My Relationship Map

This is a tool I use in a course I run at our Church. It is used in the final session of five as a way to enable people to start to think about how much they are part of a community already. Some of you may be familiar with other relationship 'maps' such as the ripple effect with 'Me' at the centre and the people in my life in circles rippling outward depending on how close I feel to them. I have adapted that idea, along with the practicals of location to help people to identify where their nurturing relationships are as opposed to where their 'emotional blackholes' are ie the people who suck the emotional life out of them. It is a simple principle - how close are those who nurture me, geographically? Am I too close geographically to those who drain me? Does the location of those closest to me emotionally prevent me from building stronger relationships? etc.

When I use this tool I do not ask the members of the group to divulge any details of their relationships - it is designed as a tool to help someone to consider small changes they may want to make to their social lives to either manage damaging relationships or to encourage nurturing ones. It is a starting point and the only group discussion required is in general terms about practicalities of making and keeping contact with people who are important to us.

1) Take a sheet of A4 paper and divide it in two (landscape seems to work best) I tend to draw a line along the middle, some people fold the paper in half and make the fold the central line.

2) The central line represents ME, write this in the middle of the page.

3) On the left hand side of the line put the title EMOTION, on the right hand side, put the title LOCATION.

4) Now plot relationships along the left side of the line - the closer a person is to me emotionally, the closer to the central line I plot them. eg I am reasonably close to my University flat mate due to the length of time we have known one another. She has lived through most of my traumas without having rejected me or just let the friendship drop due to distance and time, so she is placed close to the ME line.

5) Once I have plotted relationships according to emotional closeness I then plot the right hand side of the line according to where they are in relation to me geographically eg my flat mate lives in a different part of the UK so is fairly distant from me geographically, so although she may be close to the central line on the emotion side I put her towards the extreme right hand edge of the page.

I plot as many friendships and relationships as I am able to, but focus on those who are important to me in terms of their impact on my life - for good or ill. Again, in the group I encourage people to use initial letters of names to avoid over sharing. The tool is most effective when left for individuals to reflect quietly on what they discover about their relationship networks.

It is not meant to be complicated, it is as simple as that. The important part of the exercise is in asking key questions about my relationships and how effective (or otherwise) they may be.

Some questions I have asked myself and the groups, are:

a) Is there any imbalance in the number of nurturing versus draining relationships in my life?

b) Are the people I am closest to near to me in terms of location ie am I able to encourage contact with these people easily?

c) Is there a lack of relationships that I consider close? What do I think has caused this? Are there any steps that I feel I am able to take to build new/renewed friendships that do not trigger negative emotions in me?

d) If I can't identify any close/nurturing relationships are there any relationships that I have identified as more distant that could become closer if I plan to build them?

e) Are there any relationships that are crossing boundaries and/or may be 'too close, too soon'? Do I need to put emotional distance into any of these relationships.

The questions about the map can be as challenging or easy as you want. What is important is to make a plan to change the things you may have identified that need changing. I usually give the groups I work with the homework of identifying one friend who is a positive relationship and aim to spend at least 30 mins in the following week with them doing something positive like going out for a meal or calling round for a coffee. For those recovering from mental illness, it can be a safe first step to rebuilding their confidence, socially. For those who fail to identify anyone they are close to, I encourage them to choose one person they would like to know better and do the same task of spending 30 mins in their company in the following week.

When it comes to relationships it is important to acknowledge that for most people with BPD the fear of rejection means that looking at the reality of our relationships can be extremely challenging. I do not ask people to look at all their friendships or relationships in one go. It is sometimes easier to begin with the least close emotionally first and then work towards those that are more significant as each person feels able.

One thing that repeating this exercise often has done for me is that I have been able to monitor the growth in the number and closeness of my friendships. It's lovely to be able to look back over the past three years and notice that I have been able to learn to trust people again. That's the thing, it takes time, and hard work, particularly when I fear rejection and am tempted to retreat to my previous ways of coping. What I need to keep telling myself is that, although I used to make friends easily, I often failed to sustain them long term. Now my focus is on 'building' relationships that I can rely on. Only time and steady, small contacts seem to work for me - that way I am not tempted to perform 'psychological striptease' in order to test friendships. In setting and keeping to my own boundaries, the friendships I now have are more secure and I feel less vulnerable - not least because few of my new friends know all about me and my past traumas. They just accept me as I am in the here and now.

I Spent Christmas on my Own - By Choice

It is my guilty Christmas secret. This year I decided I wanted to spend Christmas Day on my own. I also didn't make it widely known - because suddenly other people feel obligated to invite me to join them in their 'family Christmas'. It's not that I am a Grinch or a Scrooge - I love so many things about Christmas - not least because of my faith which means for me there is more than just the surface hoo-ha about it. My main reason for spending one afternoon and evening on my own was in an effort to manage a period of time which has been triggering for me in the past. In this way I have been trying to be EFFECTIVE in using my DBT skills.

I have to admit managing this feat took a number of skills and no small amount of preparation and forethought, although I will admit not remotely anything akin to the stress inducing mayhem of trying to pack family baggage into one 24 hour intense time period.

1) I tried to manage my EXPECTATIONS. No matter how hard we try the whole of the media machine is ranged against us at this time of year, filling our screens and heads with images of warmly lit family bonhomie. Not least is the imagery of groaning tables with more food than is right for any small group to consider ramming down their throats. Most of my life, Christmas Day was the day when I felt I was given attention in tangible forms. When favourite relatives eased the gap between us and our parents. The problem for me was that just like so many coping strategies this one day did not erase the pain and confusion of all the other days spent with these people. There is a confusion for the child of the invalidating parents. Despite the ongoing lack of interest in our lives, there is a bond which is unbroken. At Christmas I lived in hope that the glow I created around tiny little traditions would magically last for the next year and transform my life and family. Inevitably, usually early in the day, my expectations were disappointed. My post Christmas crashes were epic. Because I had put so much pressure on the ability of one day to transform my life and remove all my emotional pain, the fact that nothing changed would bring sadness crashing in on my head. This year, I decided to recognise that Christmas is a season. We don't have to see all our friends and relatives on one manic day even if we need it to be at Christmas for practical reasons. So, I planned a series of events. Being part of a church at this time allowed me to PARTICIPATE in a number of really enjoyable events.

2) I considered how I could CONTRIBUTE to other's experience of Christmas. Feeling part of something is a great way to counteract the sense of failure I often feel when I am tempted to ruminate on failed relationships and friendships - and my own lack of current relationships. This year I was asked to help with the script of the Nativity at church and had a part which was absorbing, right up my street and needed a great costume. I really enjoyed channelling my inner Victoria Wood! It is interesting that this invitation to take part would not have happened if I had not taken smaller, manageable steps early in the year to contribute to drama in the church, as well as stepping in to run Sunday Club during the summer break. It was great to help out with the children's work, without feeling the pressure of responsibility. It also helped that I am up to date with my CRB (or whatever the letters are now) status. Preparation for Christmas then, has meant a continuation of the involvement I have tried to develop as part of my DBT ACCEPT skills.

