Into the system…

blogging, work, mental health, therapy, disability, benefits and more…

Posts Tagged ‘therapy

Long overdue post…

with 16 comments

I thought it was time to explain where I’ve been, but I am not planning on staying long. Just a quick hello and goodbye for now. I feel bad it’s taken me so long, but I wasn’t sure what to say and kept putting it off.

I guess I have just been busy in the real world. That and the fact I had therapy. It seems that having a one hour session a week to contain any mentalism and to whine and moan, meant that I didn’t feel the need to come here. I have just 2 sessions of therapy left now, so by the end of August that may change. Maybe I will come back sometime, but I don’t know. My therapist was never keen on me blogging whilst I was seeing her and although I wanted to continue, in part to rebel against her disapproval, it just didn’t happen. I seemingly ran out of things to say.

I’m not sure how useful therapy has been. We have hardly looked very deep or at anything especially long-term. The therapy itself was neither very long term nor intense, but that didn’t surprise me. It might have been what I supposedly needed, but the NHS was unlikely to ever provide it. I will have had a total of 20 sessions, spread over 8 and a bit months. It would have ended a lot sooner had my sessions not been on a Monday, meaning plenty of missed weeks for bank holidays, my holidays, her holidays, sickness, her training etc. She’s away again next week. I can’t wait for the sessions to end and to get my Mondays back.

So aside from therapy I’ve been busy in the real world. My mood was really quite crappy in Feb and it got to the point where I gave in and started Mirtazapine on top of my other meds in the hope it would lift my mood and help me sleep. I wasn’t keen on the idea, but it seemed to help with the mood at least. It knocked me out for all of 2 days before the insomnia returned. Coupled with the arrival of spring, my mood recovered sufficiently that I stayed in work throughout the mini-episode, albeit on just a few hours a week.

Since then my mood has continued to improve and I’m now relatively “well”. My hours at work have been increased steadily and I’m now working part time, roughly 22hrs a week on some vaguely proper work rather than mundane tasks. I’m still internally based, but the work I’ve been doing has been pretty interesting and I’ve even had colleagues to work with, although we were at different ends of the country most of the time. I did get to spend a couple of weeks in London with them though delivering some training, which was awesome and I’m down again for a few days this week. I’m back to more mundane stuff again over the next few weeks though, but generally my employer have been good at finding me things to do and helping me to get back. I genuinely love my employer and my current HR team. They have been pretty instrumental in keeping my mood afloat and life feels hopeful. Dr N (GP incase you’ve forgotten in the last 6 months) said to me the other week he’s amazed at how well things are going and I’m inclined to agree.

The only remaining issue really is my sleep. It is still poor at best. When I have been working away it has been worse than poor. There have been nights where the whole experience has been painful and fear-inducing and I just wish night never happened and that my body didn’t need sleep at all. I take forever to get to sleep, when I do get to sleep I am drifting in and out of consciousness and dream worlds. I have frequent nightmares and strange dreams. Sometimes I am unsure where reality meets my dreams and everything becomes very strange and scary. I wake up and fall asleep dreaming and wake up and fall asleep and dream and wake up etc on a roughly 10 minute cycle for a few hours and then I can’t get back to sleep again and then often it’s time to get up. Or I am just awake for hours and it is only 6am or something when I fall asleep and then I should be getting up and can’t drag myself out of bed. There seems to be little to no sign of improvement, even after reducing the reboxetine in June. I explained how desperate it was making me to Dr N and he gave me an emergency supply of Temazepam in the hope that if I had a back up plan it might help reduce my anxiety about sleep. I’ve taken it on one occasion and it didn’t seem to help, but I’m too scared to take it on a night when I need to be awake the next day incase for some strange reason it decides it might work for once and I can’t get up! Benzos have never been much help though, but at least they don’t seem to make the whole dream/hallucination thing worse like the Z drugs do. Sleepers just don’t work. No chance of me ever getting addicted.

I’m still sleeping badly and basically just putting off the time when I should try and go to sleep this evening by writing here. I’m in a hotel again, which makes it worse. At home I’m made to go to bed at the time when my bloke dictates he wants to go to bed and I am forced to stay there so I don’t want to wake him or the dog up too much.. If I wake up from a nightmare or anything he helps to bring me back to reality quicker and his presence calms me down. Usually his snores are a reminder that everything is fine and normal and the wardrobe isn’t full of strange men trying to chase me (or whatever else decides to infiltrate my dreams and reality that night). Here in a strange hotel room the boundaries between reality and nightmareworld are a lot more blurred because there is no one to calm me down and I can never quite remember where I am. Monday night was bad. Just wide awake all night. No sign of sleep and increasing frustration at the lack of sign of sleep, which never helps. Yesterday was better, but still not great. I had a lot of dream stuff going on and the every 10 minute waking thing, but at least I got some sleep. I’m meant to be trying to keep a sleep and dream diary for the next fortnight for the therapist, but the problem is I often wake up panicked and even screaming, having no idea what it was that was making me scared. I rarely remember much content. I’ve been trying to keep the notebook by the bed and jotting things down, but that wakes me up even more and just prolongs the wakeful periods between the dreamfilled ones. The problem is though none of that sleep is quality. It isn’t restful and doesn’t recharge the batteries. Eventually I have to get the sleep somehow. During the first weekend of the last 2 week stint in London (a month ago) I just crashed and slept a lot (at least by my standards! I was in bed a lot). The second week was not so bad. The first week at home was better and last week less so. This week has been worse again. I could do with crashing and catching up again, but that is unlikely to be an option any time soon with a wedding to attend on the weekend.

If I could just get the sleep issue fixed I really could be convinced that life is getting back to normal and all will be well and good. Life is getting there. This may be “recovery”, but this is definitely holding me back. It still makes the prospect of full-time work scary and possibly impossible. My shortened days at the moment make the sleep issue less of a problem – I start work late and that seems to help.

Anyway, I should stop writing. I was only meant to be here to say bye and sorry for not saying it sooner. I seem to have written a massive post. Maybe I haven’t lost the ability to blog after all. I don’t think that means I’ll be back though.

