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Subjective Units of Distress

Posted Oct 23 2008 11:58am

One of the basic tenets of Cognitive Therapy, perhaps the most commonly practiced form of psychotherapy, is that people cause themselves distress by "catastrophizing." This is when a client exaggerates the importance of things. They treat small misfortunes as complete disasters and "make mountains out of molehills." In other words, it's when a person's perspective of how things truly are is lost that he or she becomes miserable. When it comes to catastrophizing, there is no better patient than me:

Being enfeebled caused me to take a closer look at life. If my body wasn't going to perform in peak condition then my mind would, damnit! I would throw myself into my work and become the Ultimate Practitioner of the Psychological Arts. A veritable ninja in the field! I would assume my place amongst the Therapy Deities such as Freud and bask in the glow of helping others.

The day started out perfectly. Arising at 8 AM without excessive back pain, unlike the previous 19 days, I listened to a voicemail from Mrs. Jack. She said that after a long and thorough discussion of therapy's merits, the precocious 14 year-old Jack would be returning to therapy. "He said that he would like to have 'an adult conversation with you regarding your feelings toward Angie and how you might curb those feelings for the sake of the therapeutic relationship'". Fair enough.

A common technique in Cognitive Therapy is utilizing Subjective Units of Distress (SUD) to gauge emotions. A SUD helps clients to become more aware of their emotional state, which in turn helps clients decide if that emotion might be worth attempting to change. For example, if on a 1-10 scale a client reports feeling a level 9 SUD of anger over breaking a fingernail, she might recognize that she is perhaps experiencing an excessive amount of anger in relation to the event itself.

At this point in the day, I'm at a 1. No distress. None.

When I get to the office, there is a note from the landlord stating the rent on the space would be increasing by 15%. A bit high in my opinion, but nothing to get overly excited about. I am a Mental Giant now and I will not experience a SUD greater than two.

The first client of the morning does not show up. No phone call to apologize, just a "no-show." This is one of the biggest pet peeves in the therapist's world but again, not a problem. I take it in stride. Two no-shows later and I've been at work three hours, lost several hundred dollars in wages, my rent has gone up and I'm now hungry. I've reached a SUD of three.

I get two phone calls from potential clients but as I'm not on the panels of either of their insurance plans they'll need to look elsewhere. My back begins to hurt a bit but that's nothing a little stretching won't fix. As I get down onto the floor to alleviate the pain, I slam my knee into the table. The day is not quite working out the way I had planned. I have to give myself a SUD of five.

The first non-no-show of the day finally comes in at noon and the session goes poorly. He complains that I don't have enough flexibility in my schedule and that therapy is at an inconvenient time. I tell him that three new slots may have opened up this morning - due to the no-shows - but he wants a Saturday appointment and I don't hold office hours on the weekends (even the Mental Giant must socialize!). He leaves the session early and abruptly stating that he might look elsewhere for a provider, mumbling something like "if your practice fails, I wouldn't be surprised."

When I go out to the waiting room for the mail there is a returned check from my bank as one of the clients from last week has bounced a check. I'm charged a $15 fee for his miscalculation of funds. This makes no sense to me and I my irritation grows. My eye twitches. Six, seven.

I'm at an eight when the delivery person brings the wrong lunch.

A client calls to cancel for "being so fucking hungover." Then my mother calls my cell phone. "You're last blog entry really sucked, I have to say. Your stepfather and I agree that you should consider a different way to express yourself." I begin to defend myself but drop the phone, which causes the battery to fall out. When I reach down for it I feel the angry white heat of re-aggravating my back condition. I lay on the floor in the office until Dr. Steve comes in to remind me that I owe him $50 for losing last week's college football pool.

I want to label my SUD as a fifteen but as I advise my clients, "ten is the highest, the most distress you can possibly imagine. It can't get any worse if you're at a ten." I am at a ten.

As the day comes to a close and I get up off the floor, I try to do therapy on myself. I think about what I would say to a client in this spot. Was today a complete catastrophe? No, more like a series of hassles. Is my life and livelihood destroyed because of it? No, I lost some money, had a bad lunch, had a poor interaction with a client (and my mother). In truth though, it's not a total disaster. Am I in good health? Yes. Well, actually no because I have a bad back and now a hurt knee but I could be much, much worse off and hopefully I will heal soon. Rob, I ask myself, is this really worth a ten on the SUD? No it isn't, and suddenly I feel a little bit better.

Maybe I should fire my therapist. I can do this by myself!

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