3) I didn't try to pack my enjoyment of Christmas into just one day, I decided to be MINDFUL of all the small things I enjoy about the Christmas Season. I identified cinnamon and winter spices as the smell I wanted to focus on. I have returned to enjoying cooking and, latterly baking. I found the processes of preparing, baking then eating my produce allowed me to practice focusing on ONE THING AT A TIME. The effect of this aspect of mindfulness is to stop me thinking myself into either a state of anxiety or of unsustainable excitement, which is generally followed by an almighty crash in mood. I managed to bake some presents for some people who have helped me throughout this past year. I also spread out the events and socials I was involved in over the whole Christmas and New Year period. So, I started with the script and practices for the Nativity, the Nativity itself. I was invited out for coffees by a number of friends, some old, some I have made in the last year. For the first time in years I planned a Mulled Wine party, and enjoyed the preparation for it. I kept the numbers down and held it in the house of a good friend which was bigger than my own and therefore able to hold the gathering comfortably. I was assured that I am a good hostess and I was able to show off my newly developed baking skills - I even pulled off some of the lightest, yummiest mince pies EVER!! My Christmas season is not over, I and my brother looked at our diaries and have planned a lovely family 'chill' day on 2nd January - so we get to exchange presents and chill out at the end of the holidays too. New Year's Eve I usually lock myself away and hide because I find it harder than Christmas - this is when I feel the lack of an intimate relationship the most in the year. With some very good friends, I am planning a Cowboy evening to introduce their children to classic westerns - of course the menu will include beans.

4) On Christmas Day itself, I went to church which was packed and really enjoyable. Because of my preparations I didn't feel weird about all the children and families sitting in groups, leaving me to pick out the spare seat at the end of the rows. A couple of friends joined me and we all sat together in our own 'group'. A good friend who has been divorced for some time, was doing Christmas differently this year. She didn't fancy a big dinner with family so she spent the morning with her daughter's family and grandchildren opening presents. She then visited friends and family for the rest of the day - I was one of them. We laughed and ate cake and coffee for an hour, then she went to her next 'call'. Both of us made our own Christmas. Lots of friends and family phoned or texted with greetings. I was able to graze my way to my dinner in the evening. The menu was entirely my choice. I didn't have to rush to eat more chocolates than I wanted in case my favourites were swooped down upon by others.

Throughout all of this I have made a conscious decision not to overspend. This is hard for me, because the only validation available to me as a child from my parents was in the form of material things. In the past one symptom of the emotional hangover from Christmas was debt which usually took me until April to clear. Through my baking and spending time with people I have learned a new way of feeling good about giving. Because I have spaced my time with people out, I have been able to be sociable from emotionally recharged batteries, rather than feeling completely drained by Christmas Eve.

POSTSCRIPT: I have found it interesting to see the discomfort of people who suddenly realise, 'Oh no, Alma's going to be on her on ON CHRISTMAS DAY!!' The thing is I live alone 365 days a year. I am lucky I have caring friends and my brother's family with whom I feel comfortable. Yet, for me there are many times when I feel alone. Weekends throughout the year are hard. It is so difficult in summer when I think 'I'd love to just pop out to the Lakes for the day', but it's not safe to do that on your own. I have learned to enjoy drinking a coffee on my own in a cafe. I am a long way, though from being able to go to the cinema or theatre or a restaurant on my own. How come the people who have invited me with such concern to 'join them and their family' for Christmas lunch never think to invite me at other times? I know that I am lucky to have the choice. I didn't mind my close friends who checked with me in the summer about my Christmas plans, I mean the folk on Christmas Eve who suddenly notice too late. Why should it matter to them simply because it is one 24 hour period? I am doing well socially, what about the other people who maybe didn't appear at any events over Christmas because it is too hard to be among people? They probably didn't even get the last minute, panic invite. Life is lived everyday, not just on Christmas!

My Christmas Self Soothe Habits

I once heard a famous musician state that he reckoned it took over 10,000 hours of practice to master a new skill. That means, not become a master of it, but to become proficient in it. That gives me pause to think when I expect perfection almost immediately when trying to learn new skills. Let me put it this way, 10,000 hours equates to 416 days - that's well over a full calendar year spent doing nothing but practice the new skill.

DBT Core Mindfulness is a simple skill to grasp hold of, but is hard to master. Most of the DBT skills are like that, some people find themselves doubting their effectiveness because of their simplicity. However the reality is that if I work at applying self soothing skills, for example, to my day to day life, then not only do I find them becoming a habit, I find that they begin to permeate my thinking.

If I apply the effort required to master any skill ie well over a year spent doing nothing but that skill, then I realise that the time spent in even the most intensive DBT therapy only gives me approximately 182 hours of practice. Of course those 182 hours assume that I have done nothing but practice mindfulness, say as a single skill. So what? Well it has brought home to me the fact that any hope of the DBT skills I have learned becoming effective in helping is dependent on how much effort and time I invest in developing and honing those skills in my day to day life. Seems obvious. Yet I continue to berate myself for feeling as if I don't deserve to enjoy life, or I feel as if I am a complete failure if my mind wanders when I am trying to be mindful, or if I find myself 'multi-tasking' and therefore not being as effective in a task. However, in real terms I have only been practising these skills for just over two years - in mastery terms I am well short of the 10,000 hours required to be merely competent and that's okay, because outside of being able to bend the laws of time and space I have no option but to live my life in a moment by moment stream.

Which brings me to Christmas - or rather my self soothe Christmas habits. Having used mindfulness and other DBT skills over the past year or so, for the first time in ages I feel as if I am awake to Christmas. Suddenly, I am more aware of how things are changing around me. In the past my experience of Christmas was masked by an emotional mesh over my senses which filtered out the more enjoyable aspects. Along with many others in society I have absorbed the lie that 'it's for the kids' or 'the most important thing is family'. Hardly any wonder that so many who don't have children in their families, or don't have perfect families (isn't that everyone?), or are isolated have a pervading sense of disappointment, from what is a two week, or if you take in advent, a four week season. More than any other time of year the pressure is on to either live in the future (THIS year we're going to....etc.) or the past ('remember when we used to do this, I always loved Christmas'). What a time to really focus on practising mindfulness.

I like to think about it as 'Mindfulness Max' - our senses have so much to be aware of and notice, that we can take our time and really focus on the here and now. Thoughts and memories bombard us from the future and past, derailing our mindful maintenance of moment by moment experience OR giving us the opportunity to build up our mindful skills.

1. SIGHTS - There is no way this aspect of Christmas can escape anyone. One of the real pleasures of the dark days of winter is the appearance of coloured lights in windows and in shops. Even the sight of a bright pink Christmas theme in a garden centre was a pure joy to behold, if only sharing the joke with some friends that it did indeed look as if Barbie had thrown up all over the place! The reason the lights hold such delight for me is because it is such a contrast to the drab winter world outside my window.

Even when I couldn't manage to do any real Christmas decorations in my home, I tried to have a couple of candles. If that is all you can manage to cope with I encourage you to light one, turn off the electronics, for as long as you can cope with it, and watch the flicker of the flame. As with all mindfulness exercises, if you notice thoughts or painful memories, just bring yourself back to simply describing WHAT you see in front of you - what colours are there in the candle? How does the flame move? Flames in candles or fireplaces are fascinating and soothing, especially when we sync our breathing to them.

2. SOUNDS - I don't mean the brash music that blares out incessantly, I mean the sounds of winter outside. I was amazed last week when walking down a ginnel (that's an 'alley' in northern lands) I heard what sounded like hundreds of birds really close to me. I realised when I stopped and looked closely at the hedge beside me that flocks of tiny bluetits and sparrows were chirping away in the middle of a stormy winter day. I have also discovered the soothing tones of Pentatonix - they are an a capella group who have brought some fresh sounds to some very familiar Christmas songs - they don't sound remotely dirge like. The lack of over produced brass and orchestration we have grown used to in our Christmas music is so restful to me. Equally, some Christmas cheesy classics have the familiarity of old friends or comfy slippers.

