Psychotherapy Experience - Part One

After I complained to the NHS about their negligence of my care, following an extremely poor handover of care, I was referred to a community based team for therapy. It was a specialist service specifically aimed at caring for those with diagnosed personality disorders or complex needs. The team was relatively small and they provided both psychotherapy and help with social needs, like getting into education or work.

I received a letter inviting me to an assessment with one of the psychotherapists, a few weeks after I was referred. I remember going in nervous and not sure what to expect. I have a history of being assessed by mental health teams, only to be rejected because I didn’t match up to their views on how people with mental illness should present. The psychotherapist was warm and kind and most importantly she listened. Not the sort of listening when you nod and then just say what you were going to say in the first place. I mean really listening. Taking in everything the person has to say and thinking about it in the context of the person’s life. She really got what I was trying to tell her about my experience of life. I could tell she’d had a lot of experience working with young people with BPD. I felt, for the first time ever, truly understood by a professional. There was no judgement or unwanted advice. She wasn’t trying to change me, but was getting me to understand and question how I really felt. And this was only the assessment! I knew immediately I would be able to work with her.  

Within a few more weeks I was told I had been accepted to take part in a young person’s therapy group for 18-25 year olds. I would be getting a few 1:1 sessions, before coming to group every Wednesday for an hour and a half. I knew that it wasn’t going to be Dialectical Behavioural Therapy, which I had wanted for years, but I welcomed any kind of therapy I hadn’t tried before. Especially due to the state I was in emotionally.

The first day I walked into the waiting room my heart was trying to jump out of my chest. I knew the group would be all female and that the other patients were dealing with similar issues, but that was about it. I sat in the corner, looking around to see if I could guess which of the other people I would be spending a year with. I couldn’t imagine sharing all of my problems. What if they thought my problems were trivial compared to theirs? Years of being told I should be lucky I hadn’t had all these awful things happen to me, had sort of brainwashed me. I had been told the issues I had weren’t because of trauma, but because of my general nature. I wasn’t traumatised, I was just weak or bad.  

The two therapists came into the waiting room and collected us. It felt a bit like school as we filed in silently. I could feel my eyes darting around in panic and tried to calm myself. I could feel the panic rising. As we all sat in a circle I hesitated to even look at anyone else, but I could tell the others felt the same. For what felt like eternity we sat there in silence, looking back it couldn’t have been more than 30 seconds. I could hear the gentle ticking of the clock on the wall to my left.

The first thing the therapists had us do was introduce ourselves. I felt so silly. I was starting to have second thoughts about being there. I had fears it would just be like all other therapy I had had, stupid, embarrassing and useless. By the end of the session though I was starting to come round. Some of the girls were talking about why they thought they were here, and it encouraged me to think and start to contribute. Everyone seemed friendly enough. I had been worried that I wouldn’t be able to get on with a group of women. I always struggled to make friends with girls at school, they seemed bitchy and complicated. The end of the session came faster than I had expected. I didn’t feel like I’d said much at all.

Update: Writing About My Therapy Experience

Morning all, 

I just wanted to give a small update on what I'm working on currently. After having completed 3 years of psycho-dynamic therapy, which came to an end in December, I wanted to talk about my experiences with group therapy.

I started writing a few days ago and had intended for it to be one post, briefly informing people of what to expect. However, I've come to realise that I have literally pages and pages to write. I looked at cutting sections down, but decided this would take away from what I wanted to share. 

My solution is to split it into several posts. It might take some time to get it all published, so please bear with me whilst this is in progress. Hopefully it'll be interesting to people who might be nervous about accessing therapy, or who want to see how it compares to their own experience.

Take care.
Out of Darkness Xx

Why I Wrote a Complaint to the NHS

Trigger Warning - mention of suicide attempt

After I moved to live with my partner in another county, I ended up launching a lengthy complaint against the NHS. Before this point in my life I had never complained about anything. I felt that I should be grateful for the care I was receiving. After all there are other countries where I’d have to pay hundreds of thousands for what I needed. I had only moved about 2 hours away by car, but the two NHS trusts handling my care seemed completely unable to communicate this with each other. I went from having a care coordinator and being under a community mental health team, to having no care available to me.

