Today’s homework assignment is motivated by some pretty bad news. Dr. D. is taking early retirement next month, for personal reasons. Given the severe shortage of psychiatrists in London, I may find myself without anyone to even oversee my meds. It’s very unlikely that I’ll be able to locate a replacement any time soon who will complement the biomedical bit with psychotherapy. Pretty much impossible that there will be someone to continue with DBT.
My assigned task is to consider a “limiting belief” provoked by the situation. More on that shortly.
The general exercise is a cornerstone of Dialectical Behavioral Therapy. It works like this. A limiting belief holds you back. It has bad emotional and behavioral consequences. Such a belief is like a tabletop in that it arises out of misleading stories we tell ourselves, analogous to “table legs”. The legs, the “evidence”, has filtered through age-old biases and assumptions. The point of this particular DBT skill is to chip away at those misbegotten supports by simultaneously reconsidering the story, and pondering the pros and cons of holding onto the belief.
So, the limiting belief in this particular case is: that I need a psychiatrist who “treats the whole patient”. The conviction, that is, that a combination of practitioners won’t suffice; and that I certainly can’t continue to improve on my own.
The story is that by Summer 2019 my prior psychiatrist had prescribed a slew of drugs, to no avail. I was in terrible shape. Emergency-room terrible. Aphasic terrible. It was only when I started to learn DBT techniques with Dr. D that I made real progress. It is true that my occupational therapist, who first introduced me to Cognitive Behavioral Therapy (the umbrella under which DBT falls), really helped me. True, then, that someone without an MD can and did help. But it’s also true that it was Dr. D’s dual mode of treatment that brought me back to functioning.
What consequences are entrained by this limiting belief of mine? How does buying the story hold me back? In the first place, it makes me feel anxious about not making further progress. It leaves me worried that I have hit a permanent plateau, and one which, though liveable, is frequently unpleasant and sometimes horrible. Worse, maybe I’ll even backslide. That fear, in turn, makes it more likely that I truly will plateau/backslide. Obsessing about needing a new psychiatrist also leaves me blinded to the many positive things in my life.
What are the pros of sticking to the limiting belief? Practically, it may motivate me to find some sort of replacement, if only pro tem. In fact, I’m already working on that. I’ve written to the depression clinic at University of Toronto, contacted some local psychologists, and am reaching out to Hannah. Epistemically, the belief just seems to be justified by my past decline and my failure to improve until I began CBT-style therapy. And, says my philosopher’s head, it’s a pro to believe what’s true and well justified. The cons? Practically, the belief that I need a multidisciplinary psychiatrist if I’m not to fail stands to put me into a panic on my final day with Dr. D and in the weeks thereafter. The belief also makes me feel that I’m once again losing someone really important, and that it isn’t fair. Epistemically speaking, it’s a con to ignore salient facts. And the fact is, I made all that progress – yes, with Hannah and Dr. D as my coaches; but the achievements were mine. Are mine.
Obviously, the pros have it. I should try to ditch the belief. In addition to reciting the cons to myself, stressing my successes, I think another thing that may help is to recite the first three parts of my CLUM-C mantra, namely:
Change is constant
Loss is constant
Unfairness is constant