m sure the insurance companies love) or one that can be carried out without a therapist guiding it. To me, this smacks of the “think away your troubles” idea. If I could have, I would have, without the help of long-term talk therapy.

My therapy has been a long and often painful process, but never one that attempts to make me think that my memories are invalid and that my progress will come by admitting that. Talk therapy is hard work, and I don’t believe there is any shortcut to mental health. Even now, after I have largely ceased therapy, I sometimes need a “booster shot” when my problems become overwhelming. Again, this comes from recognizing that my problems are real and that thinking them away rather than hard work is not the answer.

I am sure that people will tell me that I have misunderstood CBT, what it is all about, and how it is practiced. They may have many good experiences with it. But I don’t want to take a chance on a form of therapy that denies my reality and dismisses it as “unhelpful thoughts.” I need my reality heard and validated and examined. I need depth and breadth of therapy that recognizes my “train wrecks” and to what degree they have left me wounded. I need coping mechanisms that acknowledge my past as part of what going forward may mean.

I don’t trust CBT to do those things.

Fake It Till You…Can’t

I used to have a couple of suits hanging in my closet. One was oatmeal-colored. One was blue tweed. One was rust-colored. I had a couple of silk blouses and a jacket or two that I could wear over a dress.

I called them my “Respectable Business Lady” disguises.

At the time I was working at a 9-to-5 job where the dress code was pretty casual. Fridays were jeans days, not casual days. But every so often I had to go to meetings or business conventions, and for them, I needed the disguises. I was dressing to “fit in” and to give an impression that I was competent and stable.

I don’t honestly know if the suits worked as a disguise, but I made it through meetings and conventions fairly successfully (I think), if I was allowed to collapse afterward, at home or in a hotel room. I think the disguises were as much to remind me how to behave as they were to convince people that I was indeed respectable and a business lady.

Nevertheless, I can’t really buy into the “fake it till you make it” philosophy that has been so popular in self-help books, including those promoting business and entrepreneurship help. I had no notion of becoming a respectable business lady by wearing those suits. I was always going to be awkward and out of my league. I was only trying to pretend by using protective coloration.

The essence of “fake it till you make it” is practice. As the saying goes, you get good at what you practice. Unfortunately, you can’t practice not having bipolar or another disorder. You can practice assorted coping mechanisms and get better at doing them, but they’re a solution to some of the symptoms, not the disease.

I don’t think that “fake it till you make it” really applies to people with mental health problems. No matter how much or how long you fake it, your mental disorders are not going to disappear, though they may ease up at times. I certainly don’t think the business lady disguises made me go into remission for a week or a weekend. They were merely a coping mechanism and nothing I practiced enough to get really good at.

One danger of trying to fake your way through mental illness is that you can fall into the trap of what’s called “smiling depression.” When this happens, people don’t notice that you’re miserable because your smile makes it seem you are happy. It’s another disguise, but not a permanently successful one.

Once I was teaching a class, and several women gathered around another woman and asked her what was wrong. “I didn’t think it showed,” she said. “No, honey,” I said, “it leaks out around the eyes.” She wasn’t crying or anything like that, but we could all tell something was wrong, despite her smile. We offered her conversation and sympathy until she pulled herself together a bit.

I’ve never been able to school my face into any kind of smiling depression anyway. If some people have “resting bitch face,” I have “resting sad face.” I can’t count the number of times when I didn’t feel particularly sad, but someone asked me what I was sad about. Of course, I was probably suffering from low-grade depression, like a low-grade fever, but at the time I was undiagnosed and had no idea that I had a mental problem that caused me to look that way.

Basically, what I’m saying is that when you have a mental illness like bipolar disorder, you can fake being psychologically together for a while, but you can’t sustain it forever. Certainly not until you “make it.” After I took off my Respectable Business Lady disguise, I would revert to my original self, as far from a respectable business lady as ever. Sometimes it would take me days to recover enough to feel that I was functioning again on any sort of level.

I think it’s better, ultimately, to admit who you are and what you need rather than to try to disguise or fake it. Even if your authentic self is depressed and miserable, getting help for it is still better than trying to cover it up.

