Tag Archives: NHS

Being The Perfect Therapy Client

Posted by What It Takes To Be Me in Abandonment Issues, Attachment, Coping Strategies, Expressing Emotion, Flashbacks, Psychology, Psychotherapy, Psychotherapy with A, Psychotherapy with B, PTSD/Extreme Emotional Stress Disorder, Rejection, Sef-Awareness, Sexual Abuse, Suicidal Ideation, The Therapeutic Relationship and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

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.

Anyhow..
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.

xx

Bulletpointing My Life

Posted by What It Takes To Be Me in Acceptance, Anxiety, Coping Strategies, Depression, Diagnosis, Family Dynamics, Flashbacks, Identity, Psychology, Psychotherapy, Psychotherapy with A, PTSD/Extreme Emotional Stress Disorder, Self-Harm, Sexual Abuse, Suicidal Ideation and tagged with , , , , , , , , , , , , , , , , , , , , ,

I had to go see a clinical psychologist for an assessment not very long ago; I needed a statement to say something about my mental health. It’s a long and rather convoluted story why I couldn’t simply get A. to write this statement, but in short: it was An NHS Thing and for whatever reason psychotherapists simply don’t rank very highly within the NHS. It doesn’t matter how long you’ve been seeing them or how well they know you, it doesn’t even matter if they are both UKCP and BACP accredited, the only letters that matter within the NHS are N, H – and you guessed it – S.

So, in the end I was given a number to call in order to book an appointment with an NHS affiliated clinical psychologist, who would clearly possess almost magical levels of insight, as she would apparently be able to conduct a full assess of my mental health in thirty minutes flat, having never met me before and knowing absolutely nothing about me, my background or my mental health history.

I had resolved to stay calm, but the second I was given the address to the place where the assessment was to happen, I realised it was where I had gone for an assessment five years earlier, where they ultimately deemed me too high risk and unsuitable to be in therapy.. [Being rejected by the NHS is the reason why I had to go private; while I agree that I was very high risk, there was no way I was going to accept that I wasn’t suited to be in therapy..]

Either way, I rolled up at the place with plenty of time to spare, giving my anxiety abundant opportunity to hit the roof and then proceed through it. This wasn’t helped by the fact that Dr NHS Clinical Psychologist was an hour [yes, an hour!] late.

But – eventually – I did get to go in for my assessment and as it turned out Dr NHS Clinical Psychologist really wasn’t too bad. It’s just that, when you meet someone for the first time and you have thirty minutes to talk about yourself, your background and your mental health history, well, what do you say? where do you start?

We covered the usual ground: I was adopted, I was sexually abused by my oldest brother for twelve years and for a year by a second person, I have a complicated relationship with my whole family, my parents are separated, my father lives with his male partner, my mother is bi-polar, etc etc etc. We then moved on to more recent times, talking about previous suicide attempts, self-harm as a coping strategy, the flashbacks, the recurrent depressions and so on. I have to give Dr NHS Clinical Psychologist some credit here, because she also allowed some space to talk about the more positive aspects of my life; my relationship with my sisters, my amazing friends, my studies, my volunteering, but, coming out of the meeting, while I felt that she had listened to all I had said, I really wasn’t sure what she would actually write in her statement.

It’s a strange thing when you are asked to summarize your whole life and your entire being in a very short space of time; it really highlights something, forces you to really think. And it’s exhausting.

So, the next session I had with A, was spent debriefing. It’s quite hard to look at the different parts of your life in this very concise way. It’s almost a bit of a shock to the system to go through it all like that. I mean, none of these aspects of my life are things I haven’t spent hours in therapy thinking and talking about, but there is something quite extraordinary when you have all these life stories mentally bullet pointed before you.

There is one part of me that thinks that considering all the things I’ve been through, all the unorthodox aspects of my life, I’ve actually done quite well to not be completely broken by it. And at the same time, there is another part that chokes and goes “It’s going to take a looooong time to make some sort of peace with all of this..”

But, thankfully, in spite of that assessment five years ago, I am in therapy and I will continue to give it my best shot to somehow make sense of it all.

xx

Because Tomorrow Might Be Good For Something

Posted by What It Takes To Be Me in Depression, Flashbacks, Inner Conflict, Medication, Music, Psychotherapy, Psychotherapy Breaks, Psychotherapy with A, Self-Harm, Suicidal Ideation, Video and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

*

“..I’m not crazy, I’m just a little unwell
I know, right now you can’t tell
But stay awhile and maybe then you’ll see
A different side of me..”

