Containment, for the win!

I had therapy yesterday with our therapist, K.  We spent the session reviewing some therapy homework.  At the end of the session, I told her there was something I needed to say.

K. waited, quietly.  Sometimes she takes the approach of saying nothing, to allow my to get internal communication or put my words together.

I continued, “It’s to do with being in the shower.  Nearly every time I’m in the shower, I hear things people said to me.  I never have a picture memory, it’s just these things that were said.”

K. waited.  I didn’t say anything.  “Do you need to say them outloud?”

“I don’t want to say them outloud.  I don’t want to hear it, even though I hear it in my head all the time.” My eyesight diverted to the floor as the shame came on.

“Could you write them down?” K. asked.

I thought for a moment. “Yeah, maybe.  I mean, it might work.”  I reach over for my journal.

K. stopped me.  “Would you rather write them on a sticky?  Instead of having them in your notebook, where it might be difficult to tear it out, if someone doesn’t want the words in there?”

I feel a big YES! from inside.  I nod.

K. hands me a stack of blue sticky notes.

I’m including the following words I wrote for support.  However, there is no expectation you read them.  Often, I click on trigger warnings out of curiosity.  I want you to know that the words below are NOT safe. I do NOT expect you to read them.  In fact, they are not necessary to “get” the rest of this post.

Trigger Warning:  Graphic words behind this break!
      • “You like that, don’t you?”
      • “She likes that.”
      • “I’m going to make you —.
      • “You’re going to —, NOW.”

 
I handed the sticky to her.  “I want to leave these here.”  I don’t remember if she read them or not.  But as I told her I wanted to leave them, we simultaneously spoke internally.  Parts understood that the memory/words would be left behind in her office.  Everything tough that comes along with it would stay there, safe, until next week.

It was a success in Containment! I did some grounding skills and was able to leave/drive safely home.  Today, I have had zero “fallout” from the session, which is a-freakin-mazing.

It’s great to be reminded that I can use these symptom management skills, and–oh yeah–they DO work!

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On Preparing for Therapy

It’s almost been 2 weeks since we’ve seen K. (our therapist). Snow storm hit in the beginning of the week, and so I’m a bit behind seeing her.  Honestly, I needed a little break.  Therapy has been tough.

Going through my regular night routine, and I’m preparing for tomorrow. I wanted to do some writing/internal communication about therapy.

I imagine tomorrow we’re going to follow up on the possibility of recorder/reporting parts.  I am terrified for multiple reasons to discuss this.  On one hand, I think I’m having some passive influence of Clara’s terror.  On the other hand, I’m having super rejection sensitive dysphoria (intense emotional response to the perception of disappointing/failing others–even when no actual rejection has taken place).  In other words, someone (maybe Clara again?) is afraid that K. will withdraw her care or abandon us if we continue to talk about this.

All of this is overwhelming, awful, and at times unbearable. We’re not even sure where to start with grounding when we hit this level.  It’s a level of yuck feeling that isn’t really addressed on our Crisis Continuum.  

Grounding Techniques

Why are Grounding Techniques so important?  I used to put little importance into learning them, because I felt like it was a waste of time, when I needed to work on uncovering trauma and processing memories.  Wellllll…doing trauma work kicks up trauma disorder symptoms, and if you can’t keep those symptoms “in check” … you can’t do the work.

Grounding Techniques are great because they assist with CPTSD symptoms (e.g. flashbacks, hypervigilance, panic, intrusive thoughts/feelings), and dissociation symptoms (e.g. trances, timeloss, uncontrolled switching).

Grounding helps us be present in the moment, connected to the here and now.  Ugh, why would I want to do that, when I’m in so much emotional pain all the time?  Well, that’s exactly what happens when you are not grounding.  By allowing symptoms like avoidance and dissociation to be our main coping strategies, it only reinforces feelings from the past (like the emotional pain).  In fact, surviving day-by-day casts a shadow of doubt on our future.  When even the future looks so bleak, no wonder we can’t fathom connecting to the here and now!

Increasing our present-awareness actually gives us a defense against the symptoms and control back over our lives.  There are loads of techniques out there that help people.  The trick is finding the ones that work for you (and which ones work/don’t work for each part).  Here are some grounding strategies people find helpful:

  1. Anchors – These are items in/around your home (or other place you spend a lot of time–school, work, etc).  Find things that are neutral or pleasing to you.   Hear them, touch them, connect to these things in the present.  If this is your first time finding anchors, slowly walk around your house, from room to room, and find at last 3 items that you can choose as anchors.  It’s especially helpful if these are items that were not around during your trauma.  Eventually, you will be able to identify anchors in each room, so that no matter where you are, you have something that can ground you to the present.  Here is a personal example of anchors for me:

I walk into my living room after a long day of work.  I take off my winter coat and hang it up on a hook.  I take off my purse and hang that up as well.  It was a very stressful day at work, and something that happened on the job kicked up overwhelming stress and shame.  I feel so stupid, I hate what I said, and I wish I could just erase the whole day.  Instantly, one of my child parts is crying, and another part wants to engage in self-harm due to the shame.  I feel the body’s heart rate pick up, and I realize a 3rd part is headed into an anxiety attack.