3. TASTES - at Christmas we can wage all out war on our taste buds - assaulting them with sugar and fat. This year I have rediscovered my love of cooking and baking. I am planning to reinstate my Mulled Wine party - the smells of mulled wine is matched by its soothing taste - a must have for Christmas. Along with the flavour of cloves I love the taste of cinnammon, I enjoy mince pies, short shortcrust pastry and...brussel sprouts! And why not? I have noticed that it is taking me so much longer to eat my meals - I used to be a 'bolter', now I have learned to savour most meals - not only has it helped me to regain my love of cooking, it has also improved my digestion.

4. SMELLS - these are closely allied to taste. Because of this, I think smell can be problematic in that it can evoke so many memories. Because Christmas is about tradition most of our food will have a history. For me making a menu change means that I can truly create a break with the past - this year I am doing a traditional roast beef dinner. I am learning that traditions are only valuable when they help me to enjoy the season. If I am diverted to the past then maybe the tradition needs to be replaced with a new one.

5. TOUCH - this can be a problem for those of us who live alone, or who are not in an intimate relationship. For me, touch has meant beginning with the safety of my dog and cat. Initially the cat was good for me, as he didn't overwhelm me with demands for affection. Dogs are different, dogs need you, they want to be close to and they constantly present themselves to you for strokes and cuddles - at least my dog does! Another thing I have learned to really enjoy is trips to my hairdresser. I have developed a friendship with my hairdresser - it is a positive relationship and one that I trust. I have learned to indulge myself when going for a hairdo. It takes between two and three hours, depending on how laissez faire I'm feeling about my 'do'. I am plied with coffee, trashy mags, gossip, laughs and most soothing of all: the head massage! I know and trust the staff well enough to be able to just close my eyes and focus on the experience of having the tension massaged out of my scalp - it feels safe and offers me human touch without any agenda, hidden or otherwise!

If I am tempted to wander into wishing, or hoping, or regretting about the future or the past, my task becomes to shift the focus of my senses so that they tell me about the here and now. It's okay, I still have 9,680 hours to go before I master that skill.

Small Things

When your mind and body are wracked with emotional pain, it is so difficult to do the most simple routine things. Few people who have never experienced mental illness, understand the physical impact of such struggles. When you manage to do small things, don't belittle them or discount them, Celebrate them, it has cost you and is a real achievement. The Black Dog Tribe have shared this cartoon which sums it up nicely:

When it hurts to get up and about remember the following:

1) Be kind to yourself - you would give others a break if you saw them in the same situation.
2) Be realistic about what you can do safely
3) Celebrate the small things
4) Try to enjoy the sense of achievement

Life Post DBT therapy - self help or no help?

Since being discharged from Mental Health Services in the summer, my work as a Church Mental Health volunteer has exposed me to responses to impending discharge that are different from my own. Again and again, I have encountered an expressed need to continue in a 'safe', supported environment. Usually, this has resulted in people seeking to develop and/or join peer support groups. For those who have gone through hospitalisation and intensive group therapy, there is a shared experience and understanding of certain conditions which makes peer support highly desirable. I myself have found the online peer support available through twitter and blogs to be invaluable in my ongoing DBT practice.

Certain websites have been a real help too, by providing encouragement, advice and practice from other DBT graduates. In particular, dbtselfhelp.com is an excellent resource. I have found the following article about 'The Self Help Myth' has challenged a number of assumptions I have made about the need for ongoing contact with 'peers' following graduation from the main DBT programme: http://www.dbtselfhelp.com/html/the_self_help_myth.html The article presents an interesting discussion of both the problems and solutions to the self help conundrum:

"When we first presented this idea [of a Peer Led Graduate Group] to Marsha Linehan, she told us right away that it wouldn't work because of the nature of BPD (or people with similar types of diagnosis'). People with BPD have trouble with boundary confusion as well as inappropriate behaviors when triggered by stories similar to their own and have the tendency to be addicted to crisis. We balked at this response, certain that we could make it work anyway if all the participants were focused on a goal.

But Marsha was correct. The boundaries required for leadership were outside the skill set of group members. Triggering behavior often required professional intervention. Plus, when feelings were hurt or when someone felt panic, we were unable to provide the kind of validation offered by professionals. In a peer-led situation without training it was unrealistic to ask our leaders to rise above their own lives and issues in order to exert control of the group. We even tried creating a set of rules and circumstances and guidelines that groups would have to follow. But truly, the nature of the diagnosis is ill-suited to a peer-led environment."

Helpfully, DBT participants in the USA have had a number of years to develop thinking and experience about DBT so they have tried, failed and tried again to find a way forward. It is encouraging that the same website has followed the progress of different post DBT groups in the USA which seem to be having more success. However, nearly all have had the active participation of Mental Health professionals.

My attitude to peer support has been different to some. Because I belong to a strong faith community outside of the therapeutic setting, the main aim of my development of skills, has been to allow me to build a strong social network in 'the real world'. I found the protective environment of services to be a haven to which I could retreat when I was struggling to learn and practise the DBT skills when they were new to me. For some time now, I have felt it's time to move outside of that 'safe zone'.

For me, it was crucial to keep my focus on what a 'meaningful life' looked like. That included being able to build and maintain relationships that were not dependent on a shared experience of mental illness. Although, I know that most of my new friends have had a willingness to learn about my condition and the skills that help me manage it, so I have learned that some other people outside Mental Health services, are prepared to accept me as I am. Some of my former friends have never been able to reconcile themselves to the reality of my ongoing emotional and psychological struggles and I have had to accept that they are lost to me. That has allowed me to practice the DBT skill of Radical Acceptance.

If my therapy and recovery only work in helping me develop relationships with people who struggle with the same diagnosis, or with the people who work in those settings, then that is not allowing me to develop a balanced social life. I think that this issue is shared across all mental health conditions. Stigma and the fear of rejection, naturally mean that people will gravitate to 'safe' places and people. Unfortunately, the structure of services in the past has kept people in a cycle of discharge, relapse and return to 'safe' therapeutic settings. Perhaps, this goes some way to explaining the revolving door experience of people with BPD.

Having said that, there is a need for a stepped progression from group therapy towards life after discharge. Peer support clearly has a part to play in that progress. I think that peer support works if it keeps me focused on the positive practice of my DBT skills. If I can 'recharge' my mindfulness batteries ready to return to the world outside. If I am encouraged by my peers to keep developing the skills which will enhance my life and help me to build a 'life worth living'.

These concerns were foremost in my mind when I wrote a short five week programme for our church. Finally, working alongside the Vicar we developed a series of workshops aimed at helping people coming out of Mental Health services, to integrate into the community. It is not designed to be an ongoing support group, but can help by introducing people with similar experiences, although mostly a range of diagnoses from Bipolar Disorder to Anxiety and Depression. I have found that initially people were disappointed that it wasn't a 'support group', but in the last year that we have been running it, group members have developed positive friendships within the groups which have continued after they have completed the course. In addition a number have been happy to introduce others to the course and have themselves ended up helping me to run public events, such as our Suicide Awareness Day in November.

I know some people reading this will disagree with this approach. Everyone's experience is different. The pace of recovery and progress out of services varies according to each person's experience. I don't legislate for anyone else, but, for me, the growing sense of confidence in my day to day DBT practice as well as my growing social life is a testament to the fact that moving out of my safe zone has been positive for me.

The Morning After the Day Before

Yesterday I did something I don't often do, I started to write this blog post while I was still 'coming down' from an emotional storm. Partly because I wanted to be able to articulate what was going on in my head and emotions, and partly because it is a helpful way for me to make sense of the emotions that were crashing in on me for nearly four hours.

