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This is a question and answer episode that I outlined during jury duty this week. Spending hours locked in a room with other potential jurors sure does wonders for your productivity. I’m thinking of scheduling a jury duty session in each week!

KICK ANXIETY’S ASS

Just before we get into the questions, I wanted to give a quick reminder about my online course, Kick Anxiety’s Ass! I’ve been getting a lot of questions about my books recently and how you can take what you’ve learned a bit further. If that’s something you’ve been asking yourself, then the course would be the perfect next step for you! All the details, plus an exclusive discount for podcast listeners, can be found at the end of the show notes.

With that said, let’s dive into the questions.

Hi Robert,

I found your podcast through my psychiatrist when I explained to her the heartache I’ve been experiencing.

My boyfriend and I have been together for 10 years— on and off. He had his issues when we began dating and I stuck by his side through everything. My mom traumatically passed away very unexpectedly about 5 years ago. My boyfriends family took me in and helped me cope with the drastic life change. This was our first time living together. 1 year ago, we (everything is in his name due to my student loans and the interest) purchased a home. 5 months ago, we adopted a dog. Since my mom passed, I haven’t been the same. I’ve been a walking depressed storm— which brought him down to my misery level,  something I never wanted. Medication hasn’t helped, therapy didn’t help. I don’t think I’ll ever be able to find joy again.

About a week ago, we broke up. He “cares about me but doesn’t love me”. We still live in the house and still (basically) act like we’re still together — snap-chatting, texting, tagging each other in memes. He thinks I need to find myself again- find what makes me happy. But he just got a tinder, which absolutely broke me, because he says he wants us to work out in the end.

When is it time to give up? Do I still put the effort in?

First off, I’m super sorry to hear everything that you’ve been going through. It definitely sounds like the hits keep coming. Please do say thank you to your psychiatrist for me!

The primary question here about your relationship is still really fresh, so it’s possible that things have changed since then. If this was several months of this behavior that we were talking about, my answer would be a little bit more solid, but as it was only about a week since he broke up with you and given the first part of your question about being on and off during other periods of your relationship, you might need to keep that pattern of volatility in mind.

Assume this is the full truth

As you know, it is so hard to figure out what to do when you are making guesses and interpretations at what someone really means. I think that in this case, it might be in your best interest to take him at his word. What he said was that he cares about you, but he doesn’t love you in a romantic sense right now. That sucks and probably really stings to hear, but for the purposes of just trying to figure out what the hell to do with yourself, you might need to assume that what he said is the full truth. The fact that he jumped on tinder within a week of breaking up with you definitely says something to me as well. That is not the act of someone that has one foot in and one foot out. And even if he does, I think that he forfeited the right to still have you on the hook when he opened himself up to being with other people (unless that was part of your relationship agreement).

That’s really what we want to look out for here. You can’t let yourself be strung along over time with this abstract hope that you might get back together again. If you do, that’s well and good as long as the circumstances are alright and not exploitative. But you can’t bank on that. The only thing you have is the reality of the situation, which is that he said he wants to move on. Again, shitty to cope with especially because of everything that you’ve been through, but it’s not your job to interpret all the subtext. You also don’t need to keep holding out for him indefinitely over time.

You’re allowed to feel this way

You’re allowed to feel however you feel about this. You’re allowed to feel confused, hurt, betrayed, angry etc. BUT if you haven’t yet tried to reconcile and find a solution, I do think it’s worth it to try. It seems surprising to me that you have had so much history together, you got a home and a pet together, and then suddenly after all of those investments in the relationship (that came after the death of your mother etc) he decides to cut things off. So if there are options that are unexplored, now would be the time to push a little bit before accepting what he has said as fact. Have you tried going to couples counseling together? Is there something specific that caused the sudden split that could be addressed?

Alternatively, it may be that living together has been a bit of a dress rehearsal for your future life together. That is one of the potential benefits of living together before getting married – that certainly was the case for myself and my wife. It could be that through this dress rehearsal, certain incompatibilities were revealed or it became apparent to him that there were things that he did not want to live with in the long run. Maybe you also noticed some of these things and felt that you should split as well, but he was just the one that made that call.

