Prepping for Trauma Work

One of my main reasons for going to therapy is to work on the trauma that I have experienced in my life. For me, I am the type of person who has stuffed every negative feeling and event so deep within me that I have become emotionally disconnected from it. This causes nightmares, flashbacks, dissociating, anxiety, and more; however, in order to stop all these things, I have to unleash all of those things that I have stuffed; the things that are creeping up when I don't want or expect them to. So, how do we prepare for trauma work?

As I have mentioned before, I am currently going through my timeline, which has been no easy task. As we have gotten closer to my high school years and beyond, I have had this impending sense of doom and high anxiety knowing that my most severe trauma is coming, and I will have no choice but to talk about it. If I don't,  all of the bad things will continue, which would ultimately impact my ability to live in recovery. Now, I am at that point.

Tomorrow, we are beginning work on one of my biggest traumas. I spent a lot of time in PHP talking about it, as this event has had a profound effect on my ability to cope and what I choose to cope. I even did an hour long psychodrama, because it was the 9 year anniversary of that day in March. So, I have been mentally preparing for this moment over the last week or so through positive self talk ("I talked about this before. I can do it now") and telling myself that it is necessary for my recovery. It's just knowing how deeply angry and sad I am about this that terrifies me.

Here is a sparknotes version of this story, as I am not comfortable sharing all of these details on such a public platform. My sophomore year of high school, I had just moved to Maryland after a few years in Wisconsin. In March, 4 months after I had moved, someone I was close with in Wisconsin committed suicide after his battle with mental illness had gotten too hard. In hindsight, there were obvious signs that were clearly ignored by his parents. At 14, I knew something was wrong but didn't have the capacity to do anything about it, especially from another coast. This was my first major loss, which also kicked off the horrible trend of many of my friends dying way too young (He was 18). I had no idea how to cope, but that wasn't what made this so bad; it was the fact that his parents blamed for it. In their eyes, I was the reason he committed suicide.

Most people hear this story and automatically say, "What the fuck was wrong with them?" As an adult who has lost more friends to suicide since, I honestly feel like they were looking for a reason, as most people do in these cases. People always look for the reason that this person has chosen to end his or her life; however, we rarely find that answer. But 10 years ago, that insight wasn't there. At 14, I had no ability to cope with a death, let alone the responsibility for it as well, and I held onto the blame for his death for years. The worst part is that I never showed that guilt and pain. I had learned that it is wrong to show emotions, so I stuffed it deep inside me where I wouldn't have to deal with it. Then, I chose eating disorder behaviors, alcohol, and drugs to feel numb.

The thing about unpacking these feelings and trauma is that it is a tedious and delicate process. It's like unpacking that box of your grandma's china. You are so careful to unwrap each little piece, because even the slightest rushed movement could cause it to break. You can't rush through it; you have to do it one piece at a time. If you don't, everything could be ruined. Trauma is the same way.

I can honestly say I rushed through this event in my treatment the first time around. I spent 3 days talking about it and feeling that pain for the first time in 9 years, but after that, everything switched off again. This was also due to other things that had come up; however, without giving this trauma the time and care it needed, it got repositioned and packaged back up in that china box. A piece or two came out, but most of my trauma set is still there.

I think the best thing we can do when preparing to talk about trauma is to approach ourselves with kindness and compassion. These things have had a major impact on our lives, and they can't be fixed overnight. That is one thing I have to continually remind myself of. As much as I hate feeling things long term, if I don't continue to feel them, the negative effects will be worse than the feelings. Trauma happens to us. We do not cause them. We do not have responsibility for them. We should not blame ourselves. While all of these things are much easier said than done, they are important to recognize. Trauma occurs to some degree in most people's lives; however, it is our ability to discuss and work through it that helps us succeed in this journey towards recovery.

Wake Up Call

Throughout my time in treatment and in talking to people who have successfully had longer periods of time in recovery, everyone has said that recovery is like a light switch. One day, you'll wake up and realize "What am I doing to myself?" and that's how you transition to focusing on recovery. In some ways, I agree with this; however, I don't know if I have ever truly experienced it.

The last time I was in treatment, it was my time in the hospital away from treatment that was the catalyst for my recovery. Being away from treatment made me realize that maybe I could successfully do things on my own. I didn't need to be there 6 hours a day, 7 days a week anymore. Also, being around others who were deeper in their eating disorders than me was incredibly triggering at that point.