I haven’t read many blogs of late either. I am very much out of the loop in terms of the madosphere and haven’t even read any TWIM since it moved. In fact I went weeks without looking at a single blog post, but I’ve read the odd one since, just to check you’re all still there. There are a few of you I miss a lot. Some I am in touch with in the real world. Some whom I’m not. If I’ve stopped reading, it doesn’t mean I’m not thinking of you. I do appreciate everyone who has been reading and around for me when I needed it and everyone that ever commented here. I feel a bit guilty for not being around for you, now that I don’t need it so much. Sorry.

I shall sign off. I may be back one day. I may be back another day. I may never be back. I don’t know.

Take care xx

Written by intothesystem

Wednesday, 3rd August 2011 at 10:46 pm

Home Alone…

with 18 comments

Time keeps passing. I don’t know where it goes to.

This weekend has been somewhat strange. The bloke is away for the weekend at a stag do and I’m home with just the doggy for company. I don’t remember the last time I was here on my own overnight, let alone for a whole weekend, so I don’t really know what to do with myself. Aside from my trip in the summer, there have been so few times when I’ve been without the bloke for more than a day since we went to uni. I was “well” in the summer too and now things are not so easy. I am managing, but it has made me realise how used I am to having him around and how much his presence keeps me functioning. Without him here, the temptation to give in and give up is so much greater.

Getting up and dressed is a struggle at the moment and I feel even less urge to conform when I don’t have reminders from the bloke. The guilt wears on me when he’s about and it serves to push me into action. It was only the desperate requests from the dog to be let out, that dragged me out of bed this morning. The thought of having to clean up any mess was enough to force me downstairs, but I climbed back in when she was sorted. I had to get up in the end as I was going over to a new friend’s for her kiddy’s 1st birthday party, but it took me literally hours to work myself up to that. Without that commitment today, the temptation would have been to stay in bed all weekend.

Food is another problem. The bloke is the cook in our house. I can bake cakes, but when it comes to a proper meal I don’t tend to bother. I don’t have the best appetite these days, but when food is presented to me I do tend to eat. Without the bloke around to cook for me, I don’t tend to bother. I’m even less inclined to cook at the moment as both our oven and the microwave are broken.

The dog is a commitment too and she does keep me going, but she isn’t as effective at nagging as the bloke is and I find the commitment straining. She did get me up this morning and she gets me into the kitchen, prompting me to eat at the same time that I feed her, but she is also tiring and I feel guilty when I just want to stay in bed and ignore her. She also got me to go outside for a walk, which I know is good for me, but at the same time I wish I didn’t have to. It’s so tempting not to bother, but I cannot deny her a walk for long or she turns into a great big bonkers thing, which is even more draining to live with than the walk.

I’m really tired. I want to sleep forever, yet sleeping for just a few hours seems to be enough of a challenge. It was late when I finally dragged myself upstairs to bed last night and I sat and knitted up there for a while because I couldn’t sleep.

Before the bloke left, I had to promise I’d be safe this weekend. He has been somewhat paranoid over the past few weeks that I’m suicidal again. The last two years have been particularly difficult at this time, in the run up to my birthday, so I know he is on edge. He doesn’t trust me at all and although I know his fears are not unfounded and it is only because he cares, it is still hard. One day last week I had nipped out and wasn’t home when he was due back from work. My mobile phone battery had died so he couldn’t get hold of me. I’d even left a note to say that I’d be back in a minute, because I worried that without my phone he would wonder where the hell I was, but he didn’t see it and just flew into a tailspin instead. He completely jumped to conclusions and panicked that I’d gone out to kill myself.

I’d actually nipped out to rescue the dog’s ball because she had lost it on our walk and I couldn’t get it out of the brambles and control her at the same time. She has a habit of diving head first into all the brambles and rose briers to rescue her ball then getting stuck – we both end up cut and bleeding, as I have to battle to rescue both her and the ball. I literally had to drag her home, shut her in the house and then go back out to dig out the ball from the bushes. By the time I got home I was greeted by the bloke just about to drive off in my car to try and find me, ranting and raving with anger. This isn’t the first time this has happened, but it the first time in a long while and I was disappointed that things had not moved on and that the trust hasn’t been rebuilt by now.

It turns out that he mainly panicked because he had been reading my mood log. I was updating one online and I had no idea he had been reading it. I tended to keep my notes in there very short and they were only for me, so a note mentioning suicidal planning thoughts did not necessarily mean what he thought it did. I was angry that he had invaded my privacy again, but I know it only comes from fear and concern. I don’t feel able to update the log any more though. It was meant to be for me and no one else. A reminder of how things are, because so often I cannot remember what my mood was like a week or a month ago.

But anyway. I agreed that I will be safe. I am safe, but it doesn’t mean the temptation isn’t there. My mood is low and I’d be lying if I said I didn’t think about it. This weekend would have been the perfect opportunity and there are times when I cannot help the thoughts, but I have resigned myself to sticking around for a while yet.

I know the fact it is winter and in the run up to my birthday can’t be helping. I have been in hospital at this time for the last two years, and both times I was desperately suicidal and determined not to be around for my birthday. This year I seem to have accepted that I will be around and although I am not overly happy about it, I’m resigned to it. I am low and I don’t really want to be alive, but I feel the obligation to be. Also, I’m not sure why, but being 25 seems like a much better idea than 24 anyway – something about round numbers I think. My worry is that I’m already having to battle the thoughts that 25 is a good age to die. I have no desire to see 26, even if I am sure I will see 25. I hope that my mood will pick up before those thoughts get too strong or that the approach of my 26th birthday gets too urgent.

As for my 25th birthday, as Seaneen will recall, my invite for a smear test arrived. I went and had it a couple weeks ago and it was fairly painless and straightforward, although I bled quite a bit afterwards. Unfortunately though I got a letter on Thursday saying the result was “inconclusive” so I have to go and have another one in three months. I think this was just a case of not enough cells, at least that’s what I’m hoping, but it’s still pretty annoying to have to wait before they do it again.