The trigger? I tried to get home on the bus using the Day Rider ticket I had bought in the morning, on my way to a Nativity Rehearsal (I know, that's a whole different story!). Normally, it's a matter of showing the ticket and walking straight on, but this time the driver asked for a closer look before pointing out that the ticket only allowed me to get to a stop at least two miles back from the one where I was trying to get on. It was also another three miles from the correct stop to my home. I had paid the right money, but the ticket was for less than I'd paid, apart from not remotely resembling where I got on the bus and where I needed to go - so my outward journey had been technically without a valid ticket too. Not my fault, not the fault of the current driver either. The only option? Walk the five miles home... so I got off the bus, shame faced.

Suddenly, the relatively benign set of emotions with which I had started my day, neither good nor bad, disappeared in a flood of...what feelings were they exactly? It felt like anger, but towards whom? I know I was frustrated - it is a nuisance - not sure I am the only person who has been missold a bus or train ticket and had to walk home as a result. Behind these (primary emotions) I also detected shame and an overwhelming sense of injustice. Extreme, right? Not if you know me or anything about BPD (Borderline Personality Disorder).

Some days, simple things are difficult. Going to any new place is a trial. I need to know exact routes - my favourite internet tool has to be Google Maps Street View, because this means I can actually do the journey in a safe, virtual world, before I venture out. I have learned to be this prepared for new journeys and modes of transport because the uncertainties of journeys often trigger negative emotions in me. Since having to get rid of my car, I have realised that public transport is a minefield of stressful situations for me. Even on my routine journeys, I rehearse each part of the journey in my mind, and constantly use self soothe music and/or mindful breathing while travelling. I find it difficult that I have absolutely no control over how well the journey goes, how timely it is, or even who or how many I travel with. My bus out from home yesterday actually arrived nearly twenty minutes late. So I guess, if I were to do a Chain Analysis on the triggering events, the meltdown began in that moment of anxiety as I raced to make my meeting up time. The disappointment of finding that a driver had taken all my money and not given me the correct ticket then resulted in an enormous break in my plan to manage myself and my journey.

You see, the sense of frustration would be shared among most people in the same situation. So far, so average. Frustration though wasn't my overwhelming emotion. As I walked away from the bus stop, all idea of 'being in the moment' and 'mindful' of my surroundings (which were stunning in the winter sunshine - something I normally really enjoy) were lost. Instead, I was overwhelmed with a sense of total failure, of thoughts of 'why me?', of a sense of grave injustice, of helplessness and weariness. I am certain that I was feeling despair in there - why does MY life have to be so hard?

In the middle of my 'feeling fog', I managed to think of a friend who sometimes works from home. I phoned. At first, she couldn't make sense of me because she couldn't hear me clearly, nor was I saying what it was that I needed her to do to help me. 'Breathe' she said. I did and for the first time since the incident on the bus, the whirling thoughts and emotions paused.

Together we managed to come up with a plan. My immediate practical problem was solved with the offer of a lift. The emotional fallout, however, has taken so much longer to dissipate.

It took over three hours and lunch with my friend to bring an end to the whirling emotions, initially. I finally arrived home feeling exhausted and wrung out but still battling shame and a sense of injustice.

Shame is probably the most familiar of all my secondary emotions, but what part did it play in a simple mix up over a bus ticket?

Since completing my DBT therapy, I have learned to recognise when I am vulnerable and need to be gentle with myself. However, yesterday the rush of negative emotions took me by surprise. There are a number of reasons why such a minor incident could evoke such a reaction in me. I ended up being agitated and disturbed. What baffles is me is how relatively little the primary emotion (frustration) factored in my resulting distress.

It is now over 36 hours since the incident. I am beginning to make some sense of what was happening with my emotions:

1) Over the past couple of weeks my emotional 'skin' has been thinner. I have been extra sensitive to mood changes. I have limited myself in terms of TV programmes I can 'cope' with. I have also been misreading people's words and actions, interpreting them negatively. During these times I need to be kind to myself. Not to push my limits, particularly on things where my emotions are involved. Small as it was the bus incident felt an enormous disruption to my attempts to protect myself from a flood of unmanageable feelings.

2) Although I forget it at times I am so much better at managing my life and BPD than even a year ago. What this means, though, is that I lull myself into a false sense of security and fail to maintain a weather eye on my moods. There were warning signs last week, that I was more emotionally sensitive and despite using my emotion regulation skills the underlying difficult emotions were not being fully resolved. I didn't totally ignore all of the warning signs, but I did overestimate my current levels of resilience. This has meant that I have tried to do a lot more than my normal routine. Fine if I still had my car, I am realising that the additional time and effort needed to travel by bus actually needs to be factored in by me to my emotional management. As does the fact that most people find day to day life tiring at this time of year.

3) Subliminally I have been absorbing the overwhelming political message about 'people on benefits'. My aim is to be well enough to be able to provide for myself. To be able to buy presents for loved ones without putting myself under financial pressure. To 'feel' like a productive member of society. Problem is, by even allowing that pressure to push me beyond my emotional and mental capacity to cope at the moment is to buy into the lie that I do not contribute. I wish that we as a nation would value people for being human beings, rather than for the size of their income, how hard they work, what they do, what they are, what their status is. Any one of us could suffer from mental illness in the same way that any one of us can succumb to physical illness. I can suffer from BPD and a Flu bug at one and the same time, as the same person. Perhaps, recent noises from some Health thinkers about integrated physical and mental health services is finally acknowledging that reality! As I looked at the bus driver yesterday my shame came from the fact that I couldn't even rustle up the £1.20 to make up the shortfall on the ticket. That and the fact that a full bus looked askance at my lack of funds. I felt as if I had 'BENEFIT SCUM' written in red letters across my forehead.

4) Shame is an all pervasive emotion for me. It is most damaging when it gets out of control and connects with the shame I felt as a child survivor of abuse. The bus situation MUST have been my fault. Like the song in the Sound of Music, my negative voice tells me 'somewhere in my youth or childhood, I must have done something BAD!' The shame I felt in not being able to pay an extra £1.20 (although I had actually already paid for the ticket I wanted!) opened the floodgates to a wave of shame from all the moments when I felt I was to blame for all the pain being inflicted on me.

Secondary emotions are the most problematic of the feelings to manage. This is because, they are often unconnected with the triggering incident. They are so powerful because they are ingrained on our minds, and our emotional responses. A positive emotion such as Joy is the secondary emotion to Happy. It goes deeper, it lasts longer, it has a more profound effect. A joke can make me happy. The love of a child gives me joy. That, I think is how I make sense of the difference between primary and secondary emotions. Both can be triggered by the same event and link into one another. Secondary emotions are rooted in past events and memories, with all their associations. Primary emotions are an immediate response to the present trigger, but they are reignited and fuelled by the power of the secondary emotions.

So, how do I manage shame? The short answer is I only manage it when I recognise it! So I:

a) RECOGNISE and NAME the underlying, more powerful emotion. This means taking time to be mindful and allowing myself to become aware of the feelings flitting across my mind, along with the negative thoughts which keep the triggers to the secondary emotions stoked.

b) If the emotion is SHAME or GUILT. I ASK if they belong to me ie have I done something that I need to remedy in a relationship, work situation, public interaction etc. If so, ASK 'is there anything I can do to remedy the action which caused the guilt/shame? Guilt can be useful if it reminds us to think of the needs of others. If either SHAME or GUILT rightly belongs in the past with someone who has done me harm and who has shifted their guilt onto me, then I try OPPOSITE EMOTION or give myself permission to continue doing the thing that has brought shame - this is a kind of reverse exposure. Why should I feel shame about having a long bath in the middle of the day? Why should I feel guilty if friends do something nice for me?