The Song as Self-Care

Almost six years ago, I wrote a blog post about music and its power to heal, or at least alleviate, depression. If you’ve been following this blog, you know that I’m currently in the middle of what may turn into a major depressive episode. Again, I return to thoughts of music.

I once gave my therapist a CD of the music I liked best. I had been telling her how I had been stereotyped and even ostracized for the kind of music I like best and was embarrassed to share it with others. (Okay, it was country music, or at least the style now known as Americana – not pop country.) She played snippets from several songs while I watched her not cringe at them.

It’s the music that moves me. I’ve heard a theory that the music we love and respond to when we’re in our late teens and early 20s is what we imprint on. No matter how much or what styles of music we listen to later in life, those are the tunes and songs that will move us, no matter how old we get. These were mine. Later in life I started listening to acoustic blues, light jazz, filk, and 70s oldies, but country/Americana is still what lives in me.

Right now, one of the things I’ve been feeling is emotionally constipated. And maybe it’s time to try allowing music to alleviate that logjam.

Whenever I’m really depressed, I forget how much power music holds. When I’m on an even keel, I semi-regularly throw myself “music parties.” I hole up in my study with my computer and let iTunes blast. I even sing along, though I’m a terrible singer. Sometimes my husband joins me for a while and we have guessing games. (Who’s that singing backup? Emmylou Harris. Who wrote this? No, Shel Silverstein, not Kinky Friedman.) Sometimes I look up music that resonates with Dan and download it for him.

But mostly, it is a solitary pursuit. I wrap myself up in the music and let it soothe me. Or I rock out to the music and let it energize me. Or I let the music reach inside me and pull out feelings I didn’t even know were in there. Sometimes I use the shuffle function and let it surprise me. Other times I thread a path through the songs, letting my brain tell me what to play next. (It’s one of the things I can rely on my brain for.)

Call it a way to provide myself some self-care without spending any money. Although massages and pedicures and lunches out with friends are often touted as good self-care methods, I can’t do any of those things when I’m depressed. For me, they just add extra stress – showering, getting dressed, going out among people. I love massages, but I love them when I’m feeling good, only just a bit tense. I love lunches out, but they can’t raise me out of depression. I like them better when even chicken and dumplings feels celebratory.

But at my music parties, I don’t have to deal with any of that. I can stay in my pajamas and slippers. I don’t even have to comb my hair. I can exhibit all the common habits that go with depression and not have to use spoons trying to alleviate them.

So, tonight, I believe, it’s music party time. I’ll shut off my phone. I’ll close the blinds in case I want to chair-dance and don’t want nosy neighbors to have a view. I’ll invite my husband if he wants to be there, and not worry if he doesn’t. (What I call a “party” can easily be a party of one, and most often is.) I’ll unplug my headphones from the computer so the music can fill the room, as well as my head and my heart.

And maybe next week, I’ll have something to tell my therapist about – whether it helped or not.

Caregiving: What We Owe Our Animals

By fantom_rd / adobestock.com

I’ve written before about emotional support animals and what a difference they can make in the life of a person with a mental illness such as bipolar disorder. And that’s still true. Emotional support animals and trained service animals can make a vast difference in helping a neurodivergent person cope with life and their disorder. (A thorough guide to emotional support and service animals can be found here: https://adata.org/guide/service-animals-and-emotional-support-animals.)

It’s unfortunate that misunderstanding and misuse of emotional support and service animals have made it more difficult for persons who really need them to have the comfort and utility of such a companion when they really need it. The fact that pet “vests” labeled Emotional Support Animal are available willy-nilly online is a disgrace. (I saw one site that sold all kinds of vests with assorted patches, ID cards, and collar tags. It had “It is fraudulent to represent your dog as a service animal if it is not” in really small type on only one page.) Real service animals require thorough training and provide specific kinds of support to their humans.