In other news, I’ve had a review form for DLA to fill in for a couple of weeks now and I’ve failed to do it. I wrote to them before Christmas at the same time I wrote to notify the DWP that I was starting work part-time for ESA purposes, to say there had been *some* improvement to my condition since my initial application for DLA. I felt I had to, as I have been receiving Higher Rate Care and I am not sure I should be getting that rate any more. They sent me out a review form and I started to complete it, but I made a complete mess. I filled in my surname in the first name section, my date of birth wrong and made mistakes all over the place, because I couldn’t concentrate enough to fill it in and my memory is so shoddy I kept forgetting things. After some frustration, I rang them to ask for another form because I had made so many mistakes. I got this replacement two weeks ago now and I have still not even started it. Thankfully because I requested the review rather than them, there is no deadline for me to get it back, but I know I need to do it. I can’t face it though. I can copy across the stuff that was correct on my first attempt, but I don’t know what to do about the rest of it. The form is overwhelming and I don’t know what to write, especially as my mood has been so unstable of late. Sometimes I look at the form, think nothing is wrong and answer everything as if I was fine, but other days I look at the form and realise I can’t do any of the things it asks, including filling in the form for that matter. I know you have to say how your good and bad days very and highlight what the worst case scenario is, but I just don’t know what to write. I don’t even know what to put in the diagnosis section. Should I have told them that my diagnosis is under question back when it was first questioned a year ago, or can I just tell them I don’t know any more? I guess the latter is the truth, I don’t know, but I’m not sure if I should have told them I don’t know. As far as DLA and ESA are concerned, I assume they think my diagnosis to be Bipolar II disorder, which is what it was when I applied. As I don’t know what it has been changed to, I guess I can’t tell them, but I worry about what Dr M or Dr N will write when asked. I hate having to evaluate how bad I am. I honestly don’t know.

Hmm I don’t know what else to write. There are things I keep thinking about to write, but I just don’t know what to say. It has been the same all week. For weeks really. I am meant to be keeping a diary for therapy again and I haven’t managed to write anything properly. I just don’t know what to say. Brain is mush. I cannot think, I can barely feel. I just want a new head.

I am feeling increasingly agitated this evening. I am not sure why. Maybe now is the time I stop and knit for a bit to see if it calms me down. I spent a lot of yesterday knitting – I made a hat for the little boy’s birthday today and started a frilly scarf and it kept me busy and distracted whilst I was on my own. It’s the first thing I’ve done for a while. I haven’t had the motivation or the concentration for a while. Sometimes I get the urge to knit and think of a million projects I could be doing and other days I cannot even comprehend lifting the needles. There has been a lot of the latter lately, yet yesterday my head was buzzing with ideas of things I could knit. I can only knit so much though and when my concentration is so crap lately as much as I want to make these magical creations, there’s no way I’m actually able to. I end up having to undo as much as I do.

hmm. Head is starting to spin. I’m both tired and agitated and feel like I may need to throw things soon if things get any worse. I don’t know why I am feeling like this. I have been good lately and I’m avoiding caffeine in the hope that would ease the occasional agitation, but it doesn’t seem to be helping. Maybe I should just go to bed and try to sleep or maybe I should have a bath. Perhaps I’m just grouchy and tired. I don’t know.

This is a bitty post. I don’t seem able to write properly at the moment. I started writing this about 4pm and it’s now 11.30pm. It’s not even very long. I have found it really hard to try and get things down or to concentrate on it. I have watched bits of TV and fed the animals and stuff in between, but the rest of the time I have just been staring at the box wondering what to put in it, or more likely how to slow down and speed up and unravel my thoughts to try and type them. Some of the time it feels like my brain is like treacle and the thoughts are just so slow and other times they are bouncing around and rattling off the sides and at the moment both is happening at the same time and it just feels like a big ball of mush. It all makes no sense.

Anyway I am going to stop and kick the dog outside. She’s already taken herself to bed, but she needs to go out or I’ll get woken up very early in the morning! I don’t intend on being up early. The bloke isn’t due back until at least mid-afternoon and I think I’m leaning towards a morning of hibernation.

Too much to say…

with 12 comments

I have lots on my mind and plenty that I’d like to share, but the time and motivation has been lacking. I wish I could just empty my head onto this blog, without having to go to the effort to sit here and type. When I am lying awake at night, I think about what I’d like to post, but I rarely make those posts a reality. It would be brilliant if I could make posts happen just by thinking of them. It would make me a much better blogger and would save me a lot of time. It would give me something to do when I can’t sleep. It would also mean that this post wouldn’t have taken over two weeks to materialise.

So the big news is I’ve started therapy. Or rather I’ve started the assessment sessions for therapy with the new psychologist.

The first few appointments have been okay I guess. During the first appointment we mainly talked about the practicalities of therapy and she updated me on the changes going on in the service (change in Trusts). She asked me a bit about what has been going on for me lately and how I feel therapy can help. I didn’t really know what to say, but found myself talking about the whole diagnonsense malarky. I was scared about getting onto such territory, but I guess the fact I felt able to bring it up must suggest I was relatively comfortable talking to her. I was worried about how she would react but she seemed reasonably sympathetic and supportive of my concerns. I told her I was unhappy about how they were so quick to change my diagnosis to a PD, especially when I was obviously unwell and not exactly demonstrating my usual behaviour. I think she understood, but I don’t know if she agreed as such.

I felt completely exhausted after the first appointment. I had to go straight to work and had a few errands to run and wasn’t in any frame of mind to do so. I was feeling really dazed and found it was impossible to concentrate. I didn’t get anything useful done at work, but at least I didn’t have anything important to do. I got lost twice that afternoon too. Despite looking up directions, I would forget where I was going before I got to the first junction and have to pull over and look them up again. In total, I probably spent over an hour driving in circles on that day trying to find the depot to collect a parcel. One of the places I’d been to hundreds of times before too, which is even more frustrating because I never used to get lost. If I’d been somewhere, I could always find my way back. Not any more.