Yesterday my friend encouraged me to consider with RATIONAL MIND, how much shame belongs to me for being on benefits. We then listed the positive things I am doing to help others when I feel able.

Today, I am exhausted. I can accept that I am not up to great feats of intellect or action. It's ok to give my emotions, as well as my headachy brain time and space to recover. I can also be encouraged by the fact that the after effects of emotional storms are no longer measured in days or weeks, but hours and days.

And....breathe.....I've survived another one. If you need me, you'll find me self soothing and being kind to myself.


(dbtselfhelp.com has useful advice and DBT worksheets to use: http://www.dbtselfhelp.com/html/opposite_action.html)

What's in a Name - the Impact of the BPD Label

Mind have done an excellent job of highlighting the problems of 'coming out' to friends, families and employers about mental illness. More than many conditions, Borderline Personality Disorder has received a very poor press. I know I used to have a number of cases with diagnoses of BPD when I was a Probation Officer. 'They' were seen by some colleagues as 'a pain in the arse', 'difficult', 'unpredictable' and 'frustrating to work with'. I found myself enjoying my encounters - colourful, dramatic, often artistic and articulate. Good job, because, after ten years in the probation service I was diagnosed with BPD myself. And, Yes I did encounter the same comments, or detected them in attitudes and behaviour directed at me.

I have been privileged and fortunate to live in an area which has quickly responded to the government policy change of BPD from 'untreatable' to 'treatable'. A seismic shift in attitude, hopefully closely followed by Mental Health professionals. There is a specialist Personality Disorder Service in our area, with two intensive group therapies aimed at BPD sufferers, both have been running now for over two years.

In my experience of this service over the past five years, I have had my individuality acknowledged and been supported well by my CPN when my first attempt at therapy failed. I have been supported through crisis times without being over medicated or admitted to hospital, which I would have found highly aversive. The level of support on offer during periods of instability enabled me to recover from setbacks, (which I was given time to do) and to be referred to different specialist therapy offered by the same service.

I know this is rare. I know that I am lucky. I hope that blogging and talking about my experience (positive) of being diagnosed with BPD will show good practice. Unless I am seen as a person with unique needs, with the willingness to learn how to manage my emotional turmoil, then I will continue to show up in distress and will seem to be 'impossible to manage'. Thing is somebody actually did help me to learn to manage myself and my BPD. Is it rocket science to recommend that others try to offer the same level of service?

I really urge you to copy the link and go to this blog by Rebecca in response to some videos made by others with a different experience of BPD than her. All are available on the same link. http://www.mind.org.uk/information-support/your-stories/having-a-bpd-diagnosis-my-reality/#.VG9-hvmsUnp

Meeting the Challenge, Making a Difference (Oxford Health NHS Trust)

Excellent booklet outlining the challenges and effective approaches to involvement of PD sufferers in treatment, education and staff training. Produced with full involvement of Service Users. Just so refreshing and helpful. From Oxford Health NHS Trust:

http://www.oxfordhealth.nhs.uk/resources/2014/04/MeetingTheChallenge.pdf

It's one of those days... again

I still have them. Days when for no reason an overwhelming sense of grief sits on my heart. Now, I am aware of the deep source of the grief. Now, I can say 'this too will pass'. It doesn't make it any less painful to live with. Nor does it suddenly make it 'all right'.

On these days I need to remind myself that I need to be kind to me. I tell it to others and I believe it. My biggest problem remains an underlying belief that ultimately, I am not worth caring for. That somehow, somewhere in my history is a reason, a factor in me that means I deserve the suffering I have lived through. I carry the emotional hangover of the survivor of abuse, the belief, that somehow, somewhere in my past I must have done something bad.

Because this has been a lifelong belief which has resulted in self hatred and the behaviours which have made shipwreck of important moments and relationships in my life, I still have battles to fight. Today is one of those battles.

Unlike other days which I used to fear would stretch into the rest of my life, I am learning that this day is not all the days of my life. This day can be measured and will end. Today, the overwhelming sadness and grief comes in waves, in moments. I am becoming more aware of this as I recover.

So, here it is another day of painful emotions. Today, I will be mostly looking after me. That includes eating bacon butties, watching trashy TV, taking my time over my shower, and most of all not berating myself for grief and painful emotions which come from having lived through and survived some very difficult events. Most of all, this day and these emotions are not the whole of my story. This pain means that when I have a different day, a better day, it can shine even more brightly. Today, if I can be kind to myself I am replacing another more painful moment from my past and I am able to say, I am worth caring for.

A Bad Case of the 'Yes, Buts'

'Yes' was described by James Joyce as being the most positive word in the English language. It is. Unfortunately, as with many elements in my life with BPD I often counteract the positive attitude inherent in the word by adding a massive and unnecessary 'But'. Recently, I've had a bad case of the 'yes buts'. I have been enjoying the stability of recovery, but have been in danger of trying to run ahead of my own progress by trying to short circuit the waiting and consolidation period. When I am reminded of the skills which have enabled me to continue to manage my condition on a day to day basis, or of my progress towards a more positive future, my automatic response is 'yes, but'...

'Yes, but... here I go again. I have done so well, BUT I keep struggling with depression...just proves I'm a failure

'Yes, but... I am weary of having to keep 'managing' my symptoms...just proves I'm too weak...

'Yes, but... I deserve to keep suffering...and getting on with life, feels wrong somehow...

Running a group has reminded me that I am not alone in the 'yes, buts...' When everything inside you tells you that you will fail, positive steps forward sound, difficult, foreign, too hard to achieve. It takes perseverance and determination to listen to the 'yes' without tempering it with the 'but'.

Two aspects of DBT are needed here and I have found it all too easy to forget them. The first is 'participation'. This is part of core mindfulness and says that I will participate fully in what is happening in this moment. If I am going to self soothe, then I will do so with gusto, if I am going to use opposite action and dance or sing, I will do so with gusto. There are times when I don't have the energy to even consider using any skills, that is when I need to say 'yes' to the effort of engaging and participating in one moment at a time. If I can say yes for a split second, then I can say yes for a whole second, if I can say yes for a second, I can string them together to make a minute. This brings me to the idea of willingness. Having decided to choose to live, then I am by my actions saying 'yes' to engaging with the people and the world around me.

It is all too easy to allow the 'But' to swallow the 'Yes' and prevent myself from overcoming my difficulties and suffering. 'Yes' is a springboard to a meaningful life - 'but' keeps me weighed down in the mud of the past.

When I first started DBT therapy I spent a lot of time learning to 'uncurl' physically. I was curled in on myself physically as well as emotionally. This was my way of saying 'No' to the whole of life and experience around me. 'No' kept me safe, but also cut me off from life. I was neither willing nor able to participate in anything let alone the positive in life. It was an important battle to fight - one memorable one to one session,my therapist spent the whole 50 minutes trying to get me to lift my head. I eventually managed it towards the end of that session for a short time. Eventually, after a lot more battles and many months of practising the acceptance and mindfulness skills, I was able to sit tall and look people in the eye. There are still moments when I curl in on myself - that's ok, there are still moments when I need to protect myself, as long as it doesn't become my default again.

