It's just that I can't walk because my penis got nicked pretty bad. It still bleeds when I pee. And I won't even get into the burning sensation. Feels like someone put Icy Hot inside my balls. Not on, inside.

So, I'm sorry everyone. Especially to you Betsy. You deserve better. Here, I'll send you an ecard with my deepest apologies for calling you an attention whore.

Anyway, all this laying around gives me time to prepare McCain pamphlets to hand out at the hospital. Most people don't understand that our country is in major danger and if we elect that big-eared freak we'll be screwed. I mean it. Majorly screwed. Our country is at a critical point and we must stay the course if we expect to survive. Iraq needs our help just like we need theirs. This juncture requires that we learn to manhandle our enemies like small children and beat them like red-headed step children. Then burn them alive and scatter their ashes across the world to show others that we mean business. If Saddam hadn't caused 9/11 we wouldn't be in this mess.

By the way, someone told me that this is the greatest video on the Internet and that if I link it to our blog, we'll make billions of dollars. Or pesos or something. Not sure. Either way, enjoy.

Travel journal entry from 13th June, Bs As:

He's the man, with the plan
Got ten counterfeit pesos in his hand
Heeeee's Bubba Triiiiibunales...

... to the tune of Stevie Wonder's He's Misstra Know-it-all

Can replace "Misstra Know-It-All" with "Bubba Tribunales" on all the lyrics, except for the whole cash thing. Bubba is just a petty criminal. And he only does his little malandragems to get by, to survive, to see another day and another city and bottle of red wine. He's a lovable rogue even, unlike the big-time gangster banker stockbroker described in that awesome song.

So far, the journal entries may give the impression that I was in a cynical mood in Argentina and didn't like the place that much. That's far from true. I loved the place. The people are amazing, some of the landscape is the most spectacular I've ever seen and Buenos Aires is my new favorite city on the planet. I'll write more from the travel journal where I hope some of my admiration for the place shows through. It's interesting for me too, rereading the journal. Actually it's probably interesting ONLY for me. In Buenos Aires, where everyone goes to the therapist, I realised that that's what this blog is; a form of therapy, for Bubba of course, who could do with some, even though he'd never accept it. Just pray he doesn't start going on about his childhood...

I suck in air as I receive a new blow to my gut…

My child was finally hospitalized yesterday after a year of frequent and intense raging, 3 months of escalating behavior, a week of increasing violence, and one night of absolute panic.  She didn’t physically harm a human being, my youngest child, my husband or myself...or herself.  We were all scared.  She appears remorseful and ready to accept responsibility for her actions.

I let the air out…only a little…

My first child is only 11.  She came to us at 18 months with minimal biological information… Biological mother, 24, Russian, about 5 feet tall, worked at pool, but not anymore, brown hair, brown eyes, one previous child, doesn’t smoke, drink or take drugs…Biological Father, age unknown, Mongolian, sailor, doesn’t smoke, drink or take drugs…That’s it?

We recognize she had some “issues” from the very beginning.  For years the doctors and relatives were saying, “Don’t worry about it”, “She’s just a normal child”, and “All she needs is a little extra love”.  Eventually her behavior was just unusual enough to convince a therapist and doctors that she did indeed need some help.  She is an incredibly bright charming child.  We loved her then and we continue to love her.  Loving her was not the cure-all for the illness that slowly turned her from a happy Disney child into a child who could barely hold herself together in public…a child who saved up all the anger/frustration/worry/sadness for home where she felt safe.  In the past year, she drove away every friend she could make.  Family stuck with her, but she still had trouble trusting us.

We have had our first child in therapy for years.  When it became clear that she was dealing with more than just an attachment issue, we took her to a psychiatrist.  We learned how difficult it is to get a mentally ill person and a child in particular properly evaluated and diagnosed.  She hid her symptoms from the doctors.  There was no way anyone could make a diagnosis in hour-long sessions every 4 to 6 weeks. 

We couldn’t figure out how to have her fully evaluated without committing her to the hospital.  Her behavior escalated to the point where she did start to qualify for an educational plan (IEP) through the public school system.  She did start to exhibit enough threats of violence and self harm that we could work on getting her into a day treatment program.  Before we could finish the evaluation process for the school district or the day treatment program, my daughter finally did something that forced us to have her hospitalized.  Thank heavens she didn’t harm another person.

Hopefully they can fully evaluate her and find a treatment plan that works.

