12 July 2017

Cognitive Processing Therapy - Week^HSession 2

It's actually been two weeks since session 1; what would have been week two was an off week. Social Worker had another commitment at my normal scheduled time last week, which happened to be noon the Friday before a four day weekend for Independence Day.


I've not been able to find it written anywhere that CPT has to be done in twelve consecutive weeks, including the VA's therapist manual, but having two weeks between sessions feels too long. One thing that I find helpful about this kind of therapy is that I can't avoid it-- there's going to be another session in seven days, and so I have to read the stuff and write the stuff. If I have two full weeks without a session, as happened here, that tension (or motivation) is gone and it's a lot easier to just avoid thinking about what I'm doing in therapy. Which feels counterproductive to therapy that's supposed to cause me to confront and counteract avoidance.


Several days before this session, SW called to see if I wanted to move my appointment time from 1200 to 1300. I managed to not call back; more on this in a bit, but I don't have a sense of time passing. If someone calls me it's very likely that I won't realize that several days have passed since the call came in. So it was already the day before the session this past Friday, and I figured I'd just go to the session at the (initially) scheduled time. I'd also received a postcard reminder in the mail with the initially scheduled time.

When I arrived at the clinic and tried to check in, the kiosk said I was too early. My appointment was at 1300, not 1200. So I went at talked to Front Desk, who said the same thing. After making it clear that I believed this was incorrect, I asked Front Desk when the appointment had been changed and by whom. After I looked at the call log on my phone, it turns out SW had called me, left a voicemail, and then changed the appointment time to 1300 the very next day.  Front Desk messages Social Worker, who doesn't respond. Looks at this point like I have an hour to kill.

At about 1200, SW appears at The Door; another patient is scheduled at 1200, but if that person doesn't show then I can still have my session at 1200. A few minutes pass, and SW appears at The Door again to let me know to come hither and proceed to The Back for The Session. If the 1200 patient shows up, we might need to rearrange things. (1200, unsurprisingly, never does show up that I'm made aware of.)

We discuss scheduling, including this SNAFU. I mention that I'd be much better off having the rest of the sessions actually scheduled, because my life runs on my calendar. I mention that I have no sense of time passing, that days and weeks and months can go by without my noticing. The best word I have to describe it is dissociation, but I'm not sure that this is accurate. "Zoned out" is perhaps another term to use, and short term memory (and/or loss thereof) may be involved too. I'm not sure. We discuss this a bit, and he doesn't seem to think it's PTSD related. There aren't any other factors like TBI or alcohol/drug use. I repeat, as I have before, that I've been tested for adult ADHD and the day long test was negative.

The result of the scheduling discussion was that I won't get the remaining sessions scheduled, but I will have them scheduled for the rest of July. There may be at least one more week where "due to other commitments" SW won't be able to keep the weekly schedule. When I let him know that a) we're already looking at mid-September for finishing the therapy and b) I'm planning to head back north at the end of September, I'm assured that we'll still finish and even if we don't it's okay to skip the last session. (No, it isn't okay, but I'll fight that battle later.)

I'm looking at MyHealtheVet as I'm writing this (7/11/17) and I have no future mental health appointments scheduled, including this week's session. Hrm.

It's crossed my mind not to include all of the details of scheduling and the waiting area and parking and all of that in these posts-- is is really relevant?-- but I've decided to include this stuff because it's part of being in the therapy. I feel as though it's often sugar coated, "oh you just do this 12-session therapy and you're better" and my experience says it's not really that simple.


The bulk of the actual therapy part of the session is taken up with me reading my statement on why I think the trauma (having missiles lobbed at my unit and the very real fear of chemical weapons being attached to them) happened. I actually wrote this out twice, and read the second version out loud because it was a bit more coherent. A short summary is that these things happened because I was in a unit whose job it was to be there, and because Iraq had invaded Kuwait (and, it was suspected, was considering going after Saudi Arabia as well), we were shooting at them-- therefore it was logical that Iraq was shooting at us.

I never actually got to read what I'd written on the other part of the assignment, writing about what effect the event(s) had on my life concerning safety, trust, power/control, esteem and intimacy with regard to myself, others, and the world; but since I did take the time to write it all out on my own, I still got some benefit from doing so.