If it turns out that things are actually over between you two romantically, you will need to decide what sort of contact is appropriate for you right now. For some people, having everything stay the same with the texting, tagging, etc. except not technically being together can be really painful and continue to string you along. If you are no longer going to be in a relationship with this person that you have been with for years, there may be a bit of a grieving process to go through. You didn’t lose them literally, but you lost the life that you thought you would be able to live with them. You have some experience with grief because of your mother. I’m sure it has been terrible, but can you imagine how much worse it would be if you kept getting automated texts, emails, and social media interaction from her after she passed? Every time you get a bit better at coping with the loss, these things would pull you right back in.

Similarly, with this person, if it turns out that you need to move on, you may need to take some measures to facilitate that. That could be really complicated due to the shared life that you built together, the tie to each other’s families, etc. So don’t give yourself a hard time if you struggle and flounder with that part a bit.

This isn’t always the case, though. I have definitely seen people who are able to seamlessly transition into being best friends with their former partner and find that type of relationship actually suits them much better, since they don’t have the added pressure of making sure the romantic aspect of the relationship is working.

It’s not all your fault

Overall, though, I just want to be sure that I mention that this isn’t all your fault. In a situation like this, where you’ve had so much bad stuff happen to you and your struggles seem to be correlated with other problems, it is common to blame yourself and feel terrible. Clearly, from the words you used in your question, you two have had your issues over the years. It takes two to cause dysfunction in a relationship. You didn’t do something to drive him away. If this is happening because he can’t hang with hardship and doesn’t know how to support you when you’re struggling, then that may be an indicator that you need someone with a different personality or skill set.

I also wanted to take a minute to address one of the other things you said in your question, which is that nothing is helping and you don’t think you will ever feel joy again. That’s the depression and grief talking. It’s lying to you. Hopelessness is a common symptom of depression. It’s not a nagging doubt, it convinces you that you’ve looked at things logically and concluded that you are worthless and that you will never feel good again. That’s a symptom. You are absolutely not hopeless.

Don’t stop fighting

What I will say is that even though it has been a few years since your mother died, think about all the years that she was around. 5 years is not a long time in that context, so be patient with yourself and give yourself some grace for still struggling with it. Same with your boyfriend/ex-boyfriend. If you guys are splitting, it will take some time to feel okay.

Don’t stop fighting. Don’t stop trying to do things that are beneficial like medication and therapy. If you have given a medication or a provider a fair shake and it really doesn’t seem to be helping, then look at switching. If you’re getting your medications from a primary care doctor and their not working, then perhaps see a psychiatrist. They might be able to recommend a medication that can be added as an adjunct to help boost things and give you what you need.

If absolutely nothing is working, I have some episodes where I talk about options for treatment-resistant depression. In episode 107, I cover a variety of options. In episodes 137 and 138, I go into detail about ketamine infusion treatments. Since those episodes, eskatamine nasal spray has been FDA approved, so you may be able to get it covered by your insurance.

So again, you’ve been going through a lot of shit for quite a while now. Your mind and your body is having a hard time trying to be “normal” and that is totally understandable. I know you’re suffering, but you are not doing anything wrong by feeling this way.

Take the steps to see if this is really the end between the two of you. If so, treat that as fact and act accordingly and don’t string yourself along indefinitely. Don’t give up on treatment, and do whatever you can to take really good care of yourself during the point in time. And if the things that you’re trying aren’t working, then try something else. 

I have a lot of hope for you and I’m really sorry for what you’ve been going through. But you’re going to be okay and I think you’re going to get through this. Thank you for the really good question.

Hi,

Thank you for all you do with your podcast. My best friend and I listen to them and they are so helpful. I had a question for you. I know you don’t touch on eating disorders much in the podcasts. I have struggled with one for almost 10 years. I am 20 weeks pregnant with my son, Leo, and I couldn’t be happier. While I know it is important to eat for him, and I have been able to very well, I still find myself with the thoughts and urges. I was hoping you could talk about this or give some advice. Thanks!