*

I guess there are no easy ways to talk or write about this, but as this is supposed to be an honesty-focused blog I’ll just tell it to you straight: last week I accidentally on purpose overdosed on my medication. It really wasn’t a bid to end my life, at least I don’t think it was [although I accept that others may disagree]; I didn’t even take all the tablets I had, but it was still a significant enough dose to potentially do some damage. I know my meds pretty well, and I would like to think that I know what would and wouldn’t kill me, but, the truth is – of course – that there is no way to know for sure just how much a of a medication would be lethal for a specific individual; what’s safe for one person may well be fatal for another. In some weird and rather irrational way, it was more like I was testing if it would be possible to swallow enough tablets in one sitting to get to a lethal dose. I think that was my confused logic, anyway, [which, obviously, isn’t logic at all].

I did frighteningly well in terms of establishing that it would indeed be possible, had I wanted to take more pills than I did. But, the second I had swallowed the first lot I instantly regretted it, and I decided I should go to A&E, since the meds I’m on [Amitriptyline] are known to be very toxic. In fact, the highest therapeutic dose is not that far off a dose that would be classified as toxic, and that is the precise reason why Amitriptyline is only prescribed as a last resort, when all other types of anti-depressants have failed.

Again, entirely irrationally, I decided that rather than calling for an ambulance I would get on a night bus to my local A&E, so I got myself out, started walking to the bus stop and only just missed the bus, so I carried on walking in the general direction of the hospital. After a while I began to get really unsteady on my feet, but was still clear enough to realise that passing out on the streets of London on a Saturday night would not be a great idea, especially with a lot of drunk people out and about. So I went back home, got on my bed and blacked out before I could call for an ambulance.

When I woke up it was all dark, so I thought that it was still night, but when I looked at the time on my mobile I realised that it was in fact the next evening, and I’d been out cold for nearly 24 hours and had missed several calls and texts from worried friends. This really freaked me out, since I normally wake from even the quietest of noises.

That evening I again attempted to get to A&E, but was simply still too wobbly and I had to give up and go home again. On Thursday I had an appointment with my GP, and I told her honestly what I had done, and that since I don’t even really know why I did it, or at least, the logic in the moment really wasn’t logic at all, I really needed some extra support. She heard me and then asked whether I wanted to call the mental health crisis resolution team myself, or if I wanted her to do it. I opted for the latter, because I know I would most likely have gone home and talked myself out of ringing them.

So, at the moment I am seeing the crisis team every other day. I’m not suicidal, at least not on a conscious level, but I also think that having some extra support over the next few days is a good idea, wherever that support comes from.

The crisis team, being tied to the NHS, have, as they always do, questioned both my therapy and my therapist on the grounds that they are not NHS and must therefore automatically be harmful to me.

That really makes me angry, since I am a big believer in psychotherapy in general, and in my therapy in particular. For me, psychotherapy is the most appropriate way of disentangling my thoughts and emotions, and to ultimately get away from the intrusive flashbacks and nightmares which push me to act out in this rather extreme way.

That said, what with my therapist being on maternity leave, I do feel that as much as the crisis team and I have very different ways of understanding psychotherapy and the effect it has, I am still glad to be seen by them, because it means that, should I act out again, or miss a scheduled appointment [whatever the reason] they would send the police and ambulance round to check on me, as I am in effect an out-patient and they have a duty of care. Also, they are available to talk to 24/7, should I find myself struggling with thoughts of self-harm or suicide. I can’t promise I would definitely call them if that happened – in fact – I’m fairly certain that I wouldn’t, but at least the option is there.

Hopefully things will improve soon, so I can start looking forward rather than backward, because, who knows..

;

“..tomorrow might be good for something..”

;

xx

;

Heading, and quotes at the beginning and end of this entry are from Matchbox 20‘s track Unwell. © Rob Thomas

Remember September & Stepping Into The New Year

Posted by What It Takes To Be Me in Coping Strategies, Depression, Expression Through Art, Faith, Flashbacks, Friends, Illness, Jewish holidays, Judaism, Music, Psychotherapy with A, PTSD/Extreme Emotional Stress Disorder, Self-Harm, Sexual Abuse, Suicidal Ideation, Video and tagged with , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

It’s been a while since I posted a proper update, I know. Things have been very difficult and it’s all felt too raw to put it down in black and white. To pick up where I left off: I went to the assessment at Drayton Park Women’s Crisis Centre and was offered a place the same day. It was very hard going back there, having not needed that kind of help in quite a few years. So much of my time at the therapeutic community I was staying in was designed to keep you away from the NHS mental health system, to find other ways of getting the support you need, preferably away from medication and hospital. So it was a big decision going back to Drayton Park. But needs must sometimes, and sometimes you have to swallow your pride and just accept any kind of help you can get.