This go around in treatment, I've been pretty stagnant. While I have been making good progress in my individual therapy, I haven't really done overly well with my meal plan or battling my eating disorder thoughts. Being of my stomach issues, I have days where I just generally give up on trying to follow my meal plan and focus on making it through the day; however, by restricting more, my body only gets worse, not better. I have more days where I am doing better on my meal plan, but I honestly don't think I have had a day where I have successfully completed all snacks and meals since I re-entered at the beginning of September. It's just trying to figure out if IOP is really helping?

Then, I received an e-mail from my therapist yesterday saying that they are threatening to discharge me because of my lack of progress and the number of days I have missed treatment to stay at work instead. I understand that. I fully admit that I have not been the most committed to treatment lately, but it is not because of my eating disorder. I think I might have had my wake up call.

In the days I have actually gone to IOP, I haven't found them the most effective. I have had more success with my individual sessions rather than the supported meals and groups. It ends up being more of a chore to go each day rather than providing the benefits that I need. So, what do I do?

Today, I feel more clarity in my mind than I have in a few months now. My eating disorder voice is quiet today. For the first time in 2 months, I have actually exceeded my meal plan, and I don't feel that guilty about it. I challenged myself by going to Target and actually spending some time in the grocery section. I attempted to avoid looking at labels and calorie counts, but still did on a few things. I bought a variety of foods that I can actually eat over time, rather than just a week. My stomach finally doesn't hurt today, even though I was sick most of last night. All in all, this is the first good day I've had in a long time. Nothing amazing has happened. Nothing has really changed. It's just a good day.

Maybe the wake up calls don't always come in when we expect them to, but it could be that the come in right when we need them, even if we don't realize it ourselves. I am a firm believer that everything in life happens for a reason, but it doesn't always make sense in that moment. Eventually, it always does. Maybe this wake up call is going to lead to bigger and better things and a healthier journey on my way to recovery.

Falling for Triggers

ED has a sneaky way of coming up when you least want it to. Triggers surround us every day in our lives. Even people without mental health problems face them. The slightest things set off memories, feelings, behaviors, etc. For me, triggers have been all over the place this week, and I've done kind of okay at managing them. It's just led to extreme anxiety, body checking, and a lot of ED thoughts.

My biggest trigger this week has been being sick. For the record, there are gross details following. So, if you don't like bodily functions, skip over this paragraph. TMI:
 Over the weekend, I could tell I had a UTI, but kind of let it go. I took some cranberry tablets, and drank vodka/cranberries at the bar. Nothing seemed to help. Then, it came to a head on Monday night. I was at cooking class and was in so much pain that I could barely sit, let alone stand. I typically can't stand through cooking class with my heart problems anyways, but this was worse. Then, I went to the bathroom and saw blood in my urine. I spoke with the dietician and off to the emergency room I went. After 2 hours of waiting, I had a 5 minute conversation with a doctor who prescribed me antibiotics and sent me on my merry way. I took off from work on Tuesday to rest, but I could feel increasing pain in my back. By Wednesday, it was unbearable. I worked in the morning, but left early to go see my doctor. 2 hours later, I was in a CT machine getting a scan to see if my kidneys were infected. The next day, I got a call saying they were clear and was given a script for hydrophone to help the pain. About 7 hours later, I was in urgent care again, because I was throwing up and passed out. The doctor did some tests and suggested that my UTI had cleared, but there was probably something on my kidneys that might not have been strong or big enough for the CT machine to see. I went home, threw up some more, and then went to bed. I took off Friday to rest. Today, the pain finally started to go away. Now, I'm just exhausted.

So with all of that crap happening to my body and the pile of medications I have been taking this week, eating hasn't been my favorite thing to do. It's been really hard on my stomach and hard to eat to make up calories after I've thrown up unintentionally. It's a difficult battle. My ED voice says I can just skip all of those, and it'll be fine. Skipping a few meals this week won't hurt. It'll actually help me look thinner for my brother's wedding next week. All the crazy talk.

