Surfacing After Silence

Life. After.

Shame and Guilt

Recently, I’ve had to come to terms and accept certain situations in my life.  Through this process, I have learned a significant amount about my emotions and my reactions to other people and my ability to assert control.

My old therapist will be referred to as MOT (Missouri Therapist) and my current therapist will be referred to as NYT (New York Therapist).  I know, not very original or creative, but they work.

I’ve recently begun working with my NYT–as in, I’ve seen him 4 times.  And he’s stunned me several times.  I want to say, “I trust him,” but I’ve only ever said that about MOT, and it took a couple years to get to that point.  I don’t trust easily.

I want to say upfront that I am not comparing MOT and NYT and naming one as “better” than the other, especially since I’ve seen NYT all of four times.  I worked with MOT for six years, and I made extremely significant and noticeable progress with him.  But, as with all relationships, there were some instances of miscommunication (me getting angry) that were generally worked with openly.  And there were aspects of that type of therapy that, I now realize, may have been why I left certain sessions wondering, “What the hell am I doing wrong?”  So there were emotional highs and emotional lows regarding MOT, but overall I am thankful I worked with him, and I respect his general approach.  And, although I say I may trust this NYT, I am well aware that we’re still in that “getting to know each other” phase and there will be difficult moments ahead for us.

I left a lot of sessions in MO wanting to cry, but I couldn’t really put words to why I wanted to cry other than to say, “I feel like I’m not good enough.”  (Kind of a repeating theme of my life, by the way.)  But I wouldn’t have been able to point to anything specific that resulted in that reaction.

Now I can.  For both MOT and NYT, I have kept/keep Diary Cards.  Each day I rate the strength of different emotions, rate the strength of the urges for different actions, and I circle all the skills I tried on that day.  (In other words, I’m working with DBT therapists.)  So two weeks ago, NYT looked at my diary card and said, “Wow.  You’re using a lot of skills.”  My first reaction was to explain how it might look that way, but in actuality it’s not all that true since I circle all the skills I tried, not all the skills that were effective.  He simply reaffirmed the positive effects of using that many skills.  I felt so . . . proud when I left the office that morning.  Like I had done something right.  While journaling that evening, I remembered the last session I had with MOT before being hospitalized in May.  MOT said, “I’m not sure where to go from here since it seems like you’re not committed to using skills.”  But if you were to compare diary cards from then and now, you’d see the same things circled.  I felt like shit that day, like it was my fault I wasn’t getting better.  Like all I needed to do was use more skills.  I felt guilty for not trying hard enough, even though I had hardly enough energy to get to the kitchen to eat three times a day.

Then at my last session, NYT thanked me for keeping the diary card, since they were so helpful for him.  And I realized that I had never heard those words before, regarding diary cards.  They were a required part of therapy, part of the therapeutic contract we both signed at the beginning of my work with him.  But hearing NYT say, “Thank you” made me feel good about myself, like I was doing something to help.

One of the Action Urges that I rate on a daily basis is the urge to self-harm.  I have now gone eight months with no self-harm.  NYT told me that was a great accomplishment, especially since I didn’t have a therapist for almost four of those months.  I didn’t know how to respond.  MOT never complimented me for remaining free of self-harm for 9 months, since it was an expectation.  Why give praise for something I should already be doing?  Instead, when I did self-injure, the focus was on what I should have done differently to prevent that, and the inevitable question was, “why didn’t you ask for help?”  I am fully aware that my goal is not to self-injure ever again, and that my therapist will push me toward that goal.  But there was no mention of how that was the longest I had ever gone without self-harm.  No “how can we replicate that and make your next clean streak even longer?”

As I said before: maybe there were things the MOT could have done differently, but I am no longer angry for the previous examples, because overall, I made a lot of progress because of my interactions with him.

But NYT has taught me about certain characteristics I have–and that I have the right to meet those emotional needs.

I like to hear that I am doing a good job.  I don’t need ‘fake praise’ for tiny things that don’t require any effort on my part.  But it’s nice to hear “good job” during those times when I am fighting so hard just to keep trying.  That praise gives me reason to keep trying.

I do appreciate a thank you for my actions, even if they are expected.  I am much less likely to feel bitter about my actions if no one notices them or comments on them.

I need praise.  And I say I need rather than I like because I do need it.  We could go back to childhood trauma, teenage angst, college trials, and my ‘failures,’ but let’s just say I am always wondering if I am good enough.  If I am okay.  And it felt so good to hear someone praise me for going 8 months without self-harm.  As if it doesn’t matter if I slip up later, the fact of the matter is I’ve made significant progress right now.

I also learned that these three things I like and need to hear are not a part of everyone’s communication style–especially if I do not let the other person know how his/her words affected me.  Especially if I don’t tell him/her what I would like to hear and how it helps me.  So I am learning to speak up a little more.  I explained a couple of DBT protocol that always leave me feeling bad about myself.  I take on the shame and guilt and hang on to them and obsess over them.  So NYT and I talked about different approaches to handle certain situations.  NYT asked me to let him know if I ever start to feel shame or guilt during our sessions.

Through all of this, I have also learned that I may need to ask my friends and family to say the things that help me the most, since a lot of people don’t know what someone with Bipolar Disorder would like to hear.  Some people may be afraid to say anything at all.  But if I talk to them and say, “sometimes I just need to hear that I’m doing a good job” then they will feel more comfortable saying that.

My right as a client, as a person, is to ask for what I need.  As a friend pointed out–other people may not deliver.  But some people will.  And to all of you who have remained by my side, I thank you with all of my heart.  (And I don’t take ‘heart phrases’ lightly!)


October 5, 2014 - Posted by | Uncategorized | , , , , , , , , , , , , , , , , ,


  1. I love this post. I have been thinking about some similar things in therapy. The therapist I have currently is wonderful about thanking me for showing up to our work together and encouraging me by acknowledging the good work I’m doing, the ways things are changing and even small efforts. This has helped me so much to strengthen our relationship to weather difficult times and approach difficult subjects like trauma.

    If I don’t ask for what I need, I will often act out or manipulate to get it. Then, whether it works or not, I’m straining the relationship.

    Comment by Amanda | October 5, 2014 | Reply

    • Amanda–good for you for strengthening your relationship with your therapist. One thing I found very helpful when I was upset after therapy was to journal–in as much ’emotion mind’ as I wanted. Then I’d let it sit for a while, and then reread it. Then I would write my therapist a letter based on my journaling, but from a ‘wise mind’ perspective. I would then give it to him at our next session or email it to him. And I am a firm believer in the DEAR MAN approach to communicating with others.

      Comment by surfacingaftersilence | October 6, 2014 | Reply

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