Tag Archives: stigma

Maladaptive beliefs and fear of judgment in therapy OR Speed bumps.

Maladaptive beliefs refers to  a term that describes ill formed thinking patterns, mostly negative, behaviour patterns, reaction patterns that may, but not always, have been learned during a traumatic event or childhood. Unsupported irrational thinking or beliefs. False, but accepted by the individual. 

A maladaptive schema clouds self judgment. This can be related to abandonment issues, shame, dependence, vulnerabilities, mistrust and on and on and on..

For a previous post on maladaptive beliefs click here.

In therapy one large stumbling block, is when a patient will conceal information. There are numerous reasons why this could be. Shame, trust, embarrassment, fear, humiliation, there is a long list that becomes more and more technical. 

These are things that cause us to fear that our therapist may judge us if we open up, to reveal. It can also be that the patient does not wish to change what they may be doing.

Or to that speak of it, ratifies it. That it really is a non issue, isn’t it?

There is the fear that they will be judged by their therapist. 

We are quick to self judge and doing so may believe others will do the same of us if information is revealed. 

We are often our harshest critics, our strongest judges of ourselves. As a therapist we are not there to judge but to help you lesson your own critical self judgment. 

In therapy you will often run across something the patient does not wish to discuss, an area of topic or something more specific. An example something more specific is self harm. Both the patient and the therapist may or may not know this is an on going issue, but either way the patient doesn’t wish to talk about it ‘at this time’. They may not really wish to stop practicing self harm or they may find it an embarrassing topic.
This is often because of the fear of being judged. Judged by someone that maybe doesn’t understand, They don’t self harm, so how can they know? Self harm is not understood by most, noses raise, frowns issue, many say ewe or just don’t do that. Easy advice to issue. Just don’t do that.

This can though apply to many issues, “you are not in my place so how can you possibly understand what I go through.” So the patient does not reveal.

It is difficult to provide help, with limited information. Or with a wall that has been built that a patient is unwilling to tear down, or even get close to. Therapy will be never ending when information is withheld or is just wrong.

This fear of being judged is a giant speed bump in therapy. 

Some simple examples, my meds don’t work so I stopped taking them. Perhaps you didn’t mention you drink heavily, or take other narcotics or other meds that you have not revealed. Because this would involve what you feel to be judgment or you have no intention of stopping to drink heavily, so there is no point in admitting that you do.

So to avoid being judged, patients may omit or lie. The patients hope they can receive help and just avoid these areas. Unfortunately those areas are often thorns, sometimes the root of their torment, there is no avoiding some issues unfortunately. 

We don’t take our car into the shop and tell them it goes beep beep boop and then not tell them about the purple smoke that comes out of the dashboard because we want our car to be well again. 

We may lie when we are asked if we are suicidal, because then we fear being placed in an institution for our safety, we don’t want to go there. So we may lie.
A lower self esteem, self worth often contributes to this fear of judgment. A low self esteem is linked to guilt, often this guilt may be associated with past incidents that they blame themselves for. Prime examples are child abuse, sexual assault. The mind can not comprehend how someone can be capable of doing these things, often self blame arises to justify the attackers reasoning. This is when maladaptive beliefs form. This is when it can become quite complex. The fear of judgment from what they may not be revealing may be unjustified. First off the therapist is not going to judge, even though that thought is not believed, second the undisclosed information may be unfounded to some extent, I know this sounds complex and unsorted. Rationality though, is not firm. Clear thinking is not, clear. 

The fear can be powerful too, that discussing the hidden issue, will awaken, and possibly will,  a much too powerful feeling, fear, memory or even an alter. Or cause someone else to suffer, or go to jail. Yes often a patient may be protecting an attacker, living with their attack/s but still protecting them, knowing that to reveal may cause them to be jailed. Working through this with your therapist in a controlled safe environment is the way to peace. 