I’m still holding my breath, afraid to let out that final bit of air.  My first child doesn’t have a clear medical diagnosis.  Doctors are hesitant to diagnose a young child.  Without a diagnosis and treatment neither she nor the rest of the family can feel safe.  For now her life is still on hold.

I HAVE IT WRAPPED IN TINFOIL. THE BUGS CAN'T CRAWL IN THE HOLE AND LAY EGGS THAT WAY TO CONTINUE THEIR SPECIES. I HATE INTER-SPECIES EGG-LAYING.

I'M SORRY DOC.

So why do I keep seeing this series?

I probably will never know. I also saw Seven last night (yes this was movie night). More up my alley but not as good as I would have liked considering who directed it.

I started working on the Gargoyle part of my picture yesterday but I don't know how I'm going to finish it. I think I'll try a different approach. Where my brain used to run in 2D space I'm finding it easier to think in 3D now which is good but since this was meant to be a 2D project with some 3D elements it is now getting easier to think of it as a 3D project. We'll see what happens with it. I'm going to focus on my workout today and writing even though I probably don't need to.

I find that even though I'm beginning to fall in love with these characters I'm writing now I don't feel like the world will end on the days that I don't write at all. Is that true or is this just an excuse not to write because I'm scared? I don't think I'm scared anymore but it still worries me. If I don't need to write who am I? Have I defined myself so much with writing that I will dissolve into nothing if I don't write? The big difference is that even though I want people to read what I write I don't want to become famous for it anymore. I no longer have dreams and aspirations of millions of copies sold.

But this doesn't mean I wouldn't try to get published.

The main thing is that now I would be happy to self publish online rather than having to go through traditional channels. This is a major breakthrough and takes a lot of the pressure off. Maybe that lack of urgency attached to writing really indicates the resolution of where the pressure was coming from and I have now been absolved from that expectation from myself.

Liberacion!

I was not depressed when I started the course, but I was definitely less cheery after two years of psychodynamic therapy.  Firstly, it was all negative.  What was wrong?  Why was it wrong?  How horrible was your childhood?  No balance, no positive solutions, and very often no reply at all.  And that is the second issue.  So much talk about a holding environment - I don't think so.  Lying on a grotty old bed which represented the couch - I wanted to sit but was firmly talked out of it - staring at a crack in the ceiling which reminded me of the Nile Delta.  Not helpful.

Some years later, having hit a bad patch, I took myself along to see a counsellor, a friendly lady who handed me tissues and at least made me feel that I was normal to feel sad.  At least felt listened to at a time when I wouldn't have dreamt of letting my friends, or even my husband, know the truth of how I was feeling.

So, later this year I am starting a course of cognitive behavioural therapy.  I have read a great deal about it and all the research shows that it can be at least as effective as the pills.  We'll see.  But, whatever else, it is a therapy that tries to mend and show a way forward rather than pick at the scab of unhappiness.

To summarise yesterday’s post, this quote from Latham & Locke (2007):
The theory of goal setting states that there is a positive
linear relationship between a specific high goal and task
performance. Thus, the theory makes explicit that a specific
high goal leads to even higher performance than urging
people to do their best. A goal also affects satisfaction
in that it serves as the standard for evaluating one’s own
performance. A higher goal requires higher performance
for a person to experience positive affect than does commitment
to a lower goal. Two factors affect the goals that
a person chooses: the importance of the goal to the individual
and self-efficacy, namely, self-confidence that the
goal for a specific task is, indeed, attainable. The mediators
of goal setting are choice, effort, persistence, and
strategy. Goals are moderated by ability, goal commitment,
feedback in relation to goal pursuit, the complexity
of the task for an individual or group, and situational factors
(e.g., presence of needed resources).

Today we’ll look at feedback, goal complexity, the relationship between personal goals and incentives, and satisfaction with performance.

Feedback: Without some sort of indication of the difference between where the person is performing currently and where they need to be, it seems that people have trouble working out exactly how much effort they need to put in to achieve. Usually, people who find out they’re performing below the level expected will increase their effort – or seek an alternative strategy to use. The combination of goals plus providing feedback is more effective than just setting goals.

What this means for pain management is that

• if the individual is just given tasks such as ‘do this set of exercises’, but no target is ever specified, they probably won’t persist with the exercises.
• if they are given an exercise target, eg walk for 20 minutes once a day, but it is never reviewed with them, they’ll find it more difficult to persist.
• if, however, they work together to set an exercise programme, establish how often they need to do it, and it’s reviewed periodically, then the chances of the person persisting increase.