The second appointment was a lot less structured than the first and felt like it went all over the place. We covered ten billion things, yet I don’t know how much was relevant. It felt like we were skipping over things too quickly and completely missing out others. I guess it is hard to know where to start when there is so much history to cover and so many different layers. The appointment went in no time and I can barely remember anything which was discussed. At the end she suggested we tried to start from the beginning for the third appointment and she asked me to put together a timeline of key events, separated by good times and bad times. I’d done timelines and histories before, but was a bit worried about putting it together again and leaving things out.

So the third appointment was meant to go over my time line, but we ended up talking a little about the second appointment first. When we did get on to the timeline we didn’t get very far. We only managed to cover up until the end of primary school really. She asked a lot of questions, mainly about my family and what life was like as a child. I can barely remember, so this was hard and I didn’t know what to say. I have a few clear memories and a lot of fuzziness. The session disappeared in no time. We’re meant to be picking up on it again next week. Fingers crossed we will cover a little more. There are only two more assessment sessions left.

Aside from therapy I have got very little else done over the past few weeks.

I saw Dr N a couple weeks ago and we discussed the medication question. He hadn’t got the letter from Dr M. He said it usually takes her a while. I explained what her suggestions were and we discussed it. He thinks Quetiapine should be a definite no, which I agree with. He didn’t think it helped me the first time around and as I’m already on the Lamotrigine as a mood stabiliser he is not sure it will help. He was really keen for me to come off the Reboxetine though and was keen to find an alternative. He said that I have been “really quite unwell” since I started it. I know I’ve been struggling a lot with the side effects, but I’d never really considered the physical illness to be all that important even though it is problematic. I have always thought the mental improvement was worth it. When I was so depressed before, it was just a relief to feel different. He is not so sure that Reboxetine is good for me though. He still isn’t even convinced the Reboxetine was responsible for my mental improvement. I don’t know. He seems to like the idea of trying Mirtazapine. He considers it a more effective anti-depressant and thinks it will help with my sleep. We talked about the weight gain and he said I could always stop it if that became a problem. Overall, he seemed to want me to take it and he offered to write me the script, but I wasn’t so sure. I mentioned that the bloke wasn’t keen on the idea and he said that didn’t surprise him. It’s so common for people to want you to take less pills, not more. To be fair, I’d like to take less pills, but I know that is probably not a wise option. I decided I’d like to wait and think about it a while longer though. I also mentioned that I’d got the therapy appointment through and he agreed that therapy may be a reason to hold off making any changes right now. I wouldn’t be able to tell if something was making me worse or know what to blame. So that’s how I left things. I am going to see how the first few therapy appointments go and then decide. I could try and hang on until Spring and then maybe I can manage with a lower dose of Reboxetine again anyway, but we don’t know. It’s another case of “we shall see”. It’s a phrase I seem to use often at the moment.

I had my dental hospital appointment as well a few weeks ago. That was to discuss the TMJ (jaw joint) problems I’ve been having. I had an x-ray and after a long wait the consultant poked and prodded and moved my mouth about, to come to the conclusion it’s a cartilage problem. She didn’t really offer any solutions to this problem, other than the usual stuff. I was aware of the normal management techniques already – identify habits such as nail biting, night-time grinding etc, do some simple jaw exercises and take ibuprofen regularly. She agreed that there was no evidence of night-time grinding from my teeth, so she doesn’t think a splint or mouth guard will help. She did notice that I had short, bitten nails, but I actually tend to pick at them with my fingers rather than bite them. So she’s given me some jaw exercises anyway and I see her again in 3 months.

There was one weird thing about the appointment though. The consultant reminded me an awful lot of Dr Shock, who was in charge of the ECT. Considering I attribute the jaw problems to the ECT, I found this very unsettling. I don’t really remember what Dr Shock looked like, but this consultant was an equally large woman and I remember her voice was very similar. Something about her manner reminded me of her too.

Thinking of ECT, I drove past the hospital today. I have been past a couple of times since I had the treatment and every time I go past I feel a bit weird. I think of the taxi trips over to the other hospital and the strange nervousness that went with it.

Last week I had another appointment with Dr Occy Health. It was a strange appointment, made stranger by the fact he misunderstood me near the beginning and it only become clear towards the end of the appointment that he was mistaken. When I said I was still only working 6 hours a week, split over 2 days, he thought I was working 6 hour days, twice a week (12 hours). This is understandable because it is what we were aiming for. He went through most of the appointment under the assumption I was fine, had met the 12 hour target and we should set a new target of 15 hours by the end of Feb. I didn’t realise until he went to dictate his letter at the end. We had to back track quickly and he said we should just stick to the 12 hour target for now then. He was keen to stress that managing the 6 hours was an achievement, but I felt like I’d let him down a little. He seemed so pleased at my supposed progress, it was a little disheartening to admit I’d not made the target. Admittedly part of the reason for not making that target has been the reluctance to increase the hours from HR. Rehab Consultant Woman happened to contact me when I was at my worst in December and she had been somewhat concerned that I was struggling. It seems she passed this message on to HR, which is why they wouldn’t increase my hours. I hadn’t realised this at the time. Despite the fact I have been struggling a little, I’m not sure extra hours will make it worse. If anything it may even help. I often feel that the 3 hours I am working is not long enough and I try to cram too much stuff into that short period of time. A little bit more time may help me slow down. I don’t know. Then again, I don’t have enough work to fill 3 hours, so how I expect to fill 6 I don’t know.

Anyway, I should sign off. My mood is still up and down and all over the place. I’m managing though for now. Not getting much done aside from work, doctors/therapy appointments and walking the dog, but I am treading water I guess. It is a struggle, but I just have to keep reminding myself I’m miles ahead of where I was this time last year.

I hope everyone else is coping okay. Sorry I’ve been rubbish at commenting and stuff lately. I’m trying to read what I can, but I am also trying to step away at the same time. I find myself losing time and unfortunately reading blogs seems to eat time pretty quickly, so I am holding back until I can find the time.

I feel crap…

with 23 comments

I’ve got a much longer post in the making about returning to work and all that jazz, but right now I just need to whine. The other post doesn’t portray much of how I’m really feeling. It is about recovery, yet at the moment that seems like a strange concept.

