Tag Archive | therapy

Timeline

Last week’s homework for therapy was to create a timeline of my entire life including anything major, stressful, traumatic, or highly memorable.

Umm yeah this was not fun. I went back through forty years, year by year and filled in the events. It left me feeling drained. And sad. So much pain there.

We started going through the events together, and my counselor asks questions or for more details about certain events. So far we made it to age 5. I was already tired going into the session. This format is particularly troubling. I feel like I can’t hide anything. Like every secret is coming, and that timeline is the roadmap of doom.

We spent some time discussing the molestation by my brother when I was 5, he was 12. Counselors have never focused much on this, because of my dad’s abuse taking center stage. But it seems I have considerable amounts of shame and guilt surrounding what happened with my brother. I think I have not been able to shift blame onto him like I did for my dad, so I still feel responsible or accountable. We were both kids, more equals than with dad. It is not simple. I want to forgive us both. But I don’t. It makes me feel like a bad person.

So yay, we uncovered the next topic for cpt retelling exposure. I am not sure if I should post that story once I write it. I feel much more protective of my brother than my dad. Or is it my own shame that makes this feel wrong? Have to think about it. 

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Dizzy means its working

When we approach tough topics in therapy, I get this odd dizzy feeling, like right before you pass out. I guess digging up old memories and reconnecting the feelings is so overwhelming, like system overload. If we go slowly and tackle topics I have tackled before, I almost enjoy the tingly, dizzy, disorienting feeling I can now recognize. It must actually be neurons forming or firing, or something, I have no idea, no science for this feeling. I may research it one day. Or I may not I don’t know. But I do know if we tackle topics that hit me unexpectedly, my head actually hurts. The dizzy is more like a fiery wave of hammers expanding in my skull. It gets difficult to see and to sit upright, then I struggle to breathe, and then I lose control. My emotions break free, I shake, sweat, cry, moan, twitch, try not to vomit.

This happened today when we explored a thought I still have, that I would be better off if I never told anyone about AF and finished high school with my secret in tact. I felt the shame I felt as a 16 yr old, ostracized, hated, alone. My therapist asked me how it felt when kids that used to be my friends looked at me with disgust and fear and pity…I felt today what I was never able to fully feel then. I thought I might die a moment, but I didn’t. I did stifle it though, it was too much. Way too much. So we get to explore this topic again next week. She said I am not done feeling it and have more to process.

CPT Trauma Impact Statement:Why I think this trauma occurred

My homework this week is to write a more in depth impact statement. I did this already when I started CPT many months ago, but since it was a group, we were asked to be vague and not include any details of the trauma itself. Also, since I have endured multiple traumatic events over many years of my life, I am to focus on the sexual abuse for this portion. Here is the writing prompt:

Please write at least one page on why you think the traumatic event occurred. You are not being asked to write specifics about the traumatic event. write about what you have been thinking about the cause of the event. Also, consider the effects this traumatic event has had on your beliefs about yourself, others, and the the world in the following areas: safety, trust, power/control, esteem, and intimacy.

So let’s start with the cause. What caused AF to sexually abuse me? Seriously, what a question. Simple answer is he was as close to evil as a human can get. He was sick, a true pedophile, with narcissistic and psychopathic tendencies. My abuse started at birth, at day one he chose to own and control me to serve his personal needs. Why? It is actually very complicated. I like this site to explain the roots of pedophilia by Sam Vaknin, it sounds very much like the man(?) that raised me. I’ll add some excerpts below.

  • Contrary to media-propagated myths, most of them had not been sexually abused in childhood and the vast majority of pedophiles are also drawn to adults of the opposite sex. (I have no idea if AF was abused as a child. I do know he used the services of adult female prostitutes.)
  • Pedophiles seem to have narcissistic and antisocial (psychopathic) traits. They lack empathy for their victims and express no remorse for their actions. They are in denial and, being pathological confabulators, they rationalize their transgressions, claiming that the children were merely being educated for their own good and, anyhow, derived great pleasure from it. (I still hear his voice whispering, I know you like this…ugh, vomit)

 

  • Coupled with his lack of empathy, this recurrent inability to truly comprehend others cause the pedophile to objectify the targets of his lasciviousness. Pedophilia is, in essence, auto-erotic. The pedophile uses children’s bodies to masturbate with.

