- Alex, Ambria, and I all discussed that Ambria’s boyfriend is very important to her, so she needs time to talk to him every day. Alex wanted her to see him, but we are concerned for our safety since they refuse to wear masks around one another. Phone time was a compromise.
- Ambria now gets to have 30 minutes to talk with friends as part of her coping skills
- She talked her 30 minutes and ended up a few minutes before 7pm
- I’ve started carving out the evenings from 7pm for my own self-care time. This gives me about enough time to get in a work out and get ready for bed.
- At 7:35, she started asking me what I was doing
- I replied and reciprocated the question
- She told me she didn’t feel very well
- I asked how she felt. She said she was depressed because she has nothing to look forward to.
- I asked why she felt that way and asked if she wanted to come talk about it.
- She said she didn’t have much to say and that there wasn’t much “fun” happening soon
- She said it feels like time is going slow and fast at the same time
- I gave her my perspective as an outsider: that she planned to move out in three months and that would be a huge change
- She said that seemed too far away
- She said she was also hungry because she didn’t eat much for dinner
- I asked if she ate the ramen we bought for her (Tiffany normally makes dinner and has it ready when I get home with Ambria but didn’t feel well today, so we ordered dinner.)
- She said she “barely ate any.”
- She said she felt like eating but didn’t know what
- I told her it was late for eating and that her body wouldn’t metabolize it
- Then she said she was restless
- By 8:13, she was saying she wanted to call someone
- She slowly escalated, noting that she “hated this feeling” at 8:21pm.
- I asked again if she would like to come talk. She declined saying there was only one thing that would help and she “can’t have it”
- I relayed a time when there was only one thing I wanted that I also could not have to let her know I relate to that feeling. I got a sense I was being baited into asking what the thing would be.
- Her understanding that she “can’t have it” quickly pivoted to entitlement as she said she “should be able to have it if (she feels) like (she needs) it to cope”
- I told her it felt like I was being baited.
- She said she “(didn’t) want to upset (me)”
- I made it clear that I understood what she was trying to do, that it was nearly bed time, and as a result, it probably wasn’t relevant what she wanted because it would be too late to fulfill. I told her I was frustrated that she hasn’t been able to put together a single day since she got back of just doing the basic things she’s supposed to do: keeping stuff out of the floor in her room, getting to bed on time, being ready on time to go to PHP, doing her one chore…
- She then abandoned the ploy and asked outright if she could please talk to Kian. He’s the only person she has been calling with her time, so she had just finished talking to him a few minutes earlier.
- She noted that talking to her friends was one of her big coping skills. I felt like I was being manipulated.
- She said, “I don’t know what’s wrong right now, but I need it to go away.” The implication was that Kian was the only thing that could make whatever this mysterious thing was go away. That was later stated explicitly
- I asked her to come up and discuss. I told her I wouldn’t have long.
- I tried to focus on what other coping skills she could try. She first told me she had tried all the others and they didn’t work. Later, when I pulled out the list and started going through them to try to understand what she had done, she said she knew they wouldn’t work and that Kian was the only thing that would help.
- I was continuing to focus on other skills.
- She said everything she wanted to say. When I began to respond, she got mad that she wasn’t hearing what she wanted to hear, so she left.
- She wanted to continue discussing via text. She went back to the very beginning, as if I had never said anything to her.
- She told me that she was OK to hear what I was saying, but that I was making things hard. I was being calm and patient. The only thing I can imagine she might not have liked is the content of what I was saying.
- I told her I would continue to discuss if she was willing to hear what I had to say.
- When I tried to probe deeper, she said I could never understand why Kian was the only person that would help, the implication being that I shouldn’t be questioning this. She also told me I’m not a therapist, again to try to discourage any questioning.
- I asked about other people on the list, like Tiffany. She said Tiffany was good for some problems but not this one.
- The rest of the timeline is fuzzy.
- She became more and more insistent that she had to talk to Kian
- She was beside herself, crying and was continuing to escalate. I calmly told her she was escalating. She said, “You’re fucking right, I’m escalating.”
- She became violent. She screamed and cursed. She pounded the walls, apparently trying to damage them.
- I came downstairs at one point to catch her going through a kitchen drawer. I asked what she was doing. She replied, “What do you think I’m doing?”
- I took all the blades out of the kitchen and put them away
- I began to worry about all the things that might be in her room
- She had shut herself in the downstairs bathroom at this point, so I used the time to start going through things in her room to see if I could find anything that might be harmful. (I did find quite a few items: scissors, paperclips which were an item she has said before she has used for self-harm, and several other sharp objects)
- She came back up and began to pound on the door. I told her to top and that she would damage the door. She tried to push through the door and ultimately through me to get into the room.
- I told her she would not be able to talk to Kian any more if she did not go back down. She went back down.
- I spent the next 2 hours going through everything in her room to find every potentially dangerous item I could.
- I have no way to properly secure all of these, so I have myself literally barricaded in a room with the items (since the doors are trivial to unlock)
- Once I was done, I woke Ambria up to make sure she had taken her medicine and asked her to take her shower and go to bed while she was up.
- She said she didn’t want to take it now and wanted to take it in the morning. She tried this when she first came back and nearly made us late for PHP with it. I told her she knows she isn’t able to take the shower in the morning. She finally relented.
- I emailed Alex to ask for a meeting tomorrow
- I am getting to bed now at midnight to get up tomorrow at 6am so I can start work for an hour before I take her to the program for the day.
Concerns
- It feels like Ambria has a giant list of coping skills and strategies that will not get used (She absolutely can’t warn me to put up sharp objects. She admitted that when we were in the moment and after she had been searching for them.)
- Among all the coping skills, only one is ever going to be sufficient.
- If the boyfriend is the only coping skill, what happens if they break up? What happens if he’s not able to talk some evening? Is Ambria’s entire life really hanging by that one thread, and that’s what we’re going to encourage?
- She understands how it would look in to say in therapy that the only thing that can help her is her boyfriend, so she pads the list with items that she does not seriously intend to use.
- The safety plan is a magic lamp Ambria can rub to get anything she wants, anytime she wants it, so long as she can get that thing into the plan.
- It feels like she has a gun to our heads, and Ambria understands that.
- This meltdown felt just like a meltdown from before Pathlight in which she begged me to have her vape and marijuana back.
- It seems like dependence is being pitched as the solution to her problem instead of another problem. We’ve swapped chemical dependence for interpersonal dependence on a high school relationship.
- All these plans and skills go out the window as soon as Ambria comes up against not having the final say. What will this be like in 3 months when she’s on her own? Will she be able to leverage mental health to get extensions on her rent or to be able to come in to work late every morning or to get out of a ticket for littering? What happens if she has a crisis during a busy moment at a job and can’t call her boyfriend right away? What if she’s asked to wait until after her shift?