Trigger two actually has been my brother's wedding. It's knowing that it is going to be a heavily photographed event. These pictures are going to be ones that last forever. I am just so terrified of looking fat in them that I want to restrict to make sure I look the best that I can. Rationally, that's insane, because my dress is wonderful and flowy. It'll hide my least favorite area of my body, so I can rationalize that it'll be okay. It's also just a lot of people with a lot of eyes on me. This will be the first major event since I went through treatment. I mean, I've seen my family, but I am also seeing a lot of people that I haven't seen since before I went to treatment. So, it just makes me nervous. I just keep telling myself that I need to focus on TJ and not myself that day. Maybe that'll help.

Trigger three has been my isolation due to being sick. I have spent a lot of time in my apartment by myself this week. I consider myself an extroverted person. I thrive on being social and communicating with people face to face. When I'm alone, I tend not to eat, because 1) my hunger cues really come and go. They haven't been consistent in a long time. 2) No one to hold me accountable. 3) I have never really been a person who eats when they're bored. Isolation and people not reaching out to me leads me to feeling unworthy or useless, which isn't even close to true. My feelings just get the best of me sometimes.

So, how do I cope? I wrote the massive letter to ED blog yesterday, which was really had an impact on me. I had done similar exercises in groups during my first round of treatment, but always had a time constraint on it. I also don't think I was at the place to be able to do it back then. I would love to expand it for me personally with more details about some of those situations, because I think I need to. It was my way of starting to connect to that story and begin to somewhat feel everything in my life. I'm also writing this blog today as accountability. In addition to blogging, I've been watching a lot of horrible reality television. I learned that Undercover Boss makes me cry like a baby, and Intervention makes me miss my life of being a therapist. I've thought about signing up for dance classes and challenging what might be the most triggering thing for me. That'll probably be a blog in itself one day. I've listened to a lot of music, and taken a lot of showers.

This week has proved to me that I am probably stronger than I give myself credit for. I have strongly considered myself a survivalist for a lot of the crap I've been through, but I have also turned to really negative coping skills in the past. I didn't turn to any of those this week. I thought about having a drink to unwind, but I know that drinking on antibiotics and pain pills is an overdose waiting to happen. So, I didn't. Honestly, I haven't had a drink in over a week, which hasn't happened since the first time I was in treatment. I also don't have the craving to drink anymore. I haven't done cocaine in a while. I didn't try to exercise through the pain while not eating. I even took off work which, if you know me, never happens. I'm a workaholic through and through. I engaged in appropriate self-care. Surprising, I know. I surprised myself with it too. Maybe I am capable of all of this without turning to ED.

Triggers will come up at the most inopportune moments for all the wrong reasons. But if we can learn to engage in appropriate self-care and coping skills, they become easier to manage. Those skills will become a necessary ally in the battle against ED in the fight for recovery. Even though I did engage in some behaviors this week, I know it will be okay. I may fall, but I can always get back up and make the choice for recovery.

A Letter to ED

ED,

When I first met you 10 years ago, I had no idea what I was getting myself into, but I knew you would be trouble. You came into my life when I felt like things were getting out of control. After years of being anxious, you came into my life to calm me down from the life changes that were happening around me. For the first time in my life, I found the one thing that made me feel safe and protected. The first meal I skipped, I knew I was hooked. Your voice in my head encouraged me to keep going with empty promises that I thought would be fulfilled. The promises of love, adoration, and fulfillment had me completely indentured to you, and I was willing to follow you everywhere. Even in the times when I left you behind, you would always find your way back in. To me, you were the perfect relationship: something that would never leave me, always support me, and give me the self-love that I desperately needed. Little did I know how much you would destroy my life.

You came into my life at a very opportune time. After a year of being horrifically bullied, I had just finished a year at a brand new school where I found friends that supported me, classes that challenged me, and a new love: theater. I was finally beginning to work on my identity in high school. It was time to become more independent and figure out truly what I wanted to do and who I wanted to be. Then, life happened, as it always does. My father was leaving again for a year long tour in Kuwait. It always felt like abandonment to me, even though it was just the lifestyle of being a military brat. Not only did I fall into my typical pattern of shutting down, but I was lost. I was stuffing everything so deep inside of me that it became invisible. I was able to continue being with friends, doing theater, and doing well in school, but all that stuffing caught up to me and I felt empty. Then, I had a health class that talked about eating disorders. Anorexia stuck out to me as this beautiful concept. I was intrigued. I wanted to learn more about it, and maybe even try it. That curiosity led to the internet where I saw "thinspiration" and saw that maybe I could be one of those girls that were being supported and praised just by being thin. That didn't seem so hard to me, especially because I was already on the thin side. It was all so tempting, and I fell head over heels for you.

