This episode features the first time I’m including a therapy session! I share my 5th week of doing exposure to traumatic invalidation. Listen as my therapist and I go over my homework from the previous week, dive deep into a memory of invalidation, and then process what came up for me. The big skills I practice are observing and describing, and we get some tears in there too.

Helpful resources from this episode:

DBT references:

DBT Skills Training Handouts and Worksheets – online pdf version;

DBT Skills Training Handouts and Worksheets – buy the manual from a Black-owned book store!

DBT handouts used in this episode:

Mindfulness Handout 3 – Wise Mind: States of Mind;

Mindfulness Handout 4 – Taking Hold of Your Mind: “What” Skills;

Emotion Regulation Handout 20 – Taking Care of Your Mind by Taking Care of Your Body (PLEASE);

Other resources used in this episode:

Exposure recording form

• Blank version
• Version filled out in episode 24

Treating Trauma in Dialectical Behavior Therapy: The DBT Prolonged Exposure Protocol (DBT PE) by Melanie S. Harned, PhD, ABPP

• General Handout 4 - What is DBT PE (pg 372);

New York Times - The Woman Defending Harvey Weinstein;

TikTok - @housepurrity re: western psychology;

TikTok - @purpleellaandcoco re: tantrums vs autistic meltdowns;

TikTok - @thejeffreymarsh re: how parents treat their kids;

TikTok - @neurodominos re: Melinda came in hot today;

———

More resources are available at https://therapize.joygerhard.com/

Please rate, review, and subscribe to this podcast wherever you listen.

Follow me on Facebook, Twitter, Instagram, and TikTok

Like what you hear? Support me and this podcast on Patreon.

Swan Lake by Tchaikovsky

You've got shit. I've got shit. We've all got shit. So let's therapize that shit, with your host, me, Joy Gerhard.

Please note I am not a therapist, I cannot and do not diagnose anyone or prescribe anything. This is just me, someone who struggles with mental illness, emotions and intrusive thoughts sharing what skills I've used and how I've used them.

Also trigger warning: in this podcast, I talk about sensitive topics including mental illness, suicidal ideation, self-harm, rape, childhood sexual assault, trauma and more. I also swear here and there, so listener discretion is advised.

If you're new to the podcast, some context for you: I've gotten a ton of value out of doing group therapy and watching others process their shit. In group, I can see other people's patterns and behaviors much more clearly because they aren't my patterns and behaviors, but rather they're adjacent to mine. It's such a relief! I want to share this relief with you, via this podcast, wherein I practice skills while actually in the thick of shit.

Each episode I typically do an introduction and provide some context. Then I play a recording of me actively dealing with shit. This isn't me talking about psychology or theories; I'm actually in distress, having strong emotions and strong urges. You're going to hear me crying, angry, numb.

But my intention is always to move through an emotion, never to stay there. So stick with me and we'll actually come out on the other side by the end of the episode. Alrighty. Let's hop to it.

Welcome, welcome. We're going to be doing something a little bit different today and I know I say that a lot. It is also true today. This is going to be the first episode that features one of my exposure therapy sessions. The recording I'm about to play for you is from my fifth session since I started doing exposure therapy for traumatic invalidation.

And I'm going to get into some theory here. I know that my whole deal on this podcast is that we don't spend a huge amount of time talking about theory and that I spend most of my time actually using the skills.

But in order to give some context as to what exposure is and why I'm doing it, we're going to need some theory.

What is exposure therapy? I'm so glad you asked. I have an answer. To explain why exposure works, we got to talk about PTSD for a second. So PTSD stands for Post Traumatic Stress Disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders, the DSM.

And so you know where I stand in No Nuance November (in the words of one of my favorite TikTok videos): all of Western psychology is based on whether or not you act like a white man. I've linked to that TikTok in the description, if you want to listen to the whole thing.

What a culture pathologizes is a reflection of how much other people's behavior gets in the way of what that culture values.

So in a capitalist, white supremacist patriarchal culture like the United States, the medical industrial complex pathologizes behavior that gets in the way of capitalist productivity and white supremacist hierarchy and patriarchal control.

So in addition to the utility of the DSM as a way to provide language so people can explain what their experience is, the DSM also functions as a way of gatekeeping, determining who is “worthy” in quotes of support, i.e. who is “in bad enough shape” to deserve support, and that support typically comes in the form of financial support from insurance companies, but also accommodations at schools and jobs.

None of what I just said is an original thought. I am paraphrasing from several online content creators who are queer, disabled, mentally ill people of color.

And I went through hundreds of my “liked” posts to find exactly who said these things, and I failed. So if you know folks who have shared this sentiment, let me know. I want to give them credit for it.

So getting back to trauma. Before there was PTSD as a diagnosis in the DSM, there was shell shock and before there was shell shock, there was battle fatigue. And if you weren't a soldier then you were tough out of luck in terms of having language to describe your experience and being treated as though your experience was valid.

So I'm going to be talking today about trauma from the perspective of “having a trauma response,” i.e. how my nervous system reacts, rather than talking about trauma as “a thing that happens.” Because two people can experience the exact same event, and one person might have a trauma response and the other might not. So I'm of the school of thought that trauma isn't the thing that happens, but is rather a response our nervous system has.

Our nervous system has trauma responses. And some of those responses are acute (so short term), and some responses become chronic (long term).

I think most everyone on the planet has experienced an acute trauma response. Like, you know, right after a car accident, you feel nervous and edgy and maybe you don't feel like getting into a car.

Right after being shot, you might feel jumpy or loud noises will have you panic. All of this makes total sense, right? Our nervous system is cautious and wants to make sure that we're safe. It's trying to keep us alive.

A chronic trauma response is when our trauma response gets hardwired into our brains. I'm thinking of the idiom if all you have is a hammer, everything's a nail.

A chronic trauma response – PTSD – is a survival skill that's gone off the rails. A nervous system says, “hey, this thing happened and it was scary and we were overwhelmed. And we hate that overwhelm. We are never going near that thing again.”

So PTSD becomes chronic as a result of (or is maintained by) two things: problematic beliefs and avoidance. So I'm going to be quoting the work of Melanie Harned, and she has written a book about the prolonged exposure protocol.

