Making A Plan

[Sandstone]

I need to move on, and I need to do it by myself.

Someone suggested a long time ago that " all the drama around the NHS was a distraction from healing" I don't think that was true then, but maybe now? I do know I have to accept that they are in too much of a mess to give me anything useful or soon. I can't pay for therapy, so I'm on my own with it.

• What useful suggestions can people make for putting together a practical applied plan?
• What shall I do, for how long each day / week? My time is very free, so I can put in as much as needed, but I know I need lots of down time or I get overwhelmed.

I have always done most things for myself, so maybe in itself this will enable me to reclaim the strength I used to have and have no sight of now. Yet I know I have a dismissive - avoidant attachment style, so I'm not comfortable with asking for support.

• Do I need to build more inter-personal stuff in to my plan? I've just arranged to volunteer once a week - at the moment I don't do anything out of the house, so that is a big step.

I'm feeling reasonably strong now, having just come back from a two week break in the camper van. I will get less stable and less determined.

• How shall I deal with the fading stability?
• How shall I deal with the risk to consistency? When I make a commitment to someone else to do something I will follow through, but for myself I tend to fade out. However, I know that I am quite good at climbing back on the wagon.

There will be things missing that a T would provide

• Where do I get an objective view? I will always make everything my fault and use that to demonstrate that I am too foul to deserve anything.
• How do I judge when to push myself and when to hold back?
• How do I know when I am no longer present?

Past therapies have ended because of addressing trauma too soon. I look stable, so T's tend not to put enough time and work into that phase, but it is a fragile shell. I know I need to work on stabilising activities, but they are a challenge in themselves. I break safe places, and mindfulness liberates too much. Things that can work are visual as well as physical - a metronome set slow, a breathing exercise with a visual representation of the in and out breaths.I have a list of objects for each room in the house that are safely grounding, visual and tactile. But I don't stick to practising them, feeling guilty, stupid and weak.

• What grounding and stability tools can I work on?
• How often should I rehearse them?
• How can I overcome the shamefulness of needing them?
• How shall I remember them when I need them?

There has been past concern about a lack of a crisis plan. I still have no crisis support - or any other - so if I precipitate a crisis in myself, I need a more effective strategy than taking enough anti-histamines to knock myself out. I also need to be able to do whatever it is as things build up. At best, I usually only report it retrospectively. Usually I just ignore it completely.

• How can I recognise when the build up to crisis starts?
• How can I act when it is there?

When I get to the trauma processing bit, how will I do that alone? It is hard to think about that now , because the conviction it will kill me is so strong. Yet it is also hard because I am so sure it is all too trivial to count.

• Is there a best form of exposure / processing therapy for me?
• Does it need to be done with another person? Do I risk simply rehashing my current responses and beliefs without a referee?

I've asked lots of questions - please tell me what has worked for you. Or what hasn't worked, or if you think this is a crazy and unrealistic idea. My judgement is appalling nowadays.
I find routine and structure liberating, so I'm aiming to create a plan that looks a bit like a school timetable, but with more breaks. Has anyone done this, or are there examples online?
I also need a syllabus, of what to study, what to think about, what to practice in what order

 

[Deleted member 34328]

Yes, you're asking a lot of questions which is a really good thing. I also can't help but think you've answered a lot of your questions. You seem to be looking for an order or formula that will work for you every time something comes up. I'm not sure anyone can really answer that.

Yes, I've put together plans - recently through a post here... Nothing in this is easy. But being reminded of what I do have at my disposal has helped a lot. I panic and anxiety races up at a surprising rate.

You've talked about grounding things, the need for personal space, acknowledge that breathing techniques help (metronome), structure and routine, getting out of the house for volunteering...fantastic! It sounds like you know yourself and your limits quite well.

Everyone is different and the needs are different. What works most of the time, might suddenly not work - which causes a lot of anxiety - at least for me.

I might encourage you to browse the forums/threads where there have been similar questions asked and some very helpful answers. Suggestions that you may not have thought of but that might work for you.