I’d love to talk more about eating disorders in the future. This is not my area of specialty, so I’ve been trying to find a good expert to talk to as a guest. I had someone lined up, but they weren’t able to make it to the interview and so the search continues. I’ll do my best to address your question here, though.

First off, congratulations! You said that you are happy with your pregnancy, so that’s awesome. My 1.5-year-old is also named Leo. Not short for anything, although I make up names for him all the time.

You matter

You’re well into the journey now and it sounds like you are doing a great job. It can be super scary to be pregnant with something like an eating disorder and it doesn’t help that the world puts so much pressure on you to be this perfect vessel for your unborn child. I just want to reassure you that there is no such thing as a perfect pregnant person. The world will try to make you feel so guilty for simply existing and being your own independent human while you are pregnant, but don’t forget that you are a person too and you matter so much.

The other thing is that your eating disorder doesn’t go away when you are pregnant. For some people, hormonal changes definitely change the way symptoms present themselves and interestingly, people struggle a lot less while pregnant. However, you are allowed to be pregnant AND have an eating disorder. This gets into something that I talk about with therapy patients of mine all the time. There is a difference between thoughts or urges and the actions that you actually take. For instance, take someone in a romantic relationship that is fantasizing about cheating with their neighbor. There is a certain level of this that is normal. At the further end of the spectrum, it may be indicative of something problematic. Either way, there is a huge difference between feeling the urge to do something and making the decision to actually do it.

I often talk to people that feel super guilty because they feel a certain way when in reality they are doing such as good job of letting that thought be there and not acting on it. All of the good eating and nourishment that you are doing doesn’t stop counting because you have this running background track of self-talk and thoughts generated by your eating disorder.

Mindful empowerment

I’m almost scared to say it because I am such a broken record sometimes, but mindfulness training can be very helpful in this situation. It can allow you to get better at sitting with your thoughts without being utterly terrified by them. For you, this could be very good because you may have these intrusive thoughts that are from your eating disorder while you’re trying to act in a certain way. If you give them all of the power, it will distress you, and possibly cause you to act in a way that you don’t want to act. However, if you’re able to recognize that you’re having these urges and they are allowed to be in the back seat while you do what you want to be doing, that can be very powerful for you.

Support is key – through the highs and the lows

You also will want to make sure that you are well-supported throughout this experience. Whether it is your partner if you have one, your family, your team of professionals, or all of them, make sure they are aware of how you are doing. The last thing we want is for you to struggle in isolation and to hold off your urges by white-knuckling it for as long as you possibly can only to snap later and fall into a hole of disordered eating behaviors.

I would love it if you let them know the positive and the negative. If you are doing great, tell them that. Let them praise you for it. You deserve kudos. This is hard shit! You are doing an amazing job, and if you are reinforced for acting in the way that you would logically like to despite what your emotional gut reaction is telling you, you may be more likely to act that way moving forward.

If it does turn out that you are struggling enough that you are at risk of slipping up, having people that you can reach out to in a moments notice to simply support you and encourage you to keep fighting can be the difference between a tough day and a hospitalization. Either way, even if you do turn to some of the behaviors that you are trying to avoid. Even if you have to take a trip to a treatment program. That doesn’t make you a bad parent. That makes you a parent that is trying their best to keep it together, and for the most part succeeding, despite this epic uphill battle that you have to fight every day.

So keep it up. Make sure you have the resources and support that you need. And don’t beat yourself up for actually succeeding even though it is hard for you.

I will cross my fingers for a smooth rest of your pregnancy and an uncomplicated birth. Congrats again!

Hi!

I’m 59 and my husband and daughter (38) think I have BPD. I’m a super novice with psychology stuff. I’ve been in therapy with a psychoanalyst for 3 weeks. I feel like I’m not making any progress – like I am in a boat without a paddle. Can you explain what is the process, the road map, the timeline for when I may feel ok?

Thanks! I really appreciate and enjoyed listening to your podcast today on my 2.5 hour drive back from therapy!