Well, but what I'm going to read first actually predates the book that she published. I'm going to read from the handouts that I got when I participated as a research subject at the University of Washington's Behavioral Research and Therapy Clinic back in 2016 and 2017. That's when I did my first round of exposure for my first adult rape.

Whenever I'm quoting anyone else's work, I turn on some reverb so that I sound like I'm in a Greyhound bus depot, or more accurately, a Greyhound bus depot bathroom. So again, this is from Melanie Harnett's work back in 2015.

There are two main things that make PTSD stick around over time: avoidance and problematic beliefs.

The role of avoidance. People with PTSD typically avoid in two main ways: cognitive avoidance (avoiding thoughts and memories about traumatic events) and behavioral avoidance *avoiding situations in the world that are reminders of trauma, that are believed to be dangerous, and/or that cause intense shame).

It makes sense that people with PTSD avoid in these ways because avoidance works to decrease fear and other emotions in the short term.

For example, a person who is afraid of crowds will become anxious if they are in a crowded store. If the person leaves the store, their fear will come down, and they will feel better. However, avoidance makes fear and other emotions worse in the long term. For example, how do you think the person who leaves the crowded store will feel the next time they're in a crowded place?

They are very likely to still feel afraid, and in fact, their fear may be even more intense than it was before.

That was the role of avoidance. And now I'm going to read:

The role of problematic beliefs. The reason people avoid things that make them feel fear and other painful emotions is because they believe something terrible will happen if they don't avoid.

These types of beliefs usually fall into two main categories: Beliefs about danger (like “the world is extremely dangerous,” “I will be attacked or hurt”) and negative beliefs about the self (“I'm weak and incompetent,” “I'll go crazy or lose control if I have intense emotions”).

The problem is that avoidance makes it impossible to find out if problematic beliefs are accurate.

For example, if a person avoids crowds because they believe they will be attacked, then they will never have a chance to learn that the likelihood of being attacked in a crowd is very low. Similarly, if a person avoids crowds because they think they will get so anxious that they will scream and pass out, then avoiding crowds will prevent them from finding out if this actually happens.

So those are the roles of problematic beliefs and avoidance in maintaining PTSD. Which brings us now to how exposure works. So now I'm reading from Melanie Harnett's “Treating Trauma and Dialectic Behavior Therapy - The DBT Prolonged Exposure Protocol,” or “DBT-PE.” So this is on page 372.

DBT-PE uses 3 core procedures to treat PTSD: 1) in vivo exposure involves confronting situations you avoid in real life. You will be asked to gradually approach people, places and things you've been avoiding because they remind you of your trauma, feel dangerous, or bring up distressing emotions. This will help you learn that these situations are not harmful and you can cope with them, which will make them less distressing.

2) imaginal exposure involves repeatedly describing traumatic events out loud during your therapy sessions. By talking and thinking in detail about what happened to you, your trauma memories will become less overwhelming, and will be less likely to come up unexpectedly at other times.

And 3) processing involves talking with your therapist about the emotions and thoughts that arise as a result of imaginal exposure. The goal is to help you gain a new perspective about the traumas you've experienced that will cause you less distress and enable you to change unhelpful trauma related patterns in your life.

So that's how exposure works. Now, before I play the main recording, I want to start with a short clip from my first exposure therapy session that took place on March 15th, 2022. This is me telling the story of a conversation I had with my dad. And I'm sharing this as a way of highlighting the contrast between where I started with exposure versus what you're going to hear later on in the episode that takes place 5 weeks later.

So take note of how incredibly short this telling of the memory is. It's so short that in the 20 minutes that we scheduled for the actual memory telling, the imaginal part, I had time to tell this eight times. Typically I only have time to tell a memory twice.

Also, you're going to hear my therapist's voice, which has been shared with their permission and with their voice altered for their privacy. They're going to be interjecting, asking for SUDs. SUDs stands for Subjective Units of Distress, which is a quick and dirty way to let my therapist know how much distress I'm feeling. And they are out of 100.

Alrighty, so here's the clip from my first exposure therapy session.

Swan Lake by Tchaikovsky.

So, I'm having a conversation with my dad in the kitchen, or in the dining room wherein I’m expressing concern that what happened in Indiana, the rape that happened there, will just keep happening with future partners because I don't know how to prevent it from happening.

And my dad said something to the effect of, “If you leave... if you park your car and you leave it unlocked in a bad part of town, and... I don't remember the specifics of how the rest of the conversation went. But I said something... or he said something to the effect that the take home I got was that, “well, it's not the fault of the person who breaks into the car. I mean it is the fault of the person who broke into the car. Like they're wrong, still wrong for doing that. And there are things, actions I could have taken that would have changed the outcome or prevented it from happening.

SUDs.

Fifty.

Swan Lake by Tchaikovsky

OK, welcome back to the future. Again, what you just heard is from my first exposure session, and I didn't have access to really how I felt or any of my thoughts that I had in that memory. I was just relaying the facts of what I said and what my dad said. Which is a stark contrast from what I'm about to play for you. My full therapy session from April 12th, 2022. And I'm recording this commentary on November 19th, 2022, so seven months later.

The recording is going to start off with my therapist going over the exposure forms that I filled out during the previous week. Each day in the week between my sessions, I did an imaginal exposure (which was listening to my memory recorded from the previous session), and I also did an in vivo exposure (which at the time was listening to a New York Times interview with Donna Rotunno, Harvey Weinstein's then lawyer).

This is the interview where she was asked if she'd ever been sexually assaulted, and she responded, “I have not because I've never put myself in that position.”

Which is great fun. So when the recording starts, my therapist and I are talking about my exposure forms for those tasks. I fill out these forms, answer questions about worst case scenario, whether or not the worst case scenario happened, my emotional state before, during, and after exposure, etc.

I've mentioned these forms in previous episodes. If you want to see what an exposure form looks like, I linked to one in the description, and I've shared examples on my Instagram account too you can go take a look at. Now, typically the bulk of the skills that I use in these recordings are from the DBT manual.

If you're new to the podcast, first off, welcome. And second off, DBT is a therapy modality that stands for Dialectic Behavioral Therapy and is my therapy type of choice.

The DBT manual was written by Marsha Linehan, and I've linked it in the description, both in PDF form and where you can buy a hard copy. This episode is unusual because I'm not actually going through a skill step by step, you're going to hear my therapist and me name a couple skills in session.

