Saturday, 26 April 2014

Therapy (part two)

Following on from my previous post...
Having been repeatedly let down by the unavailability of in-depth (ie. not CBT/CAT!) talking therapies in the NHS system, I am in the very fortunate position of being able to access private therapy. This is due to family members chipping in to pay for it – a situation I'm not altogether comfortable with, but I'd be a fool to refuse this opportunity. I hope at some point I can pay for it myself, and it is still under £40 a session as it's done on a sliding scale depending on income/who you see etc.

I'd also like to point out that this therapy really should be provided by the NHS (*unless mental health starts being treated within a new, non-medical paradigm – but even then treatment should still be 'free at the point of use' like the NHS). Even on a cost-only basis - especially taking into account money spent elsewhere eg. crisis care, policing and state benefits - the fact that it's not is ridiculous. Unfortunately it's a ridiculous thing that causes huge amounts of pain, distress, and lost lives as well as severely damaged lives.

However, I would hate it if anything I wrote was seen as an argument against socialised healthcare. Instead I feel the problems I have experienced within NHS mental health care actually relate to funding issues, political issues and the way in which mental health is viewed by society at large. I have met some horrible, deeply unsuitable so-called professionals in my time, but even that could be solved with better training, higher staffing levels (preventing staff burnout and increasing morale), and being able to treat people long-term so they actually recover rather than the 'fire-fighting' mental health care has become. A higher profile for mental health, and a more rewarding working environment would also mean dodgy professionals could be more easily weeded out and replaced.

Anyway, here I am, now pootling off once a week to therapy, affordable only because I have found somewhere that offers discounted rates, and family are willing and able to pay for a while. I'd like to pause for a moment and consider the last decade of sporadic involvement with mental health services, the police involvement, the benefits claimed, and the experiences that left me worse off mentally. There is a lot of cost there; financially it's staggering (I will try to estimate it one day!), and the emotional cost hasn't exactly been fun either (leading to more financial cost of treatment as my original problems have been compounded... perhaps they hoped I'd just go away and kill myself.)

So far, it seems to be going okay. Going well, even. The first thing that really struck me was that I felt better after the first couple of sessions. By that I mean I literally felt better right after each session, having expected to feel worse due to stirring everything up. I think the reason is the immense sense of relief at finally being able to open up in a non-judgemental and compassionate environment. Previously, within the NHS system (in particular with the therapist I saw last year) I always got the impression that I was doing something wrong, that they were annoyed with me for not understanding something, or having feelings rather than just 'correcting' my thoughts. It felt like they were missing the point, somehow.

Despite feeling better immediately after sessions, in general I have been struggling more the rest of the time. It actually seems to get worse leading up to a session, which I think is probably a sign that the therapy is digging in the right direction. Basically it's just the issues I have normally, but ramped up a few notches. Severe depression, fear and dissociation in the mornings. Dissociation in general more, as well as more 'staring into space' thinking. Thinking thoughts I am just daring to think, joining the dots, but leaving a terrible sense that although I know what is wrong I do not know the right way. I keep finding myself in situations where I have no idea what to do, or even what I want to do, because I am so used to overriding my feelings and trying to please everyone.

An odd and difficult thing is that I seem to be feeling things that are 'symptoms' of BPD. In particular, feeling empty (I've not felt this before), fear of abandonment and frequent urges to self-harm. It's really irritating, having spent so long pointing out that BPD was a misdiagnosis, only to find the moment I get some decent therapy I start displaying it! On the plus side, I do have a smug sense of satisfaction that the 'common-knowledge' symptoms (ie. not written in official diagnosis but attributed by psychs anyway) like being manipulative/attention-seeking/a complete bitch are utter tripe. I thought they were anyway, but if I'm in the 'BPD club' as it were, I speak from personal knowledge! On the other hand, I still don't actually have enough 'symptoms' to fulfil the BPD criteria, so perhaps not. If you take the diagnostic criteria at face value I have even less – it is written so it says 'X' behaviour happens, because of 'Y' feelings. I don't display 'X' but I do have the underlying feelings. So am I a good little 'regulated' BPD? Who has been crushed by the system into giving up showing my distress or asking for help? Probably...

