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Archive for September 2010

Therapy Non-Assessment…

with 3 comments

So I actually posted this a couple of days ago in a rush and then realised it wasn’t really finished and didn’t make much sense so pulled it. It seems plenty of you have actually read it anyway as google appears to have cached it. That’s nice of google isn’t it? dammit.

I have been trying to write about the assessment on 3rd September since it happened, but I don’t really know what to say because it didn’t really happen. Hence the “non-assessment” in the title.

The psychologist who was meant to be assessing me found out a few days before that she will be moved out of the team soon and therefore she won’t be taking on any further case-load. When I arrived, she asked me if I wanted to bother with the appointment at all as I will have to go back onto the waiting list and be reassessed when a new therapist is available. As I’d already made the effort to get to the appointment and my lift wasn’t due for another hour, I decided I might as well stay. Why they didn’t just phone me before and cancel I don’t know, but the psychologist suggested we had a chat about what “is going on for me now” and how therapy might be able to help me.

Talking about my current “needs and problems” was pretty difficult as I don’t know what they are. So much has changed and happened since I was initially referred over a year ago. Enough has happened since I was assessed by a psychologist in January too. I don’t know how much she knew of my notes, so I didn’t know where to start. There is too much to cover, so I just tried to focus on the present. The problem with the present is that there isn’t all that much going on.

She asked me what I hoped to achieve or what I want from therapy. I have always found this a hard question to answer, but I really don’t know any more. When I was really low, my answer was always just to feel better. Not exactly an easy task or one that had any obvious answers. Now I have even less idea what I want.

The fact that things have improved so much since introducing the reboxetine has left me wondering if I need therapy any more. The success of the reboxetine does suggest that my depression was mainly down to a chemical problem, so maybe therapy won’t be that helpful?

I do conceed though that although I may be feeling a lot better, that doesn’t mean there aren’t things I should be looking at. I am aware of things that do make me more susceptible to depression and other issues that exacerbate my mood when I am low, so I do want to try and address those. Only thing is, I don’t know where to start. I find it hard to remember what I was thinking and how things really were when I was so ill. I look at some of the things I wrote back in January and I wonder if I was delusional. My thoughts back then make so little sense to me now. How do I try and tackle those things if they’re no longer fresh in my mind? How can I make sense of thoughts that made so much sense then and so little sense now?

I hate the fact that Dr M judged me so quickly on how I was back then and I still wonder if she has changed her view since. She wanted to wait for the therapy assessment to discuss my diagnosis, but it seems I will have to wait longer for that too. I wanted to bring this up with the psychologist, but I was too scared. I am curious to know what a psychologist would think of me now that I’m thinking a little clearer and acting a little more like myself. Would they still be so quick to want to slap on a PD label or would they try to get to know me a bit better first? I don’t think I want to go back to the argument of diagnonsense though. I am not sure the label matters at the moment and it may be best to leave alone. Questioning things only seems to lead to more problems.

I managed to bring up some of the issues I know I need to discuss with her, but there were a few things that I didn’t know how to broach. It’s really hard to just open up to someone you’ve only met for five minutes and I do wonder how they expect us to do this on demand. The world of mental health assessments is a strange one. I don’t know how she is going to react or what she might think if I’m honest about some things, so it is quite hard to know how much to say. We didn’t talk about my past really or anything in depth, but I know I will have to again at some point.

We talked a bit about what therapy I’d had in the past and what kind of therapy I think might help in future. She was quite impressed by the range of therapy I’d experienced at The Priory, my understanding of therapy techniques and the list of things I’d tried to work on in the groups. I pointed out that a lot of it had been helpful in helping me manage things, although it didn’t really feel it at the time. When you’re really ill, therapy really isn’t helpful, but a lot of what I learnt back then has been more use as I’ve been recovering. I did point out though that although I’ve done a lot of therapy it has always been limited. We were scared to look at anything in too much depth, because we never knew when the funding would end and it seemed too risky to dig too deep and potentially leave things hanging.