But the bulk of what I'm doing in this episode is using the Observe and Describe skills from DBT. Observe and Describe are mindfulness skills; they're in the Mindfulness module of the DBT manual, specifically mindfulness handout 4, “Taking Hold of Your Mind: What Skills,” which describe the things we do, the what we do when we're practicing mindfulness.

So in this recording you're about to hear, I spend a lot of time noticing what's going on in my body, paying attention to how I feel, to the thoughts that I'm having, to the emotions that I'm having, and describing them in a non-judgmental way. I've talked about non-judgment in past episodes, if you want to go take a gander at some of those.

So this episode is going to be a little different because we're not doing a skill step-by-step. It's more kind of using the skills ad hoc, like on the fly.

So, I think I've oriented you to enough theory, and now we're going to get into the meat of the episode. So past Joy, take it away.

Swan Lake by Tchaikovsky

All right. Kind of we'll follow the usual protocol of going through your kind of exposure forms and making the plan for this week's in vivos. Then we'll do 20 minutes of imaginal, then 20 minutes of processing. Then we'll do... we'll have that time to go over diary card and do that stuff. That work for you?

Perfection

OK, great. Alright. So I've got your exposure forms up. Let me kind of go back to... ok, ok, looks like the dissociation was not there... disgust... OK, so some of those thoughts of, like, “I caused this” were coming up.

Yeah, the in vivo one on the 8th is kind of the... “What did I learned during the exposure task” is... feels like the quintessence of my experience.

Bells

Future Joy here. The April 8th in vivo that I just mentioned was listening to Harvey Weinstein's lawyer. And here is what I wrote on my exposure form in answer to the question “What did I learn during this exposure task?”

“I notice having the urge to have someone else listen to this recording like a ‘can you believe this shit?’ sort of urge. But under that is the desire to have someone else listen to it and to pick apart the argument the lawyer is making, and to validate my experience of listening to this recording. Because the lawyer is so even and ‘logical’ and presents her case so clearly. And I have this massive pit in my stomach.

“And I have the thought that it means I can't have been traumatized and that I should have known better. And I'm not validating that experience. I want someone else to validate it for me. It feels too overwhelming to do it for myself. I have the thought, ‘please don't make me lay out all my context and all my thoughts and all my beliefs. Please don't make me put together this briefing of my life so that I can explain, i.e. convince, that my experience of listening to this recording makes sense.

“I keep thinking of the idea of sea lionizing. Just the act of making an assertion and stating this is how I feel feels insurmountable because I'm expecting to have to put together a thesis document defending that, providing data, providing peer reviewed sources. I watch myself suppress even observing how I feel, because I have the belief that if I know how I feel, I'll have to defend or explain it. And I just want to be able to feel my feelings without having to argue in favor of them.”

And now back to the recording.

The big thing I realized for the in vivo one on the 8th –

I was looking at imaginal.

Oh sorry.

That's OK.

Bells

Future Joy here again. So the imaginal task that I just mentioned was listening to the retelling of my memory that I recorded in the previous therapy session. And here is what I wrote on my exposure form answering this question, “What did I learn during this exposure task?”

“I didn't guess right on what's the worst, because I didn't put down what actually ended up happening. This sense of having poison injected into my body and now it just lives there. There's no obvious emotion. It's more like intense stress, tension. And it keeps increasing and increasing and nothing that I was saying was validating it. I keep having that thought that I'm telling the story wrong. I keep focusing on my thoughts now instead of what I actually remember my thoughts being.

“Because what I actually remember is very short and very limited, and I'm not telling that accurately. And that is stressing me out on top of everything else.”

And now back to the recording.

And there's dread that I have around, “please don't make me explain this.”

Mhm, mhm.

Just the idea I have, in order to make an assertion about my experience, I have to have all of this data. I have to have all this proof, I have to have support for it, and everything else. And it's dread.

OK.

And it just occurred to me, that I may have been getting this wrong this whole time... because I've been diagnosing it as disgust –

OK

– because that's the best approximation of what I'm feeling. Really all it is... cause there's no thoughts, there's no urges associated with it. It's just like tension in the pit of my stomach. It may very well be dread, actually. It's not fear. I mean, it's a flavor of fear, I guess.

OK.

I told my sister, it feels like I've been injected with poison. Like, now I have this thing that I have no way of explaining to anyone else. Even thinking about trying to explain it to somebody else is impossible. And now it's just going to live inside me and make me feel sick.

As in like your experience of these in vivos is that or... talk to me about what you mean.

Well, so in the imaginals, the experience of that imaginal, of that memory, actually when it happened. And then doing the imaginal part, like retelling it to you, and then doing the imaginal throughout the week, and then also doing the in vivo with the lawyer thing.

It's all kind of prompting this sense of dread.

Yeah. Or just like serious... I mean I got it... I have it right now. Like massive tension in my stomach.

Ok.

But it's been really hard to put my finger on it because there's nothing else. There's just, like, no thoughts, no urges.

I imagine fear would make sense to me, right? We're doing something that's really challenging for you, that brings up a lot for you. And disgust also makes sense because I've seen you have very real disgust responses as we've been in session, right? And dread, I would house dread under kind of fear. Because dread... I think of as worry that something's going to happen almost, but it's a little different. It feels maybe heavier than worry.

Yeah, yeah. And what's interesting is both of those things, fear and disgust, both have an avoidance component of, like, “I don't wanna!” Fear being: running away from a thing, and discuss being, “oh, I don't wanna go near that thing.” So... I dunno. It’s been challenging to identify.

And I think just identifying the feeling you have in your body is enough, right? We don't have to be so precise about what exactly the emotion is, right? I think as long as you are allowing the feeling to come up and kind of riding the wave of that, that's OK.

Cool.

Let me see. Let's see what else? I see some self-validation on the 9th.

In vivo or imaginal?

Imaginable.

Hey, look at me.

bells

Future Joy here again. A reminder, the imaginal task that I just mentioned was listening to my retelling of the memory that I recorded in the previous therapy session. And here was what I wrote on my exposure form on the 9th answering the question: what did I learn during this exposure task?

