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Building Self-Confidence 101

by JustEliza on 17 April 2011

“I'm trying.”

I haven't written. Not for weeks. I rarely do when I'm feeling poorly or I'm in transition. The last few months, I've been both.

Change comes too quickly to record. And before I can explain, I'm off again, tackling the next problem.  It's been three years since I joined the system. At least you can call me patient and hard-working.

My new therapist gives me lots of homework: pages and pages of self-referential statements to agree with or dismiss. It's busy work mostly, while we work on building our therapeutic relationship, but the secondary goal is to tackle my low self-esteem.

The biggest barrier to change is  my insecure attachment. I'm 'Avoidant-Fearful' which essentially means I don't trust you, no matter how many pretty smiles I give you, and the more you know me the more dangerous you become. I'm also moderately perfectionist/obsessive which essentially means I work very hard to provide you with everything you need/want from me, often at my own expense.

How did it happen?
I had no significant, stable relationships growing up, notably my parents who were emotionally unavailable and abusive.

Why does it still happen?
I can quite successfully avoid conflict by being perfectly blameless: making no mistakes, and moreover, keeping everyone at a distance.

How do I do this?
I analyse you constantly for even the faintest signs of disapproval and, depending on the risk, adjust my personas or withdraw completely from the relationship.

What is the problem? 
I've been doing this so long, I have no cohesive sense of self -- quite a vulnerable place to be. Naturally, I'm quite skilled at putting up defences to protect you from discovering this. I suppose this makes me especially complex to treat: a rapid-cycling wheel of disordered personalities.

I've always refused to take medications. So when I go home from therapy and the sheets covering my emotions slip away, it is up to my body alone to weather and recover from the deep shuddering fear and shame. My choices make the difference: what I eat, how much I sleep, who I interact with, what I think.

It would be much easier to suppress every emotion, as I have done, than risk being sucked into a deep depression. But, 'sucked in' is often where I go, paralysed by insecurity, because behind all of those beautifully crafted walls stands a girl propped up on hope alone.

“Don't take this the wrong way...”

No one should start a conversation this way, most especially a therapist. It doesn't help that I already knew the evidence. I've seen the NICE guidance. I know it is your clinical responsibility to ensure people with enduring mental health problems do not reproduce. But why doesn't that responsibility extend to women who drink alcohol or smoke? What about the morbidly obese? Shouldn't every parent be required to pass an attachment interview or else be prescribed an abortion?

This is what we call inequality. If it were a physical or economical disability, the government would bend over backwards to ensure I was able to be a good enough parent. But since I have a mental health disability, they are obliged to advise me that I should not even try.

Is there a 'right way' to hear someone confirm everything you've already read in the literature? See, there I go intellectualising again. Let's try that again.

Is there a 'right way' to hear your therapist reinforce the same unrelenting beliefs you abuse yourself with?

Perhaps I did it the right way: nodding amicably, reassuring her and moving on. Funny, how the 'right way' always feels like I'm smothering myself. Would the 'right way' have been to burst into tears? Say how I know it will be very hard, but I want more than anything to be a family? That, against all odds, I feel safer, more secure, and more myself with children. That I'm not just a different person... I'm a person, with a clear sense of self. Being a mother means something to me.

Being told we can't have children naturally has been a massive loss. Being told I shouldn't have children because I won't properly attach to them is something else entirely.

“I'm trying.”

When I left my last therapist, I was terribly wounded by several things she said. I did not give her the opportunity to acknowledge my hurt. The interim/assessing therapist asked me what I was afraid of, and I couldn't answer.

Why am I so afraid to reveal how scared and hurt I am? Actions speak louder than words, but in my case they both drown out my emotions. I act like I'm fine. I say that I'm fine. And we smile together; how nice to be on the same page, isn't our relationship great? But my anger builds inwardly with each lie I give you. I give the same lies to myself.

“I'm trying.”

The key to making progress in therapy is to think and act differently. I could let it go, like I let everything go, and do my homework like a good girl (it's what she expects and wants, isn't it?). Or I could put the homework aside and tell her how I feel. What I believe. What I want. Because all three of those should matter, even if you (or the best available clinical evidence) don't agree with them. This is called Building Self-Confidence 101 (it's a practical lab).

It was the single most important thing I've ever said in therapy. If you blinked, you might have missed it, the bonafide inner Child. See me. Hear me. I want to make you proud.

“I'm trying.”

“I know you are.”

Comments

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Candycan said on 18 April 2011

Sorry, I may be confused here but are you saying that there is NICE guidance that people with mental health problems should be advised not to have children?

 
JustEliza said on 18 April 2011

NHS Evidence / CKS suggests the following: continued use of contraceptive until full assessment by a psychiatrist. At that point it's a risk management process to do with medications and stability. Obviously, they can't physically stop anyone from having unprotected sex around ovulation, but there is evidence that the mental health system in practice advises women with enduring mental health problems to avoid pregnant/motherhood.

CKS: www.cks.nhs.uk/.../scenario_mental_health_issues

Bias: ajp.psychiatryonline.org/.../2102.pdf

 
DorsetGirl said on 19 April 2011

I must say I have believed for a long time that there is some sort of unspoken conspiracy to stop people who are, or who have been, mentally ill from having children.  When I was in my mid to late twenties, after my second breakdown, I took a low dose of psychiatric medication for several years.  I was expressly told by my 'Mental Health Team' that this drug would not stop me conceiving, and that it was safe to use during pregnancy.  I only found out by chance, from reading a small paragraph in Health and Fitness magazine, that the type of drug I was on could affect hormone function.  I went to my GP, who sent me for blood tests which confirmed it.  The drug had rendered me infertile.  I was referred to an endocrinologist and given hormone therapy.  I also stopped taking the medication.  But without this stroke of luck my four beautiful children might never have existed.  I would have obediently taken the medication for the rest of my life, because I trusted that 'Team' of medical experts.  And I can't help suspecting that they wilfully deceived me, because if that information about the drug was in the public sector (in an ordinary magazine) then surely they must have known.  

Anyway.  Thanks, Eliza, for the links.  I will take a look later.

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