I think you need support badly. If a physical presence is unavailable to you, keep posting. Most us can safely say "been there, done that" There are some awesome people here. I know I've found that anxiety can often be lowered once I've connected to people who are ready and willing to help.

Don't know if I've really been helpful at all. I'm sorry if not. Just a few things to think about.

 

[Sandstone]

Do I focus on just one area? So perhaps say that lots of the risks are around my lack of control, so I need to look at DBT for emotional regulation? Do I put all my eggs into that one basket for a sustained period, or do I go for a broader approach and work on several things at once? Multiple stands mean there is greater chance of coming across the one helpful thing at the time I need it, and also provide a chance to continue with something else when I'm stuck some where. But it also means I might dodge the difficult when I should be pushing harder at it.

Do I buy one or more workbooks, or are free resources actually as good? How do I overcome the risk of reading something and persuading myself that I experience that? I need also to be on guard against learning about, but not learning in applied experience. I want something that enables me to measure what changes I make, and what the outcomes of those changes are. (Maybe look again at the Recovery Star)

I think I need more daly structure. It is 3:20, and I'm not dressed though I have done some gardening in two batches. I've done the physical health essentials - pills, lots of fluids, but no more. But in the past when I've talked about pushing myself harder, T's have told me to be kinder to myself. That doesn't seem to be creating healing though. I think I might be better with a sequence that I follow through the day.

More than anything though, I think I need that syllabus. I know the basic outline sequence of trauma therapy - stabilise, process, re-integrate, but there must be much more detailed structure within that. Things I need to have understood and applied before I move on. Where can I find that?

 

[Deleted member 34328]

Hi @Sandstone sorry I've been offline for a while. My own issues are pretty overwhelming right now. Slept for over 2 hours. Anxiety has been too high for too long.

I can only tell you what I know from my own experience. I'm a person who wants answers. I'm very stubborn and determined to figure things out. That can be a good thing or not depending on how it's applied. I tend to overanalyze everything. ex because my anxiety level hasn't lowered then I need to push harder. I tell myself I must be doing something wrong, so find a different angle.

My therapist is always telling me that I tend to rush ahead when I'm not ready. I argue with him all the time. A very patient guy. He applauds my stubborn attitude because it makes me fight back. Keep on keeping on, but it also makes me very hard headed, difficult to really get through to and end up stuck in a rut.

I need structure in the home mainly for the sake of the children, but also it forces me to get up and get moving. I still have to mother the kids even when my platform is very low.

I know it's frustrating to hear, but honestly, there is no one way to go about things. You can read over and over about so many different therapy approaches. Individually, 1 on 1 with a therapist or therapy groups. Sometimes a combination. There are just as many methods out there being used and what is fantastic for one person is a nightmare to someone else.

My therapist and I have been working on CBT. He doesn't push things faster than I can go. Leaves most of the decisions up to me. Encourages me to be the one in control. That's a big part of my therapy. Take back the control that was taken away from me. Insert my voice. Don't let others do the talking for me.

CBT works for me. So my approaches are generally based on my experiences. The way my therapist set it up, I can see the progress when it feels like there is none. It's exposure therapy. I've learned many coping tools, now I need to face the demons. One at a time. As hard as it is, it works. FOR ME. Not everyone. You can very easily look it up and get the specifics.

I still think you really need some support people who recognize the battle you're going through. It's a really tough fight that not many around us get. That's why this forum has been so helpful to me. I don't have family or friends who understand even a bit what this is really like from one day to another. One woman has been walking with me. She has never experienced PTSD, but she is my supporter. She and my therapist... yet I have parents and 5 other siblings, am married, have a mother-in-law etc... yet my world has been a very lonely place.

You need structure. You're searching for answers, but maybe too much info at one time will be more discouraging. I would encourage you to lighten up on yourself. You seem to be very driven and obviously have a great passion for life and those around you. All that is very good, but where do you fit into the mix? What are you doing just for you? When your lightbulb starts to dim, what do you do simply for pleasure? Do you have a special place where you can go and just sit? You mentioned gardening. You must enjoy the outdoors. Do you bike or jog?

Does any of this make sense?

