Thursday, October 2, 2008

Back Seeing A Therapist.

I am back to seeing a therapist.

I go to this program every year now. This being my third year. Since I don't have health insurance all I can afford is to see students in training. Each year I get someone new and each year I have to reexplain my situation. Usually I have new concerns I need addressed as I quickly fill the new person in within a few 50 min sessions with 32 years of my life story.

This year I am taking a more direct route. I have printed off about 30 pages from this blog and just handed it over. It is easier than explaining everything again. Truth is I am tired of explaining myself.

The person I am seeing would like to try CBT (Cognitive Behavioral Therapy MAP-3). Which for me is nothing new. CBT is the first thing I did when I first saw someone in 1996. It seems to have come full circle. The Chapter 1 she photo copied out of the CBT Book states that people with panic disorder or anxiety in general do not have a chemical imbalance in their brain. Isn't that what I have been defending over the past decade to doctors and therapists? And more recently on this blog and youtube.

I never bought into the "imbalance" but I have lived through the SSRI era of paxil and zoloft. The quick fix for all problems. I am not saying that these drugs don't work in some people. I am saying their is always a price to be paid and risks. You just have to measure the risks you are willing to take. Like right now I take Xanax. Not that it helps much.

Now for me CBT does not work at least in the past. CBT is sort of how I cope in general anyway on my own. But sure why not do it again? What else is there?

Truth be told I almost want to just stop going to therapy altogether. Sometimes I have just stopped caring. I can only do so much on my own but without support and understanding from most medical professionals, family, or the public in general how can I do it all alone?

So anyway to speed up the process with the new person I am seeing I have yet another letter I will hand her next Tuesday. In some parts it might sound harsh but I rather not have to deal with the crap I normally do.

Here is the letter it is mostly worked out but still in draft form. Oh and when it says "(packet included)" it is the print out of what I have listed in my last post about blood/needle phobia and the things in quotes is just in reference to what the CBT MAP-3 program states:

""Clients learn specific intervention skills, including how to slow down physiological reactivity through breathing retraining and muscle relaxation training"

This I already do and 90% of the time this is how I cope (this eases it but does not stop it). The other 10% of the time breaks down to the following.

1) I am not in the mood to cope that day so I just deal with the situation or to tired to deal with it so I just don't bother.
2) Other people around me cause distractions or help make the situation worse. Example when I told the dentist "I know my gums bleed but lets not talk about that" stated before hand it is brought up anyway. Or "you don't look so good" when I am already trying to focus and not pass out during a blood draw.
3) The anxiety is so intense that I have not mastered easing it at that level (happens rarely)

"how to decatastrophise through actual prediction testing:"

1) I do this as well. Example when I get my hair cut nothing overwhelming has ever happened and even if something did I would have to deal with the situation at hand and just get through it. Yet knowing this does not seem to make a difference. In fact most situations that I know are not dangerous and nothing ever has happened before, or even something I enjoy doing still sets the process in motion automatically. This can and has happened even when I am fed up with the anxiety and could careless about myself or anyone else for that matter (meaning I care zero what people think about me at that time). Basicly I question my disastrous thoughts and paint them in a different more positive way, know that I can not predict the future and it is never as bad as I imagine anyway (so far).

"how to lessen fearfulness through exposure to feared sensations in safe settings."

1) Exposure no matter how often or far apart seems to have no effect. Going to the same job everyday does not ease it. Getting my hair cut in the past once a month for 17 years.. sometimes even at places that were quiet and the people who worked there were enjoyable did not change the out come much. Also somedays at work were better than others anxiety wise. There is nothing different between the days other than the fact my body is not acting up on some. Somedays at work everything was fine other days I was throwing up.

"sensations in safe settings"

1) I can not get these sensations in a safe setting. Most I can't even bring on if I wanted to at will. Hyperventilation is not something I do during a panic attack or anxiety in general. I was able to eliminate that years ago and am not willing to do that just to get dizzy and bring that feeling back into the forefront of my mind. I also don't get dizzy during panic attacks anymore. Unless it was a long lasting dizzy spell I am not bothered by feeling temporarily dizzy as I experience that at random times be it from being tired or having a cold.