The whole first week and a half at Drayton I spent virtually all of my time in my room, feeling unable to be around people other than my named support workers. I simply felt to embarrassed to be around people while I was fighting the near constant stream of flashbacks, as the things I do to ground myself can look quite odd if you don’t know what I’m doing or why I’m doing it. I did have quite a few people come visit me, which felt more OK, because they were all people who know what I’m usually like, and who I knew could handle seeing me in that very very difficult emotional place. I know it’s hard to see someone you love struggle in the way I was – constantly having to fight this torrent of intrusive flashbacks.

Flashbacks aren’t a new phenomenon to me; regular readers will know that I suffer from single flashbacks frequently, and experience periods of sequential flashbacks every so often, but this was on a scale I’ve never known before. I’ve always understood the single flashbacks as an indicator of sorts that I am ready to perhaps deal with that specific incident in my therapy, and the periods of flashbacks tend to begin either when A. is away or when I am very stressed out about other things. But this, it was just something entirely different. A whole different ball game. As I said earlier, initially I was experiencing an incessant flow of flashbacks, most of them reasonably short and all of things I already knew had happened. Though never a pleasant experience, I was able to come out of them fairly quickly. What was really wearing me down – apart from the re-experience of the abuse situations – was the fact that they were so frequent. It felt very much as if as soon as I had worked my way out of one flashback another started, like one flashback triggered the next, and it took essentially all of my energy to remain fully in the present.

Then, one day – and I still don’t quite know why – the flashbacks changed. They became less frequent and were about things I had no conscious memory of. Although the reclining frequency was a welcome break, making it possible to at least go out of my room and spend time in the art room, it was absolutely terrifying. I always knew that there were gaps in my memory, pertaining to one specific person, but some of the things that came out were things I had absolutely no recollection of at all. I know that what emerged in those flashbacks did happen, that they weren’t figments of my imagination [although at times I tried very hard to convince myself that maybe they were].. The best way I can describe it is that it felt like I was remembering things I had forgotten I knew. These flashbacks tended to be more like long sequences, and were a lot harder to come out of, I think, in part because they caught me so unawares, memorywise, but also because the content of them were cruelty on a whole new level, and I felt paralysed by fear, unable to do the things I usually do to come out of the flashbacks. And I have to say, I’m still dealing with those memories now, feeling utterly traumatised by what those flashbacks unveiled.

I ended up spending a full three weeks at Drayton Park, and throughout those weeks, being stripped of the release and relief my various means of self-harm offered, they were probably the worst three weeks in my entire life. Every day I would ask the staff – pleading with them – to please, please let me have my scalpels, just for a little while, just to get a small break from the flashbacks. And each day my support workers told me no, because although their policy is that they recognise self-harm as a genuine coping-strategy for some people, they felt that my cutting would not be safe and could end in me, accidentally or intentionally, cutting to kill myself rather than to just relieve pain. Also, owing to my previous track record at Drayton Park, downing a pint of anti-freeze in a bid to end my life, my trust/credit rating with the staff isn’t the greatest, so their decision to not allow me to use any form of self-harm to cope, is entirely understandable.

I am now back home. Things are still difficult. The flashbacks aren’t as frequent, but I still have them fairly regularly, and it seems that an underlying depression is rearing its ugly head, and I am often struggling to get out of bed at all, unless I have to. I push myself to get to therapy and to not completely disappear in my own misery, but it’s hard work.

One thing that is good is that we’re now in the middle of a period called Yamim Noraim, [lit. Days Of Awe, commonly referred to as the High Holy Days, is the period between Rosh HaShanah and Yom Kippur] – so there are a lot of things going on at shul, and so I have more things than usual that I need to get to. Also, on the days I simply haven’t been able to go to service I’ve been able to follow it online, and I’ve made a point of always making sure I am up and appropriately dressed, even if I’m only attending service via the internet.

All in all, it’s still a bit of a roller coaster; one good day, one bad and so on, but I suppose that it’s better to have some better days than none at all.

So, for a better and sweeter new year,

שנה טובה ומתוקה

~ Shanah Tova Umetukah ~

xx

OK – so this isn’t for this new year, but this Rosh HaShanah video from Michelle Citrin still makes me smile. I mean, c’mon – I named my blog after one of her songs, after all.