 

[Sandstone]

Yes, it makes some sense, but I need to move on now. This has been my life for five years. It is time for change. The NHS won't provide trauma therapy, so I have to do it, not play around the edges.

I don't think support is an option. I can't pay someone. My husband is wholly supportive on a practical basis, but is a doer not a talker. My mother is part of the problem, and I will not burden my children. Beyond that I have no contact with anyone. I do enjoy the outdoors, but can't go out alone so rely on OH to be free and to want to go for a walk. He does so much that I try not to push him into doing things he doesn't want at the weekend. I think most of my time is spent wholly selfishly. I like making things, currently I'm learning patchwork, but I'm aware that involves spending money I don't earn

I think there are aspects of CBT that will work, but the psychologist I saw started out to do TF-CBT and moved away from it quite quickly.

You can read over and over about so many different therapy approaches.

I don't want to read about them, I want to DO them. It may be that I need to try multiple modalities either to find one that works or to take bits from each. That is why I asked for advice on whether to work on several at once or successively

now I need to face the demons. One at a time. As hard as it is, it works.

That is what I want to do. I'm convinced it is the way ahead, and I think the depth of my twin fears about it confirms this..

But an intention to do it isn't enough. I need a plan to work through, to inspire me and to give me a sense of direction.

 

[Sandstone]

OK, here is my thinking so far.

The first step needs to be planning the plan.
There are some things I know have to be there, the grounding and relaxation stuff most obviously. I'll start by

• committing to doing both metronome and breathing daily,
• and look for two others to add. I know there are many lists and examples on here.
• I'll use my colour changing light more often, maybe in association with 8 Hours of Relaxing Sleep Music: Deep Sleep, Beat Insomnia, Soft Sleeping Music ★1
• I might look at the reasons why I struggle to do this, but that might be a diversion. I'll review what I wrote 3 years ago Why Is The Idea Of Caring For Myself So Disturbing? and see if there is anything I can work on with the extra knowledge I have now. But mostly, I think this an area where i just need to act and push through all the resistance.
• I'll review the ways to use grounding objects from "Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists" which I have somewhere (checked - on Kindle)

Physical care stuff
I'll keep doing the medical things that are necessary,

• specifically the low salt and high fluid intake for kidneys,
• taking the thyroid supplement
• attending tests and appointments, even though at the moment I desperately want not to because I believe they aren't real, just a bid for attention.
• continuing the bid to lose weight, slowly. Need to look at improving the way I do this. Ask GP??
• Keep going to Tai Chi, aim to practice 3 times a week at home. Could I try to involve OH in practicing?

More to post, but it is getting overwhelming, so I'll break for breakfast and music

 

[Deleted member 34328]

I hear you. A lot to think about.

I think the biggest part of this is to not lock yourself into a box. Yes, you need a plan, but be careful not to lock yourself into it so much that you become overwhelmed and discouraged when things don't go as expected. You're thinking ahead and looking at the options you have at your immediate disposal and that's really good. Just know that life throws curve balls all the time and we need to be flexible to scrap the plan for a while and recharge the batteries. You've got demons in your closet just as I have mine. PTSD is unpredictable at best.

I've been at this for 4 years now. It's hard that all the issues aren't resolved and therapy goes on. At times I feel that my brain is somehow wired wrong. But really, I need to allow myself to take a break and just quiet down for a while. I would encourage you that while you don't lose sight of the goal, try not to be so glued to a schedule that you wear yourself into the ground.

If you have a GP that you trust, I would suggest that you run some of this past him/her. All the medical things. Yes, listen to what the dr has to say.

Do you take on 1 thing or several - I guess that depends on what the issues are. I would suggest 1 at a time. You're a very driven and structured person. Start with the smaller things and slowly work your way up knowing that you may need to drop everything for a while and give yourself a break. I think you're also person who will be really hard on yourself and perceive a needed break as a failure. It's not. Sometimes the plan is just get up out of bed and get dressed. That's it. Take a walk and make sure you eat something. That's the extent of the plan.

Are you currently taking any medication for depression or anxiety?