In that moment when I lifted my head I started to say 'Yes'. 'Yes' is being open. 'Yes' says I have hope that I can recover. 'Yes' says I am ready to enjoy my life, without those things which rob me of recognising the positive in me and my relationships. 'Yes, but' is a step along the road from 'No', dropping the 'but' takes me even further along the road to recovery:

'Yes, I want to enjoy this moment'.

'Yes, I can...'

'Yes, I am worth working through the 'buts'

'Yes, I am worth putting the effort in to my recovery and building my life from this moment on...'

To Move Forward, Do I have to Go Back?

TRIGGER WARNING: Discussion of Childhood Trauma including sexual abuse and symptoms of PTSD

It's a vexed question. After all, if your symptoms include intrusions from the past that interfere with your life now, then it stands to reason that you need to go back in order to go forward. Throughout my life I think I spent most of my energy in avoiding any emotional or cognitive acknowledgement of the trauma I had suffered throughout my formative years. All my energy was spent in avoiding any acknowledgement of the fact that I had actually suffered any trauma at all.

And there it is - trauma - a word that I refused to hear from my CPN or any other professional in relation to 'my life'. After all, until I got away from home and started looking around and experiencing life outside my family, I had thought myself relatively well off as I had grown up. We were, materially. I was unaware that the pain and grief I was suffering growing up was not related more to me being 'highly strung' and 'a bit weird' as I was told over and over. The fault always lay in me. For the fact that a grown man thought it was ok to touch me up at the age of 11 because I was 'well developed', for my mother holding my nose and force feeding me at the age of 9 because I wasn't hungry, for the fact that I made my father lose his temper so much that he smashed my head against the wall so hard I felt sick, for the numerous times people decided it was okay to use me sexually. I felt it was my fault for suddenly growing into a 'woman' and therefore causing adult men (and some women) to lose control of themselves.

This is the heart of the shame felt by so many child victims. There has to have been something wrong with me for the people who did those things to me to get away with it. On top of this of course is the fact that there was more than one abuser. So, logic says, it had to have been me who was the common factor. Right? Wrong. However, that, for so many years has been my reasoning and therefore all my behaviours, including self harming behaviours centred on the belief that I was basically flawed, destined to continue the cycles of abuse for my whole life. My overwhelming emotional experience became self hatred and all the secondary emotions associated with it, shame, guilt, anxiety, fear of rejection. It is this set of beliefs which when overlaid with a predisposition to emotional dysfunction has led to the patterns of behaviour, feeling and thinking identified as BPD (Borderline Personality Disorder).

For years I was offered counselling and therapy based on the need for me to disclose in detail my life story. These therapies attempted to get me to connect with the grief process over my childhood which had been short circuited by my attempts to just 'get on with it'. The problem being I couldn't connect myself with any real suffering. I was disconnected not only from feeling any emotional pain, but also from any identification of myself as a victim of trauma. Some approaches tried to get me to go back and relive the experiences - who wants to do that? I've survived it, I know what it felt like, I just need to release the emotional response, to free myself enough to grieve and recognise that I have been traumatised and that my reactions and my grief are understandable. More than once counsellors told me that I didn't want to get better because I could not engage emotionally. They were right, after all if dissociating myself from my experiences had got me this far, what were they offering me other than a painful journey backwards?

I suppose for me, I didn't need to remember the events, some of them were etched on my consciousness and were very much intruding in the here and now, through nightmares, flashbacks and unresolved emotions. Above all, I grappled daily with an ongoing cycle of heightened anxiety and anticipation that seemed to stream in an unbroken flow from the moments of past trauma. Each new experience of abuse throughout my life laid another wave of destructive emotion over previous ones, reinforcing the destruction and distorted emotional experiences of childhood.

One of the most difficult DBT skills to grasp hold of is Radical Acceptance. It is, for me, the most powerful and effective in helping me deal with my past experiences. It taught me that there was no therapy or magic pill which could go back to those traumas and undo them. I had tried for over forty years to manage the emotions from that without having the ability to even acknowledge that I had suffered any trauma. It also helped me to recognise that even though the feelings of trauma were ever present, they actually didn't need to be, as the threat was in the past too. I guess the experience of cycles of abuse and re-victimisation maintain the sense that even though my experience of trauma is in the past, it is inevitable that something equally damaging is going to happen again to me, because that's my life and my lot in life.

Radical Acceptance for me, has meant accepting that I can't predict the future, even if the past tells me that because people have hurt me badly then they WILL hurt me badly again. It is accepting that the past doesn't have to predict my future, or even my present, which is the beginning of saying, 'I can enjoy this moment'. I can take time now to enjoy what I am experiencing, in this moment. Feelings of shame, terror and grief, if unconnected with what is happening in this moment, do not belong here.

Slowly, I have allowed myself to feel the grief and cry - without having to relive the moments of trauma. My mind has blocked some events. Personally, I don't feel a need to seek justice through formal channels, that is my choice. This means that I don't have to recall and recount events from my past over and over again. Slowly, I have learned to accept that what I have lived through has had a part in shaping the person I am today. I don't need to remain in the past, it is done with, I have taken positives from it, at last. The rest needs to relegated to the dustbin of history. I don't need to return again and again to the prison cell to remind me, I have been released. The past, for me, belongs in the past. I have accepted what has happened to me, I have accepted that it has made me stronger than imaginable. I have accepted that I can overcome the worst that I have lived through and I am accepting that I do deserve to enjoy the life I have today. Acceptance is not a moment, it is an ongoing process and I need to practice it every time thoughts and feelings float in from my history - accept them and move on, is what I need to do. An ongoing piece of work, but I am getting better at it.

I have found as I have worked through this process of acceptance, that the symptoms of flashbacks and flooding negative emotions to triggers around me, have faded from my day to day life. Finally, I was able to let my CPN call what had happened to me 'trauma' and in that I accepted that I had suffered events which made sense of some of my emotional and psychological 'quirks'. Ultimately, one of the most freeing things to be told over and over again, was that my behaviour and responses to life were 'understandable given what you have experienced'.

I know that for some, there is a need for ongoing support and therapy to manage more severe symptoms of PTSD based on childhood experiences. I only write from my own experience and say this way has been a way for me to lay the past to rest without having to go ALL the way back.

An Image for DBT Thought Diffusion

If you've followed this blog for any length of time you will know that I love it when I find images, music, art or anything that helps me to keep using my mindfulness skills. This image is an excellent tool to use in trying to rid myself of unwanted thoughts or feelings.

When using pictures I always start by taking time to focus myself on being in the moment. Usually, I do this through just becoming aware of my breathing, until it is regular and even. In the past during periods of instability I found that I would be holding my breath for short periods of time which would increase the impact of damaging emotions. So, having noticed and adjusted my breathing, I then try to notice how my body is reacting - usually I feel tension in my shoulders and neck. The process of focusing on my breathing actually naturally helps to relieve this tension.

Once I have been able to calmly focus on my breathing I focus on the image in front of me imagining the sort of day it might have been when the photo was taken. This image starts with me lying on my back in the sun, looking up at a stunning blue sky. I notice birds singing, feel the sun on my skin, notice a slight breeze. Then I notice dandelion seeds floating by.

I then shift my focus back to my breathing before noticing any feelings or thoughts. Then I name them. Without analysing or trying to understand where they have come from, I form them into words or sentences. These sentences or words I then attach to the seeds as they float in the sky above me (a bit like the words on the screen when Sherlock is noticing people in the new TV series). I watch them as they and the seeds rise away from me into the blue and eventually float away.

I repeat this as many times as I need until I feel calm. Then I return to focusing on the here and now and my breathing until I am ready to get on with my life without the troubling thoughts or feelings, until I need to deal with them, again!