“Take away is that I went in search of support around this fear, i.e. validation that this was a scary thought to not know how to solve this problem. And dad gave me an additional thing to be worried about, akin to when he said that men are visual and they reach a point of arousal that they can't control. And now I know this thing about my dad. Now I have this in the back of my mind whenever we interact. I'm still feeling – I think it's disgust – in my body without accompanying thoughts. Just a sick feeling.” And now back to the recording.

Oh yes.

OK, so still feeling pretty high disgust, that makes sense. No numbness this time. There’s some invalidation: “it’s all my interpretation.” How do we check the facts on that? What do you remember? We've checked the facts on this before.

Yeah. And I kind of go in and out of being able to access that. Clearly I'm out of it currently. I mean, I guess the dialectic is it, it can be both. There is a component of it that's my interpretation, and there's a component of it that’s “this is what happened.”

Mhm. This the fact is, it is what happened, right? These words were said to you.

Yes, but I have it that I'm the one who's making them mean that I'm being invalidated.

There's an impact that words have on us, right? Any words that are said have some impact on us.

Yeah.

We are always responding to what is being said to us in some way, right? Sometimes we might respond neutrally, sometimes we might respond positively, and sometimes we might respond feeling horrible, right? We don't necessarily have control over whether or not we feel invalidated or validated.

Well, I think of like... if I wrote something and you found a typo in it and said, “Joy, you have a typo.” And I instantly go into a shame spiral of, “Oh my God. I'm a horrible human. Like I'll never amount to anything. I shouldn't create anything.” It's not because of anything you said. I mean, you said the phrase that then I added meaning to, I added an interpretation to it.

Sure

“Joy, you have a typo,” does not mean, “Joy, you're a horrible human,” you know.

Right. So I may not have had any intent on what I said, from what I said, but what I said still had an impact, right? I don't know that it's fair to compare, “Hey, you have a typo” to what your dad said to you in this imaginal.

So this is where I have all this internalized stuff, because he would say that I am like painting him as the villain and listening to him with the expectation that he invalidate me. So I go into these conversations primed to have that listening of him. And he would also say that Satan twists his words. He was intending to help me, so if I'm being impacted by it other than how my dad intended, then it's because of Satan.

And he can believe that.

[Laughing – cackling in fact]

He can.

Yeah.

That doesn't mean that that's what you have to believe. Or that that's what's true.

Give me a second. He can believe that. That doesn't mean that's what I have to believe, or that it's true. Yeah. Give me a second. That one's going to need a second to solidify. He can believe that. That doesn't mean I have to believe it. Or that it's true. I don't know what's happening right now, but that feels like a paradigm shift of some kind. It's very uncomfortable.

And It all makes sense, right? Because it's not only that he was my dad, still is my dad. Like it was beyond “he's an authority figure.” It's “he's an authority figure who also is my spiritual whatever.” So it was like another level up of being an authority figure.

I think what I've been doing is I've been operating under the assumption that if I were to have this conversation with my dad, to actually say to him that this was invalidating, that however he responded, would be the truth.

MHM.

If he said “no, it wasn't,” or “you're making it mean that” or whatever, and I've internalized what I imagine his response to be, and I'm using that to invalidate...

Yourself.

Myself. What is... My brain feels like what happens if you take a bunch of jewelry and you shake it up in a box and all the necklaces get all tangled up. Or yarn. Or headphone cords.

Your brain has so much practice invalidating you.

My brain has so much practice in validating me or so much practice in...

Invalidating you.

OK. Yeah. Yeah.

And so of course, it looks for ways to invalidate, right? Because you were also taught that.

Because I was also taught that. Well, certainly I was taught that my experience was not the truth. God is the truth. So it didn't matter... What was the point of checking in about what I wanted? It's important what God wants. What was the point of checking of about what I saw as my purpose? It was what God wanted me to do with my life that mattered. So there was no point in ever knowing myself. It was only really necessary to know what God wanted for me. I don't like this. OK.

This is part of the work we're doing. We’re trying to develop and instill a sense of trust in yourself. And it's hard because it's going to take time.

Yeah, and practice. Yeah. I think of when my sister and I play catch, and we purposely do it with our left hands because we're both right-handed. For a while, it feels like I don't even know my own body. It's so foreign. Like, “this is wrong. Everything about this feels wrong.” And then if we stick with it, by the end of an hour, we're actually quite good. And then we don't do it for a while, and we go back to the drawing board again. So, it’s just going to feel unnatural and wrong for a while.

Right, for some time.

Fine.

And it might take willingness, right?

Ahhh... right. My old friend willingness.

Right, because I'm seeing that kind of a theme across the board with a lot of these exposures is there is this theme of not trusting yourself, right?

Yeah, and the added layer of: I don't trust myself for what actually happened; I don't trust myself in remembering what actually happened. And then I'm also adding another layer of: if I were to go talk to my dad about this, here's what I anticipate he would say. And then I preemptively invalidate myself around that too, even though that's not happening.

We might need to sort of use Mindfulness of Current Thought when that comes up, right?

Yeah.

Kind of shelve those thoughts about what dad would say.

Yeah.

Because what dad would say doesn't change what happened to you?

What dad would say doesn't change what happened to me? What dad would say doesn't change what happened to me. WHAT?! Ok. Doesn't it though? Like if I say, “this happened,” and he goes, “Joy, that's not what happened,” doesn’t his perspective on what happened supersede my own?

What do you think the answer to that question is?

Well, this is part of the problem, right? Because I understand everybody has their own perspective on a thing. So my perspective is not the end-all, be-all of it. And I understand that my memory is fallible, as is everyone's. So... I have always had a value of wanting to be open to hearing other people's experiences.

Sure.

And taking in that information as a way of, like fleshing out my experience. But this has been a problem going back to my first rape experience as an adult. Like, this thing happened, and the dude going, “that's not what happened.”

And yet you experienced a very real impact from what happened, right?

It's kind of like, because my memories of these things are so fragmented, even immediately after they happen, it would be like if you and I were hanging out, and I was blindfolded. And I'm asking you, “hey, what does the world look like?” I have to rely on you because I don't have that information. So it's been confusing, because there's pieces that are missing and the only person who can tell me is the dude who was there. And they're telling me it didn't happen. So... my brain gets all discombobulated.

So it's sort of like the only person who can tell you THEIR perspective on what happened, right?

Oh no!!!!! Right.

Because it's not fact –

Oh God.