I feel crap. Not just a little crap, but really crap.

I’ve been trying to avoid admitting this, but pretending things are okay never does me much good. Maybe if I’m more honest and accepting of how I feel, it will help to ease the pressure a little? I am trying so hard to keep functioning that I am probably making myself worse. I don’t know, but I need to do something and I hope that writing about it will help for a moment.

My mood has dropped. Not just a little bit, but a lot. I could feel depression creeping up on me again, but this past 10 days or so have been far, far worse. During the past week, I have felt worse than at any other point in the last six months. My mood slumped at the end of September /early October, but it didn’t slump this far or this fast. Things had picked up quite nicely since then (and the increase in Reboxetine) and I thought it was just a temporary blip, but now I feel awful and I’m less sure it will be temporary this time.

Every morning is a real struggle at the moment. It is hard for anyone at this time of year, waking up when it is dark and cold outside, but this is more than just winter blues. When I wake up from yet another night of broken sleep and nightmares, I feel the familiar cloud hanging over me. It is a cliché, but it is definitely there, dark and cold, looming over the bed. I realise that it’s back. Depression is here and I am hit with a daily dose of disappointment that I haven’t woken up feeling any better. The sense of dread about yet another day hits me and I want to hide under the cover and never come out.

I know I need to keep functioning and I am forcing myself to keep going, but it is getting harder. On some days I have to go to work and there is plenty for me to do the rest of the time, so I have no choice but to keep going. I force myself out of bed, but it is getting later and later and the incentive to do so is diminishing. I was making myself get out of bed by 9am at the latest, no matter how badly I’d slept the night before, but I can’t do that now. Most mornings I am forcing myself up at 10am, but it was later than that yesterday. If it carries on like this, before long it will be lunchtime before I usually get up. I am doing my best to stop that happening.

I feel guilty when I am like this. I chastise myself for being lazy, but I don’t want to be. I just can’t find the motivation to not be. I know the bloke would chastise me too and that makes me feel more guilty and makes me want to hide how I am feeling. It is nearly always the motivation that goes first. Motivation is tied to noradrenaline and that is what the Reboxetine is meant to be working on, but it doesn’t seem to be doing enough at the moment. I need to get it back, but even forcing myself to do things isn’t likely to help much. It will just tire me out and make me frustrated when I can’t seem to cope.

I am still going to work. I refuse to admit defeat on that. I can’t give up on work. I don’t want to let people down and I don’t want to admit that I can’t cope. I’m worried that everyone will blame this relapse on work and say that I can’t do it. Maybe work is to blame, but I don’t see how it can be. It is not stressful and I was enjoying it at first. It felt really good to be going back and I had definitely missed it. I was being careful not to push myself too hard. My four hours a week were going really quickly, but as my mood has dropped, time has slowed down to a crawl and my last few shifts have felt excruciatingly long, despite being so very short. I have been struggling to find the motivation to go as well and have arrived late a few times because I had been putting off getting ready. My concentration appears to be slipping and I have to keep stopping to remind myself of what I was meant to be doing. I had run out of work the other day as well, so it felt like a complete waste of time and boredom was not helping my mood, but I have now got something new to do, which made it a little easier today.  I will manage though. I have to.

I am struggling to do much else at the moment though. Fighting depression and carrying on with work is sapping all my energy. There is housework to be done, but I am trying to get by with the bare minimum. I sit and stare at the laptop, but I don’t do much with it. I am barely bothering to read blogs or even the news at the moment. I spend too much time hitting refresh on facebook or hotukdeals, because they require little attention. I leave emails unanswered or unsent because I can’t concentrate long enough to write them properly. I am trying to knit a hat for my sister’s Christmas present, but it is slow progress and I keep making mistakes, despite switching to an easier pattern. I tried to go Christmas shopping on Monday, but I was so indecisive I barely bought anything and it took the whole day instead of the few hours I had planned. I have voluntary stuff to do – website updates and press releases to write, but I am putting it off.

I did manage to cope with fundraising at the Christmas Fair on Saturday though, which was a relief. I had been dreading it because I didn’t know how I was going to cope. Adrenaline helped get me through the day, which was a long one to say the least, but I survived. I was working with a decent bunch of girls for most of the day, so at least I had some support and there were plenty of yummy cakes to cheer me up, but I was flagging by the end of the day. We raised a decent amount of cash, which I guess makes it worth it. I felt completely frazzled afterwards though. I had to go out for the bloke’s work do in the evening, but I was exhausted and didn’t really want to go. I did and it was a nice enough evening, but I think I’m still recovering from the late night and long day. Everyone else was drunk too and I was driving, so that didn’t help me enjoy it. My head was so fuzzy, I have no idea how we got home safely. Not good really.

I curiously did the PHQ-9 and the BDI the other day, because I saw reference to the PHQ-9 somewhere and I suspected my scores would show I was depressed again. Scores of around 20 and 30 respectively puts me right on the Moderate-Severe threshold on both scales. I don’t believe that it has got that bad so quickly and I think severe is pushing it, but moderate depression is probably a fair assessment at the moment. Strangely, my scores are worse in different areas to where they used to be, but it’s still higher than I had expected. My BDI score did get up to the late 50s/early 60s though when I was really unwell, so there is a long way to go before I get like that. I did a retrospective scoring for how I was during the summer, just to compare and I would have said my PHQ-9 was about 4 or 5 (not depressed/mild depression) and my BDI around 8 (mild depression?). Things have definitely gone down hill. I think my “natural” state is probably a little on the low side anyway, but this is more than that.

Physically I feel awful as well. Tummy troubles continue. I spent one afternoon last week rolling around in agony. The pain in my gut was just so bad and it came on so suddenly I didn’t know what to do. It was probably the worst attack that I have had and it took a few hours to settle down to a dull ache. My appetite was hit by it and still hasn’t really recovered. My bowels just can’t seem to find any sort of rhythm or pattern, no matter what laxatives or diet I am eating – eat eggs and I end up with diarrhoea, eat beans and I can end up constipated. It makes no sense at all.

