玛姬的故事:为什么没有的许多原因
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需要讲述玛姬的故事
每年，有1000名大学生自杀.十分之一的大学生认真考虑自杀.甚至更多的人(多达四分之一的高中生和大学生)在焦虑和抑郁症中挣扎.有什么可以帮助这些人的?
下面是一个扩展的博客，讲述了Maggie Nelson的真实故事.仅更改了她的名字和一些小细节.我非常感谢Maggie愿意分享她的故事.我们的希望是，它可以帮助青少年，父母，老师和辅导员或其他专业人员了解严重抑郁症发作的方式和原因，以及有效的治疗方法如何将负面情绪和自我批评的循环转变为周围和更道德的循环.适应性增长.
我们给她的故事加上副标题“为什么不这样做的许多原因"，以反驳受欢迎的电视节目《 为什么要这样做的13个原因》中的叙述，其中一名少女自杀并留下了一系列内容录像带，说明了她自杀的理由.尽管我很高兴有必要将有关自杀的讨论从阴影中移开，但我对演出可能对脆弱的思想产生的影响深表忧虑.节目的基本信息是人们对你不好，生活糟透了.除了孤独和不公平之外，你还能做什么而感到恐怖?当然，这恰恰是我们要发送的错误消息.
在我们如何理解和应对负面情绪方面，我们的社会正经历着一个重要的变革时期.好消息是，与过去相比，我们的社会赋予了人们更大的分享负面情绪的自由.而且，我们大大减少了心理健康困难的耻辱，许多人自由地承认如果需要帮助，可以去看治疗师.但是，在打开通往消极情绪的途径时，我们并没有很好地确定这种情绪的含义以及如何处理它们.感觉传达了真理，但不是绝对真理.如果我们感到被拒绝，被压迫或虐待，这些都是至关重要的感觉.但是感觉本身并不意味着我们的处境是绝望的，我们的压迫者实际上是残酷的，或者面对虐待我们是无能为力的.
有效的心理功能的核心能力是意识到并调整我们的感觉，并对如何使用这些感觉引导我们迈向更适应的生存状态抱有成熟的见解.如果我们只听取这些感觉并以其面子价值来对待，那么我们常常会瘫痪.当我们一起开始工作时，Maggie通常会对压力源产生非常强烈的负面反应.我们需要帮助她学习如何诠释她的感受.最常见的干预措施之一是“是叙利亚吗?"干涉.叙利亚是一场真正的，残酷的，可怕的大规模灾难.被朋友拒绝，使父母失望或考试不及格很难，但叙利亚却不然.玛姬的感情系统将对每天的失望情绪做出反应，就好像他们是叙利亚一样.我们不得不改变它.
正如受欢迎的电视节目所揭示的那样，要应对十三项失望是艰巨的，特别是如果您是一个敏感，孤独的青少年.但这还不是叙利亚.我担心的是 13个原因可能证明自杀的可行性可以解决生活中(有时是残酷的)问题.但这不是我们要告诉弱势青少年的信息.相反，信息必须是个人拥有解决生活问题的能力；他们只需要学习如何以成熟和适应性的方式来做到这一点.我希望麦琪的故事能证明自杀对于沮丧的青少年不可行的原因.相反，它表明，即使是那些被最黑暗的抑郁症吞噬的人也可以找到出路，并最终建立非常值得生活的生活.我们希望您能从她的故事中受益.
前言:玛姬的原因……因为到处都是黑暗.
她坐在床的边缘，手压在手腕上.她什么都没感觉.她感觉到了一切.然后她感觉到手指间渗出的小滴血.当她的室友走进去并看到它时，她一直在割伤自己.所以现在她的室友知道了.而且，对于Maggie来说，这意味着每个人都会知道.每个人都会知道她是一个怪胎，她正经历着如此疯狂的疯狂以至于割舍了自己.她知道那只是她疯狂的一部分.在她的内心深处，一个充满绝望的黑洞已经持续了四年以上.甚至在那之前.也许她一直都知道，她内心深处破碎而疯狂.她拼命试图隐藏它，试图过正常的生活.但是她不能.她十四岁时爆发了.在15岁与男友发生“事件"后，病情变得更加坚硬，甚至变得更黑.不久之后，她试图吊死自己，然后被送往精神病房，这无济于事.她的二年级和三年级简直是地狱.她以为也许这已经开始变得柔和了，也许当她高中一年搬到另一所学校时结识了一些正常的生活，结识了一些新朋友，却忘了黑度了.
