Why is therapy a slow process?

K. and I are reviewing treatment goals. 

“Of course,” She says, “There’s the ongoing goals of monitoring triggers, safety, improving internal communication…” She pauses while thinking.  “And we haven’t even gotten to grieving loss yet.”

I was trying to listen, but I lost the tail-end of her sentence.  “We haven’t gotten to what yet?”

“Grieving loss.  Loss of control of the body, loss of self-identity, loss of safety…”

I started to get floaty and check out.

K. nodded, “Aaaand, now I’m triggering you.  I think we’ll stop there.”

I can’t even talk about treatment goals without dissociating. :/


Daily Symptom Management Goals

One thing being inpatient tends to do very well is kick my depressed butt back into a routine.  I took a lot of what worked from inpatient, and this time I implemented it when I got home.  It gave me a sense of safety/comfort going through some familiar motions.

The most important piece of this routine was setting daily goals.

Goals were set around symptom management skills we were learning or implementing.  Sometimes it was in reference to assignments we were working on with our individual therapist or psychiatrist.

We outlined 2-3 goals (no more than that) for each day.  Some were the same day after day, if it was a concept we were struggling learning.

Here are some of the goals I practiced while inpatient earlier this year:

  1. Work on my Crisis Continuum.
  2. Increase motivation for safety.
  3. Internal Communication to identify safe places.
  4. Work on a System Map.
  5. Hold at least 1 Internal Meeting.
  6. Share (at least the 1st section of) my System Map with therapist.
  7. Make a list of my accomplishments from working in therapy.
  8. Rework internal space to include an anger room.
  9. Cognitive Distortions assignment regarding the thought “I’m overreacting”.
  10. Boxes of Control regarding grief/loss.
  11. Cluster Journal one time today.
  12. Do Grounding Checks every 30 minutes.
  13. Make a list of Grounding Techniques based on age-appropriateness for different parts.
  14. Make a list of Self-Soothing strategies.
  15. Make a Containment strategy.
  16. Do Feelings Checks every 30 minutes.
  17. Do a Past vs. Present on loud noises as a trigger.
  18. Read Chapter 5 of the Coping book.
  19. Create an Orienting Card.
  20. Create a list of early warning signs that a flashback or increase in dissociative symptoms may be coming.
  21. Practice Dialing Down.
  22. Create a BDA for the shower.
  23. Create a Bedroom routine (for going to sleep).
  24. Create a Nighttime routine (if I wake up in the middle of the night).
  25. Maintain safety by using Opposite Action if I want to isolate.