For months after, I spent countless hours on the phone to both trusts, attempting to find out where all my data had been sent. The old trust were completely clueless and the new trust refused to treat me until they had received my information. As you can imagine this went on for months, as I gradually got more and more unwell. To cut a long story short, I ended up making some attempts on my own life and being admitted to psychiatric ward for a few days. Even after all of that, the local team simply shrugged their shoulders and said there was nothing they could do.

So, with the support of my family, I decided to write a complaint. I’ve always been a very passive person who tends to avoid conflict, even if that means I miss out or suffer. For me it wasn’t easy deciding what I wanted to do.  It was however, the first time I understood that if I wanted to get the help I needed, I would have to fight for it. Using my knowledge of previous services in the place I grew up and also my experience training as a mental health nurse, I tried to work out what sort of basic care I was entitled to. I knew that my care should have been easily transferred to another community team within a few weeks. I knew that I should have been assessed by a psychiatrist, who would look at whether or not my medication needed to change. I researched the teams and their referral processes. By finding out what they should have done, but hadn’t, I was able to formulate my complaint.

The aim of the complaint was not just to have a moan at the NHS. I wanted them to realise that I had slipped through the net and for them take action to rectify the situation. Making a complaint wasn’t just to help my individual case. I hoped that it would help others in my situation in the future. If the NHS know what they are doing wrong, in some cases they can make sure it doesn’t happen again. Of course many issues may actually be due to funding these days, but there are other ways for you to take action. Get involved with your local mind charity. They run all sorts of campaigns and events aimed at making the government take notice of mental health.

So what came of the complaint in the end? Well actually way more than I could have imagined. My current trust acknowledged the hardship I had been put through and arranged for me to be assessed by one of their community teams. They sent me a full apology signed by the director of services. As a result of actually being listened to, I was referred to the complex needs and personality disorder service. In the end I was under that team for 3 years. They put me through some pretty intensive therapy and honestly it did me so much good. Back then I couldn’t have imagined how far I would come. I certainly never thought I would be working a full time job, enjoy my relationships and take part in blogging and other forms of activism. In a way you could say that making that complaint changed my life.

Self-care checklist with hints and tips

Note: This plan is specifically tailored to my needs. You’ll need to adjust it.

Everyday Essentials - (Activities you MUST do every day to stay well)

Shower/wash/other basic hygiene

Put on clean clothes

Take your medication as prescribed

Eat 3 meals a day

Get between 7-9 hours sleep

Everyday Recommended  - (Extra daily tasks to boost wellbeing)

Talk to someone - make contact with a friend or family member even if it’s just a text.

Get time in the sunlight - Even if you can’t get outside, get those curtains open, vitamin D does wonders.

In A Week - (Weekly activities to aid recovery and keep you well)

Plan your week - to do list/shopping list/meal plan

Creative time - Minimum 3 times a week.

Relaxation - Every other day, more if you can.

Socialize - Meeting up with people at least once a week.

Exercise - cardio 3 times a week, yoga at least once.

My Self-care Tips

1. Get organized! - Get yourself a diary or create a timetable. Being organized works wonders for me. If I don’t attempt to plan my time then I know I personally will end up sitting in bed playing games and watching netflix in my pajamas. I also keep a food and mood diary and take part in meal prepping, which means I still get to eat healthy food on the days I lack the motivation to make it.  

2. Start with the basics and build up - Often my downfall will be trying to take on too much at once. When my mood pops back up after a low, it can be easy to get fooled into doing too much to try to “make up” for lost time. This only results in your mood crashing back down from exhaustion. Take it slowly. If you only get 1 thing done a day then that’s still cause for celebration.

3. Set a daily goal - I try to spread out errands and tasks throughout the week, as opposed to getting it all done in a couple of days. Things like making appointments, doing housework and responding to emails, it’s much easier to set them as a daily goal. My diary is brilliant and even has a little box to enter your goal at the top of the timetable. You can add your own or even get a chalkboard or whiteboard to write it on.