但是现在，在这里，在她上大学的第一年，黑人开始复仇.情感上的隔离几乎立即就开始了.现在，在她一年级的八周里，它已经沸腾了.她几乎每天都在剪纸.而且她正在喝酒并且做着毫无意义的性爱，并且变得越来越遥远.越来越沮丧.现在她的室友知道了.是的，她的室友知道她情绪低落，发现自己在哭.但是切割?现在，她将被称为一个怪胎.现在每个人都会看到她疯了，她会更加孤立.那么会发生什么呢?她的室友会告诉她的RA，她的RA会告诉她的父母.她对他们的想法感到畏缩.让他们知道将是无法忍受的.那怎么了他们会强迫她退学吗?她将不得不再次被关在医院吗?她的生活一团糟.永远都是一团糟.没有逃脱的混乱.也就是说，除了一种方式.只有一种出路.这次她将确保自己做对了.不会有任何后果，不会面对父母的困惑和不赞成的容貌，也不会在精神病院中进行封锁.她已经完成了这一生.
第一阶段的治疗:希望有一张黑暗中的地图.
不到24小时后，我接到了乍得的电话，乍得是我的一年级博士生之一，他正在我们的咨询和心理服务诊所进行第二次入学面试.
“怎么了?"我问.
“我需要临床咨询，"乍得说，他的声音有些发抖.
“好吧，开火."
“我刚开始和一个女孩接吻，嗯，她说她昨晚差点跳下桥.她说，她的室友在割伤自己的时候走进了她.然后她“吓坏了"，离开了宿舍，准备跳下桥.但是她的两个朋友跟着她，说服了她，然后他们今天早上把她带到了我们身边.她说她不想在这里.她的朋友们坚持要她进来."
“我马上就过去.她曾经尝试过自杀吗?"
“是的，"乍得说. “三遍，包括试图吊死."
“请给她填写我们的一些症状表格.我将在十点钟之内到达."
我告诉研讨会小组，我要带领我奔跑并抓住我的东西，然后转到CAPS.当我进入办公室时，玛姬说她不想去那里，而且她“很好".她甚至开始从椅子上站起来.
“实际上，玛姬，我们需要聊一会儿.如果您现在螺栓连接，那将对我们俩都不利.原因是因为我的专业义务是打电话给警察，这可能会变得丑陋.我知道与我聊天可能不是花一天时间最有趣的方式，但它可能比与警察打交道要好."
因此，我们的旅程开始了.在最初的两个小时内，我收集了有关她历史的更多信息.我了解到她总是有点敏感并且容易受到压力.我了解到她的焦虑和抑郁水平在13岁时如何开始变得明显恶化.她谈到讨厌自己的负面情绪和讨厌自己的情绪，以及她如何试图向所有人隐瞒这些情绪.她说事情变得越来越糟，直到15岁，她试图吊死自己，之后才住院.在大二和大三的大部分时间里，她都感到恐惧.她高三时就换了学校，幸好情况有所好转.她曾希望自己的抑郁症会过去，但是在大学的前四个星期里，这种希望就化为乌有.她很快对工作，新人们和做任何事情的自由不知所措.其他人似乎很容易调整.另一方面，她感到焦虑，自觉和困惑.
随着她越来越感到压力，沮丧的心态又回来了.情绪低落的浪潮伴随着一个声音，告诉她她是一个可怕的人，如果有人真的知道真正的玛姬，他们就会抛弃她.告诉她的声音是丑陋的，不值得爱，是一篮子令人不安的神经.随着声音的变大，她越来越多地关机.然后切割全力恢复.一周三到四次.随着抑郁症的消退，她意识到自己将永远摆脱不了.她被判处悲惨的生活.
“告诉我，你患有所谓的'基于羞耻'的抑郁症.
“那是什么?"她问.
“这是我用来形容处于抑郁停摆状态的人的术语，部分原因是他们“背叛了自己".它通常是从青春期开始，即形成一个人的身份.情况是这样的:一个人的气质敏感或“神经质"，这意味着他们很容易沮丧或紧张，并且在触发后很难缓解.这样的人，尤其是外向性低下且乐于助人的人，随着他们的身份在青春期的发展，往往会开始在自己内部发动战争.身份是一个人的一部分，它反映了一个人是谁，为什么一个人希望成为一个人以及如何成为一个人.如果一种身份形成时，个人会对他们的负面情绪感到非常沮丧，并且不被教导如何处理这些负面情绪，而他们只是希望被他人视为善良，随和，快乐的人，他们就会为自己的情绪而攻击自己.当然，这并不能使他们感觉更好，而只会使他们的情绪系统更加充实.因此，他们形成了负面情绪和批判性自言自语的内部反馈回路.当此循环“关闭"(意味着批评驱动感觉，而情绪驱动批评)时，系统进入令人沮丧的关闭状态.那有意义吗?"
“是的，"玛姬用中性的语气说. “我之前从未听说过它如此解释过."
“如何向您解释?"
“真的没有.过去我住院时，我被告知我患有严重的严重抑郁症，需要接受药物治疗.他们让我与咨询师交谈，咨询师问我我的感受，但我不喜欢与她交谈.这只会使情况变得更糟.然后我们就换了学校."
“好吧，要真正解决这个问题，我们需要您了解它，理解是什么驱动了它，并完成了促成它的未完成的情感业务.您愿意和我一起工作并给这个机会吗?"
“我猜."