* * *

Since writing the above paragraph, and another therapy session (this post is taking weeks...) things have changed a bit, at least if you were going to try and diagnose me. (I believe labels really shouldn't matter and are just an abstract concept but it's so hard not to think of them after being exposed to such stigma as the BPD label brings.) I've been experiencing severe depressive type symptoms – inability to concentrate or make the smallest decisions, lethargy, hopelessness, feeling overwhelmed and that others would be better off without me. The main thing is this horrible, horrible... sort of... arghh... everything's just there. All the things that have really hurt, ever, just in my mind. I could zoom in on the details if I wanted, though I don't. I'm feeling all these overwhelming feelings, of pain and fear and shame, and feel distant from others. This is difficult, because I want to connect so much. I want to say “I'm still here, please apply cuddles and normal service will resume... at some point!”

Finally, I've been thinking about issues to do with paying for therapy directly, rather than paying via National Insurance and tax for the NHS (yes, it is not 'free' and never, ever forget that!) The first thing is that after I was assessed they decided I needed to see someone with more training and experience than was offered at the cheapest discounted rates. The cynical part of my mind flagged this up, thinking of people profiting from others' misery. Another, larger part of my mind breathed a sigh of relief, thinking “finally someone understands”... knowing I wasn't going to be fobbed off with a simplistic and unhelpful therapy. And of course there was a part that thought “Shit! I must be really fucked up.” Anyway I was matched with a therapist who I do feel a certain sense of rapport with, so “so far so good” I suppose!

It is strange though, going over the most personal things, reliving incredibly painful times, discovering things about yourself... then handing over money. It sort of makes the whole thing seem a bit inauthentic. Like I wish there was a person who would do it because my pain matters – because I matter – not motivated by money. I suppose there's a feeling it's like buying friendship. Logically, I know that's not exactly how it is. Obviously, therapists working within the NHS are being paid for their time too, it's just that it's not as stark to the service user themselves. I suppose there's an element of 'administering angels' attributed to the NHS no matter how undeserved on the part of the individual professional. On the other hand, here I was 'matched' with a therapist who could quite easily refuse to see me, whereas in the NHS they would have to. Actually, that's not true – but they'd make up something about not being 'suitable' rather than just not see you, which is even more frustrating. Also, if I was a therapist, I would find it incredibly difficult to work in the NHS due to the limited kinds of therapies offered and being unable to work with the people who were crying out for in-depth therapy (and it's getting worse) – the people I'd really want to help. Then again, who, when their life and psyche is in painful turmoil, can actually afford to pay a private therapist?

All I can say is I wish this had come earlier. If someone had noticed how I was struggling as a teen – or rather, done something about it. If the mental health system had offered timely and appropriate help. If I'd been living here with these people earlier...
If... If...
But there's only now and onwards....

Thursday, 3 April 2014

Therapy (part one)

For some reason I'm really hesitant about writing this post. Mainly I feel really self-indulgent and sort of over-priveledged, moany, and like I should just crack on with living and leave all this stuff behind. The latter part is mainly a good thing, as it's been coupled with feeling a bit better and finding easier to get on with things. However, I do wonder if there's an aspect of wanting to shy away from sorting things out, as if my mind is going "I'm fiiiiine, look! Now let's sweep this under the carpet please!"

Anyway, continuing in the over-priveledged, self-indulgent (etc.) vein, I thought I'd write an update on where I've got with accessing therapy, with a few thoughts thrown in.

About three years ago, I briefly saw an NHS psychotherapist for an assessment period with a view to therapy. Unfortunately due to a recent life event, she decided I was too "unstable" to go through therapy then. I feel this decision was completely unreasonable. I mean, I can understand that you need to be able to reflect on things and have the time and head space to work through things, and some situations might not be compatible with that. But in my case, I was just very upset by something that had happened, and actually would have benefitted from talking it through with someone and examing the thoughts and feelings in relation to the wider picture. I could see that the reason I was so upset was because what had happened tapped into deep fears, and it left me emotionally open (vulnerable?) to exploring things that are normally locked away inside. Also, knowing that I couldn't have therapy – couldn't have a way to get better – contributed to feeling hopeless and unstable in itself. Majorly, in fact.