– just because someone else perceives it in some way, right? How you feel is fact, right?

Then what is truth? How do I ever determine objective truth?

I don't know if I can answer that.

Moving on to philosophy class.

[Laughing]

Ah.

But these are the kinds of challenges I want you to try to engage with, right? Like the challenges to this perception that you made it up.

OK, so what I'm noticing – and I said this goes back to first adult rate; this goes back all the way to beginning of my life – is the belief (and then operating from that belief) as though... It's kind of like the toddler I hang out with, when he's trying something new. He's constantly looking to an adult and being like, “huh?” And some of it, he’s looking to be applauded. And some of it, he's looking to be, like, “did I do it right?”

Yeah.

And I kind of go through life, not with the wanting to be applauded part, but the checking in, “is this, is this what happened?” And have never developed the ability to have any sort of confidence or trust in my own experience. This is very uncomfortable. Ok.

I think you are developing trust in your experience. I have heard you say things that suggest you have strong passions, things you care about, right? Those are parts of your own experience and belief system. That shows me you have some trust in how you feel, at times.

Yes. Yeah. And it's interesting that, without fail, those are things that I do exclusively alone. Running the stairs, going to the gym, embroidery. All of this stuff. I even like... my dad will be watching a movie and I will be watching it in my room. Because we're watching the same thing, but separately. Because what happens in here is there's no one else to tell me it didn't happen that way. God. Ok.

So I'm looking at time.

Yep.

I think it might be time for us to start the imaginals. But just briefly, I think perhaps continuing with this same in vivo this week and see how it goes.

Great. I mean, it's good, it's fine. I need to do at least another week of it, maybe two.

OK. All right. So I'm just going to make a note: same in vivo. But let's begin with the imaginal. Try to remember to stay in the memory as best you can.

Yeah. OK, so I kind of reverse engineer how we got into the memory, because I don't remember what prompted me coming out of my room to talk to someone about this thought of, “Oh my God, I don't know how to keep this from happening.” But something triggered an urge to talk about that thing. Something triggered the thought, and then the urge to talk about it. Do I need SUDs, by the way?

Yes, thank you.

Fifty right now.

OK, what's the worst possible outcome?

The thought that I don't know what's true. Derealization or depersonalization. And really strong tension, sick feeling in my stomach.

OK.

The conversation starts in the kitchen. I don't remember how it's going. I do remember that there's tension. We're not... We’re talking, talking at cross purposes, the sense of like being out of step in the conversation. It's like I'm playing catch with a baseball and he's playing catch with a football. And I'm feeling frustrated, feeling unheard. I’m having the thought: I'm not explaining myself well, he's not understanding it, he's not getting it.

And then we moved into the dining room. And at some point, he said, “You know, if you leave your car unlocked in a bad part of town...” And it's kind of like a record scratch moment internally, like, “that feels bad.” And then there’s a cacophony, a waterfall, a deluge – that's the word – of this very familiar feeling of: that feels bad and I have no way of explaining why. I don't know what terms to Google. I don't know how to present an argument. I'm going to need to get together like a bunch of resources to explain. I need to know what it's called. What is that? Is it victim blaming? I don't know.

There's a thing. There's gotta be a name for this list of rules that people have about here's how you stay not sexually assaulted. And there must be think pieces that exist, people explaining why that's problematic. I need to find all of those. There's this urgency of, “Oh my God, I'm going to have to do so much work to explain to him. But also to myself.”

I need to know what all the terms are. I need to know what the mechanisms are so that I can validate this bad feeling that I feel inside. Because t feels like I was just injected with poison. But now it's my responsibility to identify what the poison is. And then to create the antidote. And then to defang the snake, while also being filled with poison.

What happened next?

The conversation continued. I don't remember what either of us said aside from, I do know, at some point, he clarified that it is still the fault of the person who breaks into the car for breaking into the car. Like, that's still an illegal thing that they did. And, there were things that I could have done as the parker of the car to mitigate my risk of having my car broken into. I am not clear on whether he is using that to reference the past (like there's things I could have done to keep myself safe) or the future (like, “hey, now we know there are things you could do next time to keep yourself safe”). I know I reacted – like the feelings I had internally – was of being blamed, like I felt defensive.

SUDs.

Fifty. And I don't have... there's just... I feel like a blocked pipe or hose. There's all of this pressure building up, and I have no way of relieving the pressure. And relieving the pressure is explaining to him the impact of what he's saying in a way that has him hear me.

I keep trying. I know how the conversation went. It was still this very much like cross purposes thing. We weren't connecting on it. He wasn't getting my experience. And I just kept getting more and more frustrated. I don't know if I showed my frustration, or if I kept it all bottled up. But eventually the conversation ended and I was left feeling worse than before I went into the conversation.

Because when I went into the conversation, it was, “here's the scary thought. I don't know how to prevent this from happening. Leave, I still have this scary thought because I still don't know how to prevent it from happening, and I'm also feeling blamed. I've also been told that there is a solution, but I don't know how to apply that solution to my life.

So there's also this feeling of trying to do mental calculus. Like, well, clearly there's an answer and I have to figure it out. And I don't know how to do that, which means that it will continue to be my fault. Because I could have figured it out and could have prevented it, but I still don't know how to figure it out.

SUDs.

Sixty. My gut is so unhappy right now. Like a fist.

All right. Shall we start from the top?

OK. Something had prompted the thought: “I don't know how to prevent sexual assaults from continuing to happen.” And that's scary. I'm like, “Oh shit, this could just keep happening.” So I had left my room and started talking to Dad in the kitchen. I know that much preceded us talking in the dining room.

And I know that by the time we moved into the dining room, I was feeling frustrated, like I wasn't feeling like he was getting my experience, and we were kind of, like, butting heads. I didn't feel heard. He was fixing. And I wanted him to understand that, “Hey, this is a scary thought I am having. I feel scared about it.”

SUDs.

Fifty. At some point, we move into the dining room and at some point, he says, “You know, if you leave your car unlocked in a bad part of town...” That's the specific phrase I remember. I know that he continued the metaphor beyond that, something to the effect of, “Your car gets broken into, that's what happens.”

