Hey,

I wonder if part of the reason why it is hard to cry in front of your therapist is that if you cry in front of your therapist he is likely to ask you what is wrong. And that can be scary...

Whereas if you cry in front of your psychiatrist then he might be likely to recommend an alteration to your medication. And maybe an alteration to your medication... Is what you think is needed? Maybe crying in front of your psychiatrist is what (you think) is needed to secure his care?

I wonder why you don't think that the 'magic cure' will come from therapy? Maybe because your therapist doesn't 'target' the symptoms that you want medication to help you with?

I mean to say this very gently (as gently as humanly possible). I've heard a number of psychiatrists say 'if only I had a penny for every borderline who thought she was bi-polar'. I think that what they mean by that is that it isn't at all uncommon for someone who has trouble with unstable moods to think that medication is the answer to the unstable moods. Whereas, there are patterns in environmental stressors / prior interpretations / thoughts that tend to trigger the episodes of instability.

One technique that has been used to great effect to help with emotional instability is behavioral chain analyses. For every episode of self-injury / intense mood swing one needs to identify the triggers (both internal and external) that contributed to the mood swing. Some of those are physiological (hormonal for example, or induced by alchohol), some of those are environmental (starting a new job, for example, or having arguments with people), some of those are internal (self talk, for example, or the way one interprets things).

After a time one becomes able to identify triggers as triggers before one engages in self-injury or gets caught in the grip of a mood swing. Quite often just knowing that one is in that place can be enough to alter that place such that one doesn't self-injure or get caught in the grip of a mood swing. For example, I can be feeling really very badly indeed and when I look at the calender and see that I'm premenstrual (and thus know that the feeling will pass in a couple days) then often that is enough to make me feel better. I know that bubblebaths and exercise is what is needed to get me through that point and just knowing that (and doing those things) is enough to prevent my getting into a very bad place indeed where I just want to curl up and die.

I hated doing behavioral chain analyses, don't get me wrong. I don't know a single person who likes doing them. Most people need to be coaxed and cajoled and manipulated and coerced into doing them. It is only after a time (extremely reluctantly) that I was able to say that yeah, they really helped me learn to manage my moods. Before that time I was 100% convinced that it was impossible for me to manage my moods. They were something that I was inflicted with from without. They were biologically caused and didn't have a psychological explanation at all. They were things that I needed medication for and they were outside my control just as much as diabetes was outside the control of a person with diabetes.

Only... That turned out not to be the case. This was the way forward for me with respect to the 'magic cure' and with respect to my stopping self injuring etc.

I'm not saying that it must be the way forward for you as well... But it might be something worth thinking about... I've just noticed that often when you say you are in the grip of an intense emotion (that is outside your control) there are external triggers that would make your intense emotion understandable. Maybe appreciating the impact of some of those external triggers (and seeing what sorts of things you can do to manipulate them) would give you a greater sense (and reality) of control. Perhaps...