How Creativity and Flexibility in Therapy Changed My Healing Journey

Content warning: suicide, self-harm

This year, I hit a milestone I hardly ever thought I would achieve. After spending eight years in therapy, largely for frequent self-harm and thoughts of suicide, I was ready to see my therapist only once a month. It was the result of a lot of hard work, and the payoff was tremendous.

I want to share how crucial a flexible and creative approach to therapy proved to my healing, as well as how sticking to the same course of treatment for several years proved to be detrimental. This is not meant to be an indictment of the latter treatment — in my case, Dialectic Behavioral Therapy (DBT) — but an example of how important it is to make changes when a treatment doesn’t work, and how valuable those changes can be.

I began DBT when I was 20, following two hospitalizations and several suicide attempts. Until then, I’d never taken therapy too seriously or found it necessary. Even though I had been self-harming and thinking about suicide since I was 16, I did not feel I was worth saving and figured I was already taking up too much of other people’s space and energy. It took a year of convincing to see a mental health professional and psychiatrist at my college’s wellness center — which like many such centers, didn’t offer substantive help. It then took another year of me putting myself in extreme danger on too many occasions to earnestly seek treatment.

I was recommended DBT by a friend who’d been in a similar position. When I looked it up, it appeared it was a treatment directly aimed at helping people exactly like me: people who had high self-harm rates, constant thoughts of suicide, racing thoughts, and rapid mood swings. After my first hospitalization, I asked to be connected with a DBT therapist and saw one for a few months. I don’t remember much of it, but I did land in the hospital again a few months later. By that point, I had learned that DBT was developed to treat Borderline Personality Disorder, the symptoms of which I seemed to share. During a 15-minute consultation with a psychiatrist during this second hospitalization, I told the doctor that I’d done some research and that I probably had Borderline Personality Disorder. The doctor said that sounded right.

(While this wasn’t a formal diagnosis, it shaped my self-perception for the next four years in a devastating way. It was also incorrect. I still cannot believe that a doctor could give someone that assessment with their main basis being “the 20-year-old seems smart and knows how to use Google.” This is a great example of how putting a band-aid on an issue doesn’t actually make it better in the long run — something I would encounter over the next five years of treatment.)

But I did begin DBT with a Linehan-certified therapist, as well as group sessions — and for the first time, I felt like there was hope. First of all, I felt like I wasn’t alone or some medical oddity. Second, I loved that the therapy came with a manual containing worksheets and modules. In my first year of treatment, I learned a lot of useful things — the different kinds of emotions, how to identify their triggers, how to ask for what I need, the different ways to practice self-care, and why it was valuable to accept things I couldn’t change. Most of all, I loved the concept of the dialectic — that two seemingly opposed ideas could coexist and inform each other. I did every diary card and worksheet and participated avidly in group sessions. I talked about DBT to anybody who would listen, especially after seeing how my individual therapists and group leaders held it in such high regard. I was determined to get better.

But I continued to hurt myself. Nothing I learned addressed my belief that at my core I was a horrible, evil person who was a burden to those around me. I desperately wanted to destroy myself. And yet, I do not recall ever discussing that in session. We mainly focused on how I could regulate myself when things got dangerous, but I don’t remember if we discussed what led things to get dangerous. Even if we broke things down, like in mapping a life cycle of an emotion, that belief about myself was less important than how I responded to it. I did manage to white-knuckle it through two and a half years without self-harm, but that was to justify a return from my leave of absence from school and, eventually, to “do DBT right.”

Looking back, the effect this had on my psyche led my treatment to wildly backfire. There came a point when not having an outlet for my self-loathing became unbearable. I went back to self-harm and suicidal ideation. It was the exact same intensity as it was when I entered treatment — I just hid it better, including from my current therapist and my psychiatrist. I was confused and frustrated. My commitment to getting better never wavered, and I was using every tool at my disposal. I concluded that I was simply not fixable, and the shame of my failure was too much. Despite a key tenet of DBT being “building a life worth living,” I still, after four years, had no idea what that life could look like beyond high-functioning self-destruction. Between 22 and 25, I was consistently amazed to make it to another year.