Survival – Knowing When You Need Help

Posted by What It Takes To Be Me in Acceptance, Depression, Flashbacks, Illness, Inner Conflict, Medication, Psychotherapy with A, PTSD/Extreme Emotional Stress Disorder, Self-Harm, Suicidal Ideation, The Therapeutic Relationship and tagged with , , , , , , , , , , , , , , , , , , , ,

Things aren’t going so well.
Downward spiral at breakneck speed, I feel frightened at how quickly I’ve gone from doing really well to finding myself stuck in a pattern of inward turned anger and self-harm. A few weeks and I’ve managed to undo all the hard work I’ve put in these last four years.

Realising that I’ve lost control of things I have been forced to accept that I need someone to help me, and so on Monday I called my GP to make an appointment. Couldn’t get one until Wednesday, and let me tell you, that felt like a very long way away.

These last few days have really have been rollercoaster like, oscillating between trying to stem flashbacks by using cords and scalpels and later on feeling very very angry with myself for not having been able to stop myself from going back to this very destructive behaviour. And it’s becoming increasingly erratic. This morning I woke up and immediately reached for a fresh scalpel to punish myself for having, the previous night, used a cord coiled around my neck to make myself pass out. – There’s no logic to it, and I can see that. Yet, I don’t seem able to stop myself from acting out in this way.

I’ve been trying to do things in the last few days to try to prove to myself that I’m not quite such a bad person as I sometimes think I am. To show myself that I’m not a waste of space, that I am of some sort of value to the community. But it’s hard to hold on to those thoughts when it has to come through external actions rather than from some internal place..

Saw my GP this morning. I say my GP, but really, I saw a GP. I saw Dr H., a newbie doctor, in her own words. This turned out to be a pretty good thing; she listened to me and seemed to really take in what I was telling her, in contrast to some GPs who’ll whack out the ever-so-patronising “How Depressed Are You?” multiple choice questionnaire at the earliest possible opportunity in a bid to avoid having to actually listen to the patient. Given this opportunity to be heard I tried to be as honest as I could with Dr H. It’s hard, when you’re a bit of a people-pleaser like me, and you don’t want to make the other person feel bad, but I think I did OK.

Dr H. made the decision that she didn’t just want to start me on some meds, but that I needed to be seen by the mental health crisis team. She asked me to wait in the waiting room while she sorted it all out, as she didn’t want me to leave the clinic before she knew for sure that I’d definitely be seen by the crisis team. A reassuring touch, I have to say. I’ve certainly come across doctors who say they’re going to make a referral and send you off with a “Don’t call us, we’ll call you” style parting phrase.

As it turned out the crisis team wanted to see me at noon, so I essentially ended up going straight from the GP practice to the Highgate Mental Health Hospital. Felt quite anxious about going there, as I was still experiencing flashbacks and I was worried that I’d become too confused and disoriented on my way there. Also, I didn’t know what to expect. It’s been several years since I’ve been in touch with any form of NHS run mental health service. A lot of my work has been aimed at getting away from this system.

Then I was thinking of the advice I would give – and have given – friends who have found themselves struggling in the way I am right now: accept any help you can get, whatever that may be. This is not a time for pride, it’s a time for survival.

Talking to two members of the crisis team I did feel a lot better. They reassured me that their aim is to support people struggling with self-harm and suicidal ideation in their homes, rather than pushing people into wards, which may not at all be the best for a person. They did – of course – make it clear that if they felt I became more destructive and posed a serious danger to myself they would have to put me on a section order, but that their aim was to find alternative ways of supporting me. They made the decision – based on my previous history – that they’ll want to see me every day for now, and also asked if I would give them permission to liaise with A. regarding what would be the best way to go about things. Initially I didn’t feel comfortable with that, but in the end I decided that maybe it could be helpful to not try to keep different parts of my life separate. As I was a little unsure of A.’s number I told them I would ask A. to call them instead.

My session with A. today was quite difficult. I was just feeling so low, so defeated at finding myself back in this very dark place. I’m finding it very hard to motivate myself to not give up, keep falling into thinking that no matter how hard I try, no matter how hard I work, I will always come crashing down..

A. said a few things that made me feel a bit better, made me feel like I’m not entirely on my own. But it’s still very very hard. She also added an extra session for me this week – first thing tomorrow morning – which felt comforting. Also I have been given the number for the crisis team, which is a 24 hour care service, so I can call and talk to someone on the crisis team at any time between seeing them in person.

I hope this will help stop me falling any further. Because last time I felt the way I feel right now I drank half a litre of anti-freeze and ended up in ICU..

