Into the system…

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Posts Tagged ‘history

Back in time…

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It felt very strange to see DP again yesterday. It was like going back in time.

On my way there I was trying to remember what he looked like, but all that came to mind was the fact he was bald. When I got to the therapy centre, it took me a minute or two to recognise the building. It kinda made me realise how fuzzy my memory is of last year. I still blame ECT.

Memories started to come back though. Silly things like waiting in the kitchen until he was ready, taking off your shoes (both of us without undoing them!) and the blue sofas lined up against the wall.

We didn’t dwell on the paperwork. CORE outcome measure form and a couple of consent forms and that was it. A pleasant contrast to last week’s 50 minute form filling marathon!

Then of course he turned to me and asked me to start. I knew he would sit there in silence for the full hour if necessary, so it didn’t take me long to get going. I had taken notes with me, hoping I could update him on the last 18 months quickly without having to say anything. Sadly he wanted me to talk over things myself. I kinda knew that was coming.

I went over the main points. Last summer, The Priory, February’s overdose, ECT, Bipolar diagnosis and since. All the stuff I’ve been over a million times now. I can’t really remember, but I don’t think he said much at this point. He never did say much. I think he was a little shocked though.

The conversation moved onto what use the sessions are going to be. He seemed doubtful as to whether there was any point in working together for only four sessions. I explained the theory – that it would give me a little support in the interim and help me identify areas to work on long-term, but I am not sure he agreed. I am wondering if he just doesn’t want to work with me again. I am worried that I might have scared him off. I don’t know. I feel quite paranoid about it all.

We talked about how things are now. He asked what the current situation was care-wise, family-wise etc. I filled in some gaps. We talked about my mood too and that being what it is at the moment we got onto the question of self-harm and suicide. I think he was a little concerned and possibly a little panicked. I do wonder if he is used to dealing with this, but then surely most people in therapy have considered such things?

He pointed out that my risk level means I am a “red flag” client and he will need to talk to the EAP about whether or not we should continue. I remembered this from last time. I was a red flag last year and I’m not sure there has been a time since when that status would have been lifted. I am wondering if he is using this as a way to escape me. The other EAP therapist didn’t bring it up, but nothing has changed really when it comes to risk levels. I pointed out that the EAP were aware of my situation when they took me on this time and I hope that means it won’t be a problem, but he said he still wanted to talk to them.

He asked me about a verbal contract too. He wanted me to give my assurance that I won’t do anything to harm myself whilst I am seeing him for therapy. A repeat of the request from the EAP counsellor really. I struggled to give it, not because I have plans to do anything, but for other reasons. I think part of the reason is not wanting the added guilt. The guilt I get from wanting to break those assurances, because the suicidal thoughts are still so strong. I feel bad for even having the thoughts. I guess my reluctance is also to do with the fact I don’t trust myself any more and don’t see the point if I can break my promise. I had given my assurance to people I wouldn’t act when I made the attempt back in February and it wasn’t enough. I have assured myself enough times that I shouldn’t act, yet it wasn’t enough in the end. There have been other times though that making a promise to someone has been enough to make me think more than twice, so maybe it is worth it.

Towards the end we talked about next steps.

He thinks I should be getting more NHS support at the moment. I think he may be right, but I wonder what support there is. What point is there in the crisis team? I’m perpetually in crisis and I don’t think it would be helpful. What point is there in contacting the CMHT or asking for a urgent psych appointment? Useless social worker, J is on holiday and Dr D didn’t know what to do with me when I saw him last month anyway. What point is there in bothering Dr N any more than I already do? He has nothing more to offer me.

As we finished up, DP told me to email or text if I need to, which I am grateful for. I guess the fact he offered that option shows he cares and is trying to help. He certainly didn’t have to.

Overall the session was hard work and quite strange, but I left feeling relieved. I think it was helpful. I don’t know though. It is hard to tell.

In other news, today I had a phone call from the therapist I saw last week wondering where I was. The EAP had forgotten to contact him to say I wouldn’t be seeing him again. I wish I’d cancelled myself now, but I just didn’t know what to say. I feel bad that he was waiting for me. I hope the EAP pay him for the mix-up!

Written by intothesystem

Thursday, 10th December 2009 at 10:05 pm

NHS Psychiatrist…

with 5 comments

Bloody hell, the CMHT is in a weird and slightly scary location. The building is a dilapidated old school on a council estate, with rusty railings and dodgy damp portacabins. It was in one of these cabins that I had my appointment. My social worker met me and took me in. The ceiling was falling down from damp. It really shows how much priority mental health care gets within our social services and NHS. Most of the other council buildings are shiny and swish.

It turns out that the NHS psychiatrist I saw today has seen me before, although I wouldn’t have known if he hadn’t have told me. Dr D assessed me in February after my massive overdose and arranged for my admission to the NHS ward back in February. I don’t remember the assessment at all, but vaguely remember his face.

The appointment was fairly routine. He asked me about discharge from the ward, what happened at The Priory, what has happened since. He asked about current mood. He asked about history, self harm, suicide, family history, childhood, education etc. All the usual things. It was a chore going over it all again. The more often I do this history thing, the less I manage to cover and recall. I just skip over things because I have said them so many times I forget what I’ve told who. I think he got the main points though.

He didn’t change my medication at all, as my social worker had warned me. He seemed to think that my current meds were doing some good and that we should persevere. I didn’t know if to ask about Dr G’s planned increases up to 300mg. I think I should have, but I couldn’t find my tongue. He said my meds would be reviewed when I next return to the CMHT.

One positive outcome was a referral to therapy. My social worker needs to get this done, so I’m not holding my breath considering her previous record, but we shall see. He said the waiting list is extremely long, but the sooner the referral is done the better. As I have covered most of the shorter therapies at The Priory, especially CBT, he said they probably won’t bother with these, but he was keen for me to have psychodynamic therapy. He thinks I will need to be in intense psychodynamic therapy for years. I had expected to do some psychodynamic stuff as Dr G had mentioned it in the past, but I thought it would be for a few months. I didn’t think I would need years. I guess I never really saw the whole psychoanalytical, lie on a couch and talk about your childhood thing as for me.

I wonder what issues he thinks I will need so long to deal with. I started on some psychodynamic stuff at The Priory when I did “Life Maps” and I grappled around for some reasons for all of this, but my childhood was uneventful and I don’t know what problems there are to find. I know there are some relationship issues with my mother and I was bullied in primary school, but aside from that I am unsure. I don’t think these are deep enough and I see my condition as largely chemical.

The plan is for me to continue on these meds, wait for a referral to therapy and see him (or someone else on the team) again in around 8 weeks. This wait is better than I’d feared but it still seems a long way away. I find the future so hard to comprehend I don’t know how I will get through to then. I was told to continue to see my social worker and to use the ALERT service, the CMHT in hours, the crisis team or A&E if things get worse, but I don’t know how easy that will be. I tend to suffer in silence and hide how bad things are getting, even now after everything.

I’m glad the appointment is over. I was so nervous and didn’t really know what to expect. The next step is to contact Dr G and tell her what happened. I think she will be glad about the therapy as she had wanted to find me something before. I am scared about letting go of her support, but know I will have to eventually. Dr D seemed a little concerned that I had still been seeing a different psychiatrist and I think he wanted that to stop. I understand it would be complicated. I guess I’ve always got the option of going back to Dr G if I felt I needed it. Dr D asked me to contact Dr G and get her to send a summary of my care at The Priory and a date for which I will be discharged by her as well as a list of the therapy I’ve had at The Priory. It all seems quite final.

p.s. I updated the My Story page today.