Being The Perfect Therapy Client

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

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Bulletpointing My Life

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