因此，我们开始了治疗的第一阶段，整个过程将持续大约15个月，并有几个分水岭.在这里重述时，我将治疗分为几个阶段.第一阶段涉及让Maggie开始怀疑治疗是否真的可能.我对她的问题的详细而智能的描述帮助她意识到我知道我在说什么，给了她一张她的情感和冲突图，并努力降低了她的情绪，因为她非常失调并且不知所措. /p>
第一阶段的结束出现了，因为我们决定揭露她的内心世界以及她身上发生的一些事情.我很早就很清楚她经历了某种不愉快的性交.我怀疑这是因为她报告说与几个男人毫无感情的勾搭.她沉默寡言的情绪告诉我她正在与某些事物分离.我探了一下，发现有一个“事件"，她会告诉她什么时候准备好了.
阶段2:朝着工作方向前进，然后通过创伤
在我们工作的四个星期里，她的生活越来越好，当生活给她带来微妙的帮助时，我们将更加深入.她偶尔还是会削减自己的身分，而我们正在为此制定计划.有一天，她用一把新的剃刀将自己切成薄片，这样她就需要去看医生.她最终回家看望家庭医生，在探索自己的情绪健康过程中，她直接问她是否遭到过强奸或性侵犯.
“是的."她告诉我，她听到自己对他说.在下一个星期一，我们开会，因为她刚从周末回家时感到不舒服.
“很明显，您发生了什么事.您准备好谈论它了吗?"
“想起来真可怕."
我说，“我知道，玛姬. “但这是康复过程的一部分.自从我们第一次见面以来，我就知道您身上发生了某些事情，并且您做了所有可以尝试的事情，以至于不要去考虑它."
“哦上帝，"她哭了.
“没关系.我们可以解决这个问题."
“那是我十五岁的时候.当时是我的男朋友.他让我偷偷溜走，去了他们聚会的街上的这所房子.而且我们都喝醉了.他哄我上楼.我们在鬼混.就像凌晨2点.房间里没有其他人……".她的声音减弱了.
“然后他开始尝试脱掉我的衣服."眼泪从她的脸上流下来. “我试图告诉他不，我不想.然后他把我推到床上.我一直说我不想."她抽泣.
“我很抱歉，玛姬.那是不对的."
“那就结束了.就这样我是处女."她哭了一些. “我什至不记得拿东西回家.我偷偷回到了我的房子.然后我只是想去睡觉.然后第二天早上起来，假装什么也没有发生."
“你没有告诉任何人吗?"
“我能告诉谁?我偷偷溜出去.我喝了我的父母会生我的气.我喝醉了，一切都变得阴霾了.我主要和他的朋友们出去玩.我只在三周后才告诉我最好的朋友，我让她发誓她永远不会告诉任何人."
“他怎么了?"我问.
“我基本上开始回避他.我们再也没有发生过性行为.我避开了他，关系消失了."
“因此，您多年来一直独自应对这种创伤.
“哦天哪，"她哭了. “我只想忘记它."
“我知道.但这不会发生.记忆就在你里面.而且您还没有处理与这种创伤相关的感觉.而且它把你撕碎了."
于是，我们开始处理她的强奸案.而且，有时候当人们开始陷入他们不想考虑的创伤时，她开始失去补偿.起初实在太多了.的确，这就是为什么我从一开始就不正确的原因.她太脆弱了，缺乏足够的应对资源来管理整个流程.
玛姬的问题很大一部分是她不能让自己与父母分享任何东西.我开始探索她生活中的这一元素.
“不，我不能告诉他们.完全没有.曾经.他们会恨我."
“甚至您的母亲?"
“特别是我的母亲.你不认识她."
“好吧，你能让我跟她说话吗?至少这样我才能理解你妈妈是谁.我不会提及此事，但我需要了解您的母亲来自何处.您以为您认识她，但我告诉您，您可能无法真正理解母亲的来历.您非常害怕别人的反应，以至于经常歪曲别人的来历.我可以和她谈谈吗?"
“我不知道.还没有."
几周后，我在手机上收到一条消息:“我做得不好.噩梦又全面展开了.昨天我又开始切割.我开始自杀."
当我与她取得联系时，她感到非常恐慌. “我正在失去它.这是地狱.我需要停下来."
“我了解.我们需要送您去医院."
“天哪，我不想回到那里.我讨厌医院."
“这次我认为情况会有所不同.我将指导您，"我说. “相信我."
她打电话给她的朋友，她陪同她去急诊室. 30分钟后，我与她会面.当我到达时，她在医院的病床上来回摇摆，抽泣着.她的朋友困惑的表情凝视着我.
“没关系，"我说. “我知道您现在不知所措.但是我们可以解决这些感觉.您的父母收到通知了吗?"
“是的，"她哭了一些. “我妈妈正在路上，两个小时后会到这里."
“好，"我说. “然后你让我和她说话吗?"
她点了点头.