I am not willing to work on blood phobia in this setting because I do not feel this is the proper clinical setting to address that phobia (infomation packet included).

What I am willing to work on:

1) How to cope when my mind becomes so filled with chaos that I cannot stop the racing thoughts, worries and dreams even with deep breathing and decatastrophizing / or positive thoughts. Uncontrolled this can lead me into a depression.

2) I am not scared of when I throw up, not scared of the panic attack or anxiety in itself. I am just tired of feeling so uncomfortable all the time. Years ago I was scared and worried it would kill me on the spot. It hasn't and I have had no choice but to endure it. A lot of therapy depending on the treatment plan can include exposure, breathing techniques, distraction, self-hypnosis, religion (in a church setting treatment plan), medication etc etc.

What it does not address and what I would like and I don't even know if it is possible is deep down I do not want to be focusing on my breathing while shopping, getting my hair cut, seeing a doctor etc etc. I just want to be normal and have my body just behave itself. After all these are not dangerous situations and I know it. I would like to enjoy them without my body fighting me.

A lot of times therapy goes back and forth with "are you worried you are going to throw up?" "so what if you do throw up?" "why do you mind what people think if you throw up?" "sometimes people have a virus and throw up so it's normal" (which I am aware of but this is not a virus or a one time flu). "have you tried not to throw up? and what happens when you do try not to?" "do you worry about throwing up therefore causing a self fulfilling prophecy?" .....For me the real answer is when I am nervous I throw up it is just what happens. It is a pain to deal with and most likely damaging to my health. I do not want to throw up when nervous so how do I stop that? How do I stop my body from shaking even when I am not scared of the situation or even if I am?

How do I deal with people who are demeaning, rude, unsympathetic, uneducated or just plain jerks about my situation? How do I claim my place of power when I am not in a place of power in some situations? How do I do this without a proper support structure in place?

How do I deal with a situation that makes me nervous that I do deem as a possible dangerous situation? How do I sleep when my body refuses to?

How do I know when something real is happening such as a heart attack and not just blow it off as anxiety?

Word games:

If I say I "can't" I do not mean there is some invisable wall or force stopping me. In general I just mean I "can't" do something at that moment in time for whatever the reason or situation at hand. I do not think I always "can't" I am using the word "can't" as anyone would in everyday common language. "can't" does not mean I am unwilling.

"is just what happens" does not mean there is a law in my head that states that there is a rule, a conclusion of absolutes. I just mean in this time and space, it is what it is, and has been occuring in the now and/or past. There is no future prediction of forever happening. Most the time I am not thinking in terms of "forever" or "always" (in future tense).

"always" I am using in common terms meaning most of the time (and sometimes "always" does mean something "always" happens in the present and past)

"normal" means in general what most the population does not "do, have or think"

Word games do nothing for me other than frustrate me since I then have to define every meaning of common words I may use in a sentence to convey a thought or explain to someone who is not me how something "is" or "feels".

I am not receptive to praise in most cases. It depends on the delivery. In a normal adult voice and only when it's for something big. Some how being praised for going to the supermarket, mailbox, or any other simple everyday tasks makes me feel ill. To me it's corny and the "woooooow thaaaats Greeattt" is not needed. For some reason praise in general does not motivate me.

I am an extremely open person (maybe to open with people). You can ask me any question you want. If it is something I rather not answer at that time I will just say "I do not want to answer that". I am hard to offend so don't be concerned with that. (and no I am not worried that you are concerned).

I do not think I am always right. New information can and does change my mind about issues or changes it over time. When it comes to people in general we all in some way have a belief system. So at times I just agree to disagree.

Basicly I am flexable."

So that is it. That is my letter. Any of you who have been in therapy for any amount of time might be able to relate to what I am talking about.

You know reading over my posts sometimes I hope some of you are getting something out of this because I find it very difficult to express what I am feeling into words. That mixed with my grammar being awful....well I just hope someone gets it. :-)

No comments: