Do Your Best, Just Don’t Hurt Yourself

On a semi-regular…er, once a week or so… basis, one of many clients will refer to me as a hypocrite. Sometimes directly, sometimes indirectly. I’ve had weeks when I’ve worked six days straight. I have been known to drink too much coffee in order to offset lack of sleep. And I can be very focused on removing those little fringes from torn sheets of notebook paper.

Here’s the thing. I am a happy person, I have self-esteem, I love my family, I love my little spot in suburbia, and I love my job. People who end up in my office have some combination of unhappy, worthless core beliefs, self-injury, have difficulty forming valued relationships, feel disconnected, hate others, cling to others, restrict their eating, are anxious, and yes I could continue.

Perfectionism is almost like a cute beauty mark with a biopsy indicating it’s a malignant tumor in need of treatment. Fine on the surface while it festers, but eventually it’s going to become blatantly obvious to everyone it’s a problem. The plus to perfectionism is that treatment is more about hanging on to what works – such as achievement – and learning to let go of what doesn’t work – harsh self-appraisal, self-punishment, etc.

So when is perfectionism helpful?

When it’s adaptive perfectionism (some researchers refer to it as conscientiousness). Adaptive perfectionism is all of that great perfectionism you know and love – grades, promotions, goals, beauty, “doing the right thing,” competitive spirit, sense of accomplishment, and more – without all of the self-loathing, insecurity, and at times life-threatening behavior. We call that stuff maladaptive perfectionism.

How does you know when you’re engaging in adaptive vs maladaptive perfectionism?

One being able to accept disappointment if things do not go as planned, and not viewing these events as some sort of confirmation of inferiority. Maybe the Easter ham was overcooked. Maybe you failed an exam. Maybe you bought the wrong socks for your partner. It happens.

Another is something I’ve seen in my practice is how perfectionists motivate themselves. It often has a moral tone to it. Recurrent themes include a sense of responsibility to others (and objects in those with Hoarding Disorder) and being worthwhile to friends, family, or peers. People may criticize themselves or ritualistically engage in self-injury in order to punish themselves when they do not meet their very high standards. Those engaging in adaptive perfectionism do not do this or are at least in the process of challenging these thoughts and behaviors when they occur. They use more positive reinforcement with themselves, such as tangible rewards for a job well done or use of cheerleading statements.

Ultimately, adaptive perfectionism meets the goals of perfectionism: being the best possible and feeling good about it. Perfectionism can be broken down into subcategories, which is for another blog post.

I’m sold on the idea of adaptive perfectionism, but I’m skeptical about my ability to change.

Which is normal. The plus is that Cognitive Behavior Therapy, CBT for short (That therapy the dusting, straightening yours truly uses), is helpful for maladaptive perfectionism. CBT teaches perfectionists to challenge their thinking, practice self-kindness, and improve efficiency.

Another promising treatment is Radically Open Dialectical Behavior Therapy, or RO-DBT for short. It isn’t widespread, though that will likely change when more clinicians are trained.

Alright, I will give it a shot.

Contact Cortney Modelewski at 269-389-0402 or cortney@cortneymodelewski.com

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#OCDweek

Today is the last day of OCD Awareness Week. I have been putting up links to informative websites on my Facebook page to, well, bring some awareness. I have also spent some time reflecting on how U.S. views OCD, which is pretty warped.

OCD is a neuropsychiatric disorder, which means the cause is attributed to abnormal brain function. It is not caused by weak will, lack of exercise/nutrition, or difficulties with mothers. It is likely caused by a mix of genetic and environmental factors, with an emphasis on the genetic part. It is treatable with therapy and medication.

Misconceptions about OCD are abound. I don’t expect people in general to understand everything about the disorder, but it would be nice if people could at least tone down the judgments to be on par with epilepsy or cancer. OCD isn’t anyones fault, even if individuals with OCD (and sometimes their families) have to solve those problems anyway (DBT reference). And of the things I’ve learned in my personal and professional life, the inclination to psych problems would be higher if fear of being judged weren’t an issue. Instead, people may wait to get treatment until it’s unbearable, or worse commit suicide.

Yes, OCD can cause people to be miserable to the point of killing themselves.