 

  • Illicit sex becomes the outlet for his urgent need to live dangerously and recklessly. (incest and prostitutes)
  • The pedophile is aware of society’s view of his actions as vile, corrupt, forbidden, evil, and decadent (especially if the pedophiliac act involves incest). He derives pleasure from the sleazy nature of his pursuits because it tends to sustain his view of himself as “bad”, “a failure”, “deserving of punishment”, and “guilty”.

 

  • In extreme (mercifully uncommon) cases, the pedophile projects these torturous feelings and self-perceptions onto his victims. The children defiled and abused by his sexual attentions thus become “rotten”, “bad objects”, guilty and punishable.  (In my case, it was emotional sadism for me, and animal cruelty for my pets)
  • The pedophile treats “his” chosen child as an object, an extension of himself, devoid of a separate existence and denuded of distinct needs. He finds the child’s submissiveness and gullibility gratifying. He frowns on any sign of personal autonomy and regards it as a threat. By intimidating, cajoling, charming, and making false promises, the abuser isolates his prey from his family, school, peers, and from the rest of society and, thus, makes the child’s dependence on him total.
  • The pedophile is the guru at the center of a cult. Like other gurus, he demands complete obedience from his “partner”. He feels entitled to adulation and special treatment by his child-mate. He punishes the wayward and the straying lambs. He enforces discipline.
  • The child finds himself in a twilight zone. The pedophile imposes on him a shared psychosis, replete with persecutory delusions, “enemies”, mythical narratives, and apocalyptic scenarios if he is flouted. The child is rendered the joint guardian of a horrible secret.
  • The pedophile’s control is based on ambiguity, unpredictability, fuzziness, and ambient abuse. His ever-shifting whims exclusively define right versus wrong, desirable and unwanted, what is to be pursued and what to be avoided. He alone determines rights and obligations and alters them at will.
  • The typical pedophile is a micro-manager. He exerts control over the minutest details and behaviors. He punishes severely and abuses withholders of information and those who fail to conform to his wishes and goals.
  • The pedophile does not respect the boundaries and privacy of the (often reluctant and terrified) child. He ignores his or her wishes and treats children as objects or instruments of gratification. He seeks to control both situations and people compulsively.
  • The pedophile acts in a patronizing and condescending manner and criticizes often. He alternates between emphasizing the minutest faults (devalues) and exaggerating the looks, talents, traits, and skills (idealizes) of the child. He is wildly unrealistic in his expectations which legitimizes his subsequent abusive conduct.
  • Narcissistic pedophiles claim to be infallible, superior, talented, skillful, omnipotent, and omniscient. They often lie and confabulate to support these unfounded claims and to justify their actions. Most pedophiles suffer from cognitive deficits and reinterpret reality to fit their fantasies. (AF was actually intelligent, definitely above average, however his claims would have him be Einstein working as a technician, he was always just about to change the world, he could if he wanted to…)
  • The pedophile believes that he is in love with (or simply loves) the child. Sex is merely one way to communicate his affection and caring. (He told me this often, that he was the ONLY one that truly loved me)

 

  • The pedophile intrudes on the victim’s privacy, disrespects the child’s express wishes and personal boundaries and ignores his or her emotions, needs, and preferences. To the pedophile, “love” means enmeshment and clinging coupled with an overpowering separation anxiety (fear of being abandoned).
  • Consequently, pedophiles react badly to any perceived rejection by their victims. They turn on a dime and become dangerously vindictive, out to destroy the source of their mounting frustration. When the “relationship” looks hopeless, some pedophiles violently embark on a spree of self-destruction. (Not self destruction, he was out to destroy me until the day he died, my rejection of him was too much)

