Saturday, February 22, 2014

Setting Goals For Thomas

As I said yesterday, therapy went pretty decently mostly in the fact that I wasn't edged out of the process after my email exchange with Thomas' therapist. It actually was quite amazing because the opposite happened instead. I came in and his therapist laid out what he wanted to talk about for the session which has never happened before. I felt like this was his way of telling me he had heard me in my emails and that he now saw us as a team.

First we talked about how we needed Thomas to set some goals for his future. I loved this idea and we turned to Thomas to see what his goal might be. Right away he piped up with,

"I want to move out."

I stopped for a second, surprised. Moving out? I had far smaller goals in mind as did his therapist but we decided to talk to Thomas about this. It turns out that he's feeling pressure to leave home because he has friends that have left home for college. I feel bad for him being so focused on what amounts to a general feeling that people he knows have moved out however his closest friends and most importantly his best friend still live at home and his best friend doesn't even have his driver's license just like Thomas. The thing about Thomas is that he feels these pressures very deeply but then doesn't think through what it really means to leave home. What he does know is that he doesn't make enough money to be able to do that and he is frustrated about that.

I looked at his therapist and I said,

"I think the goals we (his therapist and I) had in mind were slightly smaller like being able to get some more hours at work, among others."

Thomas agreed that he needed to do that and decided that he was going to ask for more hours the next time he saw his manager. Now, I am not exactly thrilled about this given that he's still trying to get well but as I have in the past, I said nothing about it because I think he needs to try these sorts of small things for himself and either come to the realization himself that he's not quite ready or even better that he can be successful at it. There are some things that I just won't stand in his way about because I don't want to rob him of a chance at life.

Then his therapist suggested another small goal of perhaps just spending a night alone while my husband and I go away for a night for some alone time. Just like in the past, Thomas immediately showed anxiety about this. We dug a little deeper into this and learned that the reason (or rather one of the reasons) is that he doesn't feel like he can prepare a meal for himself. His therapist asked him if he could cook himself a TV dinner and he shook his head "no". Then his therapist asked if I put the exact directions on how to cook it taped to the front of the microwave, could he do it? Thomas again showed trepidation. We went on to question him about other meal ideas and finally he admitted that he was very anxious about doing it himself because he's never really done that.

For the record, I have tried several times over the years to teach him to make meals and he's stood by my side and cooked or watched me cook. He's been taught the skills, he just can't draw on them for himself when he is alone. What surprised me the most is that he rated his anxiety about preparing a meal a 6 out of 10. That's high for Thomas. "A 6?" I thought to myself. "How can this be so high?" His therapist pointed out that in order to move out on his own that he will need to be able to cook for himself and Thomas looked like that hadn't occurred to him. We all talked more about him moving out but then all of the anxiety about other things related to it prompted other questions.

Then, there we were, back at the recent million dollar question and that is about his delusions. His therapist went back over Thomas' inability to give himself positive affirmations like,

"Hey! I'm a pretty handsome guy!"


"I am really good at building computers."

and that led back to the fact that his sole source of affirmation is when he thinks about his delusions. Like a light bulb going off, I saw his therapist think to ask how often he thinks about this and gets "pumped up."

"Is it every day?" asked his therapist.

"Yes." Thomas admitted.

"Is it more than just every day?"


"OK, so let's explore this a little more. Is it every hour or all the time?"

Thomas thought for a minute and he said,

"It's every hour."

Wow. Just wow. Every hour? I had no idea. So his delusions consume him constantly and worse yet for those of us trying to help him, they are so entrenched and we realized even more so how serious they are. I was defeated as I am now realizing that the biggest facet of Thomas' schizophrenia are his delusions. It's not like I'm surprised necessarily, it's just that I can see now how much of his psyche they occupy and I feel like there is little hope of recovery for him from his delusions.

Therapy went on to discuss the possibility of Thomas going on disability which is a post for another day because it is a topic of importance that deserves its own post and consideration from you if you choose to contribute.

In the end, therapy taught us all that Thomas isn't yet ready to move out. We talked solely of getting a meal prepared but there is much more to consider, like him remembering to take his meds. I feel terrible for Thomas because he wants a life like his peers have but sadly it's obvious that he is far from that goal. This is what I hate about what schizophrenia has robbed from him. He's well enough to understand that his peers are moving on with a "normal" life and he is caught behind working one day a week for minimum wage and still living at home. I want more for him, he wants more for himself but there is a long road ahead yet to be traversed before he realizes this goal he has set for himself.

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