I know I felt defensive internally. I don't know if I responded defensively. Probably did, but I don't remember. And it felt... it felt bad on so many levels. And the immediate internal emotional response is kind of like... I have a 5000 piece puzzle that's just a rainbow, like a gradient of color. My internal emotional response is like when I dump that thing out and it's like, “OK, so there's a lot that needs to happen here. I need to separate out the edges. I need to turn all of it over, so it's all right face up. And I need to group things by color and I need to group things lighter to darker, but also red to purple.”

And like all of this stuff, there's a lot that needs to happen. And It's kind of like that, of “OK, hang on. So, you're saying a thing and there's a lot that's bad about it. There's some victim blamey stuff going on. I need to find data. Well first I need to identify what this thing was he just did. That's why I love a good diagnosis. I'm like, great. It's something I can Google.

If I don't have the name for the thing, my Google searches are much less effective. I'm like OK, so I need to identify exactly what just happened. Was it victim blaming? Is there another term that I should be... Should I be Googling rape culture? Is there a name for this list? Is there a name for the function of this list that we give people as a way to keep them safe?

I need to identify all of the different components of what he just said, and then I need to research it, and then I need to come up with data to support why what he's saying is not effective. All of this stuff and it's... So, instead of helping me, I just got handed... It's like, “Here's the book report you need to do.” Like, that's kind of my internal... Like, this is going to take so much work to tease apart.

Even if I don't go back and present this argument to him, I have to identify for myself why this is problematic, because... oh no. Because if I don't do that, if I don't figure out why it's problematic, then it must be that I feel bad because I'm interpreting it wrong. I need the identification, the diagnosis of the problematic part, to allow me to feel bad.

SUDs.

Sixty.

You're doing great.

Well what's weird is I notice, my SUDs... seventy is when I when I tip over to like my emotion mind is running the show, thinking mind is offline. Right now, all of it's my gut. I'm averaging it across my body, and I'm like, “OK, so it's really just my gut that's the problem, so my SUDs are still pretty low.” But like my gut is so tense right now. Like if we just did SUDs for my gut, I'd be like probably up at an eighty.

OK. So you were saying like if you don't figure out why it was problematic right, then –

– then it was my interpretation of it that’s the problem. I need the research to allow me to feel bad. I need someone else to say, “Oh, well what he just did was blame you, and it's not in line with the facts. Because here's all this data that suggests that it actually isn't about opportunistic dude walking by the car and saying it's unlocked. No, it's like that there's actual predators who are actually seeking people out blah, blah, blah, blah, blah.”

I have this sudden attachment to... I need to find all of that information. I need to collate it. I need to present... make it linear or create some sort of branching tree where I know what the relationships are between all of these things. So that I’m allowed to feel how I feel.

So it’s likely – it's almost assuredly – that I stopped listening at that point because I was doing all these mental gymnastics internally. Because I don't remember the details of the rest of the conversation, aside from, at one point, he does clarify that it's still the fault of the person who broke in for breaking into the car. Like, it's still illegal. They should not have done that. And there were things I could do to change the outcome. Again, not clear on whether that's past based (like there's things I could have done to have prevented my sexual assaults that already happened), or there's things I can do in the future.

And I just have the experience like he just gave me this thing I need to detangle or decode. I think of reading comprehension problems where it's like, “Here, read this paragraph and they answer these 12 questions.” And you read the questions and you're like, “This paragraph doesn't answer these questions.” And your instructor is like, “Yes, it does. You just have to know where to look.”

And I'm like, “I can't tease out the relevant information that will change my behavior and tell me how to change my behavior from the information he just gave me, but he thinks he's just given me that information.”

SUDs.

Seventy. So, I'm feeling confused, unsupported, kind of like left to save myself, unhelped, unheard. And as though, you know, I had this thing I started the conversation with: “Here's a scary thought. Isn't this a scary thought?” And now I still have that, “Here's a scary thought. It's still scary.” And now I have this poison in my gut on top of that. And the conversation ends at some point, but nothing gets resolved. And in fact, more gets added to my concerns.

SUDs.

Sixty.

All right, so let's stop there. It seems like SUDs were kind of hovering fifty/sixty for most of this, but got towards seventy at the end there.

Yeah.

What was happening that SUDs went up?

Like when I really get into that feeling of... that desperation of, “Oh my God, I need to go do all this research, to label what just happened. Like, that's a very familiar feeling. There’s grief associated with it. There's isolation. There's having gone through my entire life not being able to explain to other people what is going on inside me.

I think that's the... it's not anywhere near as bad as, but it has the same flavor as, locked in syndrome. Are you familiar with that one? It’s where your brain is fully functioning, and your body is completely paralyzed, and the only thing you can do is blink.

Ah.

And so you're having thoughts, you're having urges, you're having needs, you're wanting to say things, you know how to speak. You just can't do any of that so the entirety of your communication is through blinking.

My version of blinking right now is TikTok videos. I keep finding videos and sending them to Ruth and I’m like, “THIS is my experience!” And I have the same thing with when I encounter a term that I can... Like victim blaming was such a big deal. Revictimization. Secondary traumatization. Trauma repetition. Like all of these things, these terms when I encountered them, it was just like, “Oh my God, now I can wiggle my pinky. Now I can shake my head,” or something. It afforded me another way of communicating what it feels like inside me.

But when I crawl into this memory, I feel literally, completely trapped in my body, and unable to articulate any of the thoughts that I'm having and why I'm having them. Because I can't, I can't justify them. I can't explain them. And in order for my dad to hear me, I have to. So it's just this impossible, unsolvable puzzle.

So it sounds like you're kind of recognizing that in this memory, when this happened, you didn't have language that you needed.

Yes, I didn't have the language to communicate whatever was going on inside me. Oh God.

What happened just now?

Well, I think there's grief. The isolation of not having language. Not having language, in and of itself is isolating, but then not having language and that experience like... My parents don't know what that experience is like. They don't know the frustration of it.

There's something that's happening inside me and it makes sense, but not from the outside. And I'm being judged for it. I just learned the difference between a tantrum and a meltdown, like an autistic meltdown. And they look identical from the outside. But a tantrum is an ineffective communication around a need. And once that need is met (like: “Here’s that ice cream cone you're screaming about”), the emotional reaction stops.

With the meltdown, there's usually the straw that breaks the camel's back. Like, this is the last thing. But even once that need is met, the meltdown doesn't stop.

Right.

