Into the system…

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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

3 Responses

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  1. *massive hugs*

    I can imagine only too well how gutted you feel. Getting prepared mentally and emotionally for the assessment and therapy actually starting. Then the enormous disappointment. It is horrendous what it does to us, cos it can takes weeks to settle down again and adjust to the disappointment.

    Yes the system is a failure, and yet that is what we are dependent upon. It is a rotten situation.

    I think that you have recovered hugely. Hang in there. I think you have done so well. I’m hoping that this letdown does not adversely affect you for too long.

    Take care. *hugs* xx

    Hidihidi

    Thursday, 16th September 2010 at 2:43 pm

  2. Interesting write up, sorry it looks like you are going to have to wait even longer… It does sound like you got something out of the initial appointment today, if only to air your thoughts and feelings on what kind of therapy you want. It’s good you have an insight into different therapies out there!

    Ms Leftie

    Monday, 20th September 2010 at 4:04 pm

  3. […] appointment covered pretty similar territory to the last one really and I am not sure it was all that helpful. I guess it was worth meeting again, if only to […]

    Therapy Update… « Into the system…

    Wednesday, 6th October 2010 at 1:47 pm


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