I am guessing the purpose of this exercise is to see if I think I am the cause of the sexual abuse. I don’t think that, unless simply by existing, by being born into the hands of a pedophile. I believe he had a target or targets before me and that he had some after me. I did not cause any of that. His emotional instability, his sickness, his need for control and illicit sex as described above, caused the abuse. Do I have some guilt for not screaming, not running away, for believing him, for loving him, for trusting him, for allowing him? Yes I do. But that didn’t cause the abuse. He started grooming me to be sexually abused, started isolating me before I had a chance to make any choice. Even when I was older, none of it was my fault. I managed the situation the best way I could at any given moment, always fearful of his punishments and what might happen. So let’s talk about the effects, as they are extensive and life altering, and I fear I may never recover completely from the emotional trauma during my developmental years.

Safety: I often feel unsafe even when I know intellectually that I am in fact safe. I battle anxiety daily. I feel safest when alone. I am often on edge and vigilant. I do not often take risks, am highly protective of my kids and judge others harshly that do not protect kids (allowing their kids to ride ATVs, watch adult movies, wear skimpy clothes, have social media accounts…) I struggle to do anything outside of my comfort zone, plagued by panic or flashbacks, or what seems like rational fears of ‘that could be too dangerous’. I am physically weak, from a spinal injury, which adds to my feeling of inadequacy, not being able to run away or protect myself. I often feel powerless and helpless each day, waiting for others to help me.

Trust: I do not trust people much at all, and what I do give them can be yanked away at any sign of trouble. I keep everyone at arms length, a protective wall. I have learned to trust some people with some things. Most of my trust is actually sadly negative. I trust people to lie to me and they all do. Some of this is supposed to be socially acceptable and I struggle to accept it. I am always vigilant for scams, stalkers, other potential abusers. If someone is kind to me I first ask why. I trust professional relationships more, like doctors and therapists, though not all of them pass the intelligence and integrity test. I have basically no trust within personal relationships, and basically have never had any other than my marriage. I could never share my horrible secrets with my friends as a kid, and when the secrets came out, all my friends abandoned me. I think on some level I am terrified to be tricked again, to care for another psychopath, even though I know that is not very likely.

Power/Control: This is huge for me. I hate surprises. I NEED control. I need lists, to think ahead, to plan, to be on top of every detail. I used to excel at this, never forgetting anything, obsessively checking my lists and calendars. Oddly the migraines ended my ability to do this and may have done me a favor, allowing me to let go a little. I am only comfortable in relationships or events where I am in control or in charge. I enjoy teaching or public speaking, but not random social mingling. Feeling powerless so often, I try to regain it by being in command. I am good at it. I like order. I like labeling and alphabetizing and color coding and sorting. I married a chaos maker, a piler, a throw it anywhere, don’t clean it up guy. That was hard enough but then being a Mom has overwhelmed me, losing control of my house, losing order, has been difficult. The kids are finally old enough to help out and it is feeling better, less like drowning. I am 100% comfortable with my kids because I am in charge of them, I understand the relationship. I fear how this will change as they get older and I lose that, they will become like everyone else, in that fuzzy area that confuses and troubles me, where control is shared. My marriage is a struggle full of control issues. Many other situations I simply avoid if I can’t control them.

Esteem: I lack esteem. Period. I lack a sense of self. I grew up as property, enmeshed with AF’s needs and feelings, never allowed to have my own. I still struggle to have my own now. I was still in overachiever mode up to the day AF died. And then it slowly faded away, my purpose and drive was gone. I am empty inside. I feel horribly broken and damaged, like I can work my entire life to rewire a few neurons and never gain an ounce of normalcy. The isolation, humiliation, unrealistic demands, put on me by AF were total and prevented me from forming a sense of self or attachment. I was him and did everything as and for him. I don’t feel I exist, and if I do, I am bad, disgusting, rotten and worthless. I try to stop the negative thoughts and voices I hear and recognize the triggers, but there are too many.