Difficulty: It seems paradoxical that people who have achieved a difficult goal will, next time they set a goal, set a more difficult one. From the research that Locke & Latham reviewed, it seems that Bandura’s observation that ‘goal setting is first and foremost a discrepancy-creating process’ holds true. We’re not machines, simply responding to situations in our environment (discrepancies), we actively search out and create situations that demand persistence and the development of skills.

This suggests that, with encouragement, people who start to develop new skills will find ways to extend themselves by setting themselves new goals – depending upon, however, their level of self efficacy and the times they find themselves able to succeed. As the saying goes, ‘success breeds success’.

• People with pain often find themselves in an ongoing cycle of failure, as their efforts to cope using skills they’ve found helpful in the past fail to support them in their goals, and their self efficacy drops.

As I mentioned yesterday, people begin facing challenges (goals) by using skills they already have, if they don’t have those skills, they try to find skills they’ve used elsewhere to help them manage. When they find themselves without the necessary skills, they seek help from others – but if those others (especially important people, such as health care providers) cannot provide them with appropriate skills and encouragement, their self efficacy drops and they begin to withdraw from what they perceive as unsatisfying and unachievable goals.

Complexity: Most of the goals that we encourage people to develop in pain management are quite complex. They involve multiple changes across a range of thoughts and behaviours. Locke & Latham (2002) found that ‘as the complexity of the task increases and higher level skills and strategies have yet to become automatized, goal effects are dependent on the ability to discover appropriate task strategies’.

It seems that the availability of different strategies to choose from can influence how readily a complex goal can be achieved. This effect is influenced by the type of goal being demanded: performance-outcome goals can interfere with learning and integrating new strategies.

For example, a goal like ‘move all these boxes within 20 minutes’ demands speed and as a result newly acquired skills such as pacing may be forgotten. If instead, a specific difficult learning goal is required, for example ‘use your pacing skills to help you move these boxes within 20 minutes’ is given, high goals lead to better performance as compared with a general request to ‘do your best to move these boxes’.

Proximate goals: To make these complex goals more easily achieved, research suggests that it’s better to develop smaller ‘proximate’ goals. Locke & Latham found that poor performance (or errors) may be due to poorly constructed proximate goals – that is, these smaller goals may not actually directly contribute to the longer-term goals. The benefit of smaller sub-goals is probably due to the feedback from errors in the performance of these goals giving an individual a picture of how realistic their longer-term goal may be.

Goals have an influence on the level of satisfaction an individual feels. To set a goal says that the person is not satisfied with their current level of performance, and their ‘satisfaction level’ drops. As a goal is achieved, people feel more satisfied. But paradoxically, people who achieve the highest goals are the least satisfied with the present situation. They do more because they’re dissatisfied with less. Their ‘satisfaction set-point’ is set very high – and so they work very hard to achieve.

In pain management this may work against some of our patients. For example, the person who typically strives to do well may find developing ‘working to quota’ or activity regulation very hard to do, because their satisfaction comes from having achieved a very high standard. For these people specific and difficult learning goals may be more helpful than performance goals.

The above model shows what Latham & Locke (2007) describe as the ‘high performance cycle’. Although, as for all of the information I’ve review so far, it’s about organizational performance, there are many similarities between this cycle and what we observe in the performance of pain management goals.

What I’ve discovered as I’ve worked my way through the literature on goal-setting, is that while we talk about goal-setting within pain management settings, there is very little empirical research on it with patient groups. Tomorrow I’ll review one of the few papers I’ve seen – so y’all come back now!

Latham, G.P., Locke, E.A. (2007). New Developments in and Directions for Goal-Setting Research. European Psychologist, 12(4), 290-300. DOI: 10.1027/1016-9040.12.4.290

Since my last post (understandably) freaked out my "real life" friends who regularly read my blog, I thought that I'd write a post and inform my dear readers that the past couple of days I have felt pretty damn good.  Happy, even.  Content, even better.  I think I may be turning a corner of sorts.