“听着，玛姬.我知道你现在在你最黑的地方.现在，您所感觉到的只是尝试阻止，隐藏和否认所有内容所带来的痛苦.而且，相信我，当水闸打开了这种感觉时，它就糟透了.很抱歉，您感觉到了.是我们安全.如果我们听您的感受，并且以正确的方式与您建立联系，那将是治愈的."
接下来的两个小时，我和她的最好的朋友玛吉(Maggie)在眼泪，痛苦，开玩笑和疲惫不堪之间来回走动.然后她的母亲到了.我们已经讨论了我们的游戏计划.她的母亲会与Maggie接触，然后我会与她的母亲接触，然后与Maggie接触.
玛吉第一次和她妈妈说话时，我在外面等.十分钟过去了.然后她妈妈出来见我.她走近我，说:“玛姬说你一直在和她一起工作，这对一些人有帮助，而且你想和我谈谈."
“谢谢你.是的，我确实想和你谈谈."
我们找到了一个会议室，并在接下来的半小时内进行了交谈.我的目标是评估Maggie的母亲(她对Maggie的爱)，并加深对他们之间为何如此界限的理解.这次相遇之后，这个消息非常好.我的评估是，玛姬的母亲深深地爱着玛姬.她只是对如何与玛姬打交道感到困惑.她对此没有完全的责任.我们的文化无助于以此方式指导人们.考虑到她在以前的所有住院和自杀尝试中均未得到指导.玛姬有时如此敏感和冷漠，以至于她的母亲只是不知道该说些什么.
“我不知道这是什么，"玛吉的妈妈告诉我. “但这就像生活在某个时候消失了."
“关于何时?"我问.
“也许三年前.就在自杀未遂之前."
“我可以和Maggie分享吗?"
“是的，绝对."她说.
当她的母亲在外面等的时候，我和玛姬一起回到了房间. “玛姬，"我说. “我有好消息.你的母亲爱你.深.她只是不知道如何与您建立联系，因为她不知道您的状况如何.她告诉我，您的眼神就像是“一盏灯熄灭了".她想知道为什么."玛姬凝视着墙，若有所思地消化了我在告诉她的内容.
到了傍晚.我告诉了玛姬，我得走了.但是我会回来的.我会在午餐时和她一起检查一下，然后回来参观几个小时.
第二天中午我回来了，发现玛姬坐在病房里吃午餐.她看着一个完全不同的地方.
“早上过得怎么样?"
“实际上，还不错.我向精神病护士讲述了我的强奸案，"她既得意洋洋又令人惊讶地从容. “他们认为我有PTSD.而且我想我想告诉妈妈."
“哇.那真是个大新闻.你想要我来这儿吗?"
“是."
所以我四个小时后回到医院.当我到达时，她的母亲和玛姬在一起.我们同意，我将在短时间内单独与Maggie通话.
“我告诉她我有话要告诉她，"她说，因为她的母亲关上了她身后的门.
“她说了什么?"
“她说她想知道我想告诉她的一切.而且她爱我."
“我真的为您的勇敢感到骄傲.我知道这有多可怕."
“是的，我只是认为是时候了."
我们带回了玛姬的母亲，故事很快就从玛姬身上传开了.她使母亲想起了她15岁时正在约会的男孩.然后她告诉了她聚会的事，告诉她她偷偷喝醉了.她开始哭泣.
“他带我上楼.他开始脱掉我的衣服.我对他说“不"，但他没有停下来."当她对妈妈说:“对不起，我偷偷喝醉了."她的脸上流下了泪水.
“哦，亲爱的，"她含泪的母亲说. “对不起，这件事发生在你身上.我知道你发生了什么事.但是我不知道是什么.很抱歉我没有在那里保护你."
他们哭着拥抱.
接下来的两个小时会对玛吉的心理系统造成的治疗影响很难夸大.在强奸之前，她一直很沮丧，并且开始了“结束循环"的过程，这是我用来表达强烈的负面情绪然后对这些情绪变得非常自我批评的个人的术语.这造成了一个消极的恶性心理内循环.然后是强奸的创伤，这意味着玛姬在她的核心处贬值而不受尊重.在此之后，她没有受到保护或受到尊重，也没有得到公正的对待.相反，她以为父母会怪她，朋友会怪她，实际上，她基本上是在怪自己.因此，她的价值感和价值感被无法处理的强奸事件完全摧毁，没有任何后果.
现在，终于，她以最重要的依恋人物表达了这一经历.她没有得到她所担心的(惩罚，拒绝和不赞成)，而是得到了爱和对自己经历的肯定.换句话说，她正在获得对自己作为一个人的爱和认可，这是她从根本上相信自己不应该得到，永远也不会得到的东西.
被重要的他人认识和重视是社会心理的核心需求.这是我们的社会心理系统运作的基础.对于Maggie而言，这是一个根本性的变革时刻.这个事实在接下来的几周内清楚地显示了.