Intimacy: You can’t have intimacy without safety and trust, without giving up some control, without feeling you are worth it. I am working on this with my husband, my sister in law, and on some level even my mother in law. That’s it, no one else even makes the list. If anyone reaches out to me in kindness, I cry. I don’t feel worthy, and I suspect them of foul play. Close feelings always bring feelings of betrayal with them, the fear is overwhelming, and I push everyone away. I isolate myself, both out of fear and punishment. People generally do not react well to my inner thoughts and feelings, so I have learned to hide them, to put on a fake smile. I have online anonymous relationships with more intimacy than in real life at times. There can be days sometimes weeks when I can’t be touched, not a hug or even brushing past me in the kitchen, hardly can look at other people, the distress is so high. This includes my husband – the isolation will be complete at those times, I let no one in. I am starting to recognize the triggers to emotional flashbacks that starts this isolation, but I still struggle to pull myself out of it.

 

Next stage of therapy

I want to run again. I want to quit and hide. The urge is so unbelievably strong. I did quit something, couples counseling. I decided I needed to focus on my individual counseling for a while, and I was never totally happy with that counselor, probably mostly because he was a he, but I think his style made it impossible for me to trust and connect wirh him.

 Why do I want to run and hide? Because my counselor wants to know what happened to me, what AF and my brother did to a little girl. She wants me to start writing and saying out loud my most horrific memories in high def detail. I have been to about 20 different counselors in my life. None have asked for this. We discuss events vaguely, generally. We would lump 16 years of sexual and emotional abuse together into non-specific phrases like “he touched me inappropriately” and “I would wake up with him in my bed”. Never have I gone into detail of who did what, what we were wearing, what else happened that day, what my blanket looked like, what he said to me, etc. 

My counselor is giving me the choice of moving forward with cpt (cognitive processing therapy) or pe (prolonged exposure). We discussed and I read about both and I am choosing cpt. I am already familiar and comfortable with the framework. And pe sounds like hell-repeating what happened to me over and over, recording myself telling an account then listening to my recording. I understand the point of desensitization, but I believe discussing it once will be enough for me. I have so many events, thousands of traumas to choose from to retell, I think I need to start with the ones that form flashback images often. 

I feel safe with my counselor. I am not afraid of my memories themselves, but reliving the content is distressing. So it is time to try this, because counselor says it will help, and because I have never tried this.

This first step is to write my memories down. I know which one I want to start with. I have decided to post it here once I write it. My memories are fuzzy but I will do my best to write a detailed account. I thought if I shared it here first it would give me confidence to read it to my counselor, maybe, without passing out.

So why retell a traumatic event? Shouldn’t we just let it stay in the past? Isn’t better as a fuzzy memory without clear details? Won’t writing and telling it make the memory stronger, reinforce it, make the flashbacks worse?

Counselor says no. She says by recounting what happened through cpt, I can process the event, add meaning, address unbalanced thoughts, add adult perspective and emotional capacity that I did not have as a child. I should be able to make these events less powerful, less overwhelming, by feeling the emotions now that a little girl simply could not. Hmmm. Not sure I buy that, seems hokey, but like I said, I will try it because I am curious. And because so far this counselor has been right. So what if it seems hokey if it works. I would try about anything to get my life, my brain, back from this cptsd hell.

Starting in vivo exposure, sort of

But I don’t want to start this stage and I’m not sure I even agree with what my counselor has assigned for homework this week. I’m trying to decide if I am fighting it because it will be difficult, or because I think it will be stupid. I am so annoyed right now it is feeling like the latter is more likely.

Counselor looked over my white coats distress list and said we should start with an item that has about 20-30 SUDS rating. It should also be something I can do daily for about 20-30 min to see a reduction in my SUDS rating with more exposure over time. Ok…makes sense in theory.

She selected my event of calling doctor’s offices to make appointments. Hmm…my first thought is I don’t have that many appointments I need to make, and how on earth is a phone call supposed to last 20-30 minutes? And my distress is not related to speaking on the phone itself, it is about the quick decision of committing to something on the calendar. And it is low distress, not something I avoid or even get too concerned about. This seems pointless to work on except I know it eases me into the process for tackling higher distress items.

