Cognitive Processing Therapy 6.1

skinned knee
I have lived in Factoryville for almost seven years now. I have run one of the same routes probably a hundred times over those years. I have a few favorite runs, but this one, the one past Keystone College is quiet and has options for extending or shortening the run depending on how I am feeling. About ½ mile from my house is a rough patch of sidewalk before you get to the college. The sidewalk itself is smooth, but the slabs are uneven. One sits higher or lower than the next making it unpredictable. You really need to pick up your feet and watch your step to make it through unscathed. Years of running this route has made it simple to navigate though.
About three years ago, on a really hot summer day, I took off down the road carrying two water bottles and the idea that I would run until my body gave up. I think I was listening to music that day trying to get the negative self-talk out of my head when I hit that rough patch of sidewalk about ½ mile from my house. I took the first several slabs in stride without thinking or noticing, but my toe caught one particularly high step (if you live in Factoryville and walk or run down College Avenue toward Keystone College, then you know exactly which spot I am talking about), and I went down. Hard. Remember, I was carrying two water bottles. My knuckles were a little bloody, but my knees were scraped deep into several layers of skin. I looked down and saw the blood start running down my leg, but I had no sensation of physical pain. I stood all the way up, grabbed my water bottles off the ground, and walked back down the road toward my house. By the time I made it home and looked at my legs the blood and sweat had run together and poured into my socks.
Some days are like having years of experience running the same route; nothing can stop me, and I fly down the road, up the hill, and into the woods like I own it all. I am unphased by uneven sidewalks, hills, or slippery gravel. The path is familiar. I know every landmark, every half mile of that run, which houses have the nice dogs, who will give me water if I need some, and where the blind curves are for cars. That is what I am hoping for in CPT. I want to identify a stuck point, be able to fight it logically, and walk away believing the new conclusion I was able to make.
Right now, I get tripped up by the sidewalk and bloody my knees, struggle to make it to the next marker or telephone pole, get dehydrated and have no water, get chased by the Doberman/German Shepherd mix, get run off the road by the cars flying around the curves, need to walk up the entire hill, and have to skip the extra trail run at the end because I’m just too damn tired. That is realistically what CPT is for me. A struggle.
In my most recent session (I am calling it session 6.1 because my last session was considered the halfway point progress check), I had to choose a stuck point to work through with my therapist. I identified how true it was to me (100%), what happened that led to the stuck point (the event), how I felt relative to that stuck point (shame and guilt), and to what extent I felt those emotions (100%). That was easy, I had to complete that as homework early in this process. The next section was to complete the challenging questions. I completed this as homework as well. My therapist asked me question one: “What is the evidence for this stuck point being true?” I provided my evidence. She asked more questions. Socratic questioning, to make me think and question my beliefs. It helps, usually. I wasn’t trying to be difficult, but I could not grasp that anything else could possibly be true except what I currently believe. The questions all seemed vague, and the answers all seemed muddy, complicated, and messy. Sometimes I think the only way through this process is to just explain everything that happened, but I don’t know if I can handle that. Some details aren’t there, and some details are too vivid and painful to think about. When I do think about the details, I can feel myself stiffen into immediate muscle armor. I feel the guilt and shame, but I also feel fear, like it is happening right at that moment. I can’t escape the thoughts, sensations, and emotions. I also feel pain because others have their own ideas about what would make the assault my fault, and most of the time when they express their opinion it is in favor of me being the one who “asked for it.” If everyone around me believes that, why should my therapist or myself think any differently?
We did not make it any further than that point, and I had no new conclusions or thoughts. In fact, the flashbacks I was having and fighting through during the session only further solidified my original thoughts that I am to blame. The guilt and shame were intense, and the raw feeling from re-experiencing what happened claimed ownership over me. I cried. It seems to be happening a little more frequently. I hate that. I hate when other people see weakness in me. I don’t mean to say that crying or vulnerability is weak, but I do mean to say that not being able to handle how I am feeling seems weak.
So, I walked out of the office, down the stairs, and out the door feeling like I had been hit by a bus. I felt a little like I was going to dissociate but mostly like I should call my neighbor and ask her to take Ian until Tim came home, find a quiet place, and end my life. Maybe that is hard to read, but I am trying to be as honest as possible in this process. So, maybe read it again. When I say that this process is hard, I do not actually have the vocabulary to express just how difficult this is for me.
I knew I needed some help. I couldn’t figure out how to get it. It reminded me of my favorite movie growing up: Ernest Goes to Camp. A group of juvenile delinquents from a nearby facility were invited to Camp Kikakee as a second chance opportunity, but all the counselors and campers referred to them as the “last chance boys.” One of the delinquents, a tiny little guy referred to as Moose, could not swim, and he stood on the dock terrified to jump into the lake. The lifeguard saw him standing there, and with no compassion picked him up, threw him in the water, and walked away. Moose started to drown. In between gasping for breath, going underwater, and flailing, he was able to call out for help. Just like Moose, I felt like I was thrown in the water, unable to swim, and left to figure it out. I was gasping, going under, and flailing. I started to wonder if I was worth being pulled out of the water. I thought about stopping my flailing, going under, and pulling in as much water into my lungs as possible. I tried to reach out, ground myself, use coping skills, and work through pros and cons. The more I tried, the more angry and frustrated I became.
I did eventually make it to the dock. I’m still here. It was not pretty. Truthfully, it was rather ugly.
I am still trying to get up the hill, but because of how CPT works, I am not sure if my therapist believes that (or if any therapist trained in CPT would believe that). Everything I do or don’t do tends to be seen as avoidance. That seems unfair, but I understand. Maybe I am crawling slowly when I should be walking. As a runner, I know how frustrating it is to run with someone who slows down when they are capable of going harder and faster. This summer, my son started running with me. He was running a decent mile for his size and age. One day, he refused to run. He increased his mile time by four minutes. I was really frustrated that day, but he was really frustrated too. He felt like I was pushing him too hard and picking on him. In CPT, as the runner who slowed down, I am frustrated with the process. I am frustrated with myself. I am frustrated with my therapist.  It is true, I am not running. I am not walking. I am not even sure if I am crawling. But, I am certain I am still moving. I need that to be enough, but I am not sure if it is.
A week after I tripped over the sidewalk and walked home, I went out for the same run. I stumbled over the same exact spot on the sidewalk while holding water bottles. I looked down at my now deepened gashes, grabbed my water bottles, and continued running. With bloody knees, frustration, insecurity, and embarrassment I stood up and kept going. That is what I hope for myself.

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