There are many animals that provide comfort, companionship, and emotional support without being official, trained service animals. Cats, for example, are notoriously bad at being able to perform actions such as diverting a person with OCD out of a behavior loop or reminding a person to take medications. Hamsters, rats, and fish, while providing hours of comfort and emotional diversion, are not really qualified as service animals. Monkeys can be officially accepted as service animals, as can pigs and miniature horses. But the ADA (Americans with Disabilities Act) makes no provision for emotional support sloths, lizards, or rabbits. People who take these animals onto airplanes or into restaurants – or people who take untrained dogs there – screw it up for those who truly have need of nonhuman support.

But that’s not what I’m here to talk about today. I want to discuss people with mental illness and what they owe to the animals they live with. Caregiving.

It’s great that animals can act as supportive caregivers to human beings in need, but the animals have needs, too, and it is up to the human being to accommodate them.

Unfortunately, when I had my worst major depressive episode, I was not able to provide proper care for my companion animals. The cats needed regular food and water, a clean litterbox, and appropriate medical care, at a minimum. Fortunately, when I was too ill to provide those, I had a caregiver (my husband) who was. If he had not been available and willing to take over the pet-care duties, they would have been neglected, and suffered for it.

This is not to say that people with mental illnesses should not have pets. Companion animals can be a wonderful solace and comforting presence. My cats’ purring, lap-sitting, and other behaviors have been soothing and peaceful at times when I really needed it. Just their presence could bring me out of myself for a while. Caring for some other being is a powerful adjunct to therapy.

Even persons with severe mental illnesses can benefit from the presence of animals and are able to care for them, sometimes even better than they can care for themselves. Think of the homeless veteran with PTSD who cares for a companion dog, making sure it eats even if he doesn’t, and finding it shelter from the cold. It’s hard to say which is doing more for the other. And people with depression, for example, may find that caring for an animal brings them out of themselves, at least a little, and connects them with a world wider than the inside of their head.

What I am saying is that people who know they may be incapacitated by their mental illnesses probably should make preparations for a time when they are not able to care adequately for their animal companions. I was lucky to have a caregiver who was as emotionally invested in caring for the cats as I was. He took over the caregiving for them as well as for me.

It is, however, only sensible to make plans for your animal companions if you know you may be unable to give them proper care – for example, if you know you are facing hospitalization. Pet-sitting or boarding arrangements can be made in advance and called upon in case of emergency. Even a pet feeding and watering station that provides several days’ worth of sustenance can make owning a pet more practical when your coping skills disintegrate.

I wouldn’t give up my cats for anything. Unless giving them up was the only way to ensure that they received proper care. No animal should suffer just because I do.

Distance Psychotherapy: Is It for You?

By Alice / adobestock.com

I will make a confession: I have never used distance therapy, except for when I couldn’t drive to my therapist’s office, my husband wasn’t available to drive me there, or when I had the last-minute I-just-can’t-go-today feelings or I’m having-a-crisis feelings. This was in the days before teleconferencing, texting, and other long-distance forms of therapy, so occasionally my therapist would agree to do a telephone session, which I appreciated greatly. In general, they didn’t last as long as the standard psychotherapy 50-minute hour, but at times they were lifesavers.

Now, when everything seems to be online, and especially during pandemic lockdown, quarantine, or simply fears of going outside, tele-psychotherapy seems to be becoming a thing. Many services are now available via the internet, smartphones, and whatever way you pursue your online life.

I’ve been looking at these services, not because I need one now, but because I want to know what’s available in case I ever should. The APA (American Psychological Association) provides a lot of helpful information on the subject. Their site has provided a list of pluses and minuses regarding telehealth for psychology. They note: “With the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy…Research does show that some technological tools can help when used in conjunction with in-office therapy,” though “There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people.”

Inc.com provides a helpful list of the pros and cons of online therapy. Some positive aspects are that:

  • People in rural areas or those with transportation difficulties may have easier access.
  • Most online therapy services cost less than face-to-face treatment.
  • Scheduling is more convenient for many people.
  • Individuals with anxiety, especially social anxiety, are more likely to reach out to an online therapist.

among the negatives are:

  • Without being able to interact face-to-face, therapists miss out on body language and other cues that can help them arrive at an appropriate diagnosis.
  • Technological issues can become a barrier. Dropped calls, frozen videos, and trouble accessing chats aren’t conducive to treatment.
  • Some people who advertise themselves as online therapists might not be licensed mental health treatment providers.