So, if you have any to spare, thoughts and prayers are much appreciated.

xx

I Try My Hardest Not To Lose It All – An Entry About Help And Support

Posted by What It Takes To Be Me in Counselling with D, Depression, Expression Through Art, Friends, Psychology, Psychotherapy, Psychotherapy Breaks, Self-Harm, Suicidal Ideation and tagged with , , , , , , , , , , , , , , ,

For those of you who haven’t heard from me – and owing to an immense wish not to communicate with my fellow humans lately that will be the vast majority of you – as of Friday last week I am out of the Drayton ParkWomen’s Crisis Centre.

And what can I say? Well, for better or for worse this stay was very very different to my stay there earlier in the year. As this was meant only as a short term intensive intervention style stay the main focus was put on helping me use and acquire distraction techniques to enable me to better cope with my urges to self-harm once returned into the wilderness that is my home life.

Did it work? Yes and no is the honest answer. Yes, because I’m still here now, and apart from very lightly scratching myself with a scalpel purchased on my way home from Drayton Park on the day of my discharge, I haven’t actually physically harmed myself. No, because my mind has now moved on to a much darker place. A place where self-harm for the sake of release is no longer my primary urge.

I suppose that in order to understand what’s going on in my head one would need to understand the reasons behind the change in my urges, and the best way to do that is something like this (forgive me for detaching myself somewhat emotionally in composing this explanation, but it’s the best way I can think of to be able to write it and at the same time keep myself safe and away from harm); Some people self-harm for the sake of scarring themselves. I guess you could say that it is a way to show the outside world how much they are hurting on the inside. Others do it to allow themselves to feel a different kind of pain to the one they are experiencing emotionally. Finally there are people who use it as a means for breaking the pent up tension inside of them to avoid having a panic attack, physical outburst or other extreme reaction.

As for me, well, I suppose I’ve gone through stages of all of these variations, and at the moment I am stuck on the last; I am overwhelmed by powerful urges to cut myself in order to relieve the pressure.

Naturally, this is a pretty perilous place to be, in all senses of the word – and I have been working very hard at not giving in to this need for self-harm by distracting myself through various mind-numbing activities such as boxing, painting and re-painting my nails, writing lines etc. (In fact I went a bit crazy one evening at Drayton Park – spending half an hour covering the entire slated patio of the garden in pastel chalk drawings and random bits of lyrics, until one of the workers came out and helped me settle down with a hug and a good talk – an act of enormous kindness, and one I will never forget.)

However, using distraction techniques to refrain from self-harming has its downside as well as the obvious positive effect of not injuring yourself; whilst they do keep you safe for the time being they don’t actually do anything to manage or reduce the intensity of the emotional turmoil inside of you. That, I believe, can only be achieved with additional guidance where the underlying feelings and, peeling back yet another layer, the reasons for those feelings are explored and dealt with.

In the absence of my counsellor this has become increasingly more clear to me; that distraction alone is not enough to keep safe in the long run. Yes, employing distraction techniques will keep you safe for the moment – but unfortunately, without the extra direction that counselling and therapy offer, the emotional strain still keeps building and thus you may, as is the case for me, find yourself moving from the stage of wanting to self-harm to actually wanting to end your life altogether, simply for the sake of escaping the pain you are experiencing.

For me – and I have said this repeatedly – it is not a case of actually wanting to die – I just don’t want to live. In this way. And without the help I need to make sense of all those underlying emotions I mentioned earlier, I can’t see myself breaking away from it. I am more than willing to admit that I simply don’t have the tools yet to be able to do this on my own.

I have spoken to my care co-ordinator about this on a number of occasions, but she seems not only unwilling but unable to understand the severity, the depth, of this problem.

Two weeks ago, when I, for some inexplicable reason called her, naïvely hoping that she’d be able to help me make the referral to Drayton Park since I didn’t feel able to do it on my own, she actually gave me the oh-so-insightful advice “Just think happy thoughts!” – as if that would somehow magically make things ok for me, would enable me to pick myself up and put myself back together. I mean, I’ve had my fair share of You’ve just got to stay positives aimed at me – and in all honesty sometimes it’s even been helpful, but, that – “Just think happy thoughts!” – really drove me over the edge.

This same woman, by the way, made the unbelievably bright statement that “we don’t want to overcrowd you with support” when she met up with me and one of my named workers at Drayton Park for a review last week. Now, I don’t know about you, but it’s been a good ol’ while since I heard about anyone stating “overcrowded with support” as a reason for giving up on themselves and on life, so I’m not entirely sure how she reached that conclusion. Then again, she is apparently also the kind of person who thinks that a pat on the head is an acceptable form of encouragement, rather than a decidedly condescending gesture. (Yes – you guessed it – she actually, physically, patted me on the head as she was leaving the room..)