Super proud of you for dipping your toe into the therapy pool. I think a lot of people who are in their 50s, 60s, and beyond don’t think about therapy as a valid option. Likely when you were growing up, these emotional and psychological things weren’t talked about as much as they are now. I’m also super happy to hear that people of all ages listen to this show!

So let’s address your question. You have been in therapy for a few weeks and have not seen any progress yet. It’s a common concern. I think it would be helpful to back up and talk about what BPD means.

What’s BPD?

BPD is borderline personality disorder. Personality disorders are different from other types of mental health issues because they are pervasive, they related to who you are as a person, and they can really affect your relationships. Typically they develop early on and are very resistant to change. In contrast, something like social anxiety or agoraphobia, which is still tough, can be much “easier” to treat than a personality disorder.

BPD, in particular, has to do with volatility in relationships, and strong emotional reactions that are difficult to regulate. You might see a boom and bust pattern with interpersonal relationships or things like agitation, impulsivity, self-harm, or other problematic ways of coping with these strong feelings. So BPD can be tough. There are definitely people who are on a spectrum with this, from mild behaviors similar to BPD to others who have full BPD and have struggled their whole life with really difficult relationships. But regardless of where you are on that spectrum, for you to not see any major changes within three weeks would be totally normal if BPD is actually what you are experiencing.

Consider different therapies

Regarding the therapy itself, there are actually many different types of therapy. If you are truly seeing someone who is a psychoanalyst, they are going to be more focused on looking into the past and how your behavioral patterns came to be in the first place. They might ask about your childhood and early experiences a lot to try and make sense of what is happening now. Someone with a psychoanalytic approach is probably going to be more focused on helping you develop insight into your issues rather than trying to find immediate solutions.

There are a variety of other types of therapy as well, and if you find that you don’t like the approach that your therapist is using, you are definitely well within your rights to try somebody else. I cover some of the most common types of therapy in episode 105. While I think that having a psychodynamic approach can definitely be helpful in working with personality disorders, since many of them have their roots in childhood, trauma, etc. you may need some more immediate coping skills as well. Someone with a cognitive behavioral or dialectical behavioral approach could be more appropriate for you at this stage. I talk more about DBT in episode 105, but it is actually a type of therapy that was created for the treatment of BPD. It involves a lot of skills to help you regulate strong emotional reactions.

Building trust takes time

One thing to keep in mind is that successful therapy most often requires a strong rapport and working relationship with your therapist. I’m assuming that three weeks means three sessions. For someone that likely has trouble trusting other people due to your mental health issues, this may simply not be enough time to develop a strong trust in their ability to nonjudgmentally support you and hear your deeply personal history. If you have a bad vibe from the person or don’t feel like they are right for you, you can definitely go ahead and switch to someone else. But if you are not sure yet, give it some more time and see if things start moving a little more once you are able to build that trust.

As for the process, roadmap, etc. That is going to be different depending on your individual issues and the person that you are working with. As I said, personality disorders tend to be resistant to change, so this is probably not going to be a quick fix. However, it may be that you can pick up some skills and different ways of looking at things to create some immediate change and relief while you also work over time toward lasting change. Either way, you are not hopeless and you’re just starting to scratch the surface of the possibilities at this point.

Making the most of therapy

In addition to the therapy, I think it would make sense to start diving more deeply into self-help resources. Maybe you could buy a couple of books, watch some videos online, or attend some local classes about what you are going through. This will help you generalize the things that you are working on in therapy.

The last thing that I will leave you with is a tip. This goes for anyone. One great way to make the best use of therapy is to talk about therapy itself, your relationship with your therapist, and how you think things are going, WITH your therapist. Talk about it in the room with them. This can be really powerful and will help you course correct if needed and can really amplify the work that you are putting in.

I’m really proud of you for getting into this, starting therapy and trying to make change for yourself. Stick with it and don’t feel like nothings working as it’s still early days. What your experiencing so far is very normal. Trust your gut and keep at it!

Thanks for listening!

Got a topic or a guest you’d like to appear on the show? Or interested in having Duff answer a question on the podcast? Email Duff at robert@duffthepsych.com and maybe you’ll hear it on a future episode!

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