Therapy (Version 2.0): Part 1

My thoughts and observations following my assessment session for on 15/10/2019.

Covered in this session

  • Introductions
  • Identified what was to be covered in session
  • Identified main issue to be addressed
  • Established level of immediate risk
  • Next appointment time agreed.

Reflections

Wow, what a difference a change of therapist can make.

Those of you that have read my previous blog posts about therapy will be aware of how negatively I tend to approach it, but despite not having a session for almost a month I have managed to maintain my determination to get better. I’m not saying I haven’t considered giving up on therapy and going it alone – I have, whenever I feel less bad – but my mild panic attack the other day opened my eyes to how much I am struggling. I can only assume that if I didn’t have the benefit of 20 years of experience with mental health issues and various therapies that I would be in a much less functional state right now.

Back to the assessment though. It was a pre-planned phone call with a trainee therapist called Rose. She introduced herself and talked through the format of the assessment, which was undertaken much more comprehensively than for the online therapy.

Most of the session was similar to before, ie. the therapist asking for personal about the areas in which I have been struggling.

I briefly explained to Rose my history of mental health issues. I also explained that I now believe that my current struggles are related to the postnatal depression (PND) that I developed over 2 years ago and never received treatment for. My PND was compounded by interpersonal issues at work (some would say bullying). The bad experiences at work resulted in me feeling such severe guilt, anxiety, stress, self-doubt, depression and low confidence that I believe I am essentially traumatised by these events and that is why CBT isn’t right for me just yet. Rose suggested that a better path for me would be some counselling, followed by CBT once I am in a position to focus more on the here and now.

Finally, I thought, someone is actually listening to me!

In addition to immediately having more of a rappor with Rose, I also had the benefit of a few weeks of soul-searching and reflection on the last therapy to build a more articulate depiction of my current mental state. I felt I had a better grasp of what I did and didn’t want from therapy and therefore felt more in control of the assessment process. I felt that recommendations were reached with mutual input, rather than me being forced along a standard path of treatment, as if that was the only option.

Overall I felt much more was covered in a shorter time than in the online sessions. We overran the allotted time by 15 minutes but at no point did I feel rushed.

Conclusion

I found it much easier to built a rappor with Rose due to the assessment being done over the phone rather than the clunky chatting format. Her approach was friendly and quite passive (in a good way), rather than insisting on validating everything I said in a patronising manner, which is how I felt my last therapist approached things.

I feel so relieved to talk to someone that actually seemed to listen to what I was saying and understood it.

However, I am fairly sure that my positive experience has a lot to do with the therapist undertaking the assessment (Rose), so if I am referred to another therapist for the counselling then I may find myself in a similar position to the last therapy, where we just didn’t ‘click’. This may cause me some anxiety initially, but hopefully it will prove to be unfounded.

Mood at start of session: Anxious

Mood at end of session: Positive

Has anyone else had a similar experience with therapy? I would love to hear from you.

Therapy: A Decision

After a lot of consideration, I have come to the conclusion that CBT isn’t for me.

I started the therapy anticipating that this moment would come, but nevertheless it’s disappointing to be met with another dead end on my route to recovery.

Why wasn’t it working? A few reasons, including the time-consuming format (basically like WhatsApp), limited scope and focus on behaviours/goals.

More specifically, my behaviours aren’t actually an issue on a daily basis. After nearly two years of forcing myself out of bed to attend a soul-crushing job, I am well practised at doing things I would rather avoid. Also, I’m currently a full time mum to two little kids, so I really have no choice but to do everything I have to in order to meet their needs. Failure to do this would represent a much greater problem; luckily I am not in such a position.

So yeah, setting ‘goals’ felt a bit pointless because most of my day is taken up by small tasks that I would avoid (if I had that luxury). I live in a perpetual state of being outside my comfort zone.

I can talk the talk and come up with goals for setting myself more `me’ time or trying to reframe my negative thoughts, but the reality is that life is kinda something that happens ‘to’ me and once my little ones have been considered I have very little control of what I do or think about. Obviously I love them and cherish our time together, but it is rarely time spent in ways that I would choose. Getting to enjoy my children one-on-one is hard enough right now without trying to force in some alone time too!