We both recognised that intellectally I understand a lot of what is wrong, but sometimes in practice, especially emotionally, it doesn’t always help to know that. I can understand the cycles and can even intervene with the thoughts and behaviours, but somehow it doesn’t seem to change the way I feel. If anything, intellectualising things can actually complicate matters, because I end up getting frustrated that I feel no different, even though I try to do all the things that “should help”. With this in mind, she said a psychodynamic/psychoanalytical approach would probably be more helpful as she didn’t want me to intellectualise things too much. Dr G always said this too, so I was expecting that. She thought that CBT is probably not going to help, because of the risk I’d intellectualise things too much and would avoid connecting with things more emotionally. I am glad about this as I feared that I would just be offered a short course of CBT, which often seems to be the only therapy on offer. She seemed to agree though with my general assessment of CBT. I think it can be useful for some people, particularly those with milder, usually reactionary, depression, stress and anxiety-related problems, but for anything more complex it’s often a waste of time or can even make things worse.  I always get fed up of the assumption that CBT will fix all my problems and if it doesn’t then it is my fault. The NHS, politicans and everyone else seems so fixated on CBT and how it can be the answer to all mental health issues. Although I agree that therapy can be important, CBT isn’t the only therapy out there. It is not a panacea. It doesn’t work for everyone and in my experience it doesn’t really help me.

We talked about what kind of person I would feel best working with. I pointed out that I generally find it easier to talk to and prefer to work with men, but we also recognised that it might be good to challenge that by seeing a female therapist, especially as I think that  my relationship with my mother is definitely one that needs to be looked at. She said some motherly transference may be helpful! I find that thought a little scary and I’m not sure I want to go there, but she may have a point. She mentioned that someone is due back from maternity in November who might be suitable, but she wasn’t sure what was happening with all the service changes.

It seems that the therapy service for our local Mental Health Trust is out to tender. It could be taken on by another part of the NHS or a private company, but at the moment it basically means there isn’t really a service at all. A lot of the therapists are being transferred to other parts of the trust and the waiting lists are just getting longer. They hope it will bring about improvements in the long term, but it’s not really helping me. They expect to take on new therapists when the future of the service is decided, but how long that is going to take seems to be anyone’s guess. The psychologist warned me that because of the changes it may well be January before someone will come available to assess me properly, so it is unlikely that I will receive therapy now for another 6 months.

Towards the end of the session we talked for a bit about the failings of the NHS, specifically around the provision of therapy. She agreed that IAPT is making it harder for people with more severe conditions or complex issues to access therapy. Money is being diverted towards CBT at the expense of other forms of therapy. IAPT specifically focusses on providing CBT for people with mild depression and anxiety, which is all well and good, but it is doing so at the expense of others. Potential new therapists are tending to go into CBT because that’s where the money is, so it’s only going to cause bigger shortages and problems in future. I read something recently that said that a lot of money in the NHS is wasted on catering for the “worried well” and I think that this probably applies to the provision of CBT too. If someone hints of showing signs of stress or depression, there’s a good chance now they will be referred for a short course of CBT, so that the NHS can claim that they are offering people “talking therapies” over medication in more cases and that they are meeting targets to make therapy more accessible. These cases will skew the stats and will make it easier to ignore the smaller number of people with more severe or enduring problems that are waiting for therapy even longer.

Anyway, after all that, we did agree that we’d meet one more time to discuss in more depth what my aims may be and what I want from a therapist. She said if I’m going to have to wait a while longer yet, I may as well make myself a shopping list for what I want from therapy and my therapist! Quite a good idea I think, although how much my requests will be honoured is anyone’s guess. I may as well make use of the appointment time whilst I’ve got it though and maybe she can give me some idea of where to start. I see her again on Friday, so fingers crossed it will be helpful in some way.

I am pretty disappointed by the whole thing though. Not only because I will be waiting much longer and I got my hopes up about this assessment, but because I think I probably could have worked with her. It’s a shame she is being moved elsewhere and I will have to see someone else. The whole system is a total failure and I’m fed up of it.

Written by intothesystem

Monday, 13th September 2010 at 4:31 pm

Dr Occy Health…

with 4 comments

So if I can now be considered “stable”, why has so little changed over the last few months? I know it is good that I am generally feeling a lot better, but I’m getting a bit fed up of this “stability” to be honest. It seems that I am still unable to return to normality and start living my life again. I am still stuck in the limbo I’ve been describing for months now and it is getting tiresome.

I know this feeling mainly comes from the fact I am still not back at work. Before I was ill, I pretty much defined myself by my work. I was probably a workaholic and I really enjoyed my job, so to stop working was a massive adjustment and disappointment. When I was first signed off I never imagined I would have been off this long. It has been over two years now.

On Thursday I returned to Dr Occy Health (I can’t remember what I referred to him as last time). I was disappointed that the outcome was little different to last time. I had gone in there hoping that I would have some goals to work to and a rough schedule planned for my return – 1 afternoon a week, 2 afternoons a week, 2 days etc. It soon became clear that he had nothing like that in mind and if anything he still didn’t expect me to be going back at all.

