I know this is a bit like the London double-deckers; for a long time there’s not a single bus, and then there are five all at once. The Heinz Ketchup effect.. But, you see, one of my readers commented on the post I uploaded last night, and in responding to his comment I realised that it could well be turned into a blog post in its own right, so here I am again, updating my blog merely hours after my last offering. You’ve got to strike while the iron is hot and all that.. I hope you don’t mind.
The comment was in reference to my mentioning that five years ago, following an initial psychological assessment, I was deemed to be too high risk and unsuitable for psychotherapy, and the commenter said that “From the posts I’ve read by you, you certainly seem like the sort of patient that therapists are delighted to have.” My initial reaction was to feel flattered by this comment, and I instantly thought that I rather agree, biased as I am; I do think I make a good client. I have a bit of a chequered past, quite a few things in my baggage – obvious material to work with so to speak – and I am also reasonably self-aware, rather analytically minded and fairly articulate. Not a bad prospect for a psychotherapist.
Then again, I am no different to any other psychotherapy client; I think we all want to see ourselves as good clients – interesting, intelligent people – who therapists are happy to work with. And we all wish to be the favourite client, the one our therapist is really looking forward to seeing, because we challenge them just the right amount without being burdensome or draining. [If you’re in therapy yourself, I’m sure you will know what I mean.]
Yet, having been turned down by the NHS for therapy I really struggled to find someone who was willing to take me on. Naturally I had to give up on the idea of getting free therapy on the NHS, but I figured that outside of The Service there had to be plenty of privately practicing therapists who would want to work with me.
In reality it took me quite a few months to find a therapist. I had to go to many ‘first appointments’ and found myself being repeatedly rejected. Many of the therapists I saw, said exactly what the NHS assessor had said; that I was simply too high risk, what with my recent serious suicide attempt and my habit of using self-harm as a coping strategy. And I can understand that. I imagine it can be quite challenging – scary even – to work with, and in a sense – be responsible for – a client who may well choose to down a litre of anti-freeze rather than turn up to session. Naturally, not everyone will be up for that. But, at the same time, the way I always saw it – and I would always make this clear at assessments – I’ve always seen therapy as the way forward for me, the thing which will eventually help me manage my past in a more positive way, and also – while I have many times become depressed while in therapy, I’ve never made an attempt to end my life when I’ve been in therapy or had counselling. That has only ever happened when I’ve not had a place to take my thoughts and emotions, when I’ve felt I’ve not been able to share what’s going on for me.
The other reason given to me, when therapists declined taking me on, was that they felt they simply didn’t have the experience they needed to be able to work with someone with such a complex background. There are quite a few aspects – issues, if you will – to work on; I was adopted, so a high potential for major attachment and abandonment issues and possible identity crises. I was sexually abused and suffer from intense flashbacks of this, and so more than one therapist said that I should probably look for someone who specialised in this area, perhaps a therapist trained in EMDR or TF-CBT. I have one parent who is gay, I have another parent who has struggled a lot with the rollercoaster that is bi-polar disorder. So lots of different things to work on in therapy, perhaps too many, for some.
I also suspect, although I don’t know this for sure, that I probably came across as someone who might be a bit of a handful to manage in session, because I happen to be ridiculously well read on the theory of psychotherapy, particularly psychoanalytic and psychodynamic therapy, which was also what I wanted to do. I am not someone who will hold back on commenting if I feel that the therapist is ‘text booking’ me. And also, there is a definite barrier to get through; the fact that I often, knowingly or unknowingly, intellectualise and theorise in order to not have to deal with actual emotions. Hiding behind my theoretic understanding of things, so as to not really have to deal with anything. I don’t do it so much anymore – in fact, these days I tell myself off if I notice that I am slipping back into this pattern – but five years ago, that was certainly something I did a lot.
In the end, having tried for a good few months to find myself a therapist and failed, I asked the house therapists in the therapeutic community I had recently moved in to, to set me up with one of their trainees, because I felt I would never be able to get anyone to take me on on my own.
Long-term readers of this blog with remember that this turned out to not have been a great idea, as the person who was ‘assigned to me’ wasn’t a particularly good match for me and the chemistry just wasn’t there. Having thought it through, I ultimately decided to terminate with her, as I felt that I could probably carry on seeing her for years and still never get what I wanted from our work together. It wasn’t a decision I took lightly, but, I always felt it was the right decision for me. I’m sure B. – my previous therapist – is a great therapist; she just wasn’t the right one for me.
As it turned out, I actually managed to find a therapist that seemed a good fit for me before I had even let B. know for sure that I was going to move on. Almost as if by magic, I had completely by chance contacted two different therapy organisations, both of which A. happened to be affiliated with, and already the first time I spoke to her on the phone, I felt she could be the right person for me to be doing this very important work with. Going for my first initial appointment with her I was nervous, but also felt decidedly positive. I had a good feeling about it.
I have since asked A. how come she decided to take me on – thinking about the many people who had turned me down – and, although she slightly dodged the question in her funny little way, she did say that she never considered not taking me on. I am still not entirely sure why that was, but maybe she saw it somewhat similarly to how I saw it; I seemed like someone she could work well enough with me to give me a chance.
We’ve certainly had our moments over the years, A. and I, and I know that I can definitely be more than just a little challenging at times, and not always in a nice way, but I do think that we speak similar enough languages to be able to communicate well and to work things through. I also know that A. can stand up to me, and that she won’t be cornered or pushed around by my intellectualisations or red herrings, something I really appreciate. In fact, only the other session, she was challenging me and I commented that she’s asking very difficult questions, to which she responded Good! and we exchanged a quick smile across the room.