I am incredibly fortunate that unlike my first two therapists, my current therapist realized DBT wasn’t working. Our sessions already weren’t exclusively focused on DBT. We spent a lot of time talking about my upbringing and my relationship to my family, something I did not know how to broach, and was frankly scared to. We also talked about how I saw myself. At some point, we got rid of the diary card. We talked more about the relief I felt when I self-harmed. And we talked about how I did not have Borderline Personality Disorder. How I wasn’t under-regulated — I was over-regulated. I wasn’t self-harming because I couldn’t control myself — I was self-harming because I was feeling suffocated and only knew how to blame myself for my feelings. Of course a therapy that emphasized regulation was only ever going to do so much. These revelations took place over the course of about three months, and were already clearly helping. I had, at the very least, some explanation for my inner dialogue. We decided to make a more formal shift — to step away from DBT and do more inner work and get to know me.

Four hours after that particular session ended, I had given myself a concussion and was standing on my windowsill, trying to figure out how to jump. Get to know me? Have my suspicions about myself — that I was a monster — confirmed? That was absolutely terrifying. At some point I got scared, climbed off, and called a friend. It was the first time in a long time that I could admit that I’d put myself in danger. It was the last time I ever put myself in that position.

I am still flabbergasted that I had this reaction after, at that point, five years of therapy that was supposed to prevent suicide and self-harm. Somehow, DBT, which is intended to help patients combat feelings of worthlessness, only reaffirmed those beliefs. What’s even stranger is that not once did the thought that maybe the therapy was the problem cross my mind, or until now, the mind of my therapists. This resulted in me getting treatment for painful emotions without ever getting an understanding of why they were so painful, and it resulted in me having such reverence for the treatment that I was ashamed when it wasn’t working.

Employing a more holistic approach that took cues from me did wonders. My therapy sessions were now focused on discussing my childhood, Jungian analysis, and schema therapy. The latter is a treatment that helps patients understand what they believe about themselves, why they believe that, how that shapes their behaviors, and how to challenge unhealthy beliefs and nurture positive ones. It incorporates DBT, CBT, psychoanalysis, and other methods. I completed a questionnaire in which I rated how I related to over 200 statements. When the scores were added up, my therapist had a sense not only of what my core beliefs were, but of how accurate they actually were. For example, for a person who believed she was selfish and impulsive, I scored incredibly low on the questions that measured selfishness and lack of self-control. My therapist explained that this gap occurred as a result of schemas, or beliefs, that children develop in response to their environment, which lead to dysfunctional behavior in adulthood. I scored highest in Self-Sacrifice, Failure, and Defectiveness/Shame.

The fact that these were beliefs I developed in response to what I was taught about myself, rather than personality traits that were inherently true, was what turned everything around. When my therapist and I discussed how any given incident made me feel, I was asked to sit with that emotion and imagine a time when I felt that way when I was little. It was the first time I had proof that I could tolerate an uncomfortable emotion. I also learned that as an adult, I didn’t need to use the same coping mechanisms I used as a child. I could make my own rules, be there for myself when I was in distress and build my own life based on what fit my needs — the “life worth living” I could never imagine while in DBT.

In just over a year of employing this new approach, I went from seeing my therapist once a week to once a month. After the end of this year, it will be bi-monthly. This January, I realized I was two years self-harm free. I finally feel like I can stop counting. For the first time in my life, I am happy to be alive and take up space.

It is my hope that the person reading this, especially if it is a mental health practitioner, feels impelled to consider both the strengths and limitations of treatments they employ. I also hope that both patients and practitioners can discuss how important it is to differentiate between reverence and admiration for a type of therapy and its effectiveness. This is hardly exclusive to DBT. It is just sometimes easier to find an approach that’s “right” versus an approach that works, and the psychiatric community is not immune to this.

And finally, if the person reading this is a patient who feels their treatment is at a dead end, and thinks it’s their fault, I hope that they can find some relief, and know that it isn’t.