Did I mention that most of my posts are drafted whilst breastfeeding…?

Anyway, this lack of autonomy will be resolved in time and I know it. But presently I consider that my problems are more emotional than behavioural. I can fight against my ‘flight’ instinct, but am not sufficiently equipped to manage the emotional fallout. I have an emotional resilience issue. And the result of this is my negative emotions spilling out into other areas of my life.

I only had a couple of sessions of CBT, but after each one I felt frustrated, confused, triggered – worse, basically. When I raised this with my therapist she made impractical suggestions like ‘go for a walk’ or ‘have some alone time after sessions’. I personally felt that the issue was predominantly her manner and/or the format.

BUT… rather than giving up on therapy completely, I am going to try getting referred for a different type of therapy next to see whether a change in format and focus will help me to find a more practical approach.

Wish me luck?

Therapy: Part 2

My thoughts and observations following my second CBT session on 20/09/2019.

Covered in this session

  • Wellbeing check
  • Discussed goals
  • Discussed incident where I met up with work colleague
  • Homework set
  • Feedback on session given
  • Next appointment time agreed

Homework

To add goals to my planner and to review/complete the CBT diagram based on my meeting with my colleague (thoughts, feelings, behaviours).

Reflections

I wasn’t feeling particularly positive about the session after the last one went badly, but as I have promised my partner that I would do my best to engage with it I tried to remain open-minded.

During the break between sessions I had struggled with the goal-setting homework as I felt totally at a loss to identify what changes might improve my mental health, so I plucked a few generic ones out of the air – goals that on an intellectual level I thought were probably pitched right. I then emailed my therapist to explain how I had struggled to devise them. I needn’t have bothered; during the session she told me that the goals were ‘great’ and that we would discuss how I get on with them at my next session. Again, she missed the point.

At this point I felt pretty overwhelmed and upset as I really expected that she would discuss how I might go about meeting my goals rather than skip over them so quickly, but I guess there just wasn’t time..? It was very disappointing to receive no advice about how to achieve the goals I had set. This was quite triggering for me as it is essentially what my manager did for two years at my job, before I left to go on maternity leave. I would have pressed the therapist for more support/guidance, but at the time I was giving her the benefit of the doubt (I wasn’t sure if she was going to come back to it)… But then we ran out of time anyway.

The next item on the agenda was to discuss the meeting I had recently had with my colleague, as I had felt pretty low afterwards and realised that it was probably a good example of a situation that I struggle to process. However, rather than offering any advice, my therapist’s reaction was to 1. Offer empty platitudes about how hard I must have found it and 2. Turn it into homework, to be discussed next time! Not exactly what I was after.

Overall I was disheartened that more wasn’t covered in the session. The therapy format seems to be too introspective, with little practical advice. More time was allocated to risk assessment and providing feedback on the session than to addressing any issues I was actually having.

Frustrations

I’m not sure if the problem is me or the therapist, but we just don’t seem to communicate very well. I find her input either vacuous or patronising and considering I have actually attempted to articulate my concerns to her, she doesn’t seem to understand where I’m coming from at all.

Once again I finished the session feeling worse than at the start. I was (and still am) confused about how the therapy will progress in future sessions and at which point it will be determined that the sessions have run their course. A new experience for me is a sense that I might get dropped by my therapist! I fear that as the therapy is ‘outsourced’ they will be wanting to get me ticked off ASAP to keep their statistics looking favourable. This is the opposite situation to when I was paying for sessions privately and was anxious that the psychologist was working too slowly. I’m never happy, eh?

Conclusions

I was left feeling more lost at the end of the session than ever. My misgivings about the type of therapy and this therapist in particular continue to weigh heavily on my mind. I think I need to evaluate the potential worth of continuing with this.

Mood at start of session: Anxious

Mood at end of session: Frustrated/Deflated

Has anyone else had a similar experience with therapy? I would love to hear from you.