It’s not a personality quirk.

It’s mental torture.

Stigma continues to decrease as people continue to speak out. OCD Awareness Week is one way to do that. Having OCD does not mean someone is defective. It just is what it is.

 

 

 

 

You’re Not In DBT, part 2

In You’re Not in DBT, part 1, I gave a brief definition of Dialectical Behavior Therapy (DBT) and suggested your therapist may be engaging in dishonesty behavior if claiming to provide DBT services when they are not providing all modes of DBT service delivery.

Today we’ll talk about what to expect from DBT and how to find a provider.

What to Expect (Briefly)

  1. Providing a commitment not to kill yourself or engage in self-harm – and keeping that commitment.
  2. Avoiding psychiatric hospitalization like the plague.
  3. One hour of individual therapy and one to two hours of skills training per week, with homework.
  4. It’s behavioral, so you change your behavior – yes, that’s easier said than done, but the plus side is you get guidance on change.
  5. And there is a big emphasis on acceptance – you are where you are.
  6. Getting comfy with what seem like contradictions – dialectics.
  7. Tracking emotions, symptoms, and skills used on a diary card on a daily basis.
  8. Acronyms upon acronyms.
  9. Structure – all sessions have an agenda, starting with keeping you alive followed by sticking with therapy and ending with everything else. You don’t get much time to ramble.
  10. Being viewed as capable – which means you’re held accountable for your actions.
  11. Many, many “Assumptions,” a noteworthy one being the relationship between the therapist and client as a relationship between equal people. Yep, your therapist is a human, not unlike you.

Where do I find a DBT therapist?

Check the Behavioral Tech “Find a Therapist” directory

Also check the DBT-Linehan Board of Certification website

You can also ask your psychiatrist or get a referral from an inpatient program, if applicable. Chances are pretty good they’ll suggest it before you ask if there is a program close to you, and your risk of committing suicide is high.

Next in the series will feature alternatives to DBT, for those who find DBT ineffective, don’t have access to it, or just don’t plain care for it.

Accepting Suicide

Attempt, thoughts, knowing someone who had an attempt or thoughts – you will be hard pressed to find a person who hasn’t been impacted by suicide. If they talk about it. A lot of people won’t out of fear of being judged.

It’s World Suicide Prevention Day. Suicide can be prevented. In order to do so, however, it’s necessary to accept – which means without judgment – that it exists and needs to be addressed. No calling it a sin or a sign of weakness. No keeping it quiet. No more stigma.

As long as there are psychiatric disorders, trauma, addiction, chronic health conditions, and loss, there will be suicidal thoughts and suicide attempts. It is what it is, and it needn’t be.

Check out these resources:

International Association for Suicide Prevention

National Suicide Prevention Lifeline

10 Things Not to Say to a Suicidal Person

Finding a Mental Health Professional

Suicide Attempts as Traumatic Events

I spend a lot of time talking about suicide with clients, and for many it’s the centerpiece of therapy agendas for months. In the case of DBT, it’s tracked on a diary card (log of symptoms, emotions, and skills used). During behavioral or CBT sessions, I usually do a verbal check-in and a PHQ-9 every four weeks. I have one client right now who isn’t experiencing suicidal thinking to some degree. That I’m aware of, anyway; this person could be keeping something from me.

I went to the Beck Institute training on CBT for Depression and Suicidality, which was very fabulous and worth attending if you are a clinician. Of the many things I learned, one was a protocol on suicide prevention. Part of the protocol – and we were told we often wouldn’t do this with folks due to time constraints and client readiness – is on treating suicide attempts as traumatic events

How we (therapists who use therapies related to CBT) treat traumatic events is through prolonged exposure – the person tells their story and listens to their story on recording over and over and over, amongst other things. The trainer said the process used  is sort of like prolonged exposure and stressed we seek supervision should we decide to do it.

I’ve known attempting suicide is frequently traumatic for people. It doesn’t take much brain power to figure that out. What hadn’t clicked until then was my clients don’t describe suicide attempts as traumatic. They may bring up traumatic events during hospitalization, restraints in particular. The suicide itself, no. I’m not entirely sure why, and I plan on asking those who’ve made attempts about it.