Ok, so I’ve lost the track a bit here, but on the other hand it does rather perfectly illustrate the fact that not only do people suffering from depression and other emotional difficulties have to deal with the actual difficulty in itself, but often – and I’ve heard this said time and time again by people who are in a similar situation to me – find themselves having to also struggle to convince the people who are meant to be there to support them that lending an occasional helping hand will not necessarily render them completely dependent on others from here on out.

There is a lot more I could write on this subject, but I think that for now I’ll leave it be and just concentrate on the things that are going my way, rather than the things that aren’t. Things like having people around me who picks up the thread and helps me where the system seems to have failed. And friends I can call and just cry and not say a word to and they will still understand me.

How’s that for positive thinking?

xx

PS. No need to freak out over the scalpels, they are no longer in my possession; I called Drayton Park and the workers helped me calm down and have a breather before supporting me to dispose of the offending objects.

I Stumble, I Tumble, I Spin, I Fall – An Entry About Losing Control

Posted by What It Takes To Be Me in Counselling with D, Depression, Diagnosis, Expressing Emotion, Psychotherapy Breaks, Self-Harm, Suicidal Ideation, Work and tagged with , , , , , , , , , , , , , , , , , , , , , , ,

Remember that little voice I was talking about in my last entry? The one that tells me that I’m just gonna have to get through this? That there’s no other option? It’s gone AWOL. Completely muted. It’s been nowhere to be heard this week. Not good. At all.

I am really struggling at the moment. Not just a little, but to the point of wondering if it’s really worth it. All that darn talk about light at the end of the tunnel. Yeah yeah. Sure. Whatever. What I want to know is when?? How long am I supposed to hang on to the ridiculously vague hope of things getting better? Seriously?

I feel like I have really given it my best shot. No two ways about it. I couldn’t do it any better than I am. I really couldn’t. I haven’t self-harmed for a very long time, I stopped researching suicide methods entirely, I got myself back to work and I even managed to be good to myself by deciding that working full-time is not the best thing for me right now.

I’ve ticked every single box on the “Rid yourself of depression” step-by-step list. I genuinely feel I have. And yet this depression keeps rearing its ugly head, reminding me of all the things that I am up against. No, I’m not after a free ride. Not at all. I know that there is no such thing as a free ride when it comes to depression and over-coming emotional trauma. But couldn’t I at least be allowed to have a good streak that lasted long enough for me to actually catch my breath before being pushed head first below the surface again?

I am so incredibly sick of this illness. And this whole thing with diagnosis. Recurrent Major Depressive Disorder. Big words, but what the bleeding heck is that supposed to mean? That I have been experiencing more than one depressive episode? Well, duh? Really? I’m glad you told me, ’cause I sure hadn’t noticed.. Or even worse, does it mean that I am doomed to have recurring depressive episodes forever? Honestly? Because if that’s the case, why even try to get out of the one I’m in. For the sheer joy of getting knocked down again?

I had an appointment with S., my care co-ordinator on Wednesday, and being the happy little helper that I am I agreed to allow a third year student nurse to sit in on our meeting. Big mistake I’m sorry to say. Not only did S. spend half the time explaining to him why she had wanted to meet with both me and Dev two weeks earlier etc etc etc (could she really not have gone over the background with him before actually meeting with me?) but also, – and I’m trying to put this in an as gentle way as I can – the poor fella just didn’t seem quite mentally capable of grasping the basic concept of depression and kept coming up with these annoyingly naïve positive comments to whatever I said. This, naturally, made me feel like I wasn’t being taken serious (when talking about having suffered some pretty horrendous flash-backs at work) and also I had to – yet again – practise my skill of holding my frustration back. In other words, the exact opposite of what I have been trying to do. Great! Enormously helpful.

Later in the session we ended up talking about my family and I said that I really really miss them at the moment, especially my nephews – and this guy goes “So, does that make you feel like getting back in touch with your family? Maybe they are exactly the reason you need to get back with them? Does that make you feel hopeful?” Again, surely S. could have had the foresight to have given him at least a the bare essentials on my history before inviting him to join in? Or am I being unfair?

What else? (As I’m going on a monster moan I may as well do it properly. This is meant to be honesty-focused after all). Oh yeah – as great as my boss has been in helping me out with sorting out my working hours and such, it seems my working part-time is breeding contempt in my two closest colleagues. On the one hand I can understand it – they can’t see that my day off is actually my toughest day of the entire week, but on the other hand it’s really none of their damn business what the reason for my absence is. I’ve told them that both Den and the MD of our company are aware of them, and that should be enough.