“Hey guys, I know it was a stressful day, but it’s over now.  The only thing we need to do now is relax.” I take my parts away from the door and show them our living room.  “I know some of you feel like you’re stuck in trauma time, but that time is over, see?”

I point to our large flat-screen TV. “It’s 2019. We didn’t have a TV like that when we [at unsafe place], right?”

Then, I sit down on the living room couch and point to a big blown-up photograph on the wall  which is of the body eating breakfast outside in Austria.  “Oh, look! That’s Salzburg!  We went to see where Sound of Music was made.  Remember what Austria was like?”

If parts who are struggling didn’t go to Austria, we might share the experience with them in detail.  Or, we might try a different anchor: “Do you like this bracelet? It’s a grounding bead bracelet we made at Sheppard Pratt.  Do you want to help me make a new one?  Which color should we use?”

Some of the things, like the grounding beads, and other art supplies, have a special place in our living room, so we know that’s a good “grounding/anchor spot” we can always count on being there.

2.  Grounding Bag or Grounding Kit – We keep a clear makeup bag like this in our purse.  This makes them visible and easy to access in a moment of need.  Inside, we have a conglomerate of items that different parts find soothing, like:

  • Burt’s Bees Lip Balm (the tingling sensation is sooo grounding)
  • Peppermints
  • Gum
  • Tea Bags
  • A few colored pens (pink, purple) if parts want to write in our journal
  • Lavender scented hand lotion
  • Essential oil (with roller) I can roll on my skin if I need to smell something calming (we link cinnamon)
  • Fidget spinner
  • Silly putty
  • Grounding stone (a smooth river rock)

3.  Soooo many more ideas… There are just way too many for me to go on about.  Beauty After Bruises blog has an excellent post about Grounding and gives a nice list of ideas for you to try out.

My last bit of advice…is keep a list! It can be overwhelming to be introduced to so many new things.  As you try skills that work for you, keep a list in your journal to easily flip to when you need a refresher.

Here’s to a happy, in-the-moment, New Year!

Phase One and Symptom Management

As I’ve been doing more work with our therapist, K., I’ve been reviewing some of the tools I learned at Sheppard Pratt this go around.  Some visitors who have never heard of the skills I’ve brought home have been asking for a better understanding of what I’m referring to.  Before I start sharing these skills and how I use them, I thought I’d talk a little bit about why I use them.

Sheppard Pratt follows the Triphasic Model of Trauma Treatment.  The three phases are:

  1. Safety and Stabilization – Establishing safety, Recognizing symptoms, Creating emotional stability
  2. Processing Trauma Memories – Done in outpatient therapy, using Phase One skills to not be stuck in avoidance or overwhelmed with traumatic material.
  3. Integration – Referring to an integrated understanding of the current day, present, healed self. Trauma is part of your life story, but not the main focus anymore. This does not refer to integration of alters or parts.

[Source, Adapted from Herman, 1992]

Since Sheppard Pratt is an inpatient hospital, their main goal is to return the patient to their outpatient team with Phase One goals of safety and stabilization accomplished.

Before learning skills, safety is paramount.  In our case, we had to work with parts and our inpatient team to identify who was unsafe, their thoughts about safety, and their reasons for a lack of motivation to remain safe.  As is always the case, we discover underneath the chaos of safety issues, an immense emotional pain.  Helpling parts understand this isn’t “bad” behavior, they aren’t in “trouble”, and most importantly they aren’t alone–that we don’t have to hurt the body anymore in order to be heard–is vital.

Once risky behaviors have been identified, and there is some kind of mutual safety agreement, and safety plan in place, we can begin working on symptom management.

Many of the symptom management skills are specifically learned in Phase One of trauma treatment.

Side Note: I feel it is important to be clear, here.  I have twelve years of trauma treatment under my belt.  Even after all this time, I learned helpful tools going back to Phase One.  There has been a wealth of research on DID over the past twelve years.  I had no idea I was missing out on skills.  Many of the skills gave me a sense of power and control back over my life.

Symptom Management skills are basically lumped together under the following categories:

  1. Crisis Planning
  2. Grounding techniques
  3. Breathing/Meditation/Imagery
  4. Medications (PRNs)
  5. Addressing Co-occurring Disorders
  6. Hospitalization if needed to prevent harm to self or others

Besides establishing safety, the overall goals of symptom management include (1) enhancing awareness, (2) emotion regulation, (3) decreasing affect (or part) phobia, (4) building distress tolerance, and (5) enhancing effectiveness in personal relationships (and with parts). [Source]

In the upcoming posts, I plan to talk a little bit more about what each category is, and the things I learned to support our DID System find things that worked.