她又在医院呆了两天.她的情绪大幅度下降.下个月，在她的情绪以及与母亲的关系上都发生了相当根本的变化.实际上，她再也不会危险地自杀.从那时起，她与母亲的关系的语气和语气在质上有所不同.他们终于可以互相交谈真正发生了什么.从这个角度来看，她终于可以被看见和认识，并感到很有价值.
我向他们俩解释了玛姬如何根据她从事的所有内战对她的妈妈有相当扭曲的看法.我向他们解释了玛姬如何具有“神经质气质"，这仅意味着她有一个敏感的反应性负面影响系统.我解释了她是如何反抗自己的，然后创造了各种私人对公共的过滤条件，并且隐藏了“真实的自我".我教他们两个如何互相交谈.首先，在医院提供一些课程，然后在接下来的几周中，我与Maggie合作进行门诊个人治疗.
阶段3:学习CALM MO来处理冲突和困扰.
强奸对她母亲的启示以及随之而来的医治具有变革意义.但是，玛姬仍然有一条路去寻找心理健康.她仍然很焦虑，经常陷入自我批评的循环中.她对消极事件非常敏感.她已经停止割伤，不再有自杀倾向，并且开始拥有积极的经历.但是仍然经常“吓坏了"，很多时候都不快乐.
还有一个事实是，她的父亲知道发生了什么事，但不知道发生了什么.玛姬终于向他透露了圣诞节假期期间发生的事情.交流进行得很好，但还不如与母亲的交流恢复.我犯了一个错误，那就是不指导麦琪并准备她的父亲会如何反应.父亲很少会有所不同.他们在司法和报应以及使事情变得正确方面变得更加活跃，这就是这里发生的事情.她的父亲开始认真提起提起法律诉讼，由于种种原因，这不是一个选择，最重要的是根本不在Maggie那里.
我们的治疗重点是通过发现自己的情感甜蜜点来改善自己的情感健康.情感上的甜蜜点是一方面可以感知并调整自己的情绪，另一方面可以自适应地调节情绪之间的“空间".我训练人们发现情感上的甜蜜点的主要策略是指导他们培养CALM MO.
培养CALM MO是我开发的一种心理正念方法，与ACT和Dan Siegel的人际神经生物学有很多共同点.我告诉人们，当他们遇到负面事件时，PT博客博主Susan Heiter称之为“颠簸"，他们需要激活CALM MO透视图，以帮助适应性地处理随后的感受，想法和行动.它是首字母缩写词. M. O.代表两件事，一是"Modus Operandi"(工作方式)和"Meta-cognitive Observer". CALM指的是元认知观察者的态度.目标不是要变得批判和控制(当他们感到颠簸时有多少人得到控制)，而是要变得对自己和他人充满好奇，接受，充满爱心/同情，并积极朝着适应性结果发展.
Maggie在与父亲的活动真正教会她如何使用时，正在开发CALM MO的能力.玛姬在家中，她的家人正在游览另一所大学，就像她在秋天想知道JMU是否适合她一样.她父亲整天心情都很脾气暴躁，这使她感到非常紧张.巡回演出后，她的计划是去和一个男朋友一起去看一场音乐会.她正计划与他作为朋友在华盛顿特区的一家酒店过夜.他们从旅行团回到家后，她告诉了父亲她的计划.
“不可能，"他说. “只是没有发生."
“爸爸，我很了解这个家伙.没事.什么都不会发生."
“什么都不会发生，因为你不会."他宣称.
“爸爸，我真的很期待."
“你想去吗?您年满18岁.实际上，这个年龄足以做出决定.去啊.顺便说一句，这也意味着您已经足够支付自己的大学学费了.所以，你走了，你从大学开始就按自己的方式行事！"
那是一次艰苦的交流，使她完全不安.不久之后，她一个人呆在自己的房间里，哭了起来，感觉完全不知所措.她告诉她的朋友她不去，他很不高兴.所以现在她感到完全被困住了.她父亲怎么能这样对她?一切都糟透了.
一个小时后，她的妈妈走进她的房间. “我知道你很沮丧，亲爱的.我明白."
“妈妈，这不公平，"玛姬宣称.
“有时候生活不公平.亨里克斯博士会告诉你什么?"
“他会告诉我激活我的CALM MO."这是她第一次在恐慌中真正考虑到这一点.
“听起来很有趣，那是什么?"她妈妈问.
“它说，当你感到压力时，要对发生的事情感到好奇，接受负面情绪，对自己和他人充满爱心和同情心，并有动力获得最佳结果."
“好吧，"她的母亲说. “我们可以在这里应用吗?"
所以他们做到了.并立即开始改变她体验活动的方式.一个重大转变是她将“好奇"的注意力转移到了父亲身上.她以一种好奇的态度问自己，他的感受和原因.她很快想起他整天都很脾气暴躁.当他们迷路的时候就开始了，全家人迟到了.她爸爸讨厌迷路.他对调动并不满意.他爱JMU，真的很希望她能从那里毕业.当然，他们之间还发生了强奸事件.显然，她去一个城市，和一个男孩在旅馆里过夜，激发了这种想法.他到底想做什么?她问自己.一个小声音告诉她他只是想保护她.