And I think that illustrates our relationship quite well.
I don’t know if I really am that magic Favourite Client, and by now that doesn’t even seem all that important anymore, but I do feel that we have a decent enough relationship that I could be.
And that’s enough.
Very nice, as usual. I think, having read this, that I might be able to say a bit more about why it is possible that many therapists today, as opposed to 25 years ago, might shy away from someone who is challenging (at least in the USA). At that time, I had a substantial inpatient practice, as did many other psychologists. Private insurance paid for relatively long stays (two to three months wasn’t that uncommon). As a result, those of us who learned to do psychotherapy with people who had made serious suicide attempts or were self-mutilating or where severely dissociative got used to the sort of work and attitude that was required with a challenging population. As the insurance companies began to pull back on paying for lengthy hospitalizations, the subsequent generations of therapists didn’t get the experience that psychologists like me did. Hence some of their discomfort, especially in taking someone challenging outside of the safety that is present in a hospital. I imagine that the NHS also doesn’t rely on psychiatric hospitalization much, so that most of today’s therapists simply don’t have the kind of experience that many of my generation of therapists were lucky enough to get (I’m in my mid-60s).
i find this so interesting. I too am about to start psychotherapy t,(have had my initial assessments, two of them!) to help me manage how I manage my everyday life, of course because of the coping mechanisms (or maybe lack of) developed during my childhood. Though my life is not at all complex as yours, I think psychotherapy is something more people should embark on, at least to give them the chance to unfold in a safe environment. I’ve read your blog for a long time now, far before I even considered psychotherapy for myself, interestingly I stumbled across it when I was looking up Reform Judaism as I was in a relationship with a Jewish man at the time. I’m glad I stumbled across it – I look forward to your new posts! :) x
Hello, and thank you for the comment and compliment. I think you do have a point in what you are saying in terms of gaining necessary experience (although I have a feeling that the National Health Service vs private practice here in the UK is somewhat different to how things work in the US).
That said, many of the therapists I went for initial consultation with were very experienced therapists, some of whom had worked in a hospital setting previously. I think for some it was the prospect of having so many different issues to work on in a single client that was the decider. Perhaps it came down to the ethics of ‘Could I offer this client what she needs?’ Another thought that came to me just now is that therapists (and psychologists) working within the NHS tend to work as part of a team, so while the relationship with the client is one-on-one, the opportunity to discuss challenging situations with a colleague may be more readily available. Of course, privately practicing therapists, too, have supervision etc, but the chance to just quickly ‘debrief’ at lunchtime might not be there to the same degree? Particularly if they are working from home as opposed to at a pooled private practice.
When I started seeing A., she was still in training (by far the most neophyte therapist I’ve ever had), and at a guess she would have had more regular supervision, as well as course mates to talk things through with. Of course, this is just me guessing; for all I know, the reason she took me on could have simply been ‘newbie enthusiasm’ or that she needed a long-term multiple session client to gain her qualification. :)
Ultimately, I suppose that for me what matters is the personality match – much more so than anything else, and whilst I’ve generally not been acutely suicidal or actively engaging in self-harm, the therapists who turned me down because the prospect of dealing with such a client was too uncomfortable, would likely not have been the right therapist for me, anyway.
(Sorry for the long-winded response. When I get going, I keep going..)
Once again thanks for taking the time to read my blog.
Have a lovely day,
I’m glad you find what I write interesting and comment-worthy. (Very nice ego-strokes for me!) It’s good to hear that you’re about to embark on your own therapeutic journey; my basic stand-point is that everyone needs therapy. We can all do with a place to vent, reflect and learn more about ourselves – whatever our background. As long as we’re in therapy because it’s something we want to do (as opposed to ‘because my parents want me to’ or ‘because the doc said I had to’), I think it’s one of the most useful things we can do.
Not so sure about your life not being as complex as mine; everyone’s life and inner world is a mystery maze with hidden things to discover, it’s just that in my case there are some very obvious nooks and crannies to start with. ;)
Anyway, I hope you find the right therapist for you, and that you get what you want from the journey. Therapy can be a bumpy ride, but as I often put it; I don’t think it’s meant to be easy, I think it’s meant to be worth it.
All the very best,
All of what you’ve said is important. I would add only one thing. The hospital experience I’m talking about has to do with the opportunity to work with complicated in patients for a long enough time with each one to become comfortable as a therapist. There are plenty of therapists in the US today who have had hospital experience today, but few under 50 who were able to treat patients for long periods of time in the hospital, rather than just a week or two. In that amount of time little more than surface stabilization is possible, largely due to medication.
Great to see you back more frequently. You write beautifully. X
Thanks for the comment! Nothing makes a writer happier than being told they write beautifully! :) Also, glad to hear you’ve enjoyed the more frequent updates. I’m going to try to post more often than I have been. It’s just that I’ve been ridiculously busy with course work and stuff lately.
Again, thanks for dropping by.
All the very best,
There’s never any pressure. Sometimes you just need the break – I understand that! You’re so much more put together than I feel – its good to read of someone that survived this.
Keep looking after yourself. X
I know there’s no pressure, other than from myself.. I don’t like not updating my blog. [Living with an inflated sense of importance is SUCH a drag. :P ]
Anyway, you take care.