So she actually recommended that I create reasons to extend my phone calls, like asking the receptionist to wait while I grab my purse or answer the door. I really can’t bother and annoy these poor people with fake situations. I won’t do that. I think it is silly.

She also recommended calling and making fake appointments, then calling back and canceling. This feels like lying and seems a waste of everyone’s time. How is my distress supposed to go down if I am worried about lying and the situation is not authentic? I don’t like this. It seems like she is force fitting this ill advised plan, and my confidence in her is considerably shaken.

I don’t see the benefit to her plan.

I will go ahead and schedule some appointments that need scheduling and document my calls, using my new skills and awareness while I call. I will complete a challenging beliefs worksheet for any stuck points I encounter.

But I refuse to make fake phone calls and stall while on the phone just to log air time. The science isn’t sound here…can’t connect the dots.

The White Coats are Coming

lab_coats

I mean Doctors, not mad scientists, because I’m much less distressed about scientists in general. But Doctors? Doctors offices, hospitals, Eeek, gulp.

OK, I sound like I’m kidding, because I do that to lessen the intensity for myself. But seriously this is the next stage of my homework for individual counseling. If you recall I had created a list of situations that cause me distress, and then rated the situations using the 0-100 SUDS, subjective units of distress scale. We noticed that I had some doctor related situations on my list with different ratings. I told my therapist I wanted to start with doctors because I view that as more of a necessity than some of the other social situations. I can’t ask Hubby to go to the dentist or gynecologist for me – I kinda have to do that myself, and it would be great if I could do it with less distress. I’ve always managed to go…eventually…if I have to…and then my heart is racing, I sweat through my clothes or the paper gown, I shake in fear, I can’t sleep for days, I can’t eat or binge eat…I don’t manage the distress well. And because these are not daily situations, I can build up loads of anxiety for the next time, never getting exposure and practice like I do for say the grocery store. Certain situations have never become easier – I simply (ha, simply, she says) grit my teeth and get through it without passing out somehow.

So I’m supposed to break down all of the situations related to doctors and make a new list with SUDS ratings, getting as specific as possible. I have a few ways I can think of to organize this list or it would already be done. I’m not sure if it is more helpful to group by type of symptoms and SUDS rating, type of doctor/situation, or by my fears. Let’s see what happens.

 

Before the appointment is made:

  • Deciding it is an important issue (50) – I get annoyed with the hassle, feel fear what if I ignore a really bad problem, don’t trust my judgment what if this isn’t a problem at all, what if no one believes me or understands me, probably no one can help me anyway
  • Calling receptionist to make an appointment for myself or my family (40) – What if I commit to a date and something else comes up or I forgot about something else or we don’t have the money that day or I don’t feel well and can’t drive that day
  • talking to Hubby about money/schedule (80) – How do I explain my concerns without blaming him or over worrying him but get his input and support, and I might need him to drive me and get a day off of work and I hate asking too much I feel like such a burden and a pain in the butt, why can’t I do this stuff myself, I should be working and not depending on him so much right now
  • Can’t sleep several nights before appointment as I start to imagine and prepare (80) – The nights are really long and I try to relax but it gets worse, and I have nightmares when I do fall asleep
  • Get ready very early and slowly, trick myself one step at a time to stay calm (80) – I can’t rush at all or the anxiety will overwhelm me. I learned to give myselm time to move slowly, dress slowly, check and recheck my pockets and purse so I don’t forget anything, check my map, do calming breathing, drive slowly, and arrive early

 

Stressors at the appointment

  • Driving to unknown location for first time (80)
  • Driving to known location (10)
  • Arriving Late to appointment (90)
  • Forgetting something (wallet, insurance card, phone, etc) (90)
  • germs in the office, signing in touch the shared pen, people coughing near you in waiting room (80)
  • public weighing (60)
  • confusing or triggering forms to fill out with history – how much to share? (80)
  • nurse/doctor might not understand my problem (60)
  • I might be asked to undress (80)
  • I might be touched without warning (100)
  • some touching can be triggering – dentist hovering over me, ob/gyn exam (100)
  • if they hurt me i lose even more trust, hard to speak up (100)
  • new doctor – I don’t trust them yet or know what they will ask me to do (80)
  • I have to share private details about myself (80)
  • I ask for certain tests/labs and feel frustrated doctor didn’t think of it – are they idiots? (70)