Judging is a human trait, it is something we do.  A therapist understands, unless they are not worthy, and then you should seek another promptly, judging a patient will be a detriment to therapy. It will create distrust. A therapist will be more aware of this than most and will strive to not show any signs of judgment. But, perhaps there really is no judgment to be made either? Most often, this is the case.

The judgment that is feared, is often not warranted, It may be from maladapted beliefs. Something the therapist will help the patient with, rather than ridiculing them or even judging, as perhaps there is no judgment to make, no ill thoughts, only help.

We can also conceal or lie to impress. We want our therapist to like us, so the truth may be stretched or completely changed to impress. This too becomes complex. Honesty with your therapist will go a long way to your healing. 

There may be other reasons for fearing judgment. Criminal activities being an example. If you tell your therapist, are they going to report you to the authorities? To your partner or parents? The answer too, is not so easy, this varies from place to place, how the laws may protect your privileges, your right to confidentially.

There will be few, if any areas though, that will keep your therapist from taking further action if they fear you are a danger to others or yourself, they have a legal responsibility to take action in that case.

If though, you have gone to the trouble of seeing a therapist, because you have those thoughts. To answer yes, when asked are you suicidal, or not to say I am not fine, when asked how you are. This is going to help you. It may be possible if you answer those questions honestly that more care will be sought for you, it may be possible that, with your therapists help you right that second too, things can turn around and further care in a hospital for example, may not always be needed.

See You have taken the step to seek therapy, to seek help, to feel better, but you have to take the second step too, and reveal with honestly. Speed bumps are for parking lots. Don’t make therapy a parking lot.

 

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“That is normal”

NORMAL

Normal can be comforting. 

If we think we are odd, to be told that this is normal, this feeling (if we believe it) can be comforting. It is good sometimes to discover we are not “odd”.

In a session, it can be difficult to not say to a patient, this is normal, that is a normal reaction, your feelings are perfectly normal. 

It is true. 

Sometimes it is not what the patient wants to hear. A lot of times, mostly because they do not feel this is the case.

Sometimes because they want to feel that they are not normal.

Or how could there be a “normal” reaction or behaviour, response or feeling, for what they went through?

I have a new patient.  I met her in the hospital yesterday, we spent a lot of time together. Her sixth attempt to end things was just thwarted, barely, she has slipped through the cracks in the “system”. This happens all too often. Not receiving help after her previous attempts, filing some of those attempts away as acting out or seeking attention. 

This too, can be “normal”.  Sad as it is. 

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Liebster Award

Joyce nominated me for the Liebster Award. 🙂

I confess I am very far behind (years… eeeps) on accepting and re-awarding awards, I maintain comments are reward enough for me. It also gets me off the hook with answering the questions that are posed with each award…. So this time I am going to answer the questions properly, with due dilligance, with the answers expected, in my normally evasive way, uhm… I should pick one of those?

Joyce asked:

1. Where do you live?
2. What do you find most satisfying about blogging?
3. What is the hardest thing about blogging?
4. What do you think is the biggest problem facing mental health today?
5. Have you found that the blogging community is a great source of support?
6. How long have you been blogging?
7. What is your passion in life?
8. If you could live anywhere in the world, where would you live?
9. Why?
10. What do you like most about yourself?
11. What are you the most proud of?

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Memories can torment us

My last post was about memories, the hidden ones that can cause such disruptions. This post will continue with that topic.

Education is the key toward understanding. This does not mean taking courses, writing exams or studying. Understanding is the way forward to helping remove the stigma attached to Mental Health.

Why do I post about stigma so much?

Because the stigma attached to mental health issues is so detrimental to healing and funding. Because it remains a dark issue, one hidden, it becomes a back burner issue when funds are dispersed as well.

As a society we are not stupid, we have the capability for understanding, compassion, to understand the things that occur in minds is how we can reduce stigma, so rather than worsen how someone feels, we can be more helpful. When someone stretches an arm to receive change and we notice scars on their arm we do not ask probing questions or allow that look of horror slip across our face. How no response other than a smile can go so far. By learning more about the illnesses that occur in minds, we can do so much more. 

