Monday 18 January 2021

Interpersonal Therapy (Take two) Session 2

(TRIGGER WARNING: Mention of past trauma, and an abusive relationship)

Leading up to session 2 of Interpersonal Therapy, I thought I would have to talk about past trauma and previous episodes of Depression. I spent the past week ruminating over this, feeling much worse by the time session 2 came around. I even had a horribly triggering dream; the night before therapy. It involved confronting my abusive ex about everything he'd done, and him denying everything. His friends, and some of my ex friends didn't believe me either. It made me feel so invalidated and unsafe. I woke up paranoid, and unable to do much. It took a while to get out of bed, as I wanted to stay away from everyone. I just felt that no one around me was a safe person (even though the people I live with, my parents and my cat, are extremely safe). 

Even before this dream, I spent the week depressed most days and unable to motivate myself to do much. I tried to do enjoyable things; activities my therapist refer to as "anti-depressant". The one thing I could get myself to do was play casual games. I found this had become more of a habit than something enjoyable though. It distracted me from awful thoughts and feelings, but it didn't do anything to lift my mood as such. 

As it turned out, session 2 of IPT was mostly about my most recent depressive episode. At first, we went through the PHQ, GAD etc questionnaires (to assess and quantify levels of depression, anxiety, and daily functioning/lifestyle), then we went on to the symptom review. I will list below the 5 most prominent symptoms for me:

1. No motivation - I had to go back to past trauma to explain how it linked to my feelings now. I felt stuck in one place. Memories of the past seemed to hold me back. I guess I was triggered by thoughts of past trauma, and they held me in one place when I ruminated on them. I felt like I couldn't move on, especially as I anticipated talking about my past yet again. I know I need to address things, but I'd really rather avoid them.

2. No energy - The energy that constantly worrying about the past takes is exhausting. Thinking about what I need to talk about takes all my energy as well. I think we forget that just thinking can take its toll on our energy levels. Even if all we're doing is sitting and remembering, we are still exerting ourselves. A phrase I used to describe my frame of mind is that I felt the weight of the world on my shoulders.

3. Feel guilty -  I am taking a long time to do things, because of the symptoms of my depression. I am slowed down, and motivation levels are low. Because of this, I may take ages in the shower, planning things, getting dressed, cooking etc. I feel guilty because people may have to wait for me, or wait to use the bathroom. The way I behave has an impact on others, it doesn't happen in a vacuum. I also worry that my problems have an impact on others; such as my frame of mind, my feelings, the way I talk etc. I also assume that my mood has an impact on others. I suppose I'm an empath because of the way a room's atmosphere or a person's mood affects me. I understand other's emotions a lot too. I'm like a sponge to be honest! Not everyone is like that though, and I have to remember that me being sad won't always bring others down. I'm allowed to feel how I feel without guilt!

4. Think other people don't like me - I read into everything! I look for clues that someone doesn't like me, or is drifting away from me. I talk about it on Twitter, because I want that reassurance even though deep down I know it won't help me in the long run. I need to reassure myself and trust others. My lack of trust, my paranoia, and the things I type, I feel are pushing people away. This is a big big part of why I decided to try Interpersonal Therapy. As I said in Session 1 , it involves addressing problems in relationships, role changes, disputes etc. Part of my Borderline Personality Disorder symptoms involves being terrified of rejection and abandonment. I do things to avoid that rejection or maintain that friendship, even if it has turned toxic. In the past, I have begged bullies to stay "friends" with me, so I don't end up alone.

5. Can't make decisions - Due to lack of energy and motivation, I have been finding it do hard to come to a decision about simple things, such as what to eat, what to do to entertain myself etc. It takes me ages to decide, I talk myself out of it, or I spend so long thinking about it, or flicking between activities etc, that there is simply no time left to actually engage in the activity. Alongside this, my concentration levels have been low, so I haven't been able to focus on things, or I worry that I won't be able to focus on or enjoy something. I may have mentioned this before, but the thought of being bored/not enjoying something becomes unbearable rather than slightly disappointing. I think it is part of the extreme mood swings and emotions I get, especially with BPD.  

After going through the symptom review, my therapist noted that I take on so much pressure from assumptions about other people's thoughts about me, how my moods/behaviour impacts others and so on. It's no wonder I have no energy! She then asked about my most recent depressive episode.

I explained to her that I believe it started during lockdown, about 4 months ago when my physical gastro symptoms developed. I have experienced chronic constipation, moderate/severe abdominal pain, appetite changes, bloating, and bloody mucus in my stools. Because of all these symptoms, I started off fed up, then my appetite changed even more, and I noticed something wasn't right when my sleep changed. I would wake up many times in the night (not just because of pain) and I would be deep in thought for a while before I could settle down to sleep again. I would get more tired, much earlier, and therefore would wake up much earlier. I usually take a nap halfway through the day, to try and replenish my energy slightly (it never fully replenishes, due to the nature of my chronic physical conditions such as Fibromyalgia). I found recently that I needed more and more, or longer and longer naps however, and I was desperate to sleep all the time!

My moods were low anyway, but I wasn't sure how low exactly until it affected my sleep first of all. 

As well as having physical gastro symptoms which frustrated and worried me, I had conflicts with some family members I used to be close to. I won't go into details, but it involved some nastiness that I wouldn't tolerate. Trying to make the peace didn't work, and because I saw certain people in a different light, it affected how I expected others to be and therefore affected my moods further. My support circle seemed to be getting smaller and smaller.

Another thing that kept this particular depressive episode going, was my worries about pushing friends away. I wrote some fairly bitter things on social media, that didn't go down well. What I was looking for was support and reassurance, but quite understandably, it was misinterpreted and now I worry that others are drifting away from me, or beginning to see me in the way I see myself (i.e. as some kind of horrible monster who craves attention constantly).

I told my therapist that I do tend to be extremely self critical, and it's something I'm trying to work on, but not getting very far with. She said that I am very critical of myself and conflicts with relationships seem to be a big part of this latest depressive episode, but she would explore other reasons too. Conflicts in relationships need to be addressed first though.

We finally moved on to antidepressant activities. The gaming needed to be put to one side really, as it served no real purpose other than as a slight distraction. She asked me what else I enjoyed doing, and I mentioned my musical side. I play flute, guitar, and keyboard. I also enjoy singing and writing lyrics. Apparently, when I said this to her, my tone of voice became much brighter and happier sounding. She set me "homework" to do more musical things, then tell her how it went in the next session. 

Again, time went on very quickly, and we had been speaking for over an hour, so we had to leave it there. Next session is 1pm on 18th Jan. 


Amy's Mystery Illness: "I'm a Survivor":

Amy's Mystery Illness: Interpersonal Therapy (Take two) Session 1:

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