这种认识立即带来了另一种见解.她对强奸对她的生命意味着什么感到恐惧.她总是需要照顾吗?她会一直被视为弱势群体吗?别人会设法控制她吗?她会被判断为无法做出正确的决定吗?是的.这些想法引起了共鸣.这就是为什么他的反应令她如此沮丧的原因.这意味着她暗中担心过的所有这些事情.
有了更深入的了解之后，其他部分就到位了. She was in a much better place to accept her feelings. Yes, this sucked, but it was hardly torture. And both her father's feeling and her own made perfect sense. So, she could hold a loving attitude toward both in the midst of the conflict. And the path forward seemed clear. Make the best out of the night and find a time to process this event with her father going forward. A half an hour later she and her mother were making popcorn and getting ready to watch a movie.
Just before the movie started, her mother commented, “That CALM MO thing really works, huh?" and they both chuckled and sank comfortably into the couch.
Gaining mastery in moments of intense emotional activation are the crucial learning events that lead to lasting change. And indeed, this event allowed Maggie a profound sense of mastery of her intrapsychic and interpersonal world. And it set the stage for two months of continued growth. She got a job. She altered her appearance, such that she starting leaning in to her physical attractiveness rather than trying to hide it. (Importantly, she now started to actually believe she was physically attractive). She also made many new friends and was really starting to flourish.
Her improvement was so dramatic that I thought we were basically ready to move to a more maintenance phase. However, real life isn't about riding off into the sunset.
Phase 4: The Vicious Return of PTSD Nightmares
In the back half of the spring semester, Maggie was really starting to feel confident that the majority of her troubles were behind her. She heard about a sexual assault awareness event on campus and decided to go over and give a show of support. So, without much forethought, she went.
She was alone. The event was taking place in a large room. A primary activity was that folks were making T-shirts representing the assault in some way. She walked into a large room. She saw hundreds of T-shirts. The lights were bright. There were so many T-shirts. The room started to spin. She lost her breath. Images flashed. She felt a pain in her gut. She valiantly tried to activate a CALM MO perspective, but it was overloaded. She made her way to a counselor at the table and tried to say something, but nothing came out. She almost fainted. Then she saw a classmate she had talked to once or twice. She was also alone. The classmate said hi. She said hello back and they started talking. They spent two hours together sharing their stories.
She felt much calmer as she left. However, that night her nightmares returned. With a vengeance. The next day she was in a bit of a haze. She maintained her perspective and carried on. However, the following night, the same thing. And again on the third night. She called me and we moved our appointment up.
The next three weeks were tough. Nightmares every night. Exhaustion during the day. My frame was that we got a little over-confident, given how much progress she made. The nightmares were telling us there was still unfinished emotional business related to the rape. We talked more about what it could be. We hung in there. It was hard because it seemed her conscious self was largely at peace with it. But her subconscious self was not.
Eventually, the nightmares subsided. She was brave and strong and courageous and her system began to settle back down. But a problem had emerged that would give Maggie one additional lesson in working to adaptively regulate her feelings.
Phase 5: Learning Effective Self-Talk in the Moment
During the period in the spring semester when Maggie had been growing emotionally, she had been spending less time on her classes. Indeed, if there had been a positive point of focus for Maggie in the fall, it was her studies. The one positive attribute about herself she could (sort of) acknowledge was that she was smart. And so, she would focus on her studies in times of stress to prove to herself that she could get good grades. In the middle of the spring, with a much more active social life, she had started to fall behind on her studies. She figured that she could cram during the final month and really bring her grades up. And then she was bulldozed by the return of her nightmares and other PTSD symptoms. This had thrown her off her academics, as she was chronically fatigued and easily distracted. As her PTSD symptoms finally started to abate, it began to dawn on her she was seriously behind. She knew she was not going to do as well as she would like. In fact, she was so behind in chemistry that realized she might fail.
Her intelligence and good grades had been her anchor. When she was in her dark places, it was the one hook she could hang some pride on. As she came down from the PTSD resurgence, she awoke to the realization that the spring semester might bring a truly poor performance in her grades. This created a brutally strong negative wave of emotion.
The final phase of our treatment would be to teach her how to direct her cognitive system of justification toward effective self-talk.
“I am freaking out," she told me. “I have no idea what I am doing in chemistry. The final is today. I am going to fail. My parents are going to kill me. I can't function. What am I going to do?" Sobbing followed.
The Beckian cognitive approach teaches folks to separate the known, empirical facts from one's interpretations and expectations. We went through what we knew factually of Maggie's situation. The basic fact was that she did not understand several relevant concepts in chemistry and that her final was that day. That was the situation. But that was not really what Maggie was responding to emotionally. What was causing her to panic was the way she was interpreting and narrating her situation. She inferred that her difficulty understanding chemistry concepts meant that she would fail the final. And then, if she failed the final, she would fail the course. From that, she then came to believe that she would be “killed" by her parents. This image was horrible and intolerable because she believed that she would then be a failure as a person because she would have greatly disappointed the people that she loves. In other words, Maggie was in a panic because she had made a string of interpretations that led to a catastrophic expectation for the future.