Discussion from there centered on how I'm interpreting why the bad stuff happened, rather than on the specifics of the events that caused it-- how am I seeing the world? An example that came up was carrying a firearm. While there have been a number of cases where yayhoos with guns have showed up at public places and started shooting, the likelihood of needing a weapon that you're carrying in day to day life is rather low. The threat landscape for an individual carrying a firearm changes internally, because when you're packing heat you are also in different mindset than when you're not.

There's a subplot here, because I did a remote tour just before I joined the unit I went to the Desert with. A fair amount of my time during that 15 months was spent on exercises and training (which is normal and expected), all of which was directly applicable to my time in the Desert. I didn't do any training before shipping out for Desert Shield, because I really didn't have to-- I'd done all of the wartime training, with the exception of the mobile unit specific stuff, at the unit I'd just come from. So mindset matters a lot, and being in a place and a time where the USSR was not that far away wasn't all that different from going to Saudi Arabia where Iraq wasn't that far away.

One of my wartime duties during said remote tour was "runner", meaning I got to go outside and take stuff from my squadron to a command post and back. This of course involved a lot of wearing chem gear out in the elements. Driving a pickup truck in a gas mask with glasses insert, for the record, isn't either easy or fun. Doing so, including being outside during Alarm Black, also meant that I got a fair amount of practice at least pretending that whatever was outside my chem gear (which I was walking and driving through) would kill me in seconds. I had to demonstrate, that I could do that and my regular job in Mission Oriented Protective Posture (MOPP) 4, meaning the mask and hood and the whole getup. So it was in that mindset, that at some point I'd have to spend multiple 12-hour shifts doing my job in MOPP 4 after an attack involving chemical weapons, that I arrived in the Desert.

At one point, the powers that be came up with MOPP Alpha, which was "take cover, don mask hood and gloves, keep all skin covered". If you were caught outside, it was recommended that you wear your rain poncho. If chemical agents were detected, then go to MOPP 4.  To me it didn't make sense-- a few months before that I'd spent 12 hours at a time in MOPP 4 Alarm Black during an exercise, and now in real world you're telling me to basically just fake it? Aside from which-- imagine that you have a bucket over your head and you're wearing gloves like you'd wear snowmobiling. Now, wearing those, pull on an extra pair of pants, an extra jacket, and a pair of boots that you have to tie and keep in mind that you're doing all this knowing that chemical agents have actually been detected.

I am also reminded of a guy in my unit who was about 6' 5" tall; the pants legs of his chem gear weren't long enough, and the official recommendation was that he use duct tape to cover the several inches between the bottom of the protective suit and his boots. Imagine doing all of the above and then having to wrap your ankles several times around with duct tape.

So what we were really talking about in the session was (as I'm reading my notes) levels of safety and what could have happened vs what actually did happen. One of the reasons some officer in the Desert came up with MOPP Alpha was the likelihood of chemical agents actually showing up, the other was that chem gear was a finite resource-- the suit can be "used up" and for whatever reason there was a question about how many we had available. He/she/they looked at the situation and came up with MOPP Alpha.

As it turned out, there were officially no chemical agents dropped on us. There could have been, though, and that's the thing that's been stuck in my head all these years. When someone came running through the hallways of the bunker I was sitting in that one night like Paul Revere, telling us all to make sure we had our masks on, that's the moment I knew that shit was real. Whatever it was that prompted that person to do that, I don't know, but the only thing that makes sense in that context was that someone had detected something, or thought they had. History says otherwise. I'll never know.

The other difficult thing that came up was that I didn't have anywhere to run to for at least half of every 24 hours. "On duty" meant that there was an underground bunker to run to when the alerts went out. "Off duty" meant that I was in a house that was away from the city and the main site. I'm from the Midwest, where the first thing you learn as a kid after you learn to walk is that when the sirens go off for a tornado you find a basement or cellar or some similar place. This was the Desert, and there were no basements underneath what passed for barracks (they were actually houses, and I'm not complaining about comfort level-- they just weren't what you'd think of when hearing the word "barracks"). You could choose which bedroom to be in, or the living room or kitchen or bathroom, but no one room offered any more protection than the other. I can't find the exact document where I read this, but the idea was that if one or more SCUD missiles made it past the Patriot batteries, and there were chemical agents along for the ride, hopefully one site or the other would remain a safe zone.

