I finished therapy again.
It’s awkward, finishing therapy. I’ve never known it not to be. This might be because therapy is nothing like what you see on TV. The therapists I’ve seen on TV say goodbye to their clients with tears and moving movements where the client walks out into the sunshine, gulping back grateful tears, marching into their future with their head held high. My experience is not that. Instead, I mumble through an awkward conversation, saying “thank you,” too many times and shuffling out of the door without making eye contact. Granted, I am not great at goodbyes even with people I sincerely love, let alone with strangers I have spilled all my secrets to.
My therapist never feels more like a stranger than at the end of the journey. That’s not really a bad thing, in fact, I’m sure it’s how it’s meant to be. A therapist’s job is not to be someone who will be missed and longed for, that is the opposite of what their job is. Their job is to enable you to manage your own life without their constant input. Consequently, the feeling at the end of therapy is just like that. It’s awkward because you are essentially standing in front of someone and admitting that you might not need them in your life anymore. That they are dispensable to you.
There is fear in that, too. Fear that maybe I do need my therapist still. Fear that one morning I might wake up and need help again, that the sunshine I am currently standing in will fade to darkness and I will be alone and afraid again.
But I have learned that I cannot live my life in fear of a relapse that might never come, so I finished therapy.
So what else have I learned?
Well, I am hoping to blog about what I have learned quite regularly. My hope is that this will not only be helpful for others who might be struggling, but it will also help me remember what I learned, and to live in it. First, however, I need to tell you a little bit more about the type of therapy I’ve been having.
I’ve been having RODBT therapy. This is (ready for it?) Radically Open – Dialectical Behaviour Therapy. This is based on DBT (Dialectical Behaviour Therapy) which is a type of CBT that was developed for patients with Borderline Personality Disorder. RODBT was developed specifically to help people with difficult to treat Over Control Disorders. Examples of over control disorders might be: anorexia nervosa, chronic depression, and Obsessive Compulsive Disorder. Basically, it sums me up!
That tells you what RODBT is for, how it used, but it doesn’t really tell you what it’s like. So what is it like? What is like to be having the type of therapy that, when you type it into google, throws back a long list of academic and medical articles? Well, sometimes, it was like a lesson. One thing about all CBT based therapy is it is essentially re-informing a person’s understanding of themselves- there’s a lot of learning there! RODBT is no different. There were a lot of worksheets, a lot of “terms,” a lot of re-learning what it means to be me and live in my brain. For people who think that therapy is easy, that you simply show up and recount your day and your shopping list to a friendly face, it could not be less true. Therapy is hard work. RODBT is hard work.
It is also very illuminating. In so many ways it has completely opened my eyes to my own behavior, but let’s just focus on one for today. So here it is: One thing I learned from RODBT.
Forcing myself to change doesn’t work
Something that happens a lot with mental health is people on the outside will say; “why can’t you just try to eat something/go to an event/not be anxious and see if you get through it? Can’t you just push through?”
RODBT taught me that the answer is No. No, I cannot. A person with my temperament, someone with over-control can push through, but they shouldn’t. It will do nothing for them. They will get through it, but they won’t get better. In fact, they will only get worse.
That probably doesn’t make sense, so let’s take an example, something that’s reflective of my experience. As a child, I was frightened of going to new places. However, I often had to, even if I was frightened. My brain would identify that this was something that threatened me, something that made me unsafe. However, since I would not have the power or control to leave the situation, I would emotionally detach and shut down. This would result in minimal communication. My Mum and I once went on a day trip to Israel from Egypt where I barely spoke two words to her the whole trip. At the time she probably thought I was being a grumpy teenager, (and yes, there was probably something of that in there) but inside my mind, I was threatened by all these new factors that I could not control, so I had withdrawn. I got through the experience, of course, I did, but I did not have an enjoyable time getting through it. I came away from the experience reinforced in my own mindset that I did not enjoy traveling to new places that much. What does this mean? Well, it’s strangely simple: Exposure therapy does not work on people with Over Control disorders.
A person with Over control will simply withdraw and survive and learn nothing from the experience. In fact, their misconceptions will only be reinforced. An anorexic forced to eat will not heal. A person with OCD cut off from their routines will not heal. They will indulge their enforcers, they will eat and they will stop, but only for the time that they are made to. Then they will breathe a sigh of relief, thank God they survived, and go back to their over control. They will not have learned from the experience.
So how does a person with an over-control disorder learn?
Well, instead of being forced out of their control, feeling threatened, and then withdrawing, they can learn to relinquish their control in small moments. Instead of being forced to eat a whole meal, they can choose to do something less threatening to them, something that challenges their control but not in a way that is very threatening. If someone had told me that I had to eat everything they said, I would not be able to do it. But I chose to challenge my control in areas near to food. I chose to try a different brand of the juice I always drink. I chose to eat the same dinner I always eat in a different place. I learned to challenge myself without triggering my threat response. (For the full journey of this, please check out my instagram @elphreads for my #OCDchallenge)
In my mind, I characterize it like a zookeeper winning over a timid sloths affection by introducing them to very small pieces of fruit, one at a time. Then maybe one little stroke, one little petting session. As someone with over-control, I need recognize my sensitive threat trigger and try to work with it not against it.
So no, unhelpful, ignorant person who asks me if I can just push through. No, I can’t. Because whilst that might put my idiosyncrasies, my needs, my strange behaviors out of view, whilst that might solve your problem of having to deal with all of those things about me, it won’t help me. It won’t help me build up the positive associations I need with this thing in order to grow into a healthier human being.
Forcing myself to change doesn’t work, and I’m not going to pretend to do it just to indulge an unnecessary, cruel stigma.
That’s one thing I’ve learnt from RODBT.
Tune in next week for the next thing I learned from RODBT.
If you have questions about RODBT, or about CBT, or perhaps you are currently going through the therapy yourself do drop me a line at @elphreads on Instagram or @EmmaLouisePH on Twitter. I want to hear from you! Let’s go through it together.