That year, I lost enough weight to feel fantastic about myself. I was getting responses from friends and family about how great I looked, because I was thin, but in shape. I felt in control of my life for the first time in years. I was able to decide how I wanted my body to look and the ways I would do that, which was skipping meals and counting calories. On the outside, I showed everyone how great I was doing, but on the inside, a battle was raging on. That year, I was cutting, exercising, and spending hours listening to you tell me that I still wasn't enough and that I wouldn't be until I lost more weight. On top of that, my constant need for change was starting to creep in. I was maintaining in a sick twisted world, because I had all of these unfulfilled needs. It didn't matter though, because I was thin. You were my best friend, and there was nothing else that mattered. Finally, my life became more in control. My father returned from Kuwait. We were moving to the DC area, and I was able to let you go. I had to to focus on my friends and making the most of my time before another move, because I had learned that once you say goodbye, things change. Relationships will end. Your best friends then won't be your best friends later, because you'll lose touch. So, I had to focus on my friends, because I felt that they wouldn't be there later. I would have a new life in Maryland, and I would leave it all, including you, ED, behind. Little did I know that I had been ingrained with triggers, and you would show up when I would least expect you.

In March 2006, you were there for me when I experienced my first major loss. After weeks of communication and crazy talk, Mark was gone. Suicide is a tricky concept, especially when you're 14. Even trickier when someone would say you contributed to the reasons for it. Again, at 14, I had no capability of processing what was happening. Then, you were there, just when I needed you again. You came in and comforted me in a way that no one else could. My friends were so supportive, but I had no idea how to verbalize what was going on. Also, my life was so busy that I stuffed it, put on a brave face, and kept going. ED, you were there to help me cope with this loss, and it helped me survive in order to keep doing well. 

After a few months of being with you again, we had a new struggle to face: health problems. Starting in 8th grade, I had always been told that I had asthma, but inhalers never seemed to work. This came to head my junior year when I would begin hyperventilating during classes with no warning. After seeing multiple doctors, spending hours in the emergency room, and just freaking everyone out, I needed some answers. You took a seat on the back burner, so I could have enough energy to see everyone and get some help. Luckily, one doctor randomly knew about Vocal Chord Dysfunction, and I was able to regain control. With that diagnosis, I felt like I was able to better handle my health issues, and didn't need you to help me control my life. I was capable of doing it again. So, we parted ways again... for now.

Recovery is a beautiful thing. I spent a year and a half living this beautiful life with my friends in Maryland. Then, we moved back to Wisconsin, and for the first time in my life, I returned to those best friends that I had desperately missed. For the first time, those attachments weren't broken. I spent my senior year with my closest friends and began looking at new opportunities to have this great life in college. For the first time, I felt confident without you. I was in control of my destiny, and nothing was going to stop me... Or so I thought.

My dream of going to college was slightly derailed for a variety of reasons. All of a sudden, I found myself applying to a local 2 year college to work on credits rather than moving across the country to start fresh. On top of that, my life at home was spiraling out of control quickly. My grandmother had been diagnosed with a brain tumor. My dad became this completely different person: one I didn't recognize, let alone had respect for. Then, October came and so did you.

October 2008 is potentially the worst month of my entire life. My father left to live with his parents leaving behind a grieving family trying to grapple with our first grandparent with cancer. My grandmother deteriorated quickly. Everything was falling apart. I did what I always do. I took 17 credits, worked at McDonalds and the VFW, and was involved in 2 musicals. Stuff it and keep going. It all came to a head the last week of the month. My grandmother died. This lead to actions and words by my father that made me lose all respect for him, and the beginning of the end of our relationship. When you grow up a daddy's girl, that's an impossible concept to even try and comprehend. Also, I started to take care of everyone else, but not myself. I worked as hard as I could to make sure that everyone else was handling these losses, and I put on my brave face and kept going. There you were to support me while I was supporting everyone else. You always knew exactly when I needed you to help me out. I relapsed and quickly got out of control.

Relapse is difficult, because not only do you fall back into these behaviors, but there's a significant amount of guilt and shame that come with it. I was also so ashamed of running back to you, because I knew on some rational level what I was doing to myself, but you felt safe. This relapse was particularly easy though, because no one noticed. It was me and you. You took care of me while I was taking care of everyone else. It was a beautiful partnership. This one lasted for a long time before we broke up again.