As you know, I had my 1st session with this therapist yesterday and it felt really good.  Now. don't get me wrong -- I'm not saying I had one session of therapy and that now everything is all puppies and rainbows.  Most of the session was just gathering background information, anyway.  But the mere fact of going in there, admitting (to myself and to her) the obvious fact that I've been having a rough time of late and that things are feeling a little out of my control, and affirmatively seeking help -- it felt like a big step.  This isn't my first time trying the therapy thing, but in the past when I tried, I would usually see someone once or twice, think to myself, "why am I wasting my money?  Things are ok in my life, I'm a big girl and I can deal with my own problems, I think I'll take that money and go buy some shoes."  This time it's different.  This time I know this is something I need to do for myself right now.  And doing something that is so truly, 100% for myself and for my own well-being...it's even more satisfying (if not as sexy) as that hot pair of shoes.  ;)  Also, the therapist is a total doll -- this little Jewish woman with a New York accent who I just wanted to grab and hug.  But also a very to-the-point person, which I definitely need.  So I am really looking forward to seeing her weekly and to really do the work to figure out what is going on with me, even though I know it will be a challenging.

Today I was looking back at my old blog, and I had a little bit of nostalgia.  In some ways, this is a  very different kind of blog than the old one was.  As I read it, my first thought was, Hey, I used to be really funny!  But then I realized that in my old blog I was often writing for my audience.  I knew my mom would read it, I knew my core group of readers liked my funny anecdotes, so I made a concerted effort to be witty.  Now, for better or for worse, I write for myself.  I know that my posts haven't been very funny, especially lately, but they have been completely genuine and uncensored. 

Writing has often been, and still is, like another form of therapy.  I write something and it comes out sounding just as raw and painful and intense as it felt at the time I was writing it, but something about just putting out there what I am feeling helps diffuse those feelings and thoughts and make them less scary.  I'm a firm believer that the scariest thoughts and fears are the ones that you bottle inside and don't share with anyone, until they become larger than life.  So many times just speaking those scary words is enough.  Just to have someone listen, to say "I understand" or "I worry about that too" or "I'm here if you need to talk." 

Anyway, I suppose this is another way of saying don't worry about me.  Yes, I have been going through a rough time.  Yes, I have been blogging very openly about it.  And yes, I very, very much appreciate all the thoughts and concern.  But deep down I DO know that everything will be ok (and when I lose sight of that feeling, which recently I have, I'll need to read this post to remind me!)

 In other news, since I last blogged about EHB we have been on 2 more dates -- one last week and one last night -- and things are still going well.  (More details on that later, perhaps...I know, I'm such a tease!)  For now all I will say is that there may  have been a little bit of public smooching.  :)  Isn't it funny how life can bring so many different emotions and experiences at the same time, dear readers?

*Ice Cube, people.  Please tell me you got the reference.

This one came from listening to a song by David Gray, called "Shine". There were two images in my head and this was one of them. It's just based on a feeling about my home where I grew up. I was away at school when I did this. I was sort of reminising about the summer and how I would take my two ferrets out at night since it was cooler. I remembered how the tulips in my mom's garden just always looked like they were glowing because of the moonlight. I think there is something more to this but, I'm not sure how to explain.

But what surprised me is the list of terms that people have entered into search engines (Google for example) that brought them to my blog. This control panel feature provided something that I had not expected.

The top term that has landed searchers on my blog is “jung mandalas”. Hunh. Interesting. I wrote one post that included Jung and mandalas. However, I have written *56* posts on topics related to dissociative identity disorder, while THAT search term is tied for second with another search term (ahem, “mandalas”).

But, I am pretty psyched that “emily first girl blog did” ranks 5^th ... people are aware of me, my diagnosis, and my blog about my research and experiences.

Interestingly, I am the top ranked Google hit for the search term, “gloria steinum dissociative disorder”. Without the quotes. No, as far as I know, she does not have DID. But who knows.

And then a lot of expected stuff like “Lamical”, “changing therapists”, “two rivers hospital trauma program” or “alters +dissociation”. Make sense.

But what saddened me, and what prompted me to write this post, were some of the more desperate search terms. Some of these took the wind right of out my sails. I know the despair when *I* have entered some heavy search terms, and I could feel their pain as they entered theirs.

• changing therapists transference
• escalating anger abuse husband (tied for 6^th)
• rejection of family after therapy
• suddenly feeling crazy
• people who don’t understand cutting
• mpd suicide integration code
• cycle of anger
• establishing trust co-workers
• dissociative identity disorder – accepting
• punishment cutting trauma

As much as I get great satisfaction publishing on this blog, sometimes reality hits me really hard.