 

Types of appointments

  • family doctor in town (20) – 5 min drive, been there many times, low confidence in doctor abilities for anything complex but trust to monitor vitamin D and cholesterol
  • pediatrician (50) – 30 min drive, high confidence in doctors, rarely go unless kids aren’t getting better or I know they need vaccines or other issues discussed, high fear of other germs in the office
  • my dentist (80) – 30 min drive, high confidence in ability but feel they overcharge and attempt to oversell and I hate saying no, I hate laying down in the chair while they surround me, it always hurts no matter how much novocaine is used, I feel ashamed for having bad teeth and eating candy, one hygienist knows my neighbor so there is lack of privacy too
  • back doctor (40) – 2 hour drive, hubby always goes with me and usually drives so I don’t get too tired/overwhelmed, high confidence in doctor, they don’t hardly touch me, I undress in private for xrays, everyone is kind and professional
  • neurologist for migraines (30) – 2 hour drive, hubby drives me, no touching at all, no undressing
  • botox for migraines (80) – 2 hour drive, hubby drives me, triggering position as I lay down and doctor hovers over me, procedure is fairly quick but fairly painful with 50 injections in my face, neck, head, shoulders like many beestings
  • dentists for kids (20) – 1 minute drive, no one touches me, low stress
  • optometrist (20) – 30 minute drive, no touching, once every year or two as needed, ask for dilation instead of air puff
  • urgent care center (60) – do I really need to go? it is super expensive so I don’t trust my own judgment vs fear, can it wait. minimal touching depends on what is being examined.

 

Stressors after the appointment

  • I don’t trust diagnosis and do my own research before filling Rx or doing next steps (80)
  • I don’t schedule followup if I feel fine – waste money (30)
  • I feel guilty for not following doctors orders (30)
  • waiting for lab results creates anxiety and then I feel like a failure if something is wrong, like a bad grade (60)
  • feel guilty spending money on Rx (50)
  • pick up candy with meds at pharmacy (40)
  • might get frustrated with pharmacy if meds aren’t ready on time (40)

 

(photo credit: By Pi. from Leiden, Holland (Lab 15 – Lab Coats) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons)

SUDS, no soap just distress

I delivered my homework to my counselor feeling pretty darn good about my efforts from my previous post. She looks it over, and says great now we can start the next step of defining these further.

Whatcha mean further? I thought we were done with these three categories?

She tells me about SUDS, the Subjective Units of Distress Scale. She wants me to go back through my list and rate each situation with a number between 0-100 for how much anxiety and distress I would experience if I attempted to complete the task.

100? All of the other scales usually go to 10 being the worst. I wondered why this one was different. I asked her for some benchmarks to help me rate, and she said I needed to determine those, thats the subjective part. Ummm, ok, sure, but what does anxiety or distress of 100 look or feel like? Is that a panic attack, or a trip to the E.R. or getting dizzy and leaving an event…

She said yes. It is whatever you say it is.

Fine. I will create my own scale. I may need to adjust this as I keep working to give myself better clues. I have been avoiding some fear causing situations so long that I am not in tune with how I feel exactly.

100-worst anxiety ever felt, my head and heart may explode, better back up everyone
90-extremely uncomfortable, cannot tolerate, dizzy, cannot breathe, choking, need to leave NOW
80-very uncomfortable, cannot speak, swirling thoughts, senses heightened, want to hide or get to my safe zone
70-uncomfortable, starting to sweat, dry mouth, might be able to push through it
60-struggling but can manage, no physical signs, ugly thoughts that i can control
50-moderate distress but is manageable with breathing, blood pressure may raise
40-mild stress with no interference, muscles tense, jaw tight
30-very mild stress, not bothered or hindered
20-extremely mild stress
10-no stress, not relaxed
0-completely relaxed, life is good, brain is good