I’ve been in and out of therapy since I was 17 – that’s 26 years – but three years ago, I found out about a condition I never knew I had, and a group therapy I never knew I wanted.
My history as a patient with clinical depression and anxiety led me to old-school Freudian psychotherapy after my mother died when I was 16, talking therapy, autogenic training, a fancy version of cognitive behavioural therapy (CBT) with a tough-as-nails private therapist, a cuddly version of CBT on the NHS, and finally group therapy with a weekly double session of dialectic-based and mentalisation-based therapy (DBT/MBT to the pros).
The group was a new adventure, and I want to share some of the things I learnt with you. First, let me quickly lay out my pretty rubbish childhood: only-child; parents divorced when I was five; custody battle; dad moved away and remarried; mum married a violent, gambling alcoholic; police round during the night; next divorce; mum got cancer; she started hitting me; I started hitting back; two years of war at home; second cancer; she died; I’ve lived on my own ever since.
When I had to go into therapy again around three years ago for anxiety and anger after visceral rows with my dad, I was diagnosed with a fresh new condition: borderline personality disorder. I nearly flipped at the psychologist – what kind of a wimpy thing is that: “borderline”? Can I please have a real diagnosis?
As it turned out, he was spot on. Borderline personality disorder (BPD) is, roughly speaking, a disability to regulate emotions. This can manifest itself both as flipping far too easily (that would be me) or knuckling under for fear of confrontation. The psychologist recommended one year of DBT/MBT group therapy at a hospital with a psychiatric ward.
Expecting hell to be other people, at the first couple of sessions there were about 15 partcipants, two therapists and a trainee therapist. To be honest, I wasn’t sure if this lot of people would be safe to keep in one room without security. Some had the aggressive energy of teenage girls you see on a bus shouting, ‘You disrespecting me?’, while the person next to them would freeze at the thought of even saying their name. Why on earth would they put both sides of the BPD-spectrum in the same room?
To learn from each other, that’s why. And I can’t believe my luck of having found that therapist who diagnosed me, and for the amazing six people – in the end an all-female group – who were left after six months as most of the original participants dropped out.
We talked and talked and talked. We encouraged one another and validated all sorts of feelings – from how to survive a family holiday to what to do on the anniversary of the first time you were raped.
Of course, we didn’t just meet for a natter: the sessions were guided by two therapists, one of whom led the first hour to work on emotion control and behavioural skills with the goal of improving ‘interpersonal effectiveness’ – the fancy term for ‘being reasonable’ – and the other led the ‘mentalisation’ hour with mindfulness and mindful techniques to cope with stressful situations.
There are so many learnings from this year, but one particular hand-out helped me tremendously. It’s called Understanding Misunderstanding, and it explains why some of us have difficulties regulating emotions and suggests a way forward.
First, the biology: when we are upset, we sometimes freeze, go blank, can’t think or react unreasonably. This is because in circumstances of stress, our bodies divert all energy to survival, so the higher, emotional brain functions can become compromised. Essentially this means we can only think properly when we feel safe.
Misunderstanding is taken by our brain as a threat. And we all have different triggers that can set off the emotional alarm bell.
“When people experience neglect, abuse, fright etc in their formative years, these experiences sensitise the emotional brain to react with an alarm signal quicker than for people who haven’t had these experiences,” the hand-out reads.
Now, I could tell the story of my delightful childhood to everyone I meet to explain future flip-outs, but that might be a little bit too much information. It was – is – easier to learn how to handle emotions, which is the main purpose of the group therapy.
The magic word here is ‘mentalise’. Step back, don’t judge, put yourself in the other person’s shoes. Here are the ways to mentalise a misunderstanding:
· Don’t label: he’s not just a loser, you are not just a bitch. Labels don’t help to be thoughtful about what has happened, and the word “just” is especially unhelpful.
· Don’t overanalyse and judge: shoulda/coulda/woulda don’t help, neither does a fixation just on facts (for example, who said what). Think about the motivation and feelings of the people involved.
· Don’t blame others: we all influence each other.
· Don’t be too certain: relationships are, theoretically, open-ended. Keep an open mind as well.
· Don’t be overly analytical: instead of hiding behind big words, just acknowledge how you feel.
Our homework was to practise these guidelines in everyday situations, and write down a few of them to discuss in the following session. Having handled a situation well – whether this was confronting a shop assistant about being short-changed or telling controlling parents to back off – became a major achievement to discuss with fellow group members. We had proud moments and we cheered each other on. Being mindful almost became addictive.
What mentalisation really comes down to is the recognition that you can’t read other people’s minds, and only by taking a genuine interest can you understand them. Mentalisation replaces alarm with curiosity.
One way to strengthen the ability to mentalise is with mindfulness training. You can do these exercises anytime, anywhere. Just take two minutes out to sit on a park bench, think about nothing (no cheating!) and listen to the different sounds around you. Mindfulness calms and focuses, and it allows the brain to regain its balance.
As for me, I haven’t had a shouting match since. I am certainly calmer, and in that calmness lies strength to cut out those people with whom I will never have a reasonable, mindful conversation – people who are only interested in themselves.
The group hasn’t helped directly with depression and anxiety, but that was never its purpose. In a way, though, it has made me happier by being more balanced.
Instead of going mental, I try to mentalise. I try to be borderline nice.