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...

2 comments:

  1. HI Myrtle

    My second-hand experience of the NHS is that it is extremely difficult to get good long-term therapy. I know of one person - not family - who was assessed as needing psychotherapy, eventually was assigned a therapist but was abused by her. Now, rather than being assigned another therapist this person had to go back to her GP and enter the entire screening system again.

    Have you looked for private therapy? Now I know this can be horrendously expensive but some charities, certainly in Scotland, offer free therapy. Again I know of another person who received two or three years' counselling for very severe issues.

    Hope this is of some help.

    Take care,

    Calum

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  2. Thanks for commenting - I was going to reply before but then I thought the next post would explain, only it's taken me 3 weeks to write it! I would recommend going private - but screening therapists carefully - to anyone who can scrape together the money. I'd have done it sooner if they hadn't kept offering false hope then discharging me fom mental health services.

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