When people have no one to reach out for, they secretly put their fears and despair into a search engine in the privacy (although perhaps not the safety) of their own homes.

(PS - and no, Wordpress does not log any identifying information about who visits my site. Not even IP addresses, so continue to read without worry.)

I had a very nice visit with the shrink today.  We went over her notes from my initial evaluation with her and decided that we didn't really need to do a re-evaluation as I am most definitely Bipolar II.  Part of me is very pissed off and part of me is very relieved.  The pissed off part wanted her to do some kind of elaborate tests to determine conclusively that I am or am not Bipolar.  The relieved part is so because the last two and a half years haven't been for naught.  She did say that if I ever wanted a second opinion I was welcome to get one as it would not hurt her feelings.  I thought that was nice.  We also talked about my anxiety levels and how that's come down a good bit in the last few weeks.  I told her I don't much care for the Clonazepam and she was in agreement that it can be nasty stuff, but told me to take it if I need it.  And as always we talked about the dread lithium and when I'll be coming off of it.  Today we actually talked about trying me on Lamictal again so that might be happening in the not too distant future.  We shall see.

Tomorrow is the meeting with the new therapist.  I think I might need a Clonazepam for that - well maybe half of one.  I'm always nervous meeting new medical type people and this will be no exception.  I am taking Rob with me for support, so that should help some.  Actually, I guess I should say, I'm having Rob take me as I'm making him drive me tomorrow so I don't have to deal with parking downtown.  That right there would cause me rather considerable anxiety.  Anyway, I know it'll be fine, I'm just nervous, that's all.  I've got my outfit and jewelry for tomorrow all picked out already to make a good impression.  I'm wearing a very old skirt (that still looks new) and a brand new necklace.  It should be lovely.

I had been worried that I was sliding back into another depression phase, but after talking to the shrink today I don't think that's the case.  I think it's the side effects of the Clonazepam.  It makes feel almost hungover after it wears off, it makes me want to sleep a lot, makes it hard to concentrate, I stare off into space kind of goofy like - it's just not good.  But it does take the edge off the anxiety.  ;)  What're ya gonna do, eh?

I did this drawing back around the end of '06 maybe.  It was the first time I just kind of let go and let whatever happen, happen. I knew I couldn't draw so I wasn't expecting much. There was just this image in my head. I saw this scary looking forest with trees that looked like they might reach out and grab you, or at least try to trap you in some way. There was a lake or a pond, which I saw as some place peaceful. A place of reflection, self-reflection. Then off a little ways there was this brilliantly colored tree that was just kind of bursting with life. I felt like I was caught some where between the forest and the pond. I want so badly to get to that tree. I want to be that tree. It sounds cheesey maybe but, that was how I was feeling.

   An Overview of Evidence-Based Support for the Therapeutic Use of Music in Occupational Therapy

Abstract: Music is a modality present in occupational therapy, yet little educational material about music exists within the field. This paper presents a myriad of possibilities for practitioners considering using music, providing a resource of research within and outside the field. Applications are organized around enhancement of occupational performance, utilizing three distinct methods: (1) Music-assisted occupation, (2) Music as occupation, and (3) Music in preparation for occupation. The potential effects of music in the areas of pain/discomfort, movement, emotion, cognition, self-expression/communication, relationships/groups, culture/society and community, and personal meaning/motivation, are discussed in terms of enhancing occupation.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

  Effects of indoor gardening on sleep, agitation, and cognition in dementia patients - a pilot study,

Abstract:  A pilot study was performed to examine the efficacy of indoor gardening on sleep, agitation and cognition of dementia patients.

Twenty-three institutionalized dementia patients who had sleep disturbance and/or agitation participated in a 5-week study protocol of 1 week of baseline and 4 weeks of treatment. The study design was a one group repeated measures study. For the first and fifth week of the study period, sleep patterns, agitation, and cognition were evaluated using a sleep diary, Modified Cohen-Mansfield Agitation Inventory and revised Hasegawa Dementia Scale respectively.

Significant improvement in wake after sleep onset, nap, nocturnal sleep time, and nocturnal sleep efficiency was identified. On the contrary sleep onset time, wake-up time, total sleep time did not change after indoor gardening. Agitation and cognition score was significantly improved.