Despite the concerns, research consistently shows that online treatment can be very effective for many mental health issues. Here are the results of a few studies:

  • 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
  • 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, “effective, acceptable and practical health care.” The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
  • 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
  • A recent review of studies published in the journal World Psychiatry compared people who received CBT treatment online with those who received it in person.  The two settings were shown to be equally effective.

One possible pitfall, warns APA, is that “online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.” The services I explored charge about $35 to $80 per week for unlimited messaging and one live session per week. MDLive provides a psychiatrist at $284 for the first visit and $108 afterward. (They have lower rates for seeing a therapist rather than a psychiatrist, and do accept insurance.)

Business Insider, in its article on the subject, dealt specifically with a service infelicitously known as Woebot. Unlike the other services, Woebot is a “chatbot” that substitutes artificial intelligence and natural language processing for a real, live therapist. It uses cognitive behavioral therapy. Their website claims that Woebot “is the delivery mechanism for a suite of clinically-validated therapy programs that address many of today’s mental health challenges, from generalized anxiety and depression to specific conditions like postpartum depression, adult and adolescent depression, and substance abuse.” Like a non-directive therapist, it asks probing questions and responds to questions and answers from the user. For now, it is free to users, though they seem to be exploring a paying model.

Other telehealth counseling services include:

Amwell

Betterhelp

Brightside (depression and anxiety, not bipolar or mania)

Online-Therapy.com

ReGain (couples therapy)

Talkspace

teencounseling (will consult with parents)

If you decide to try online therapy, it’s best to compare services and determine what services they offer, at what price, and what the credentials of their therapists are. If you have already tried it, I would be glad to know the results. Feel free to comment.

 

 

A Sensory Self-Soothing Room

Photo from the author’s collection

Not long ago, I read in the Creativity in Therapy blog (http://creativityintherapy.com/2016/05/create-a-sensory-self-soothing-kit/) an article by Carolyn Mehlomakulu, art therapist, called “Create a Sensory Self-Soothing Kit.” The idea was that a box filled with items that engage your five senses is an excellent tool for being grounded when you need centering or self-care. The recommendations were for any five things that appeal to the senses of touch, sight, hearing, taste, and smell. I tried the exercise and came up with the following:

Touch – plush animal

Sight – amber necklace

Hearing – iPod playlist

Taste – caramel

Smell – Oolong tea

I never actually made myself such a self-comfort box, but I remember the exercise as a way to think about my senses and how nourishing them can nourish me.

Lately, though, I have acquired a room of my own and have been decorating it to suit myself. Recently, I realized that it has all the requisites of a comfort kit toolbox.

Touch – I have quite a collection of stuffed animals stashed around the room. A great many of them were gifts from my husband, who knows my history with stuffed animals (as we used to call them). Every Easter there was a new stuffed rabbit in our Easter baskets, along with the chocolate bunny and the jelly beans.

Perhaps the most important plushie in my room is named “Trauma Bunny.” My husband found her in the store he works at, squashed behind two huge bags of dog food in the pet aisle, rather than in toys where she belonged. Of course, he bought her and brought her home to me. Now she sits on my desk, guarding my headphones and cellphone, close enough for me to reach out and pat her on the head or fondle her ears.

Sight – I have furnished my room with many things I like to look at, from travel souvenirs to prints and paintings that have significance for me. Even the walls are a toasty rusty-brickish color that makes me feel warm just to look at. I also have a television, where I can watch shows that comfort me, such as ones on the Food Network. I have two windows, and the blinds are always up on at least one of them. The view isn’t terrific, but the sunshine is welcome.

Hearing – I do have iTunes on my computer, with more music than I could listen to in a week. Among the tunes are ones recorded by some of my singer/songwriter friends, as well as the well-known artists I like best, ones you don’t hear on the radio anymore. There is also instrumental music, from Vince Guaraldi to Béla Fleck, if I want something less distracting than voices and lyrics.