Which is why my dad called me stubbornly negative. Because he would go to solve the last thing, the last straw, and it didn't solve my meltdown. Because the meltdown is about sensory overload, like the my nervous system freaking out. And it happened with [my former partner]. He would like go to solve the problem and it didn't solve the problem.

So when I found there was a TikTok that explained this, I just had this wave of relief and grief. Relief that now I have language for that. And grief that I've gone this long being this misunderstood.

Like every conversation I have with Ruth about this stuff, she says she's enjoying getting to know me on a much more profound level. And there's relief there. But also, like, I'm 38 years old. And all this time, my family had these stories about me.

Another TikTok I saw is that toxic parents treat, punish their children... they assume negative intent when their kids disobey, as opposed to like, this is just the natural part of development or whatever. Like “that kid’s being willful!”

Like I was related to as having malicious intent, but no way to... I didn't know the language for it.

This is so understandably painful for you.

Yeah. It sucks.

It really struck me when you said: “the isolation of not having language.”

Well, yeah, the irony being the thing that triggered the tears is you said that I didn’t have language. And then I added the internal experience of that to it. And I look back and a lot of things click into place. Why, when I learn a term, it feels like I can breathe. There's data, there's proof.

A lot of times I feel like I'm held underwater. And there’s not being able to breathe, but then there's also the combativeness of like.... when one's held under water, one doesn't just... I mean, I suppose the most effective thing to do is to play dead, you know? But our instinct is to fight. So when I'm held underwater, there's all of this mental energy that goes into: I have to prove, I have to explain, I have to figure this out. There's so much work that I'm doing. And this is the first time I've gone through the memory and actually accessed that feeling of the puzzle being dumped out and being, like, “Put this together now! Your survival, your validation depends on you putting this puzzle together.”

So I'm thrashing around mentally, and when I can finally find a word for it... I remember finding that word, “victim blaming,” and it was just like ahhh. Because it’s like being given the key to a library. Now I know what term to search for. Which means I'm going to find just so many references and resources about this thing.

It's like being given a the front of the box of the puzzle. It's like here's how you put all of those bits together. But without that, it's incredibly, incredibly isolating. Which is why my closest friends in the entire world are all mentally ill, and most of them have trauma. So we don't need language.

There's more easily accessible understanding.

Yup. Yeah, my friend Ebony once had a massive dissociation event in a QFC in the water bottle aisle looking for fizzy water. So now when we talk about feeling dissociated after a therapy session, it’s like, “It's the water bottle aisle of the QFC!” And that's our shorthand for it. And it's lovely that we have that because, I know what that experience feels like. They know what that experience feels like. It's why I drifted away from all of my previous friends who... I mean, everybody has some sort of trauma, but they weren't processing it or weren't aware of it or whatever.

And it's like I didn't know how to... I don't know how to talk to them anymore. Because I still don't have language to explain to somebody who doesn't know what it's like. So yeah.

I think that the fact that you were able to access this today is really huge. It shows me that you are. We're making progress here with engaging with this memory. This is some new learning for you.

Well, it's been weird telling it up till now because I know that when he said that it was like throwing a bomb into an orchestra pit. It was just like, internally, cacophony. It was just chaos. It was like, “Oh shit!!” But I couldn't have told you what the chaos was, what was going on. And then realizing I'm like, “Oh, I have that experience all the time.”

And that's overwhelming, too. I have the thought that that's overwhelming, just being present with my experience. I kind of want to just take this recording and give it to the diagnostician I'm going to be meeting with in a month, and be like, “I'm not going to answer anymore questionnaires. Just listen to this and you tell me if I'm neurodivergent.”

You have more language to describe your experience. Right now you are increasing that.

Yeah. And it's still new enough where I feel like I have to whip out my pocket dictionary. Like I know I have much more language around like describing PTSD than I used to, and I'm still not great at describing it to people who never experienced it. There's an exhaustion like a preemptive exhaustion around the idea of, “Oh, I have to go into my archives and I have to put this all together again.”

Because it's like I do the puzzle, I dump the puzzle now here in session and then I take it apart and I put it back in the box. Because I don't memorize everything we just said to each other. And there is, I can feel it, the dread of trying to explain this to somebody else. Which is why the recording feels so like... ahhh, I can just send the audio. I can transcribe it and just write it all down and be like, “Here, here’s what I got.”

Because there's still some overwhelm around recreating or regurgitating stuff like this, big kind of epiphanies and shifts and stuff.

They take time to percolate, right? I think you were sort of taking moments earlier to sort of allow some things to percolate.

Right. I was like, “Stop talking!”

[Laughing] And that's OK, right? Sometimes we need to give ourselves time to process.

Yeah, I appreciate your patience in letting me. Feels like my brain is Jello that's solidifying. Or curing. That's concrete. Jello doesn't cure.

I am honored to be alongside you in this process.

Thank you. It's a relief. That video, that TikTok I sent you, that in the comments everybody's like... Was it Marissa was the name of the therapist? It's like Marissa is everyone's therapist and she's a menace! It's not a bad description because I have that experience when you drop truth, like when you were saying earlier things about like, “Your dad can have that thought and it doesn't mean it's truth,” I was just like, “What are you doing?! You're creating chaos in my brain!”

And it's good and necessary chaos. Yeah, it's very uncomfortable, but like as my mom says, it's pain with a purpose. Ok. Did you want to do diary cards?

You feel that need to shift.

Sure. I think there's a lot of relief that's going through my system, but also still discomfort. So my body is just like, “We don't know what's happening.”

OK. And that may come down, right?

Yeah.

Let me bring up your diary card, OK? Looks like sadness and anger, pretty low level. Shame as well. Disgust very high this week – that makes sense to me.

Yeah.

Self-harm urges at a two, suicidal ideation at a one. Seems like staying pretty low for the moment.

Yep, Yep.

No self-harm. Meds as prescribed all week. Nice work. Lots of consistent exercise. No lying, no reaching out to exes or dating apps, no ineffective communication. Effective communication every day. Nice. OK, let's see. What do we need to do about sleep hygiene?

Ah yes. Yeah, it was like 50/50 this week. So I'm taking my meds consistently at 11.

Ok.

Which means that should be able to go to sleep by like 12:30. I'm not doing it consistently, like I'm fighting through the fatigue.

OK.