Ya Get Me?

I love the English language. I toy with it, play with it, take words and mess with them, a bit like a trick footballer playing with a ball. Sometimes it's a bit random - especially when a word enters my head and I need to hear what it sounds like out loud. I especially love it when I discover some new 'in' word or phrase.

Recently I've been fascinated by people saying, 'ya get me?' after almost everything they say. I guess it is a way of making sure that your listeners are, in fact, listening. On another level though, it's also a way of checking out you are being understood. That started me thinking, maybe I need to start using it especially when talking about my mental health.

For most people with BPD (Borderline Personality Disorder) there is a sense of unease, a lack of belonging that is all pervasive. I had grown up with a sense of not being able to connect with the world and, more especially, with the people around me. I had a sense of otherness, of being an alien in a world that failed to notice how much I was struggling to belong. My nickname as a child was 'Moonman'- says it all really. I also did not communicate with adults, seeking to communicate through one childhood friend in particular, until the school in their wisdom removed him from me and forced me to try to speak to teachers and others at school. I was six before I was really able to do that.

This sense of alienation is a hallmark of BPD, a condition which creates a gulf between me and those around me, and which no one, but me is aware of. The only way I found to describe it when trying to help GPs and others understand, before my diagnosis, was a sense that I was 'locked inside my own heading screaming'. When I was most distressed I kept repeating 'I am not made for this world. The problem for me was that in my day to day life no one could see my distress, or if they did, they didn't understand its causes.

Lack of stable identity, caused by an inability to make emotional sense of the world around me is a symptom of BPD which goes to the core of the social theories of its causes. If we learn about our place in the world through the responses from those around us, then the invalidating home and family environment becomes a twisted mirror in which a distorted image of the self is formed. So, paradoxically the relationships which are most problematic to me are those which value me - they just clash with the internalised invalidated image and so are often rejected as untrustworthy. If the internal monologue of self criticism and self hatred meets with evidence to the contrary the resulting dissonance can be unbearable.

I am more comfortable with the feelings of failure and disconnection with the relationships around me, than I am with affirming, loving relationships. If my fundamental belief about myself is that I not worthy of life affirming love, then it is hardly surprising that I allow myself to become involved with destructive and abusive relationships. They are where I believe I belong.

As I work on my recovery I am trying to learn to find validation in small things at first. However, one of the ways that I still struggle to make people 'get me' is that I do probably need more affirmation in work and social situations than most people. The twisted mirror image of myself is still in the process of being untwisted. Slowly, I am trusting myself to develop new relationships. Trust takes time.

Being an alien, in a strange planet it is often easier to spend most of my time alone. This was one of my major coping mechanisms in the past. I deliberately retreated from intimate relationships because I just couldn't make sense of them, nor could my boyfriends make sense of the contradictions in me. On the one hand I craved affection, but on the other I behaved constantly in ways which would drive a wedge between us. The role of alien was so much more comfortable to me, then, than the sense of belonging to and with someone. There were times when I could happily go for weeks on end without any meaningful contact with anyone. It was safe, unchallenging and didn't cause any jarring or contradiction to my internalised view of myself. What I didn't realise for years, was that this was reinforcing the sense of isolation I was trying to combat.

Where am I today? I am trying to find new ways of connecting with the world around me. I am having to learn that patterns of invalidation established from early childhood will take time to change. I am trying out new ways of relating to friends, without retreating into becoming a recluse in order to protect myself from kindness and affection. The structure offered by the DBT Inter Personal Effectiveness Module helps me to find my place in most relationship situations. In the past I would swing wildly between shutting myself off and exposing myself too early in relationships usually sharing way too much about my struggles and my past history. I am consciously holding back when I need to in order to build trust on both sides of relationships.

So do 'ya get me?' The reality is that there are many times when I don't get myself. I am working on rebuilding my sense of self, without the overlaid turmoil of out of control emotions and moods, and the non stop internal self condemnatory commentary. All of which is a new experience for me, not all of it comfortable or pleasant. Slowly, but surely I am untwisting the mirror image.

Routine - Bars of Protection or Restriction?

One of the most difficult things about completing a long period of intensive therapy is the loss of routine. I used to think I was quite a random person, I'm not sure that I come across as needing structure in my life, that I'm a spontaneous, carefree person - WRONG! I don't cope well with unpredictability in relationships or life.

I arrive routinely at least fifteen minutes early for most appointments, no matter how trivial. If I've made a commitment I will be there! I will do practice runs to new locations, either in real life or online through google street view (that has saved me so much time I love it!). Even informal arrangements have to be made and pinned down for me in good time. This helps me manage anxiety that has in the past led to panic attacks. So, it is hardly surprising that after nearly two years of intensive therapy and five years of having the same Care Co-ordinator a certain level of apprehension flooded me when contemplating final discharge.

For over a year I had two, weekly appointments around which to build my routines. This was more than enough to provide stability as the levels of exhaustion experienced by me just trying to get by meant that any more structured activity was unsustainable.

I have come to the end of a period of two months during which I have tried to transition from those routines to new ones around which to structure my day to day life. As well as changes to formal appointments, I had major changes to two friendships which were part of my care plan throughout my time in therapy. One friend moved away and another got a job. These things happen - it's life. The challenge becomes, when you don't have work to structure your routines, where do you begin?

What has helped me is to take an idea I first came across in the film 'About A Boy'. In it the feckless hero didn't need to work, but rather than be bored he divided his days into 'units' of time - 1 unit equals 30 mins. So, Breakfast and Coffee counts as two units. Haircut could extend to four units etc. I have adopted this attitude and have begun by trying to establish a daily structure. I know for some people with PD issues this sounds like madness - but it is very much part of my managing my life in order to maintain stability in my emotions. This is how I structure my day:

Before breakfast - quiet time, pray, take time to be mindful. 1 Unit (30 mins)

Breakfast & large pot of coffee 2 units

Walk Dog - 4 units

Lunch - 1 unit

Blog/Gym/Meet Friends 4 units

Dinner - 3 units

Relaxation - 6 units (Includes Self Soothe activities, take a bath, watch good tv and films, Wii Sports, read, listen to music)

The daily structure works for me because it has the flexibility to include meeting with other people as well as allowing me space and time to care for myself and my animals.

I have taken more time to establish a weekly routine because, along with my therapy appointments I also had two fixed times in each week when I would spend time with my Care Plan friends. Now, I have used my voluntary work and socialising to build a loose routine which can be changed depending on whether I feel like 'people' or not.

Monday - Evening Course

Tuesday - time to self

Wednesday - Women's group & spend afternoon with friend

Thursday - time to self/blogging/volunteering

Friday - Running Group - time to self

Saturday - time to self

Sunday - Church

You may notice there is a lot of time for myself - I enjoy my own company, but I need to ensure I make myself spend time with others. So, I have developed a balance of social and group activities that I can cope with. As long as I have space to myself and/or for writing then I feel my life is balanced. The amount of self space also allows me to build in more activities as and when I feel able.

I have found that, as I have recovered, I have been able to tolerate more social times than previously. Above all, if I can't keep to the routines, I don't just give up all together, I allow myself to have a Vacation (DBT Skill) and then begin the routine again at the next natural point. Usually the following day. For example, if Sunday at church has exhausted me, I give the dog a shorter walk on the Monday morning, take the afternoon to myself, so that I am better able to cope with the course on Monday evening.

Everyone is different, but, for me, structure and routine are essential elements of my long term recovery. It's also a good early warning sign that things may be going awry because both myself and my close friends can tell if I am struggling when the routines are disrupted for any length of time.