We talked about how I’d been, my job and what barriers there were for me returning to work. Unfortunately there are quite a few barriers. He seemed concerned about the number of unknowns involved. As I have mentioned plenty of times, I work in consultancy. This means that things are unpredictable because everything is dependent on client demand. It is what appealed about the job, but it also makes it difficult to plan ahead. I can’t just resume my old job on reduced hours and responsibilities because my old job doesn’t exist any more. I have to find myself a role, which is going to be difficult especially as I won’t know when I will be ready to start and roles are coming up and being filled all the time. I will be of no use to a client if I’m only in for a couple hours a week anyway, so I don’t know what opportunities there are for me.

There is also the problem that I am based in Manchester and all the support network and internal work is very much London-centric. The Manchester office is simply a regional base where people drop in for meetings, to get their laptops fixed or to perhaps spend a day working away from the client, but no-one really works there on a permanent basis. Everyone is based on a client site at least 95% of the time. We have no HR staff up here, my career counsellor is based in London and I have no manager to report to. I will essentially be on my own. Dr Occy Health does not like this very much and I think he wants some face-to-face support to be put in place before I try to go back.

I told him I was keen to do something to get back soon though. He wouldn’t let me make any firm plans to return and he did not want to give my employer any idea when I may be back as he wasn’t happy about committing me to anything. During the appointment he started to draft his report for my employer and he was quite clear about not setting any deadlines for my return.

One thing that worried me was the way he always talks about “if I return”. I don’t what to think that I may never go back. He seems to be pretty careful about not raising my expectations, which I guess is probably a good thing, but it also knocks my confidence. If he is so worried about how I cope, does that mean I won’t be able to? He is clearly very concerned and I find that a little disconcerting. I know the likelihood of anyone returning after such a long absence is pretty slim, but surely I can be one of the minority?

I think he may be worried, not only about what pressure I put on myself, but also how things may end up with my employer. They may be well meaning and understanding in theory, but the demands of the business are such that I can see it being very easy for me to fall into the trap of taking on too much, too soon. I think once I am back in that environment the competitive nature of the place is likely to put pressure on me. I recognise that and maybe that acknowledgement will be enough to prevent these problems, but I am not entirely sure it will.

He asked me what I wanted in life. Not just with my career, but my entire future. I told him that I honestly don’t know. I told him that I spent so much of the past two years not expecting or wanting to have a future, that I find it hard to comprehend. He said this was sad and I guess it is, but it is just the way that things were. I don’t know how things are going to turn out. I don’t trust myself not to relapse. I am still kinda expecting everything to just fall apart again and I worry about getting my hopes up about anything. Being relatively well and stable is not something I am used to any more. I am genuinely scared about what the future holds and I don’t know where to start.

I think he asked me about the future, because he really wants me to consider another career. He seems to think that returning to the same company isn’t wise, but I’ve thought about this before and I am not sure I can see myself anywhere else, anytime soon. Dr M definitely thinks the same too. Whenever I talk about my work and my company she expresses her concern and in particular, her distaste for the competitive nature of the place. There seems to be an expectation that because I have been mentally ill, I should just get a nice, easy, repetitive job that doesn’t involve any stress or pressure. I really don’t like this.

Even if I did want to reconsider my career, I don’t feel I have any other option. I feel almost a sense of duty to return to my employer after all they have done to support me whilst I’ve been ill. I hope that they will do what they can to maintain that support and to keep me in work, but I do have my doubts.

No employer in their right mind would take me on now with this absence behind me either, so what choice do I have? I am concerned enough about how I will find roles within my current company, let alone finding a whole new employer. What manager is going to want to trust me with a client if I’m likely to have another meltdown and take two years leave at no notice?! It is a big risk for anyone to take on and I completely understand that. If they’re offered me or any other one of my 250 peers, it would be stupid of them to choose me. DDA or no DDA, that is a fact. They are a better fit for the job, because they are less of a risk and minimising risk is a massive part of our job. I know there is a point when that risk will become minimal. If I manage to get through the initial stress and pressure of a return and stay well, then there is a good chance I can maintain that, but there is the difficult bit beforehand to negotiate. It’s a bit of a catch 22, because I will need a role and responsibility in order to gain the trust and confidence of future managers, but getting that first role without a proven track record is going to be pretty hard.

So what other options would there be? A life on incapacity? No thanks. I doubt that option will be open to me for much longer either – I doubt I’d pass a medical now, even if I am still deemed unfit for work by occupational health. The WCA for ESA is notoriously bad at turning down seriously ill people, I still find it hard to believe I got through it the first time.