I met someone who finally threatened your relationship with me. I fell head over heels for someone else, but you were always there. You would tell me that I wasn't good enough for him... that he would never love me, because he was still in love with someone else... that the only way I would be good enough was to be thin. I did the dance between you two for as long as I could. You were there for me when he didn't know how to be. You helped me through losing Peter and Logan. You always did when I lost people. But, he was there for me in dealing with my father and trying to figure out what kind of relationship we could have, if any. He began to support me the way you always did. The first year was a constant battle in my head between who I should listen to. In the end, you won, but not for long.

My study abroad in Spain could not have come at a more opportune time. After taking a break from my romantic relationship, I needed some time to figure me out. I ran away to Madrid to see if I could have a life without him and without you. The 4 weeks I spent in Spain were the foundation to my identity. For the first time, I was in control of what I was doing, and it was an amazing feeling. After spending 6 years at that time with you always there in some capacity, I was able to let you go. I returned from Spain happy and healthy. I went back to my romantic relationship and was prepared to take on anything without you. This was short lived unfortunately.

Fall 2010 was another difficult time. I was randomly passing out, feeling like my heart was beating out of my chest when I would stand up, and just constantly miserable. It's really difficult to be in and out of doctor's offices and the Emergency room when the person who has promised to love and support you refuses to be there. Luckily, I didn't need him, because I had you. You became that love and assistance that I needed while sitting in emergency rooms by myself. You were there for me when I was diagnosed with Postural Orthostatic Tachycardia Syndrome and told that I would probably be on medication for the rest of my life. Without you and my mom, I probably never would have gone to those appointments. You only went to take advantage of my POTS, but you were still there. Then, as my relationship was falling apart and choices were made that drove us even further, you became stronger and stronger. My friends and family were so supportive, but it just felt like you were the only one who understood. I could hear all around me that I needed help, but I just couldn't seem to get away from you. My relationship ended, but you were still there. You faded a bit when I was able to spend time with my friends and become back in touch with my life outside of my relationship. Then, I had a life of fresh starts, and away you went.

Moving to Milwaukee in Fall 2011 was probably one of the best decisions I have ever made. I was originally going to commute for graduate school, but decided that I needed a new place to figure out what my life would look like since it would be nothing like I had planned. I was beginning a new life in a new school, meeting new people, and living in a new city where no one knew my dirty laundry. It was exhilarating. I didn't need you, because I was in control of my choices. Even when I lost 2 amazing people in my life a day apart, I was okay. One of those losses led me to someone who understood my relationship with you. Finally, I had someone who understood, and I didn't need you. I lived another beautiful year and a half in recovery. It wasn't perfect, but it was better than being in a full blown relapse. I had moments of weakness where I would dabble in behaviors and miss our relationship, but I knew that I needed a new life. I was doing well without you, and I wanted to stay that way. It did until I graduated with my Master's.

ED, you have always served as a wall between whatever identity I have and the things I have never dealt with. You have always protected me from feeling the things I never wanted to feel. You helped me stuff all of those traumatic events deep down inside of me. You made sure that, if I got overwhelmed by emotions, I wouldn't have to deal with them. We would skip a meal, and I would be fine. You did your job, and I was able to manage my life better... or so I thought.

After getting my Master's, I wasn't strong enough to hold back all of these feelings and memories from flooding me every day, especially when working as a therapist. Every day, I was speaking to people with some similar experiences to my own. It became draining to just be me and work with clients. There you were. Our relationship began again, but it wasn't unnoticed this time. Working with other clinicians, your presence was easily seen by my supervisor, who really pushed me to go to therapy. I went for one session, but I never went back. I was okay with that though. So were you. I had pseudosessions with my supervisor, which helped me be okay for a while, but you were still there. I entered a romantic relationship that challenged, but encouraged you as well. This built and built until one day, the switch went on. I knew I couldn't stay with you, but I knew I needed help to get out of it. With the help of my family, I got on a train, left everything behind in Milwaukee, and decided to look for a new life without you.