Finally.. I was meant to see D. tomorrow. But I won’t be. Unfortunately a family matter has arisen and she’s had to cancel the next two weeks of counselling. To start with. Obviously I feel for her, it’s never easy when those things happen, whatever they are, and ultimately we are all only human and sometimes we have to prioritise. But as much as I accept this, it doesn’t stop her prolonged ansence from having a pretty bad effect on me. I mean, of course that’s a mere side effect – but it’s still there. So I had a bit of a breakdown today.

I had already been struggling a good deal with thoughts of self-harm and suicidal ideation in the last few days, and in order to motivate myself to resist my urges I kept repeating to myself that I’ve made it through nearly four weeks without counselling and I just need to hang on for another few days and I’d be back on the road to normality again. That, if I think about it, it’s only hours, really, until I’d have my time back again. And that although there is no miracle cure, at least that should ease the pressure a little. The space and place that is there just for me to vent whatever is brewing in my head.

And then I was told that that’s not happening.

I was sort of ok with it for a few hours, while I was still at work. But then on the way home I just started crying. All that pent up sadness and loss and confusion just bubbled out of me. Surprisingly I actually had the mental awareness to realise that this might be rather a good thing; that allowing myself to express these feelings is precisely what I need to be doing. But, of course, me being me I quickly reverted to the safer path of checking myself out of this emotional turmoil, turning it back on myself in the way I’m most comfortable with; the self-punishing thought pattern of Blithering heck, woman, get a grip! What’s there to cry about? You have no reason to cry. Only weak people cry, and you can’t afford to be weak because people will take advantage of you. So, literally within minutes, I had switched from indulging in self-pity to absolutely bursting to find a razor and start carving up my arm.

I didn’t. God knows how, – I guess my tattoo and the lack of razors in my flat helped somewhat – and I didn’t. Instead I picked the phone up. First I called the Samaritans and found myself having another good cry over the pathetic mess that is my life, how stupid I am to even think that good things would ever happen to me and how I’m never going to get away from feeling this way. Then I called Drayton Park Women’s Crisis Centre. I’m not even really sure why. It was just something I did. One of the workers picked up – the one who’s always so cheerful I can’t help but to think of her as being chemically imbalanced no matter how sweet she is – and even though I’ve never actually had a one to one session with her I just started to cough up how badly I was wrestling with the idea of harming myself. She assumed that this was a direct result of having been told that I won’t be seeing D. earlier in the day. I didn’t even get a chance to tell her that this urge has been intensifying over the last few days, but maybe that doesn’t really matter – because I’m pretty sure that although this explosion of emotion isn’t purely down to my disappointment with this setback, it was more than likely the final trigger.

Hm.. Odd.. As I’ve been writing this seizmically proportioned rant I think that little voice has returned. Fair enough, it’s still very faint, and my demons definitely still outshout it. But at least it feels like it’s there.

And I guess that’s something.

I just hope I can hold on to it.

xx

“..when all I really want, I said to myself, is to survive the present..” [Nuala O’Faolain]

Too Depressed For Psychotherapy?

Posted by What It Takes To Be Me in Counselling with D, Depression, Psychotherapy and tagged with , , , ,

Another Friday, another counselling session with D.
But, what have I been doing with myself in between sessions?

Well, I’ve had a pretty big week for someone who doesn’t normally venture outside if it can be avoided, and there is one specific event I want to tell you about.

As I mentioned in a previous blog entry I’m on the waiting list for psychotherapy through the NHS. And Monday was The Big Day – my initial assessment with Dr J. It took place at Hill House in North London, a very tall building semi-hidden behind the Archway tube station; frighteningly unfamiliar territory to me.

Nervous as I was I had given myself plenty of time to get there and as a consequence arrived ridiculously early. I had planned on bringing a book and my journal with me; they had both been neatly laid out on the coffee table at home the previous evening, but I had still managed to somehow leave them behind.

Not wanting to sit in the waiting room with just myself and my jittery nerves I found the nearest Woolworth and bought a hideous turquoise notebook in which I started scribbling frantically once back in the waiting area.

While waiting I was also asked to fill out one of those standard forms that is meant to give an indication of just how depressed you really are. If you’re not familiar with these questionnaires, basically you’re given about thirty statements which you should rate the validity of based on how you have been feeling in the last week. It includes statements like ” I have felt it would be better if I were dead” and “I have felt too overwhelmed to talk about my problems”, and you get to choose between “Never”, “Only occasionally”, “Sometimes”, “Often” and “Most of the time”.

