One of the things we did at Sheppard Pratt’s Trauma Disorders Program, was every evening after dinner, we convened in our small group to go over our progress on our goals for the day.
In 2007/2008, everyone led off their share, by saying “Our goals for today were A, B, and C. Today….(explain what we accomplished towards these goals). My safety is….(explain any issues with safety), and my plans for this evening are….(explain what we are going to do to wind down, make sure parts are in their safe places, use coping skills, etc.).
During our last stay in 2018, it wasn’t as structured, but still had the same goal. We reviewed what progress we made on our goals and chatted about what we were doing that evening.
It’s still a helpful technique, to wrap our mind around the day’s events. There have been days I’ve been surprised to find out I had gaps of time loss, and a little internal communication helped improve awareness. It also helps parts feel heard and not ignored or avoided.
Here’s our basic outline for our night check-in. I hope it helps give yous some ideas that are helpful!
- Read off goals for today and progress/outcomes of working on these goals.
- Celebrate successes! Even small wins can be huge for some parts.
- What number am I on the Crisis Continuum right now?
- Did we experience any triggers today?
- Is anyone having intense emotions right now? (If so, are there self-soothing skills, grounding skills, imagery, or other things that might help you contain?
- Do I need to ask anyone (external) for help right now? If not, try to engage with an outside person before bed in a positive way (e.g. give 1 complement to them).
Then when we get into bed and get ready for sleep, we’re usually in a safer space. We pay attention to our body to help parts relax any muscles they have tensed (facial, neck, or lap muscles) and do deep breathing to fall asleep well.
Tomorrow is therapy day! So, here’s to a good night’s sleep!
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.
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:
- Work on my Crisis Continuum.
- Increase motivation for safety.
- Internal Communication to identify safe places.
- Work on a System Map.
- Hold at least 1 Internal Meeting.
- Share (at least the 1st section of) my System Map with therapist.
- Make a list of my accomplishments from working in therapy.
- Rework internal space to include an anger room.
- Cognitive Distortions assignment regarding the thought “I’m overreacting”.
- Boxes of Control regarding grief/loss.
- Cluster Journal one time today.
- Do Grounding Checks every 30 minutes.
- Make a list of Grounding Techniques based on age-appropriateness for different parts.
- Make a list of Self-Soothing strategies.
- Make a Containment strategy.
- Do Feelings Checks every 30 minutes.
- Do a Past vs. Present on loud noises as a trigger.
- Read Chapter 5 of the Coping book.
- Create an Orienting Card.
- Create a list of early warning signs that a flashback or increase in dissociative symptoms may be coming.
- Practice Dialing Down.
- Create a BDA for the shower.
- Create a Bedroom routine (for going to sleep).
- Create a Nighttime routine (if I wake up in the middle of the night).
- Maintain safety by using Opposite Action if I want to isolate.