Therapy Techniques that Worked: 1. Self Care

Therapy, in my experience, is something that I inevitably drop out of, usually with a renewed sense of ‘screw this, I’ll manage by myself’ and a vow to never return.

My childish attitude aside, the fact is that I eventually felt strong enough to go it alone and manage without the support of a therapist. Objectively, the therapy was successful.

So I find myself wondering, of all the ‘tools’ and techniques that I have been taught over the last 20 years, which have actually worked for me?

Self Care

When we are going through a difficult time, are busy caring for others or experiencing low self-esteem, it is easy to neglect our own needs.

Meeting only the bare minimum requirements to function in your life is not meeting your needs.

So often, we don’t make time for those restorative or rejuvenating activities that can make the difference between self-belief and self-doubt.

I am personally guilty of this. As a mum to a breastfeeding newborn and a toddler, I am very much in demand and barely have time to look after myself. Sometimes I feel slightly irked that my partner leaves me with the kids while he is having a longer shower or taking a few extra minutes for self-grooming (a close shave with beard oil, what a luxury!), but the fact is, I am the one in the wrong. He understands his own self-care activities and ensures that they are undertaken on a regular basis. What’s more, he would never begrudge me the same opportunity, but I simply don’t take him up on it. But I should!

What constitutes self-care?

The concept of self-care encompasses a wide range of activities, so it is inherently subjective by nature. However, there is one key aspect that connects all of these activities, which is that it boosts the wellbeing of the individual doing it.

Here are some examples of self-care:

  • Self-grooming
  • Eating healthily
  • Dressing up
  • Getting enough sleep
  • Taking time to relax
  • Enjoyable activities
  • Restorative activities
  • Medicating appropriately
  • Avoiding upsetting situations

Why is self-care so important?

In addition to the obvious physical health benefits, self-care helps you to foster a positive relationship with yourself, promoting wellbeing through feelings of increased self-worth and self-confidence. Attending to your needs can help you to strengthen your sense of autonomy over your body and your life.

Self-care as part of therapy can also be a key technique to help to shift patterns of thinking about ourselves or our bodies. By allowing ourselves to feel good, or by allowing ourselves to feel pleasure rather than pain, we really can believe (in time) that we are ‘worth it’.

So be kind to yourself! I in turn will try to follow my own advice as I have definitely not set enough time aside to help myself feel good since our new baby arrived.

Let’s do this then! I think I’m going to start with a nice sit down with a hot (yes, hot!) cuppa. If I’m lucky and my little one goes in their crib early, I might even get to have a ‘proper’ shower. I LOVE feeling clean.

Tell me, what does self-care look like for you?

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.

Therapy: A Prologue

Tonight I have my first session of online therapy.

As the appointment approaches, I can feel my senses of cynicism and fatalism growing. It is fair to say that I don’t have high hopes.

I have been open so far about the fact I am currently struggling with my mental health, but haven’t gone into much detail. Perhaps I will in time, but I feel more comfortable keeping things quite general for now.

I am trying to maintain an open mind about the session and I really want to try and engage with it in order to give myself the best chance of recovery. I owe it to myself, but also to my little family, who are affected by my issues to some degree on a daily basis.

However, I have a number of concerns that are playing on my mind.

  1. The format. I’m not convinced by the online (chatting) element of the therapy, but mental health services here are now overstretched and underfunded, so I guess I’m lucky that I can access help at all.
  2. The type of therapy. It is essentially going to be CBT, which is most appropriate for treatment of depression and anxiety. I would say that these are secondary issues arising from my ‘primary’ mental health issues, so it seems to me that I would be treating the symptoms rather than the cause. Other types of therapy have worked better for me in the past, but unfortunately they are not available to me (at least, not without high cost). It seems that I always seem to fall into the gap between being too crazy for X but not crazy enough for Y. I’m sure I’m not the only person to experience this?
  3. Past experience. The fact is, I have been there/ done that before. If it didn’t work previously, why would it work now?

On reflection, I do find it hard to discuss my feelings with people and am infinitely more articulate via the written word so it could have positive results after all?

Well, I suppose time will tell. I will keep you updated.