Needless to say, it’s pretty obvious how to score high versus low on the depression scale – so it really is key to be honest. At least if your aim is – like mine – to get the right kind of help.

I’ve taken this test probably about fifteen or twenty times in the last six months, and I have to say that this time round I could really see a marked difference in how I am managing my depression. A significant positive improvement.

Dead on the hour Dr J., a long-haired woman in her early forties, who I had not met before arrived. She led me to her tiny-bordering-on-claustrophobic little office in complete silence and gestured for me to sit down on one of the chairs, still not talking. I’ve been in therapy a number of times before, so this – the absence of a proper greeting – didn’t come as a surprise to me, but I think had I not been familiar with this particular approach, I would have been somewhat taken aback by it.

Knowing that the good doctor would not be the first to break radio silence I said the first things that came to mind: “Let me just put these things away (meaning my iPod and the notebook). I always write when I’m nervous,” immediately wondering what she would make of that, slightly beating myself up over being so utterly un-original.

Thus began The Assessment.

I was asked to tell The Doctor about myself, (“Wow, that’s a big question – I wonder if I have a big answer to it.”) so I did, starting out by verbally bullet pointing the basics; That I have been living in the UK for about five years, but grew up in a small town in the north of Sweden. That I was adopted from India at the age of six months, but feel Swedish through and through since I don’t remember anything of my time at the orphanages where I stayed. I also stated, almost casually, that I was sexually abused from when I was about four and a half years old until I was seventeen and that the abuse came to light having overdosed on a random cocktail of my
mother’s sleeping pills and anti-depressants. I admitted that I have been and still am struggling a lot with the way my family have dealt with the knowledge of the abuse and mentioned that I was still expected to see my abuser, a member of my family (not my father), whenever I go home. I then went on to talk about growing up caring for my bipolar mother, with all of her ups and downs, but that neither she nor the rest of my family are likely to acknowledge this (the sense that my role was to be her carer) as being either valid or true. I ended my life-story recap by describing how I drank half a litre of anti-freeze liquid over a period of three days in March of this year, in an attempt to kill myself.

At this point Dr J. stepped in and commented that I seemed very emotionally detached from the things I was talking about, and I explained that this is one of the reasons why I feel I would benefit from psychotherapy; that I want to learn to connect to my feelings surrounding my childhood and my family, and find ways to deal with them that don’t include resorting to occasional self-harm or other drastic action. In short, I want to feel real. I want to learn how to respond to things without immediately putting up a three-foot thick wall to shield me from any potentially painful feelings.

The assessment lasted for a bit over an hour and at the end of it Dr J. said that she didn’t really question my intellectual suitability for this sort of treatment, as I am clearly very articulate and perfectly able to express myself verbally, but that she had some serious concerns regarding my safety, as therapy often brings out a lot of very difficult things and you are bound to experience an abundance of complicated feelings which may be very difficult to manage.

Since my history points towards an acutely self-destructive pattern she simply couldn’t overlook the fact that my risk-factor is high. I pointed out the things I have done to keep myself safe; not keeping razors at home, using distraction techniques to control my impulsiveness, calling help-lines for support if needed and the fact that I have been able to manage the week between my counselling sessions in a positive way. So, she responded that she would still need to talk to D. and to my care co-ordinator, and also to the women’s crisis centre where I had been staying when I made my last suicide attempt, before making any decision, and that once she’s talked to them she would ask me back for another session to discuss the outcome.

I feel quite happy about this, because if she hadn’t felt the need to talk to others who have been working with me I’d have thought her rather irresponsible, taking on someone who on paper is very high risk without any consideration. I mean, there is no two ways about it; in the eyes of any professional I amhigh risk, and taking my word for it that I’ve changed would be very reckless, indeed. Having said that, I hope that once she has talked to D. and my care-coordinator, she will feel that I am capable of coping with psychotherapy and give me the opportunity to prove it.

In my session with D. today we talked about the assessment and also the fact that I have come a long way since I first started counselling with her. And that I have worked very very hard at finding alternative ways to deal with destructive impulses. She also said that she definitely feels confident enough regarding my risk-factor to recommend me for psychotherapy, but that she fully appreciates Dr J.’s concerns.

Hopefully what D. says about me will weigh heavily enough to sway Dr J. ‘my’ way, because I think I could benefit hugely from therapy.

Anyway, I am going to end this entry here. Dev is forever teasing me that blog entries are meant to be short and concise, and that this is a writing style I have yet to master.

All I have to say to that is; I could write that way if I wanted to, I just don’t want to . So there! :þ

xx