Therapy: Part 1

My thoughts and observations following my first CBT session on 10/09/2019.

***Trigger Warning*** Discussion of self-harm

Covered in this session

  • Introductions
  • Identified main issue to be addressed
  • Established level of familiarity with CBT
  • Established level of immediate risk
  • Pamphlets offered for information and support in the meantime
  • Homework set
  • Next appointment time agreed.

Homework

To identify at least three ‘goals’ related to my mental health issues, to work on in therapy.

Reflections

I was surprised how nervous I felt at the start of the session, especially as it was an online ‘chatting’ format so minimal social interaction involved. I’m not really sure why I felt nervous to be honest. Recent events have taught me not to get my hopes up for a positive experience when I try to do something to improve my mental health.

I was referred to a perinatal mental health service after my little one was born due to a traumatic birth and for a brief time leading up to my assessment appointment, I felt genuinely hopeful that I might finally be able to access some help. Unfortunately the reality was quite different – they basically told me that they couldn’t do anything for me. I didn’t tick the right boxes I guess, the usual ‘too crazy/not crazy enough’ paradox. I was gutted. But, in trying to make every effort to recover for the sake of my family I have settled for CBT.

The format was mostly fine in the end. In fact, the ‘chatting’ worked well for me as it meant I could join the session using my phone and still be able to breastfeed or see to the kids if necessary. I felt that writing things down slowed the flow of conversation quite significantly, so little was actually covered in the time. It was probably a bit too easy for me to get distracted really, but distractions are unavoidable where kids are involved. The next session is at 9am and that is a chaotic time in our home, so I’ll be surprised if I can concentrate at all!

I found the therapist to be pleasant enough, but the session felt very scripted – probably unavoidable, but it was so much more obvious in writing – and personally I found the approach quite patronising. There didn’t seem to be any adjustments to accommodate the fact I had undergone therapy before, so I felt pretty bored by about halfway through the session.

Frustrations

I wasn’t naive enough to assume that one session would make me feel any better, but I was disappointed that I actually came away from it feeling worse.

During the mandatory ‘risk assessment’ phase of the session, the therapist spent far too long (in my opinion) focusing on my risk of suicidal thoughts or self-harm. In fact, because of the way these things are measured on their outdated questionnaires, she thought I had experienced suicidal thoughts, which I hadn’t. This approach, to conflate the two concepts of suicidal urges and self-harm is a real pet peeve of mine as, in some circumstances at least, they represent quite distinct motivations – e.g. the urge for an emotional release vs a desire to inflict actual or lasting harm, or many things in between.

I understand that the therapist needs to ensure that I am safe during our sessions, but the approach made me feel like my therapist didn’t/couldn’t understand my thought processes or how they are acted out. This in turn made me feel like the therapy was less likely to be effective. Finally, I felt frustrated and guilty that my efforts to improve my emotional wellbeing and resilience for my family would apparently fail again.

I appreciate that I was jumping to conclusions with my thinking there, but this is how my brain works!

It was also quite clear from the explanations provided within the session that the CBT is designed to provide short-term assistance with depression and anxiety, so the likelihood is that any notable improvement in my mental health will just be due to a ‘bandaid’ effect whilst I’m actively supported. I will be reliant on my own emotional resources again soon enough, so I need to utilise any respite to hone my emotional toolkit.

I did express to the therapist that I found the session quite frustrating (though not why), so hopefully I will have the opportunity to elaborate on that later.

Conclusions

Overall I was a bit disappointed with the session, but nevertheless I will try to keep an open mind.

Mood at start of session: Nervous

Mood at end of session: Frustrated

Has anyone else had a similar experience when starting therapy of some kind, especially CBT? I would love to hear from you.

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