I encouraged her to come on in for a special session. We spent two hours together, in which she was taught in the moment how to understand and gain insight into the vicious cycle of panic, how to identify her pattern of catastrophic thinking and how to replace those extremely negative interpretations with more realistic narratives about her situation.
The first thing I did to help Maggie was to identify how she wanted to be. That is, what was her valued state of being, given her capacities and situation? The current situation was that she was not understanding chemistry, that she was three hours away from taking her final and was fearful that if she failed chemistry bad things would happen. I basically narrated for Maggie two options. Option one was that we could focus on the worse possible outcome, blame her and the school for the unfairness of it all, and crawl up into a little ball, and weep like a baby. Option two was that we can see the difficult situation for what it was currently, understand what it might (or might not) mean for the future, and try to adapt to it in a way that minimized bad outcomes and taught her how to cope more effectively with stress.
Framed with the option, Maggie said, “Obviously, I want option two. But I don't know how!"
To which I replied, “Exactly. You don't know how. So we will teach you.让我们开始工作. Whatever your final grade is in chemistry, we can turn this into a growth experience because you don't know how to cope with stressful life events without decompensating. But it is one of the most important things to learn living life as an adult."
So Maggie came on down to my office, and I told her that we would start by doing what she would normally do. I had her bring in her chemistry book and so I told her to go ahead and proceed to study the part she wanted to learn about. She opened the book to the page, and within 30 seconds tears were running down her face. “I don't know this. I missed two classes when I went home, remember? And besides, he sucks as an instructor. I barely understand it when I am there. I don't know what I am doing. I am definitely going to fail this course."
“See what happened, there?"我问. “Looking at chemistry problems you don't know gets you into a catastrophic narrative. Remember what I have taught you about thinking about your thinking. When you find yourself in a narrative like this, what are you supposed to ask yourself?"
Taking a deep breath she replied, “I am supposed to ask myself, ‘Is my thought accurate?' and ‘Is it helpful?'."
“So, is thinking that you are guaranteed to fail this course an accurate statement?"
“Well, I think so!" Then she chuckles through her tears, knowing what I would say. “I guess I don't know for a fact I will fail. And, you are right, it does not help me to think I am going to fail. It only makes me panic."
“Actually, it is appropriate for you to be concerned that it might happen, because it might. There is a grain of possible truth here. But focusing on it now and claiming it is certainly going to happen is neither fully accurate nor helpful. Given your situation, what would be most helpful?"
“I don't know." A pause. “I guess, based on what you've said, I need to focus on doing what I can to take the test with the best mindset I can and then try to cope with whatever happens."
“Exactly. So, what can we do to get you into a better mindset."
“I have no clue."
“Well, is your final cumulative?"
“是."
“Did you understand any of it?"
“Well the stuff on covalent bonding was pretty straight forward. I also did well on that stuff on entropy and thermodynamics."
“Teach me some of that stuff." So, for the next 15 minutes she reviews stuff she knows. Her mood shifts.
“What are you thinking and feeling now?"我问.
“I don't know, I guess I feel a little better. I know some of this stuff pretty well and it will be on the final."
“Do they ever curve the grades?"我问.
“Yes, they curve the grades."
“Listen, I have no idea what you are going to get on your chemistry final or for your final grade. But what I do know is that focusing on what you don't know and catastrophizing future outcomes makes you miserable and puts you in no position to take the exam in an effective way. Remember what we talked about in earlier sessions regarding arousal and performance. Extreme anxiety is horrible for effective performance. Keep that in mind. Ok, let's look at another section." Maggie turns to a different chapter that is difficult for her. Again the tears begin to flow.
“Ok," I ask. “What are the tears about?"
“My being smart is one of my good features. Looking at this tells me I am not smart. If that is true, then what do I have? Nothing!"
“Here again, notice how you frame your interpretations. Whereas before the negative focus was on your future and disapproval from your parents, now you are focusing on something fundamental about your character. Let's test out this conclusion you have reached, namely that if someone can't understand this section of your book, they are not fundamentally smart. Here, pass me the book."
She hands it too me and I stare at the complicated chemical formula on the page. “I have no idea what this means. I guess I am an idiot, then."
“No, of course, not" she says.
“But why not?"
“Because you are a professor of psychology."
“But you're a student who has blown off several classes for lots of different reasons and stopped paying attention to developing your chemistry skills. No one can learn this stuff who doesn't try to learn it. As we both know, for a host of reasons you have not really been focused on your studies the last two months. The point here, Maggie, is that you are engaging in what I call a ‘character assassination', which is that because you are in a less than ideal spot, you see yourself as fundamentally bad or unworthy in some way. A different and I believe more adaptive frame is that the situation is not ideal and we will learn from it. But that doesn't mean you are fundamentally worthless or incompetent."