Indoor gardening was found to be effective for sleep, agitation, and cognition of dementia patients. Randomized controlled studies of larger sample size are needed to confirm treatment effect.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

 I'm slightly nervous because I have a job interview tomorrow. Well, sort of. It's with a recruitment agency, so it's not actually for a real job, it's just for them to get to know me and put me on their books. But it's a good first step towards getting an actual job. If they like me, they'll be able help me with that side of things. They seemed to like my CV, which is a good sign. God, I hope tomorrow goes well. I've had to go out today and buy a suit, because I didn't have one before and I get the feeling they'll be expecting a smart appearance. For the first time in my life, I'm going to have to pull off 'smart'. I've been a student for so long, all I've known look-wise is student-ish!

 None of these things would have been possible were I still drinking, that's for sure.

What is WRONG with those people? I so want to do this shiznit. I wonder if out of hours stuff is coolio with them?

Supervising is something I've always planned to do, I just thought I would wait awhile before doing so. You know, just to make sure I actually know what the fuck I'm doing before I start telling other people what to do. To be fair, though, I do know what I'm doing in regards to young people.

Existere, clinical supervisor. Has a certain ring to it.

Lyle was admitted on a Tuesday, and I was taken aback by how young and high-functioning he seemed.  Our average client was in his late 40s, but this guy was in his early 20s, and handsome, had all his teeth, and dressed very well for anyone, let alone a client in a psychiatric home.  He had bags and bags of stuff, and within 30 minutes of his arrival, I had already been lectured by the head of housekeeping that she didn't want to be held responsible for ruining his clothes and that I needed to tell him to dress in the shitty clothes the home gave out for free.  Within 35 minutes of his arrival, Lyle had stormed into my office and demanded that he should be allowed to leave and go get some french fries (all clients had to stay on facility grounds for the first 3 days) and that he should be allowed to write whenever he wanted (he totally was).  I calmed him down easily enough and then had to explain to him that his stuff was too nice.  Together, he and I went through his stuff, and itemized it all.  He started to balk when I told him I had to confiscate the hospital scrubs from him.

"Man, why?  What the fuck?"

"Lyle, the nursing staff here wears hospital scrubs.  You can't look like the nursing staff here."

"Yeah, but what if I want to go back to med school?"

"Ummm, I'll hold onto them for you."

He was the most difficult kind of sick, the kind where he has absolutely no awareness as to how sick he is.  He showed himself to be incredibly delusional but also very capable of keeping himself looking put together.  He would comb the want ads for jobs in the "sales fields" and showed me his portfolio of drawings so that he could apply to art school as well.  His drawings were just random words drawn out with a flourish, HUUUUUUGE on tiny scraps of paper.  He would always always complain about his medication, how he was on too much, how it wasn't the stuff he was used to, and told me that he preferred Lipitor, that Lipitor was the only "brain pill" that worked for him, and that he figured that out in med school.  Lipitor is a cholesterol drug.  "Lyle, the doctor did a full evaluation on you and this is the best medication for you, according to hi......wait, are you wearing a grill?  Where did you get a grill?"  Lyle, voice muffled by the huge silver and blue grill covering all of his top teeth, responded "I just found it- it's pretty tight, huh?"  He could talk at length about his job skills and then show me an "important certificate signifying his job skills", which was a piece of notebook paper that he had put stickers all over.  I would search his earnest face for sarcasm and find none.

Lyle unnerved me with his dogged assertions that he was not in the least bit crazy, and in his sharp and accurate criticisms of our facility.  It infuriated me how he would roll his eyes at my suggestions that he go take his medication, at my shoddy office, and at the terribly ineffective paperwork that we to keep up with,  mainly because I agreed with him.  It was like if the weird bully from middle school suddenly had tons of free hours to come and critique you completely.  I could normally send away bored clients by suggesting that a card game was going on in the activities area, but Lyle would not be swayed.  He was smart enough to be bored by our traditional means of entertainment, but not well enough to do anything else.  He would frequently demand to be discharged, to which I would reply "ok sure, but where are you going to go?".  His response was to criticize the facility and stalk off.

One day, after dealing with several crises with a furious client, Lyle stormed into my office as usual and demanded that he be allowed to work for Cutco, as a door to door knife salesman.  "Lyle, really, think of how that sounds.  You really think that's a good job for you?"  He demanded that he be discharged, and then, wrinkling his nose at me, said "You know, you could really use some lipstick.  Your whole face is just blah."  I felt myself reaching the end of the rope and letting go, and I leaned over to him and mock whispered "You know, the day that I want advice about beauty products, or really about anything, from a person in a psychiatric facility, I will LET YOU KNOW".