In general, my body feels really run down. I have a cold sore and have had a few spots break out lately. I think I may have a urinary infection of some form. I’ve spent most of this week constantly needing to wee, although thankfully it hasn’t felt burny/stingy, so I’m not sure. Last night, a lymph node at the back of my head (behind my right ear, up from my neck) has swelled up and it is really painful. It feels like someone has hammered something into the back of my head and that they are constantly notching up the pressure. I couldn’t sleep at all with it last night. I had the same thing happen on the other side a while back and it took a few days to go down. I hope it does soon. I am not sure how much longer I can take this.

I went and saw Dr N this evening. I was hoping he could at least suggest something to fix my body, if not my mind. Sadly he didn’t have much to offer either. That may be partly because I didn’t know what to say to him. I didn’t tell him all that I wanted or meant to. I seem to have forgotten how to talk about this stuff and I keep forgetting things I should do or say.

He asked me what had triggered my mood. I said I didn’t know. Possibly the time of year, but I’m not really sure. He asked what support I was getting from the CMHT. Nothing is the answer I gave and the truthful one too. I had a phone call last week to tell me they’ve “closed” my case, because I no longer have a worker. They had forgotten to sign off my old CPA when my social worker C left, which was back in June, but someone had found it and said they would send it off to me so they could close my case. Dr N had received a copy too, remembering that there was an apology attached to the front. I don’t know what he thought about that. He asked what other support I have. I reminded him that I am still seeing Dr M as an outpatient, but I won’t see her until January now. He asked about the psychology referral. I’ve not heard anything. He sighed at that.

He mentioned that her last letter suggested that I drop the Reboxetine a few days a week to see if that helps the side effects. She suggested either going every other day – 6mg one day and 8mg the next or even 8mg in the week when I have to work or am at home alone and 6mg at weekends when I have more support. Dr N said he thought the latter may be worth a try, because he hopes that improving how I feel physically may ease my mental symptoms too. He doesn’t think 6 or 8mg will make that much difference either way to my mood, but it might help with the tummy troubles. I am not so sure about the idea, especially in light of my dropping mood. In fact, I’d even tried a few days on a slightly higher dose – 10mg (an extra half tablet), just to see if that could kick my mood back up quickly. No such luck though. I guess it is worth a try.

I didn’t know what else to say to him and in the end we just wished each other a good Christmas and I left. I walked out and finally started crying. I’ve needed to for days, but the tears hadn’t come. I don’t know what to do to stop this decline and I don’t feel like I have anyone to help me. I am scared about Christmas and January and all the memories that this time of year is dragging up. This time last year I was telling myself I just have to get through Christmas. I am doing the same now. The problem is, last time I got through Christmas, only to try and kill myself when January came. I don’t want that to happen again. I am not as bad as I was back then. Things have moved on a lot in the past year. I have hope that my mood can recover again, where as last year I had no hope at all, but I am starting to feel more and more helpless and I fear that I will always be waiting for the next relapse. I am terrified that every time I try to live a normal life, depression will come back and bite me. I don’t want that to happen. My mood has to pick up soon. I need to keep going.

This only seems to scratch at the surface of what I am thinking right now. I am scared. I am worried about what everyone will think. I don’t want to let everyone down. Everyone has been so pleased about the progress I had been making and seemed to be excited about me getting better. I had been so pleased too. I thought I was getting my life back. I am going back to work at last. I am driving again. Everything seemed to be getting back to normal. Things seemed to be going really well. Then I am hit with this slump in mood and I don’t know what to do with myself. I know recovery is a difficult process and I’m always going to have set backs, but this feels different. It isn’t just a bad day or two. Nasty thoughts are creeping back in. I am having to put on my happy face. Life feels like a struggle, rather than just being life. I hope it is just a blip. I really do.

I’m also scared about the diagnosis stuff being stirred up. I was recovering, medication was helping, my condition wasn’t pervasive and untreatable, so I couldn’t have had a Personality Disorder. If I’m getting ill again then people will probably start thinking that it was just a co-incidence and that I do have a PD after all. Maybe I am being paranoid, but I am scared about this. I was glad that I had responded to medication. I may have been treatment resistant, but at least I was treatable.  Now I just feel like a failure. It will be back to the theory that I need therapy if I am ever to recover and I will be blamed for not recovering. No doubt I will never get offered therapy anyway, even if I need it, but I was hoping I didn’t need it. I don’t know. I don’t want to think about it. Whenever I think about what went on earlier this year about my diagnosis I get panicky, anxious and upset. It seems to hit a nerve and I have to stop thinking about it.

I hate feeling like this. We will see how things go. At least I have admitted it now. I have been carrying around these thoughts like a guilty burden. I have been secretly acknowledging the depression, whilst denying it in the hope it would go away and that no one else would find out. I feel like I am letting everyone down. I wanted to have a “happy ever after” for this blog and then I’m back here again whining about depression again. That isn’t what I wanted. Sorry.

8mg…

with 8 comments

I saw Dr M this morning. I’d not seen her for ages. It was back in July, just before I went to Europe (I haven’t written about my trip, but anyone following my twitter feed will know that I spent 2 and a half weeks InterRailing during July/August), so a lot has happened since then. She suggested that it was a good sign I hadn’t needed to see her sooner, but I indicated that it wasn’t especially. It probably would have been if I hadn’t have wanted to see her about a month ago. I couldn’t get an appointment then. This was the first Monday we could both do.

She asked about my trip. She was impressed and relieved that I managed on my own whilst I was away. It feels so long ago now, I didn’t really know what to say, other than that I coped, enjoyed most of it, but found it really exhausting.  I could have told her more, but didn’t see the point. There was limited time and plenty of other things to cover.

We talked about things with the bloke. Before I went away, things between us had been somewhat up in the air. When I last saw Dr M, there was a very real chance that we would split up. I haven’t written about this here before now, because I don’t think the bloke would be overly comfortable about me sharing this with the world.