“I know that at one level. But that just makes me feel like a loser.我为什么要这样呢? Why can't I just think like a normal person?"
“Good question. And we have done lots of work together that I think helps you answer that question. You turned against yourself when you were 13 and developed a very strong inner critic. Because of your unique learning history, you build justification narratives for what is happening that tend to be pessimistic, catastrophizing, and self-blaming. There are lots of reasons for this. It keeps you somewhat submissive in conflict, it often drives you to perfection in ways that are associated with past success, and it has become a bit of a habit. But regardless of why you have learned to be this way, now the key point is that when you think this way, you feel like shit and when you feel like shit, your thoughts shift more toward thinking this way, so it is a cycle. The main issue that I want to help you see is that your narrator is a key part of your mental health. I want to help you see its connections between your feelings and your actions and how they are all interrelated. I want to help you see how those interrelations get you in maladaptive spaces. Through awareness of your thoughts, acceptance of where you are and who you are, and the idea of what is a realistically adaptive way of being that will move you toward your goals in the future, we can learn new pathways of dealing with stress."
Maggie and I spent the next few hours together, practicing distraction (i.e., going for a walk), the CALM MO acceptance of her thoughts and feelings in the moment, the cognitive intervention of replacing extreme negative interpretations with more helpful ones, and going over the most adaptive game plan for the test (i.e., focus on the questions she knew, emphasize the thought that she can tolerate whatever the outcome might be, and stay with the test for as long as she can tolerate it, and hand it in before she decompensates into a full blown panic). Just before the test, she described herself as being in a “pretty good" mindset.
Maggie later returned to my office just to let me know she stayed fairly regulated during the exam. She felt like she probably failed it, but at least she was doing okay. The next day she wrote to tell me that she told her parents she probably failed chemistry, but actually was doing ok with it because she was training herself on how to cope. She said her parents were surprisingly cool with it.
A couple of days later, she returned home for the summer. A week later she wrote and told me she “somehow" ended up with a C in the course and was having a great summer. To which I wrote her the note: “I guess you did not ‘know' you were going to fail after all. :o)."
The Final Phase: Consolidation and Maintenance with Chad
When Maggie came back in the fall we met for a few sessions. She had had a good summer. There had been a few bumps in the road with some family stressors, but nothing she had a difficult time managing. She had realized that because she does have a “sensitive" system, she will often have strong initial reactions, but everything changes when she relates to these feelings in the manner in which she had learned. And she was free of PTSD symptoms.
Given how well she was doing, we decided to transfer her over to Chad, the doctoral student she first encountered. Her work with Chad largely involved retelling the stories of the previous year and the lessons she learned from them. She also would use the space to develop new notions about herself and who she could be. She was really coming into her own as a computer programmer. She had experienced some sexist encounters, as computer programing is a very male dominated field. She worked with Chad on some of those issues and on basically building a sense of self on a very different foundation than she had during her early teenage years.
One day she came in with a big announcement. She had Chad keep it a secret and swung by my office.
“I am going to NASA for an internship next semester!" She was heading down to Florida in the next couple of months, where she would train with them in advanced computer engineering. Over the next few years, Maggie would continue to check in and update me on her latest. Her trajectory had changed.
She had re-written her narrative. Her relationships were different. Her emotions were different. Her self was different.
I asked Maggie if I could tell her story.
“Absolutely," she said. “If it can give one person hope that there is something on the other side, I would be thrilled."
“Pretty remarkable", I said in a way that she knew honored her character. “Recall that at first, we could not even tell your mother."
She chuckled. “Yeah, well, a lot has changed."
Conclusion: Maggie's Reasons for Living
I spoke briefly with Maggie about 13 Reasons before posting this article. “I hate that show," she said. I asked Maggie to offer a summary of her experience as a way of reaching out to all those suffering individuals who are boxed in and feel like they have every reason to kill themselves. Here is what she said:
The treatment that I received from Dr. Gregg Henriques was lifesaving. This is not an exaggeration—I would not be here today if I had never met Gregg. After dealing with severe depression and the aftermath of a sexual assault, I wanted to kill myself. Indeed, I had tried several times previously and was convinced this time I would succeed. I came to Dr. Henriques in October of 2014, as I started to spiral out of control into another suicidal crisis̉—one I thought would be my last. The effects of this therapy were already visible by December, when I was hospitalized. Had I not been in treatment with Gregg, I would have killed myself then, but instead I checked myself into an inpatient treatment center because some hope had started to emerge deep inside of me. While it has not been an easy battle, I have since made a huge recovery. Years later I am not only glad that I did not end my life, but I am very happy to be living the life I am, as I am feeling hopeful and fulfilled in a way that I would have never guessed possible when I entered therapy. I know many college students are suffering with profound emotional problems and I hope that my story can help raise awareness and get them the help they need.