How do I know when that 'gut feeling' is just my body talking?

When I was sixteen one of my best friends had a boyfriend who could be euphemistically described as 'an interesting character'. He was an unfortunate soul, who seemed to attract disaster. On one occasion a riot spilled over from a neighbouring area where he lived in Belfast. The rioting hordes descended on his street and rioted along its length. One solitary car was severely vandalised - Geoff's.

One day he announced to my friend that he was emigrating to Russia, as he believed this was the right thing to do. The thing was that he had never shown the remotest interest in that part of the world, never even mentioned it to anyone, let alone his girlfriend. In fact, Geoff had never even been abroad for a holiday before. Nor did he have any idea of purpose or job when he got there. As she explored his desire to emigrate to - not just visit - Russia, she asked him what made him think it was a good idea. 'My stomach' he answered. I actually admire the stickability of my friend as they lasted nearly two years in a relationship!

In some ways I am more like Geoff than I would like to think. How many times have I said to myself, this or that 'feels' right. Or how many times do people tell me to go 'with your gut feeling'. Instinct is a useful tool for navigating the big and small decisions of life. However, when you are emotionally dysregulated, knowing what is your gut and what is an extreme reaction due to unrecognised feelings becomes a real problem.

I have learned very late in life, that I am not always as good at reading people and situations as I think. This is not because I am unable to empathise or understand facial expressions, or read and respond to circumstances in the normal course of life. It is because, when my emotions are involved, I do not always recognise that I am interacting with them through the filter of whatever emotion is predominant in a given situation. Over the past week, I have believed that someone I value highly has started to hate me. This may seem dramatic, in fact many of my reactions to everyday ups and downs in friendships and relationships are seen by others as dramatic, theatrical even, because those on the outside are not privy to the power of the emotions evoked. So, when I have a disagreement, sometimes even just an exchange of views on the current economic situation, with a friend I can feel as if I have destroyed the relationship simply based on how my gut is guiding me to interpret what is going on.

I think the feelings that 'present' most often in my gut are anxiety, fear and anger. It is hardly surprising because these are the most difficult emotions for me to manage. They invariably involve physical sensations as part of the body's normal defence responses. This is fine if I am being chased by a lion or bear and need to escape and stay alive. This is not okay, when I am in the middle of a political discussion with a friend. The feelings are natural, but in context, they are out of place. This means that my body and mind are reacting to an unreal situation, but with very real threat responses.

For those observing me, my reactions appear over dramatic and long lasting, for me bringing my threat level back to normal takes effort and skill. This process is invisible to those around me and has resulted in my being dismissed, misunderstood, patronised and belittled in the past, thereby increasing the gut feeling of threat and keeping the cycle going.

In response to these experiences, I have developed some checks and balances to make sure that when I am tempted to rely on my gut feeling, alone, I am able to slow the process down and take stock. When I realised I was reacting to my friend in a negative way, I was able to ask another trusted friend if they thought I had damaged my other friendship. I also considered the information I had on the friend I feared 'hated' me. I considered the level of reaction - hate is an extreme - was I misinterpreting a lesser emotion in him such as distraction, preoccupation with other things going on? The DBT skills are aimed at restoring balance when emotions take over and throw me off kilter.

Wise Mind helps me to walk the mid line between trusting entirely in my 'gut feeling' which in certain circumstances can be so wrong it's funny (with hindsight) and a tendency I have had to dissociate myself from all emotions and become entirely rational. The latter resulted in me being emotionally numb for over ten years, the former resulted in some of my most explosive and unflattering moments ever.

If anxiety or anger are distorting my decision making or affecting my relationships because they are misplaced or out of proportion to the situation I try the following:

1) Quickly ask a trusted friend if the situation warrants my emotional response.
2) If I have a decision to make I use Pro's and Con's to ensure that any action I take is based on something other than how I am feeling in the moment. Don't make promises when you're happy, don't make decisions when you're angry.
3) Using Wise Mind I consider my experience of a person or situation - is what I think is happening in accordance with my previous experience of that person or situation? Has anything significant changed in the relationship or situation that would make my extreme emotions understandable? Can the reaction of the person or the situation itself be understood in a less traumatic way than I am currently seeing it?

Useful worksheet for decision making from @DBTPath

Ultimately, my gut feeling is only trusted by me when I have gone through this process. Taking the time to ask myself to notice and describe what is happening around me often changes the gut feeling anyway.

And what of Geoff? Well a couple of weeks after his stomach 'told' him to up sticks and move to Russia, he was admitted to hospital with an inflamed peptic ulcer. His stomach had been out of sorts simply because he was physically unwell. He didn't get to Russia after all. My friend broke up with him not long after.

Opposite Action - the Suck it and See DBT Skill

I've gone against the grain today. I don't often feel the urge or need to spontaneously embark upon household chores. However, today I was feeling low - have been struggling a lot for the past couple of weeks.

Of course, when things are going well I don't pay attention to all of the DBT skills. I become complacent, lazy even, and revert to a few well worn skills which risk me not challenging or changing my difficult emotions at all. We are, after all, creatures of habit. When the foundational maintenance skills of the Mindfulness and Emotion Regulation modules, have not succeeded in preventing me from swinging down or up, I need to bring out the 'big guns' of Distress Tolerance and Emotion Change.

Often I don't really fancy the idea of Opposite Action, for two reasons. One is that the painful emotion is what I have become accustomed to and so I fail to recognise that I don't need, or deserve, to feel this way. The second reason is that it requires action and effort. When I am battling difficult emotions I am often weary. What I fail to remember every time I feel like this is that when I do 'give it a go', by moving and changing my posture and intention, I actually give myself a break from the draining emotions. I know that I have been told that opposite action to how I'm feeling will result in me no longer feeling as bad as when I embarked on doing the opposite action. That's why I now call it the 'suck it and see' skill.

If I'm not getting anywhere by allowing the emotion to dictate how I am behaving, then maybe doing the opposite to what I feel like doing, is worth trying.

This is how I have found myself discovering the delight of bright sparkling windows in my south facing kitchen just as the sun breaks through some threatening clouds. Having achieved this small triumph, I continued to produce sparkling dishes, enjoying the feeling of cleared worktops for the first time in a number of days. This is a reminder that when I was at my lowest my house resembled the aftermath of a house ransacking, not unlike how the ravages of my emotions had left me internally. It is this reality which means for me that Opposite Action is particularly effective. If my environment can reflect my inner turmoil, working to improve it can help me to overcome the same turmoil.

This leads me on to another aspect of Opposite Action which reveals a vital element of DBT Mindfulness; Willingness. In the past, I have struggled to understand this beyond feeling when I was challenged about it during treatment, that it meant I was being 'contrary' or 'difficult'. I have since learned that it is much deeper than that. When I decide to engage with people and life around me, then I willingly engage myself in life itself. If I shut myself away because of fear, anxiety, anger, mistrust or whatever feeling is driving me at the time, then I am saying that I am not willing to engage with the world around me. This means that I fail to enjoy the positives of life, because I fail to engage with them, for fear that in engaging with the positives, I will have to face the painful and difficult.

Today I was in danger of allowing my low mood to prevent me from engaging positively with my life as it is, rather than how I wish it could be. In deciding that I had nothing to lose in trying to do some small chores, I managed to overcome my low mood, for a time. I also have learned that my moods do not need to dictate the direction of my days. If I can overcome a mood for a minute, then I can learn to overcome it for an hour, a day, perhaps, a week and eventually I hope I will find that my moods no longer control me, but I control my moods.