After much chasing up of referrals and the first step of a complaint about my (lack of) treatment, I was eventually assessed again, and put on the waiting list for therapy. During the assessment, the psychologist seemed to really understand, including suggesting there was a trauma-based reaction going on. I was told it'd be about six months on the waiting list until I saw someone. It was actually nine months, and then the therapist I saw did an "extended assessment" over about six sessions, which took another three months. So, a year after being put on the waiting list for therapy, and over three years after I'd originally been referred by by my GP, I still hadn't actually had any treatment at all. (* It could be argued, probably by the mental health team, that during this time I had sometimes seen a CPN, and occasionally the Crisis Team, and that every interaction is a little healing moment... but that would be utter rubbish in this instance.)

And then... the therapist decided I wasn't ready/suitable for therapy. Her reasons were outlined in a letter my GP printed off for me that I'm not supposed to have seen. I received an edited version of the letter through the post. Her main reason seemed to be that I apparently don't realise I need to change. On a basic level this is ludicrous – who would anyone go to therapy if they didn't want to change something within themselves? I would like to change the way I feel, to uncover the unconscious thought processess behind it all, and deal with the distressing memories and feelings. But of course that's not what she meant. What she meant was that I needed to realise I am bad, a fucked up person who makes things difficult for everyone else so no wonder I feel awful, and if I could only change and be compliant and not have feelings it would all be ok. Clearly, telling myself this/having this reinforced for years doesn't seem to have worked, but all that's needed is a therapist to tell me and I'll buck my ideas up and JUST BE FINE.

I suppose I might think she's spouting tripe precisely because she's right and I can't accept I need to change (a sort of catch-22 of inescapable condemnation, oh joy). However in the context of some odd things she said in our last two sessions, I really do think she was barking up the wrong tree. She basically seemed to think I must be doing something which makes bad situations happen, which in turn make me feel bad. She just couldn't seem to grasp that I just feel bad, unrelated to what is actually going on. I mean, obviously I'm affected by life the same as everyone else, and if my baseline is low then things will affect me more. I'm also fully aware that the bad feelings I have stem from past events. But she didn't seem bothered about working through this stuff, just wanting to know what crazy shit I'm doing right now that makes me feel bad!

She also seemed to think I must have massive problems in relationships/friendships. This misunderstanding probably stems from the fact that mental health workers assume every relationship in your life is the same as the relationship you have with them (gosh what a depressing thought!) I would agree there might be similarities, but only in relationships that are dysfunctional, even abusive. How else would you describe a relationship where the power balance is all one way, where one side can collude to have the other locked up, or alternately make the person feel like a waste of time, or cut them off altogether, and yet the other person keeps going back because there is something they desperately need from the relationship?

In hindsight, I suppose I can see I might have problems in romantic relationships. As I detangle all the thoughts and feelings associated with Mr. Blokey I can see that. But these issues are to do with being too submissive, desperate to please, and feeling inadequate – not me being crazy, demanding or otherwise a horrific person to be with. Yet the therapist would have me go futher down that road of submission and denying my own needs, rather than learn to feel worthy of being loved.

I think a large part of the problem is that the therapist could only offer/is only trained in short-term therapies, although I don't know this for definite. Across the mental health service, longer-term therapies are like gold dust, with funding diverted into the IAPT (Improving Access to Psychological Therapies) scheme, which provides short-term, quick-fix (supposedly) therapies like Cognitive Behavioural Therapy. (Even the name sounds chilling! We will modify your behaviour! Conform!) The therapist I saw seemed keen on using a Cognitive Analytic Therapy framework; CAT being the slightly more in-depth relation of CBT.

Having decided I was unsuitable for therapy, they discharged me from services altogether, because I'd previously decided against meeting with a CPN. I had started seeing one, but after the first few appointments began seeing the therapist, so it seemed a bit pointless to see the CPN too – after all, it was treatment I was after, not just a chat and going over the same old ground. The letter also advised my GP not to refer me back to secondary services because I feel let down by them! This winds me up immensely, a sort of perfectly-reasonable-on-the-face-of-it-but-subtly-passing-the-buck statement. It's not that they don't offer the right treatment or support, it's my issue of feeling let down by services.

Anyway, this post was started two weeks ago, after I had an assessment at a private therapy centre. The feelings I described at the beginning of this post are a bit different now; but sort of everything thrown in together. This post has got so long, and real life beckons, so I must leave further musings until next time...