The whole idea of the trip to Europe, was to give us some time apart to reassess things. I was going to just take a “boring” holiday somewhere, but options are limited for solo travellers and I’d always wanted to go InterRailing, so I decided to give it a go. It also seemed like a great chance to test myself to see if I could be more independent and to cope on my own.

I’d talked about all of this at my last appointment and Dr M was keen to know what has happened since then. Things between us have settled down and pretty much gone back to how they were before things became difficult. It’s almost as if nothing had happened. Neither me, nor Dr M could decide if this was a good thing or not. On the whole, it is probably good. Things were not good at all when I left and it is nice to know that he missed me a lot, but it has also been a little disappointing. When I got back, we talked a bit about what had happened and how we should try to improve things and appreciate each other more. Unfortunately, it doesn’t feel like anything has changed or improved.

We talked about my trip to Occy Health. I explained what he said about not starting a proper scheduled return yet, but how we tried to think about the ways we can solve some of the problems that are stopping me from getting back to work. I told her that he’d said I could try to visit the office and that I managed to go to a meeting last week for a couple of hours, which she was impressed by. It was a really big step, so that’s good. However, she seemed disappointed that there was nothing further planned yet. I suggested that I will probably try to go in again in the next week or so, but I hadn’t decided when yet. She wanted me to try to commit to a time and hoped that I could start to go in on a more regular basis, even if it is only once a week for a few weeks. She thinks that a routine and commitment to going to work on a specific day, would help me prepare for it better. I said that is actually what I’d hoped for, but that Dr Occy Health wasn’t sure and she seemed to accept this, but she thought it would probably be okay if I chose to do it, rather than having my work-place imposing it on me. She may be right and I was considering this myself. I will try and decide when would be best.

We did talk about my mood and how it has recently dropped quite a bit. I don’t think she was too concerned or especially surprised, although she was possibly a little disappointed. She asked about the usual stuff . Sleep, suicide, anxiety… She was not surprised to hear of my nightmares or generally rubbish sleep (occasionally too much or usually too little and never feeling rested). I had to admit that suicidal thoughts had returned, although they were a lot less frequent and different to how they were a year ago. She hadn’t actually realised that the thoughts had pretty much gone away over the summer, which was a surprise. I’m sure I’d told her last time that I wasn’t really suicidal any more and that I no longer felt that life was completely hopeless. Although I can feel pretty awful at the moment, I have got my hope back that I can be well again. A year ago, I could never imagine a life without feeling horrifically depressed, so it was no wonder I could see no future and wanted to end it. I do get frustrated at the fact that I have got worse again. I wonder if I will always be waiting for the next relapse and if so, is it worth it? I am able to cope with these thoughts at the moment, as I still have some hope of a recovery.

We talked about the risk that I may do something impulsive if I have a particularly bad day. I told her there was no immediate risk of me killing myself and that I have no intention to make any detailed long-term suicide plans like I have in the past, but that I couldn’t guarantee that I wouldn’t just do something on impulse. I don’t tend to be impulsive and have never made the decision that way in the past, but if an opportunity presented itself, there are times when I can be very tempted to take it. She recognised this and I guess she knows that there is always a greater risk of completed suicide when people are either recovering or deteriorating. When you are really, seriously depressed, it is far too much effort to kill yourself, but when you’re having a bad day after a series of not-so-bad days it can seem a lot worse and you are also more likely to have the energy and drive to do something about it.

I mentioned that I felt that the arrival of autumn did not seem to be helping and she agreed that there was probably a seasonal element. She had noticed back in the spring that things seemed to improve a lot faster for me when the weather picked up in April, so it is natural, I guess, that things would get worse again when the summer ended.

We talked about my medication and she agreed that it probably needs a tweak, if only to help me get through winter. Her first instinct was to add Quetiapine. Apparently, it was licensed the other day in the EU as an augmentation treatment for Major Depressive Disorder, although she admitted that most psychiatrists had been using that way for a while anyway. She asked if I’d been on it before and I confirmed that I had. I was taking it along with Venlafaxine, back in February 2009 when I overdosed on it. She asked what doses I’d been on and I said I couldn’t remember but I did get right up to 550mg. She said that for MDD they use a max dose of 300mg, but I had been on that sort of a dose for a while too, so I’m not sure it would help. I also mentioned that it never seemed to help with insomnia and that I had put on weight last time. She said she didn’t expect it to help the insomnia and she seemed genuinely surprised about the weight. Although it didn’t help me with insomnia, I know plenty of people who find it knocks them out, so that seems a little strange. There are also plenty of people that have found it made them put on weight too, so I am not alone. Both drowsiness and weight gain are listed in the common side effects, so you would have thought she was aware of that. Anyway, I said no to Quetiapine.

The other options were to do nothing, increase the Reboxetine, swap the Reboxetine or try to add something else. I wasn’t sure doing nothing was a good idea and we both agreed that stopping the Reboxetine was a really stupid idea, as it is the first AD that has ever helped me. Reboxetine has shown that Noradrenaline is probably the key to my wonky brain chemicals and there aren’t many others that help on that front, so we’re not sure what else to do. She didn’t have any bright ideas of anything else to try really. If not quetiapine, then she said we’d probably be looking at augmenting with Lithium or another anti-depressant, but she wasn’t sure what would be best. She said she would have a look for some ideas though before I next see her and she was welcome to any suggestions I may have – so if anyone has any ideas, let me know. I’ve been on most of the common combinations already and my only real thought is perhaps bupropion, but it’s not licensed as an AD here (although it is used an awful lot in the US), so I don’t know if she’d give it a go. I know a couple of people who have found it helpful though, so it may be worth a try.

In the end, we decided that increasing the Reboxetine was probably the best option for now, although I am worried about how I will be with the side-effects. It is worth a go though and if it is too much then we will have to try something else. I hope it helps, without making me feel too awful. She said she’d get a letter sent to Dr N. I have plenty left at the moment anyway, so will just increase the dose myself for now. It only comes in 4mg tablets anyway, so it makes little difference. So yes. I am now going to be taking 8mg of Reboxetine. I didn’t actually tell her that I’ve occasionally taken 8mg anyway, when I’ve not been able to cut one of the tablets in half to make the 6mg. One day doesn’t make much difference though, but 8mg over a week probably will. We will see anyway.