Anyway, we went on to talk about what I can do now. He said the primary objective needs to be starting some contact with work and working out how I can start to “reconnect with the workplace”, but there is no way I should take on any responsibility any time soon.

He set me the “homework” of looking for opportunities and ideas for ways in which I could start to make contact with work. He didn’t seem to expect me to actually carry any of those out, although he said if I felt up to it I could perhaps make a start. It was suggested that when I was ready, I could perhaps try visiting the office for an hour or two to see how I feel about it. Maybe I could shadow someone for an afternoon, just to remind myself of the kind of work that we do. Maybe there is some training I can get involved with. Maybe I could just meet up with someone to talk through some ideas. These are all possibilities in theory, but whether or not any of them will happen is another matter. I remember talking about these sorts of things with Dr R, the previous Dr Occy Health and although I brought them up with HR, there seemed to be a reluctance on their part and nothing really came of them.

I contacted my HR rep after the appointment anyway to see what she thought of the suggestions, but she said she’d like to wait for the report to arrive before discussing anything. My copy of the report arrived this morning, so hopefully she will be in touch soon. I also just found out that she’s pregnant and going on maternity in a couple of weeks and I don’t know who will be taking over. I guess it probably doesn’t make much difference as they will be based in London anyway, but the latest HR rep has been pretty good and some consistency would probably be helpful when I am trying to go back.

Anyway, we will have to see what happens. The plan is to review things in a couple of months. I hope that I will be able to try some of the suggestions before then, but whether or not they will let me is another matter.

There is a breakfast meeting of the office forum in a few weeks time and they have kept my place on the committee open whilst I’ve been off. I’d quite like to go along and there should be no pressure, so maybe I will be able to go to that.

I still feel a lot of guilt about not working and aside from Dr Occy Health, I think everyone is expecting me to get back to work now. If I’m relatively well, generally coping on a day to day basis and even capable of going travelling for a couple of weeks, there should be no reason why I can’t go back to work, right? Sadly not. I guess it is different. There is no pressure on me at the moment. I can do as much or little as I feel like and I don’t have to worry too much about making mistakes or breaking commitments. I can’t carry on like this forever though. I am going to have to test myself eventually.

I also still worry about the benefits side of things. I don’t want to be on ESA any longer. You hear all the time at the moment about how people are stuck in the cycle of claiming benefits and how we should all just get back to work. I wish they realised just how hard it was, even for those that genuinely want to go to work, have a job to go to and are even feeling ready enough to try. There are so many barriers to overcome and the things at stake are too much if things don’t work out. I guess I just have to be patient. I will get back eventually.

Anyway. This post is long enough. I’ve said so much of this before, which is partly why it is so frustrating. I just feel like I’m not getting anywhere. I suspect I will be writing about work a lot over the next few months. Hopefully there will be some progress soon.

p.s. I also want to write about my therapy assessment – but I don’t have the time now. That was also pretty frustrating and disappointing, but I will try and explain soon.

Written by intothesystem

Wednesday, 8th September 2010 at 11:35 am

Back for now…

with 9 comments

So I’ve been missing from my blog for a while and it has been months since I last updated regularly. I have drifted away from here and I keep considering retiring from this place because in many ways I don’t need it anymore. I am a lot stronger than I was and I am not sure there is much point in saying “things are okay, I guess” a million times.

When things were worse, I needed the support and safety of this blog. It was a good outlet for my thoughts and feelings, especially as they were so awful and overwhelming a lot of the time. It was a good place to rid myself of the never-ending woe-is-me thoughts. The madosphere provided a much-needed support network and I am grateful for that, but thankfully I haven’t needed it much at all lately. The odd time that I have needed to talk, I’ve tended to reach for twitter instead. The rest of the time I’ve been okay managing alone.

I don’t want to stop writing here completely though and so I’m reluctant to retire. I like the reassurance that my blog and support network is here if I need it. There have been times recently when I’ve wished for the time to sit down and write, but I haven’t had the chance. There are still plenty of thoughts and feelings that I need to process and writing is an important method for me to do that. I have always used writing to cope with things and I think I need to start doing it more. When you get out of the habit though, it is hard to start writing again. I spend a lot of time wondering what to write or how to start. It seems impossible to try and catch up on everything that has happened since I was last here and I just get overwhelmed and decide not to bother.

I am going to try though. I am drafting a few posts. I don’t have the time to finish them now, but I will soon.

Today I had occy health, tomorrow I have a therapy assessment. Both are giving me plenty of things to think about.

Written by intothesystem

Thursday, 2nd September 2010 at 10:43 pm