How Many Skills Does It Take?

Recently I completed a course of physical therapy on my left wrist, which had developed arthritis, a cyst, and a malformed ligament.  I broke my left wrist ice skating with my boyfriend when I was 19 years old, during a cold Iowa and Minnesota winter while on a concert band tour.  I don’t even want to tell you what year that was.  A long, long time ago.  I played the clarinet.  I did not get to complete the tour with a broken wrist.

My aging body’s response to this injury caused the wrist to become weak and immobile.  It interfered with my old lady yoga practice.  No Downward Dog.  No Sun Salutation.  No weight or flexibility from that wrist.   This March I visited an orthopedic specialist who sent me to physical therapy, adding,  “and you will probably need a cortisone shot to restore the flexibility.”

I winced.  Shots are not my thing.  A trill of fear lit up my stomach.  “Avoid,”  I thought.

The Hand Therapist gave me a strengthening regimen that I did daily, bending, squeezing, pressing. I did these faithfully, Building Mastery.    I am really good at Building Mastery, those daily behaviors that add to competence and confidence.   I secretly hoped Building Mastery would eliminate the need for The Shot. The Hand Therapist measured the flexibility and strength each visit.   The daily exercises did their jobs, increasing both qualities.  However, my wrist remained stiff and sore, and it refused to allow weight bearing.  Still no Downward Dog pose.

More Building Mastery was due.  I did the exercises more.  They built more strength, then it leveled out.  After three months of work and progress, the wrist required The Shot.

Uff Da, as we say in Minnesota.  I wanted to avoid it.

I have a legitimate reason for disliking shots in my hands and arms. Twenty-seven years ago I was treated for breast cancer.  At that time, before pic lines or ports were a standard part of the treatment protocol,  chemotherapy treatment required a new IV line twice a month for six months.  By the time the six months were over, my veins were overused and I was getting phobic about needles.   My veins would not accommodate needles anymore.   It became stressful and traumatic.   If I watched the IV procedure, my arm or hand would just pull away from the needle.  So I looked away.   I successfully avoided shots and needles during these intervening years.  Until I could not avoid them anymore.

Opposite Action and Distract were in order.  I had The Shot, after experiencing a lot of anxiety.   I forced myself to go to the appointment, then I used my iPad to play a distracting game during the procedure, so I was able to allow my hand to be still.  The Shot hurt, but it had the desired effect, increasing flexibility and reducing pain.  But I found myself thinking, “Just how many skills does it take to fix me?”

All of them, I think.

Facing The Shot, I realized it had been a very long time since I had faced such feelings of vulnerability and fear.  It was a good reminder that some DBT  clients face this challenge daily.  They march  into each day using skills,  allowing themselves to find the courage to face their vulnerability, coming to therapy, trying again and again until something works, until someone can predict that when I use this skill, I can make this desired thing happen.  What a sense of freedom and power that brings to healing.  As a therapist,  I love being with my clients to hear about that moment.

I attended Gentle Yoga the other day.  I could support Downward Dog with my hand and wrist with my elbow fully extended.  That made me smile.

So many times over the years my clients have asked me, “Do you use the skills?”  I say, “Yes, indeed, I do.  It’s required that I do, because I live a life just like you do.” Often, at first, they look at me skeptically, not really believing it.  But it is true.  Every life requires all the skills.

Jacqueline Stratton MSW

Jacqueline Stratton MSW, LICSW, DBT-Linehan Board of Certification, Certified Clinician is a Clinical Social Worker in Private Practice at Southbridge Counseling Associates in Savage, MN. She has specialties of working with Dialectic Behavior Therapy (DBT), adolescents and young adults with theco-occurring disorders of chemical dependency and various mental health or behavioral disorders, especially ADHD, Borderline Personality Disorder, and other common mental health issues. Jacqueline was a staff therapist at Chrysalis a Center for Women; a trainer for the Minnesota Child Welfare Training System for 6 years; a County Child Protection Worker as well as a County Children’s Mental Health Case Manager; and a Co-occurring Disorders Therapist at Hazelden Center for Youth and Families in Plymouth, MN. Jacqueline is a graduate of Iowa State University and the University of Minnesota.

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