The first 2 weeks of treatment, I was still holding onto you. I would openly tell people that I would be there for a short period of time to go back to work in Milwaukee. In other words, I realized I had made a mistake and wanted to stay with you. Slowly but surely, rational me started kicking into gear, and I knew that I couldn't continue this relationship or I would lose my life. After experiencing so many losses, I couldn't put others through that. It also didn't seem fair to my friends who lost their lives too young. Here I was actively destroying my own life by choice. In the memory of my friends, that's just not fair. After 12 weeks in treatment, I was feeling okay with letting you go, but was still battling with depression. I felt like I had ruined my life by not being with you. It was my hardest break-up of all, but I have a new life in recovery.

Recovery is never perfect though. I ended up running back to you when I felt out of control, but I recognized it and got back into treatment. I always go back when I don't feel like I can handle things. But the truth is, I absolutely can. I don't need you to make me feel worthy of love, because I have friends and family who love me. I don't need you to help gain control, because I am capable of making my own choices and can handle when the unexpected happens. I don't need your voice in the back of my head telling me how awful I am, because there's no evidence of that. I just don't need you. So goodbye, ED. I will not miss you. This life in recovery isn't easy, but it's worth it.

Good riddance,
Heidi

How do you know if you have to go back to treatment?

How do I know when it might be time to go back to treatment? What are my signs of relapse and recovery? How do I know when to ask for extra support? What behaviors do I engage in at the beginning of a relapse? What are my triggers that may lead to a relapse? What are my thoughts related to when I am entering a relapse? Who can I call when I am struggling? How will I know that I need to seek treatment again? What steps can I take to get myself the help I need?

I had to fill out a 5 page discharge packet when I left treatment asking me all of these questions above. Lately, I've been looking back at it, because I can feel myself falling into a relapse.

It started slowly. I have felt for months now that the medication for my heart condition has not been as effective as it had been, even while I was in treatment. I saw a cardiologist, who was less than helpful, who recommended that I don't "reinvent the wheel" by changing my medication. So, I just decided rather than pumping medication into my body that isn't really helping, I would just stop taking it. This is typically one of my first relapse steps, as my medication slows my heart rate down from the normal resting rate of 120-ish.

What behaviors do I engage in at the beginning of a relapse?

Then, I caught myself providing excuses to skip meals, especially during the work day. "Sorry, I can't come too, because I just have too much work to do." "I am in the middle of something, so I can't go eat lunch now." "I need to sleep, so I will just skip breakfast to sleep in more." Any bullshit reason that was there I would use; however, I was eating larger meals at dinner of particularly unhealthy food aka take out to make up for some calories and the occasional snack during the day. I can always hear the voice of my last dietician in my head when I skip meals. "Do we need to place a tube?" No really. I would rather feel like shit eating all this food than feel like a failure for having a tube placed. But my ED mind takes over and those words fade away and I feel safe and warm in my restriction. The empty feeling in my stomach is like fuel to a fire to continue these patterns.

What are my triggers that may lead to a relapse?

All of a sudden on Friday night, I found myself waking up to the middle of a panic attack during the night. I had been having a nightmare when it started, and I woke up to hyperventilating, which is in my top 5 most terrifying experiences. Since then, I have been restricting often. I did eat at all on Saturday; however, I knew I needed to try and eat dinner. So, I ordered a sub from Jimmy John's, which feels safe and would be easy on my already anxious stomach. Then, I did something I swore I would never do. I purged. My M.O. has always been restricting. As I once told a psychiatrist who had placed me a 45 minute waiting time after meals before entering my room, "Does a serial killer change their M.O.? No, because it works. I'm not all of a sudden going to become a purger." Well, then that happened and it was totally overwhelming. I had a very difficult time eating all day yesterday with the amount of guilt I was experiencing. So, again, I ate very little yesterday. I don't own a scale, but I can tell I am down weight, and I love it. There's just still some fraction of a healthy mind left that says don't do it.

What steps can I take to get myself the help I need?

Last night, I went out with my brother and his fiance, because I have been isolating so much lately. I told them what has been going on, and they agreed that maybe going back to McCallum Place isn't to worst idea right now, especially with how off track I've gotten and my thought process that's telling me to keep going. So, I spoke with my boss this morning, who agreed to work with my schedule to allow me to do an IOP after work. Then, I made the call that I didn't really want to make. I called the same girl that I had done my intake with to say that I needed to come back and get some maintenance before things get so bad that I need to go back to a PHP like 6 months ago. This is a step that I really hoped I would never have to take.

How will I know that I need to seek treatment again?

When you realize that you're out of control and just can't keep doing this, I know that I need to go.