July

Julia de Burgos, tr. by Jack Agüeros, from Song of the Simple Truth: The Complete Poems of Julia de Burgos; "To Julia de Burgos"

Dear Therapists,

I had just logged into a Zoom session for my Diagnosing Pathology class and my cohort was in deep discussion with one particular student as we all waited for our professor. This student in particular was already working in some sort of clinical setting, not yet giving therapy, but a new client profile had come across her desk with a diagnosis of borderline personality disorder. She didn’t know much about the diagnosis herself, but she was concerned because her boss said, “Whoa, good luck with that one. Borderlines are very difficult to work with.”

Difficult. It’s not the first time I’ve heard that word. Every time I hear a professional utter the word, “difficult” when referencing a client it stings. Is that how you really see us? As patients/clients that are stuck in a downward spiral whose struggles are too much for you to handle? Don’t you believe in what you do and that there is hope for us?

My heart breaks for whoever this person is that has borderline personality disorder because the cards have been stacked against them before they’ve even gotten started. One of my school assignments required me to write about working with a difficult population and this was my response:

“If we get the idea that a particular diagnosis or population is difficult to work with it feels like we are setting ourselves up for failure. Maybe we will treat them differently or have lower expectations or refuse to work with them because we have a negative perception.”

In 2022, I attended the Healing Together conference hosted by An Infinite Mind in Orlando, Florida. I was sitting in a session where I could hear and learn about lived experiences with dissociation and an excerpt from a book was read aloud as an example of how some clinicians view dissociative identity disorder. The presenter who read the excerpt was sad, the audience was sad, and I felt infuriated. The gist of the excerpt talked about how a clinician should be wary because clients with dissociative identity disorder are difficult to work with and that they bring unsolvable problems to therapy.

Unsolvable problems? Listen, if a client’s problem was easy to solve, they wouldn’t need therapy! Of course we are bringing our unsolvable problems to you. We believe in your ability to help us. We were trusting you enough to share our struggles. When we hear you call us difficult, challenging, resistant, and a myriad of other words, you break our trust and confidence.

My ask of you is that you reframe your perspective of difficult clients. My therapist always says that behavior is communication, so when you find a client’s behavior particularly difficult, ask yourself, “What is my client trying to tell me?” “What does my client need right now?” Seek out peer consultation or supervision without passing judgment on how difficult a client is for you.

I’ve always carried around my own judgment about myself as a client in therapy. I used to tell my therapist, “Thank you for putting up with me” and her response was, “There’s nothing to put up with.” When I had the opportunity to watch her present at a conference once, I went up to her just before it started to tell her she’d do a great job. She just smiled and said, “Everything I’m presenting today, I learned from you.” I thought about that for a long time. Not once, in our years of therapy had she ever shown any indication of frustration, feeling challenged, or felt I was difficult. She simply adapted her interventions as needed.

The NICABM posted back on June 11, 2022 on their Facebook page a quote from Pat Ogden, PhD; “When we call clients resistant or difficult, it’s because our interventions are not working and we feel incompetent.” As clients, we don’t think you’re incompetent. We think there’s something wrong with us and we believe you when we hear you say we’re difficult. So, please, choose carefully. Your words matter.

Sincerely,

A DID Client

References

Seize the day, boys. Make your lives extraordinary.

But still I couldn't get the idea off my mind. So I made a notebook from scratch, and decided it was gonna be my journal. I didn't have anything to write on it, but I could decorate the pages anyway. And then I discovered art journal and junk journal, and for a while I did that and I was happy.

After a while, I found a pretty notebook and bought it without realizing it had lined paper. Now I had to write on it, right? So I did. Instead of writing about my day, I write about the animes I watch, the music I listen, the things that make me happy... I don't write every day, but I write about things I love and that I think are gonna be worth to remember in the future.

-hydration: carry around a water bottle. a funky metal water bottle you can put stickers on is like $10 and if you can’t afford it just chronically refill a gatorade bottle or smth. Just having water nearby will help. And hydration really, really helps with energy levels for things like...

-exercise: my advice for this always is "find a sport you actually like", but if you're coming off of a years-long depressive sedentary period, start by walking. Like, TO places. The bus stop. A neat tree in your neighborhood. Is there a convenience store nearby? Go get a gatorade (see:hydration). Is there a library or other place where people gather? Even better. This is free and doesn't have to take any longer than 10 minutes at first. And don't go telling yourself "oh it was only 10 minutes it doesn't count" STOP! That is the depression talking! Literally any amount of movement is 100x more movement than you were getting on the couch! You're doing great! And once you're in a good exercise habit, it will help a lot with...

-sleep: ah, the white whale. But remember that literally just lying quietly in the dark is resting, even if you don't sleep (it's science!). Try to be in bed, no lights or phones, at the same time every night and just...chill. listen to some chill music. Try not to get up for a least a few hours. And then, the next day, when you’re wrecked?? Try to avoid napping at all costs. Your circadian rhythm should theoretically stabilize after a few nights of doing this, and resting should become easier. Human chemistry is SO routine based, just keep your schedule as best you can!

Nutrition: yeah this is depression hell. But it's not as expensive as it seems to "eat healthy". Apples, bananas, and oranges are all cheaper than chips and also require pretty much no prep, just shove em in your mouth (and don't give me that shit about caloric content; yes, I know chips are more filling, but they're not going to give you the happy chemicals you need to help depression. If you're so broke you will starve without 100 extra calories from a bag of doritos, your depression has environmental causes much deeper than lack of apples.) If you CAN cook even a little bit: frozen vegetables are cheap af and they slap with some butter and garlic powder. Throw some frozen peas in your mac and cheese. Kale and zucchini are cheap as hell in summer and they are delicious when flash fried with butter and salt. I know taking 5 minutes to cook seems insurmountable when you’re depressed but as my therapist always says, the cure for depression is doing the things depression doesn't want you to do. And it will improve your mood so, so, so much to get some fruits and veggies in you.