Lyle didn't seem fazed by what I said and walked out of my office in a huff as usual, but I sat back, stunned and embarrassed at myself for speaking so poorly to a client.  I had never spoken to him with anything less than respect, adhering to my policy of comforting the disturbed, but I had such a hard time remembering that around Lyle.  I called him back into my office a bit later and apologized for speaking to him rudely, and he interrupted me to tell me that he was thinking of getting a job in the kitchen here and wondered if I knew how much they paid and if they had vacation time.  I looked at him for a few seconds and then pulled out an application to give him.  After losing my temper a bit, my vision cleared and I could again look at Lyle as what he was:  a sick man with an incredible talent of hiding it.   So I sat back and decided to learn from him for a while.

  Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: a randomized pilot trial,

Abstract: This randomized pilot study investigated the effects of meditation with yoga (and psychoeducation) versus group therapy with hypnosis (and psychoeducation) versus psychoeducation alone on diagnostic status and symptom levels among 46 individuals with long-term depressive disorders. Results indicate that significantly more meditation group participants experienced a remission than did controls at 9-month follow-up. Eight hypnosis group participants also experienced a remission, but the difference from controls was not statistically significant. Three control participants, but no meditation or hypnosis participants, developed a new depressive episode during the study, though this difference did not reach statistical significance in any case. Although all groups reported some reduction in symptom levels, they did not differ significantly in that outcome. Overall, these results suggest that these two interventions show promise for treating low- to moderate-level depression.

for the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

i like my therapist. we've made some progress in the few months i've been seeing her. but sometimes she suggests things (planting seeds for me to nuture in overanalysis) that really throw me for loops. case in point.. today's session she tells me my relationship with mr. multiples is too big a part of my life. that i shouldn't center/focus 90% (her number) of my life around one "all-consuming" facet.  "whoa" i think. maybe she's right. i mean we do spend an awful amount of time together. (awful being the wrong word, b/c really it's everything but awful). i will admit, i'm madly in love with him right now, and things are in a good place. i think we both have a better understanding of each other and we're starting to get deep into resolving the ugly stuff (mostly my stuff to begin with). and really, i'm all smiles and sappy thoughts.

she thinks that it's not healthy that my mood is so dependent on our day to day relations. but really, seeing him in the morning or during the day if even briefly -- it drastically alters my mood. isn't it a good thing if i'm happy?

happy thoughts = happy person = happy life?

for the first time ever (thanks to her help) i'm more content in the moment. instead of always looking around the corner for what's next or what could fall apart, i'm just sitting back and enjoying the present. because really? in some ways -- i really do have it all right now. or the makings of it all. right. here. in my pocket.

i'm so confused. she suggests a bunch of excercises to get us closer, and to help us find those things in common to sustain us.. one of which is a suggestion that perhaps to break things up a bit we spend time with other people. like dating other people. um, excuse me, what?  yeah, here’s how i see that going..  multiple relationships ensue, and with my luck before long he decides that a secondary relationship needs to become the primary one. i’ve seen it play out in my head a million different ways.  none of which i view as being positive. conventional wisdom would suggest that the third party is the one at fault for ruining the original relationship.  if that person hadn’t interfered, they say, the original relationship would have flourished.

personally, i reject this theory. maybe i’m too apt to believe that people do things for their own reasons independent of the actions of others, but i cannot accept that a relationship could be strengthened by an extraneous partner.  if a third party is involved in the break up of a relationship, in my way of thinking, it was ready to die anyhow. i don't want this to die. hell, it's not even sick right now.

sorry doc, but this one i won't do. and if i know him as well as i think i do -- he won't go for it either. i'll take a hit and say maybe we need more time apart, solo time or with other people as friends but nothing more. the mere thought of mr multiples spending my quality time and sharing those small gestures that speak volumes of how much he cares with another less messed-up girl, and she'll soon start to realize the type of catch he is, and i'm no longer even remotely close to being happy when i'm left out in the cold..

and that makes no rational sense...

and maybe that's why she's suggesting it? so that i can really, really look and ponder and feel out all of my options and go for the one that's the best fit. after all what i do is always my choice. but she's throwing out something i'd never consider. so that i can realistically see it from all points of views. i think you just witnessed the wheels of in my brain spinning. see? this is why i write folks. because it's how my mind thinks best.

:)