I also have a cat tree by the window, where my two cats love to sit or sleep. Both cats purr nicely and loudly. One of them even snores when she sleeps – daintily, but she definitely snores. (Of course, petting the cats also qualifies as touch, and watching them bathe themselves, which I find soothing, counts for sight as well.)

Taste – My husband keeps my room stocked with things he knows I like such as Cocoa Puffs. There’s always diet cola in the bottom drawer on the lefthand side of my desk. Right now there are honey-roasted peanuts in case I need a more proteinaceous snack.

I generally eat only one meal a day, and when I’m really depressed sometimes skip eating altogether. It’s good to know that there’s something here that is easy to access, requires no cooking, and meets some of my basic needs and likes.

Smell – Since I’ve transferred most of my library to an ereader, there are fewer books in my room, but most of the ones I still have are old and retain that almost-indefinable book smell – dust, paper, and some other distinctive aroma that I remember from trips to the used book store as a kid.

I also have a candle that smells like snickerdoodle cookies. I’ve never lit it, but sometimes I just pick it up for a deep sniff. Then there’s my tiny Mr. Coffee, which I use for tea, including oolong, herb tea, and possibly my favorite, the spicy smell of Constant Comment tea.

I practically live here, even though the house is fairly large and there are sensory delights in the other spaces as well. But what I have here, I recently realized, is a comfort box that’s just the size of a room.

Yes, It Was That Bad

By patpitchaya/adobestock.com

There’s a tendency, once you’ve started to heal from the wounds that mental illness has left you with, to forget how bad it really was at the time. It’s not that time heals all wounds. It’s just that the memories fade as they flow backward into the past. You find yourself asking, was I really that miserable? That irrational? That out of control? Once therapy and medication – or whatever works for you – have gotten you past the crisis stage, it gets harder to remember what it all felt like at the time.

Nor do we want to. Going through an episode of serious mental illness is hard enough when you do it once. Reliving it is devoutly to be avoided, if possible.

Still, the memories get a little fuzzy around the edges. Now that you are mentally healthier, you know that you would never tolerate the kind of treatment you used to, or be so self-destructive, or put yourself down so thoroughly. The times when you did those things, when you felt those ways, seem in some sense unreal.

I think that’s one reason that some people go off their meds. It’s not just that they feel better or think that they’re cured. It’s that on some level they can’t remember how bad it really was back then. So why should they need psychotropics?

Well, I’m here to tell you that, yes, it’s much better now, but yes, it was that bad back then. You may not remember the weeping and wailing and total despair. You may not remember that you were immobilized for months at a time. You may not recollect pushing away people that were trying to help you. But all that happened.

Perhaps you don’t recall what it was that led you to consider self-harm or suicide. You wouldn’t think that way now, of course – you’re so much more stable. Perhaps you think to yourself that an abusive partner wasn’t really all that bad. After all, you got away from him/her/them. It was survivable, so it must have been not that big a deal.

But it was that big a deal. Denying the experiences you’ve had and minimizing their effects on you make it harder to see the long way you’ve come. It’s hard for me to remember now the major bipolar depressive episode that lasted for literally years, when I wasn’t able to work, or write, or read, or be there for my husband or even myself. But it happened, and I can’t deny it. I’d be lying to myself if I tried.

I’m not recommending that you wallow in the memories of the horrible times. I’d rather think about it as keeping little bits of them in a box on a shelf. Every now and then, on a day when you feel particularly strong, you open the lid and peek in. It may be shocking to realize how bad off you were, but a positive relief when you consider how far you’ve come. As the saying goes, the bad times make the good seem so much better.

Bad and good, your experiences have made you what you are today. Denying or minimizing the bad makes it seem like your journey was less long and hard than you know it was. In a way, mental illness is the yardstick by which we can measure mental health. Moving onward and upward are important, but so is being realistic about the past. Yes, it was that bad.  And yes, you made it through anyway!

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