Heads or tails? Live or die? Call it in the air.
As Saudi and U.S. military ambulances took away the wounded, U.S. servicemen and women stood stunned, as if unable to believe that a Scud -- an unguided ballistic missile known for its inaccuracy -- could be launched against such a sprawling city as Dhahran and hit a building housing American soldiers.  --Washington Post, Tuesday, February 26, 1991; full story here.

One other thing about what I did and where I was; I worked in radio communications, which is one of the tools used in command and control of armed forces. The thing about working in radio communications is that, if things are working right, you are transmitting a signal that someone else can hear several hundred miles away. If in doubt, triangulate the signal and aim something big and explosive in that direction. There's nothing stealth about radio.

I got to see a lot of briefings. We (meaning us airmen) were both allowed and encouraged to attend the daily staff briefings on what was going on and I did whenever I could. There was a lot of stuff I didn't care about-- the weather briefing didn't change much one day to the next-- but especially once Desert Shield became Desert Storm, there were a lot of photos and a lot of videos of shit in Iraq blowing up. (When you're a young airman in your first war, that shit's pretty cool.)

It wasn't until I was a civilian sitting at home after being out for a number of years, that I started seeing the same kinds of photos and videos on CNN (among other places) during the wars in Iraq and Afghanistan. The talk was always of targeting command and control elements of the enemy, and blowing that shit up. The realization I had was that the shit being blown up then, and the shit being blown up when I was in the Desert-- command and control-- was exactly where I worked, just on the other side of the lines. That there was command and control on the other side meant that there were also radio guys who'd dropped out of college to join the military. Enlisted people with wives and girlfriends and families, lists of what they'd do when they got back home, the same bitches and moans and gripes and complaints I had but in a different language.

I had a unique view of Desert Shield and Desert Storm, compared to a lot of people-- I'd come from the pointy end of the spear back to the hand holding it. I'd also spent high school and some college as a hacker exploring the world of cyberspace, where borders and distance-- in fact, a lot of rules-- are very different. I'm a sponge when it comes to information, and being where I was with the background I had meant that what my senses picked up went straight into my brain.

A lot of it stuck.


One notable change I made this week: I play a lot of Urban Terror. It's a game, a first person shooter that's a mod of Quake III. As a game, it has nothing to do with the Desert or PTSD, other than for me it's a diversion. When I was in Wisconsin, I'd often play for a couple of hours between getting off of work and going to get breakfast before going home. Here, I play sometimes for several hours a day, especially if I'm feeling like shit and want to disappear into a different world for a while. Within the game, I'm skilled enough that it's immersive.

I decided to stop playing while I'm doing CPT; the hours (and hours) I spend playing are better spent making sure I'm getting my stuff done for the therapy, and for thinking about and doing due diligence on what I'm planning for after the therapy is done. I can't afford to just "not be here" for several hours a day; I have enough trouble with that already.

Putting away the crutches and walking on sore limbs, even when it's mental and not physical, is a bitch.


I promised I'd post a list of the stuck points I've identified. Here is that list, with the disclaimer that it's an initial list. Some of these will get crossed off, others will get modified, I will find others as I work through the rest of the therapy. They are not cast in stone. Yours will be different. (As I'm copying, pasting, and formatting these I see several I need to tweak.)

  • I don't deserve to live when other people lost their lives
  • If we'd have been in the right environment we'd have been much safer
  • I cannot trust others to understand (any of this)
  • I need to be on guard all the time because something terrible will happen
  • I need to be able to protect others
  • I must control my life/what happens to me
  • No civilian can understand any of this, no one will ever see me as being a good person
  • I must always stand my ground against threats
  • No one can ever really be trusted
  • Doing my job meant that a lot of people died and I feel responsible for what happened to them
  • I don't have a future because I can't manage this
  • The country made my service irrelevant after 9/11
  • If people find out I have all these thoughts they will never accept me as a person
  • I cannot ever rely on people/the military/government who say they will help, they will always fail (you're safe in this bunker-- no wait, you're not)
  • If there is a noise/alarm then it is something I need to worry about-- a threat
  • If something happens to alter my plans I cannot adjust because doing so will compromise safety
  • I didn't see as much/the same level of action as others so how I am feeling isn't as important 

No comments:

Post a Comment

If you'd like your comment to stay private, please let me know in your comment. Anonymous comments are also allowed.