Less Me  

I have been in therapy before.  I know how it works.  I have come to see you because of an inability to function at my job that has left me very low-functioning.  A problem within my marriage, while accurate, is secondary.  I need for you to understand this.

Forms of treatment:  While medication may give the greatest immediate relief, the time you spend with a client before they are medicated is extremely valuable, especially if the client has life long issues they have struggled with.  You have an opportunity to see the true depth of the struggle, coping mechanisms and emotive stressors that the medication may mask.

Once having a clear picture of the factors involved with a particular client, medication may be helpful in assisting said client through the behavior exercises.  Please be advised, due to the ineffectiveness of current medications, it is typically a temporary fix that assists with therapy and therefore not the most effective life-long treatment.  Behavior modification and coping skill training, i.e. behavior therapy; can be lifelong, giving each client the tools necessary to effectively manage their lives through all types of stressful encounters and life events.

I have very strong survival skills.  What you are seeing when I come in is fight or flight response.  I am reacting to the immediate crisis and stress of the visit.  During that time, I will appear high-functioning, rigid, seeking to respond accurately and somewhat controlling.  My mind will process information very quickly.  I may seem somewhat impulsive.  It is important for you to understand that because of this defense mechanism, I can mask my actual difficulty subconsciously.  And you or I may not even see that I am doing it.  Please remember I have limited control over this response.  That is what the pre-work my husband and I do is for.  Trying to de-stress the situation.  Trying to get me as far out of fight or flight as we can, so you are able to see what needs to be addressed.  You need to see me in a non-crisis mode.  I am currently in high-crisis mode.  See the challenge?  The papers that I brought in last week were indicators of the true difficulties I am dealing with.

It is not my desire to control our sessions, as it is not my intention to control my life to the extent that I am currently doing.  Unfortunately I am not able to back off my fight or flight response.  If I were able to on my own, I would not have needed to come and see you.  What you are seeing is not willful control, but subconscious control.  As I said before, I am trapped inside a box.  The instructions for getting out of the box are written on the outside of the box.  In order for me to get out, I need you to read the instructions to me one week at a time.  This is necessary because it is my responsibility to get myself out of the box, I just need your assistance.

I need for you to understand that I have overcome a good amount of difficulty from my troubled childhood.  It is apparent that there is a problem with complex post traumatic stress disorder (C-PTSD).  Do a wiki search on it, it’s fascinating.

In the meanwhile, it may be more important to focus on the actual problem at hand and not spend too much time concerning ourselves with fancy labels.  In the end, the label will hold much less significance than the actual form of treatment.

If we were to get too caught up with labels, we could include light renderings of borderline personality disorder with strong challenges in avoidance, dependence and a sprinkle of obsessive-compulsive behavior just for fun.  But I don’t know if the time expended on this will increase success of treatment.

Behavioral therapy has always been most effective with me in past undertakings.  I am concerned however, with your seemingly assumptive nature.  Maybe you could be so kind as to explain it to me.

It is extremely important for you to understand that it is not my desire to diagnose myself.  I do not have the skills necessary to do so.  In a period of crisis, if it appears that important information that I am relaying is being overlooked, I may be prone to providing a diagnosis in an attempt to cease the crisis due to exhaustion.

The exhaustion is usually caused by long periods of hyper-vigilance. This can present itself as depression, and may even be depression caused by the exhaustion.  The periods of hyper-vigilance many times can present itself as manic states.  There is a good possibility it is only an out-of-control fight or flight response instead.

As I told you before, I am able to be acutely high functioning at times of crisis.  I do not appear to be able to function during non-crisis periods.  This is evidenced by my procrastination with lower brain function in non-crisis situations, until situations get behind or out of hand.  Paying bills late even though I have the money.  Doing unnecessary tasks prior to a stressful meeting to make me late.  Arguing with my husband if we have not been effectively problem-solving.  Putting off important tasks at work until almost deadline time.  Once a threat is introduced, as in not completing necessary tasks and fear of getting in trouble is introduced, my mind unlocks and I become extremely high functioning, hyper-vigilant.

My ability to maintain this level of high alert remains until the crisis is over, and then I have a period of being exhausted.  If situations remain non-threatening, it is difficult to stay on task, concentrate and prioritize activities.  My brain does not function as effectively.  I understand that this could be misread as bipolar disorder.  I feel it’s more important to focus on the how & why of it and not be so concerned with the label.

I need to go over my fears with you and relearn how to distinguish between rational thoughts & irrational thoughts.  I need to be taught how to move from an irrational thought that will throw me into lock-down to an ability to recognize a rational response and ‘follow through action’.  Assisting me with being able to move myself into the follow through action is something I am not able to do on my own.  I will need your assistance with this.

I also need to investigate my hyper-vigilance and gain assistance in understanding when it is necessary & good, along with times that it is not necessary.  I need some techniques to assist me in keeping these precursor thoughts rational and methods for minimizing my hyper-vigilance.

I need to be taught how to exist during non-crisis.  Currently my brain becomes scattered and easily distracted during non-crisis periods.  The only times I am able to effectively function is in crisis.

It is important for you to understand that I am not asking you to immediately fix me.  I understand that the process takes time.  I do however feel that we need to ‘begin’ immediately.  There is a period of time when you need to observe and gather information.  Build a foundation of understanding of what I am struggling with.

At the same time, you need to understand that I am in a high state of crisis currently and need ‘action indicators’ so that my subconscious mind feels that we are actively working on the problem, so it doesn’t feel the need to step in and take over to ‘save me’.  That is why I keep asking you for little activities to assist me ‘to’ our next appointment.

Please keep in mind that while I am unable to fix the problem I am having on my own, I have a very clear understanding of my difficulties and coping mechanisms.  I know them better than you; I have lived with them for over 30 years.  I also know how to ‘get around’ them so we can ‘treat’ me.  I am not always able to get around them, but I do know ‘how’ to do it, usually.

You are not going to ‘fix’ me.  You are going to help me learn how to live every day in a ‘non-crisis’ environment.  You are going to give me techniques to manage my anxiety and control my irrational beliefs.