Partially because I've been enjoying the embroidery that I'm working on.

OK.

I actually just finished it. So, the alarm that I have for my meds has been really effective. Hearing my own voice.

Bells

Future Joy here again. This is what I recorded and set as my alarm to remind me to take my evening medications.

Stop what you're doing and take your evening meds. Get a water bottle. Get your meds. Take them now. I'm just going to keep talking until you take them. Don't turn me off. Don't turn me off! Take your meds. Go fill up your water bottle if you need to. Take your meds, and then you can turn me off. Don't do it. Don't turn me off until you've taken your meds. Do you have water? Go get more water and then take your meds!

And now back to the recording.

I think I need to do that for bedtime starting at like 12:15, like, “Hey, wind down whatever you're doing. Go brush your teeth.”

OK, so alarm for sleep routine. Great. Let's see, let's see... we discussed self-care, great. Exposure... OK. Yes, I see lots of embroidery happening this week. So it seems like there's almost a couple added exposures that you did here with Hannah Gatsby’s book.

I had to stop.

OK.

It was too much. Everything's a trigger right now, like literally everything is a trigger. I'm super sensitive to all the things so...

It makes sense to me that you're feeling a little bit more raw right now, right?

Yeah. Like my nervous system is kind of primed and ready to go, like on a hair trigger.

But it sounds like you are noticing, right? You're noticing when that's happening and kind of working to take care of yourself. I'm seeing there's self-care happening, going to the gym, things like that.

Yeah. And I had a very helpful conversation with Ruth because I was really struggling with identifying, like what emotion I was feeling. And she’s like, “What if you didn't have to identify it? What if you could just be like, ‘This is how my body feels right now. And that's how it feels, whether I understand how it feels or not.’” And then she also suggested, “What if you did your self care intentionally rather than kind of like ad hoc? Do the thing that you actually are like, ‘I'd rather stay home and eat an entire pack of Twizzlers, and drink wine and watch Netflix.’” She's like, “Do it!”

[Laughing] Sure!

Yeah, I've also been noticing I don't want to watch new things. I have my comfort shows. The familiarity. I don't want to have to learn new characters or any of that.

Sure, and that's totally that's great, right? Kind of noticing that and giving yourself those moments of care. I'm on board with what Ruth is saying. Intentional self-care is sort of like, PLEASE skill, but in addition to PLEASE skill, right?

Yeah.

Having intentional moments of care for self is really, really important.

Right.

So I might say, for some homework for you, I know you're already doing so much homework. I would say to do one thing every day that is intentional care for self.

Fine. It's funny because this is like my inner Puritan comes out. Like, “No, you suffer through it. You pull yourself up by your bootstraps, we're not going to be soft. It's not OK for you to stay home from the gym! Gym is self-care! And we're gonna beat you into doing it.” I've been struggling holding the dialectic around the gym, too, because like I have the thought, it's good to move my body to kind of get some of the emotions out. And there are days where I get there and I sit in the parking lot and I'm like, “I don't want to do this.”

And Ruth is like, “Maybe listen to your body and go home.” And then I have the Puritan in me, all like, “No, we must go, like this is healthy for us, goddammit.”

Hmm.

And it's hard to tell, am I avoiding self-care or is going home self-care? I don't know.

It might be helpful to really try to get into wise mind around the gym when that's happening. Observe, like, “Ok, I really don't want to do this and maybe I need to listen to myself about that.” Because and even noticing those thoughts of like, “No, we have to do this! This is what care is!” Kind of noticing, “Oh, there's that Puritan brain. There it is.”

Yeah.

Let's maybe shift from acting on that, right?

Yeah. My aunt also pointed out like it's impossible for me to pull myself up by my bootstraps. Like they're attached to me. I can pull you up by your bootstraps, and you can pull me up by my bootstraps, but I cannot pull myself up by my own bootstraps. Idioms. Weird. So just that phrase, “pull myself up,” that's an impossible thing I'm asking of myself, Joy.

Mhm.

So yes, one thing every day that self-care. On purpose, as opposed to being like, “Well, I embroidered today, I guess I'll categorize that as self-care.” No. OK, got it.

Minimum one thing. If you do more than that, great. If not, that's OK, as long as it's one thing.

Splendid.

Swan Lake by Tchaikovsky

Welcome back to the future. One of the things that struck me as I was listening back to all of this was that there are a lot of times, a lot of things that I mentioned, that are screaming, “How did you not know you were autistic, Joy? How did no one notice this?” Like I mentioned wanting it to create a branching tree of how all these different ideas are related to each other.

I also talked about the grief and isolation that I have of not having language for my internal experience. Again, big red flag. Do some research, Joy, maybe you're autistic. And at the time this recording was made, I had done a bunch of online assessments, and talked about that in previous episodes. But I hadn't actually had my formal diagnosis yet. That would come about... I think a month later.

Since then, I have in fact been formally diagnosed. But yeah, there are a lot of things I listen to now, and I'm like, “Oh Joy, that's obvious.”

Another thing I wanted to mention is that all the TikTok videos that I mentioned in the recording are linked in the description, if you want to go and take a listen to the full videos. They’re all from creators that I respect a lot and are remarkable in their ability to distill very complex ideas into kind of bite sized pieces.

Oh, and before I forget, a huge thank you to my Patreon supporters. We actually have a new supporter this week. Andrew, from the Great state of Washington, started supporting me on Patreon. So a huge, massive, gargantuan thank you to Andrew, as well as to the OG Patreon supporters, Anne and Ruth. Y'all are superstars and are 94.7% of the reason that this podcast exists for public consumption. So, thank you so much to you guys.

And if you, dear listener, would like to support this podcast in the same way, a link to my Patreon is in the description. So that pretty much wraps it up. I don't have any more to add, this is already a very long episode, so I'm just going to end it here and do my typical sign off of ending super abrupt –

Swan Lake by Tchaikovsky

This has been “Let's Therapist That Shit!!!” with your host, me, Joy Gerhard, if you like what you heard, please rate, review, subscribe and tell your friends about it. I'll see you next time.

Intro and outro music is Swan Lake Opus 20 by Pyotr Tchaikovsky, performed by the London Symphony Orchestra, conducted by Anatole Fistoulari, released on LP by Richmond High Fidelity / London Records in nineteen fifty-two.