After that, I remembered that I had also been for the therapy assessment. I told her what had happened and that I will probably be waiting for someone to come back from maternity leave. She named the person she thought it would be. We shall see what happens anyway. She isn’t impressed that I’ve been waiting over a year and was shaking her head saying “it’s probably only going to get worse, only going to get worse…” as she looked at her diary to book our next appointment. It really isn’t good.

Anyway, time was up then and I had to go. I see her again in 6 weeks, so we shall see how we go with the Reboxetine.

Written by intothesystem

Monday, 11th October 2010 at 2:08 pm

Therapy Update…

with 4 comments

So I had my second therapy appointment a few weeks ago now, but I haven’t had the chance to post about it yet. I’ve wanted to write a lot over the past few weeks, but for one reason or another I haven’t managed it.

The 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 let us bring things to a close a little better, but it still felt a bit like a waste of time. It would have felt very rushed if we only had the one appointment though and I guess I may as well make the most of the psychologist’s time whilst I have it.

Unfortunately, she didn’t really have any further information on the future of the therapy service or when I might be able to see another therapist. They don’t know what is going to happen and it is unlikely that anyone else will be joining the team in the near future. It seems there are only 3 therapists working in the service at the moment, which explains why the waiting lists are so long. Two of those are CBT therapists, so are not really suitable, although apparently one of those is “much more than just a CBT therapist”. The other therapist is male and the assessing psychologist thought that a female might be better and more challenging for me (due to my usual preference of dealing with men). They all have full case loads anyway, so wouldn’t be able to take me on, even if they were considered suitable. It was suggested that perhaps the “much more than CBT” therapist could have maybe taken me on, but the assessing psychologist wasn’t sure if she had the space or if she’d really be suitable. She was going to talk to the team manager and discuss that possibility, but she did think that someone else would probably be better. If she can take me on though I wondered if I should just see her. At least there would be a concrete offer of therapy soon, which could mean I would get started before I am planning to go back to work. I am worried that if I have to keep waiting I will miss my opportunity.

The other option is to wait for the therapist that is out on maternity leave until November and hope that she will be able to take me on. She is a psychodynamic therapist and the psychologist I saw thinks she would be best placed to work with me. I am worried that she will decide not to come back to work or that she won’t have room in her case load for me though. Even worse, I worry that I won’t like her or be able to work with her. If I am going to have to wait a few more months, I’d like there to be some guarantee of a positive outcome at the end of it.

Otherwise I will just be waiting for someone else to join the service, although the likelihood of that happening and them being suitable seems pretty slim. I still can’t believe there are only 3 therapists for the whole service. I dread to think how many people they are meant to be covering between them or how many people are waiting.

As well as talking about therapists, we also talked about topics for therapy and what things I needed to address when I eventually get offered a therapist. We didn’t really identify much more aside from the previous session, but we did look at a few things in more depth.

We talked about school and about bullying a little. I never used to think much of the bullying I went through at school. I didn’t think it really bothered me, aside from making me a bit miserable at the time, but I’d been dreaming a lot about some of the main protagonists lately and some of the dreams or nightmares have been really upsetting. They have been less frequent in the past fortnight, but in the weeks before that they were starting to bother me a lot. I would wake up shaking and confused. I don’t know why it has suddenly come up in my dreams. There is no reason for it to be a problem all of a sudden. I’ve had a lot of nightmares in general lately, but school has definitely been the main focus. Some of these dreams are so realistic, they feel like buried memories and I wake up terrified that I’m back at school. Others are strange and convoluted and make little sense. It has made me think about how I felt back then, a little more. I wonder if things were actually worse than I remembered or hurt me more than I would like to admit. There are periods from school that are really clear in my memory, but other times are just gone and I wonder how much of that is me trying to forget the worst of it all. My  memory is patchy these days anyway, especially since the ECT, but my long-term memory is certainly less affected than more recent times.

Specifically we talked about how there were two kinds of bullying I went through and how they affected me differently. I was teased and bullied during a lot of primary and early secondary school. On the surface, most of the bullying at secondary school came in the form of name calling and the occasional push on the stairs from a bunch of lads in the year above. This was annoying, but I tended to brush it off and ignore them, or be pretty mouthy back. I was usually too quick for them..

On the other hand, even though it was less visible, it was the other stuff that got me. There was always a lot of teasing and bitching from most of the girls, many of whom were meant to be friends. There were a lot of things supposedly said in jest, that really hurt and worse of all, they were meant to hurt. People would pretend to be nice, but many of them were pretty damn cruel when they wanted to be.

In the long-term, this side of things has certainly had the most effect on me. I became afraid to get close to anyone, because they always seemed to stab me in the back. Even now I struggle to trust friends and worry about what they really think about me. I get anxious in social situations and never feel good enough. If people are being nice, I always worry they aren’t genuine. I try to come across as confident, but afterwards I always analyse everything to death and worry I came across as an idiot. I have little true self-esteem (although I can pretend), but when it was battered constantly for years, that is probably understandable. The only thing I have much faith in is my intelligence, ability at school/work and the like and over the past couple years that has somewhat taken a knock too, due to being ill.

Anyway, this wasn’t what I set out to write about, but we didn’t discuss all that much else aside from what I wrote about in the last post.

We left the situation with the psychologist planning to talk to her manager to discuss whether “Not Just CBT Therapist” or “Maternity Leave Therapist” would be best placed to take me on. She was then going to call me to let me know what is happening.

I thought she had forgotten about me, but she finally called on Monday. It seems I will have to wait for “Maternity Therapist” to come back. She may not be able to take me on straight away, but at least they will know more then. It could be months before I actually get to see someone now though.

I’m still frustrated by this. To think the wait is coming to an end and then to be let down is annoying. I just don’t know if it will be worth bothering by the time I actually get to see someone.

Oh well. I don’t know why I expected anything better.

Written by intothesystem

Wednesday, 6th October 2010 at 1:47 pm

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