 

[Sandstone]

I've stepped back from this for several days, partly because of guests, partly because it is hard, partly because I was made uncomfortably aware of my dissociativeness. Climbing back on the wagon is a skill I do have, so here goes.

Based on things I've been helped with in other posts, I think the next steps are

My attitude to myself
I need to be kinder to me, less harsh and judgemental. Feeling differently about myself is too great a challenge straight off but I think taking steps towards it will help me feel I'm worth preserving when stability deserts me

• I shall praise myself for what I do, and live with the discomfort of not feeling it.
• When I feel inclined to attack myself, I shall ask myself what I'd have said to my daughters when they were young, instead of what I think I deserve to be told.

I know that any sort of change will feel incongruous, and that this in itself can be a threat to me. I also know that when I do start to look at traumas I can become very unstable very quickly. I need to build up distress tolerance, so of the available therapies, DBT looks most relevant. I'll start by

• looking at the books I already have to see what I can learn and do
• checking here for recommended resources
• maybe post asking about DBT applied inwards rather than to external relationships.
• for the present, shelve looking at traumas until I have more techniques to manage it ( is this avoidance?)
• maybe look more into somatic stuff as a way in

 

[Sandstone]

knowing that you may need to drop everything for a while and give yourself a break

I know that the break will take me otherwise. I'm so familiar with that need for down time. But I'm also driven on by the impossibility of going on as things are.
If the NHS should ever come through, or if our financial situation should ever improve enough to pay for therapy then any of the things I'm planning would only be good in conjunction with that.

Mostly though, I'm aware that I have a lot of theory in my head, but I'm not applying it enough. There are somethings that have changed and moved on through that learning in the last five years, but not enough to give me my life back.

sometimes the plan is just get up out of bed and get dressed. That's it. Take a walk and make sure you eat something. That's the extent of the plan.

That sounds like a lot for a bad day! Out of bed is often big enough, and sometimes even drinking is beyond me, let alone eating. But having a direction, and moving in that direction more days than not sounds doable. Maybe my biggest asset in this is that what really counts is not the falling over, but the getting up, again and again.

Are you currently taking any medication for Depression or anxiety?

No, it has been confirmed several times that I'm not depressed, though I have tried at least four meds, with no beneficial effects. I think anxiety may well be an issue, but that expresses itself largely physically, and I mostly ignore it.

 

[rosey]

Dbt really helped me did not adress the trauma but has given me a basis to do that now. For the trauma you could try self emdr.

@Sandstone has covered all the relaxation side light boxes and mindfulness.

Join some groups yoga is good. Build it into your weekly routine and make it non negotiable (i am bad at talking myself out of things) loads of local free groups esp at library.

Btw it is not just the nhs some private hospitals are equally bad.

 

[Sandstone]

Monitoring and Goal Setting
I'm going to use

• The Recovery Star, which I've posted about before. Does Being Here Make Us Forget What "normal" Really Is?

I like the forms in which it presents the stages of recovery - as a ladder moving from Stuck through to Self Reliance. It's a good reminder for me that this is slow, staged process, not a quick fix. I have my baseline scores from a couple of years ago, and am interested to see how they have changed, or not in different categories.

• I shall use it monthly, to see where I am,
• celebrate where I've grown
• and where my focus needs to be over the next few weeks

I know that lists on paper tend to hang around looking at me accusingly, so I'm going to use

• an online reminder tool, that allows me to set a list of activities for a day

Contrary to what I wrote earlier, I realise I would only use a timetable to beat myself up, but having a list of 3-5 actions for a day is do-able. I also know it s good because on days when I simply can't do anything, I can dismiss them and not have them around as reminder of my non-achievement.

So today my list is

• Goals from Recovery Star,
• Practice Tai Chi,
• look at this Plan post,
• skim some of a work book to see if it would fit the Goals,
• shower,
• make a tomato sauce

It's midday, and I've done three of them. I'm pleased with that.

 

[joeylittle]

Hi, @Sandstone - I stumbled on this link and thought you might find it useful; (of course, no worries if you don't).
Link Removed