Stigma, as I have often said, goes both ways. Someone suffering often, does not wish to seek help or share their torments with friends and family, where they could receive support and help, because some things are just not understood. Or believed.

So this post goes on, hopefully, to making some more aware of what goes on in some minds.

It is also, somewhat a continuation of my last post about memories. Memories can be fuzzy or clear, real or false, the point though, is they are real to the patient. We are not to judge the memory or question it, but to help the patient cope with the memory and its effects. Some memories are as clear and crisp as the day they were recorded, many are fragments that combine to form a memory.

This is where this post is going.

Hidden memories can be haunting for some.  These unconscious roots to the past can set up internal defense mechanisms of denial or dissociation, or more disruptive ones such as redirection/displacement, the list goes on, including aggressive anxiety. It is a long list.

I have, on previous posts, mentioned DID or Dissociative Identity Disorder. This is or was also known as Multiple Personality Disorder, made famous years back with the series Sybil. Memories are very tightly entwined with this disorder and how the patient has coped with trauma, and continues to do so.

Stigma is also a very large part of the trauma associated with DID. For many just can’t comprehend how this can be, or flat out disbelieve it. How does this make someone suffering with it, feel or why would they want to talk to others about it? 

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Stigma

 

How do you describe a sunset to a person that has been blind from birth?

 

How do you sign, to a deaf person, what a child’s laugh, sounds like?

 

How can you explain the depth of anxiety someone with OCD feels, when a routine is disrupted?

 

How can you feel how deep depression can become, when you have only had a taste of it?

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Today… Is another one of those “Days”

 

 Wednesday, September 10

World Suicide Prevention Day 2014

We seem to have “days” for a lot of things now. A day to stop bullying, Mental awareness day, Causal Friday, pancake Tuesday…

 

I am not trying to belittle this, though. To bring awareness is one of the steps to removing the stigma. If having a day causes someone to read a blog, and rethink a decision… then these days are grand to have. 

With so many, they become muddled, treated with disdain, why are you wearing a pink shirt today… Why is that ribbon on your car, but people ask. 

So this is why we have those days.

Why is there only one day that is World Suicide Prevention day? For me, this is every day. But then I have seen more than my share of attempts, I have intervened directly in some, I have intercepted ones that I felt were fast approaching also. I know I will see more, I wish that this was not so.

Today Cat posted two lines on his blog, you can read  Cats Post here that I wish to share.

“Back then, every turn was met by another brick wall. I’m not exactly sure what changed or when, and neither can I say there is light at the end of the tunnel, but at least there is a tunnel.”

It is hard to see that tunnel sometimes, that tomorrow, the one that may finally be a bit better. We must always look down the tunnel though, allow for that tomorrow.

Why?

Because of this next bit I am also borrowing from Cat.

 

“Golden Gate Bridge in San Francisco is well known for its suicides. Its massive height of 756feet almost guarantees few survivors. Without a doubt, the leap over the edge is most certainly that final decision.

Up until last year, out of more than 1,500 people to jump, only 34 survived. More than 50% of them said they instantly regretted jumping. Half way down, they suddenly realised there was in fact another option.  I cannot help but think of those who took that final thought to their graves.

 

I  am finishing this post with a reblog of a post I did not too long ago. Because if reading it gives a tiny flicker, to someone that is thinking.. If it makes someone abort a decision, to rethink, to wait for tomorrow, I will be happy.

I was at the hospital when a call came in, I was asked to ride along, we did not know how far things had progressed, it was hoped, not this far.

 

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Depression is an equal opportunity employer

Yesterday, I heard this often with my patients, I received an email from a blogger friend too, with the same question.

Robin Williams had everything, success, friends, money…  With all of that he still let go, he had all that to hold on to… and yet it was not enough.

I have none of that, why should I continue, what do I have to hold on to, what do I have to look forward too.

Tough questions.

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