4. Reflect on your week - Reflection is a huge part of recovery. Being able to look back and see your progress is a great motivator. It also helps me to see when I can add more activities or if I’m lacking in an area. Keeping a journal is a brilliant way to do this.

5. Learn to say no - Balancing your life is no easy task. Often friends, family and work will want things from you. Whether that’s offering support, attending social events or putting in a few extra hours. There are times when all these things are happening at once and you notice your mental health starting to deteriorate. This is the time to prioritise what’s important to you and this might mean saying no. It’s okay to say it. It seems scary, but the people who really care about you won’t be angry at you. More often than not they’ll understand you rearranging to protect your health.

Self-care for recovery

Back in December I posted about the importance of self-care. As I mentioned self-care is the act of looking after oneself, whether that’s physically, mentally or spiritually. For those of us with BPD, it’s vital in retaining the emotional resilience to cope with our day to day stressors. Even if you don’t live with any mental health problems self-care is still important. Stress affects us all in this busy, ruthless world where our worth is often based on how much we earn, or how useful we are to society. The day in day out struggle to keep a roof over our heads, feed ourselves and just stay afloat, makes us weary. Without self-care most people would be heading for some sort of crisis in their life. You just never realize until you get there.

Having been signed off work since the beginning of January, recovering from a breakdown, I had been allowing myself to stagnate. Most days I found myself simply laying in bed, staring at the ceiling. I felt unable to look after myself in any way; even small actions seemed like mountains. I had gotten trapped in a vicious cycle of feeling bad, so neglecting my needs and therefore feeling even worse. I found myself spiralling down. What I needed to do was to build up the courage to break that cycle. There had to be a self-care intervention.

One afternoon I worked up the energy to force myself to self-care. I started by cleaning the house; I find a messy house equals a messy mind. I put things away, dusted and hoovered. You know what? I hated every last second of it. I felt tired, my limbs were heavy, I wanted to give up. All the symptoms of a low episode were still there, but in that moment I was able to fight through it. After wards I took a shower. I hadn’t had one in over a week and now I wanted to feel clean to match the house. I often struggle with personal care, because sitting in my own filth gives me a reason to feel terrible; almost like the outside mirrors the inside. I know that I always feel better after a good shower, but my BPD tries to stop me, I don’t think she wants me to escape her claws. But, I did it. After every little thing I did I felt better and better. I planned my week, I started eating good food and even managed to do some yoga and meditation. Over the next few days my mood began lifting and stabilizing.

Over the last few weeks I have gotten myself into a place, where I am no longer spiralling. I won’t say that it’s been perfect, because I’ve been up and down. I had fallen back into old habits a few times, but each time I was able to dig myself back out. Recovery is complicated and it’s normal to be taking two steps forward and one step back. For example I just spent a couple of days in bed, using alcohol to numb the pain and hating myself. With support, I made it out.

I aim to go back to work at the end of the month and for this I need my recovery to continue. In order to do this I have to keep up the self-care. Neglecting it could cause a relapse and actually stopping could be a sign of things starting to breakdown again. My intention is to set some realistic goals. In December I had planned to do more self-care as part of my new years resolution. Now it makes even more sense to do this.

I will be starting this self-care challenge to see if I can keep it up and make slow changes to my life. I hope anyone who reads this might consider doing the same. I hope to be posting weekly updates of how it’s been going and how it’s been affecting my mood. I’m going to be starting small at just a few activities a week and slowly build up. I’m going to post a checklist of sorts for the self-care I should be doing everyday and some less frequent ones. With any luck this should help to keep my mind out of trouble.

As a further note: Self care is hard. A moment will come where you have just enough energy. You have to fight. You can gain back control. It might take some time, but eventually that day will come. It’s okay to ask for help too, that’s a sign of you acknowledging your own needs. We don’t have to do it alone. Set reasonable goals. Praise yourself and don’t get mad if you can’t manage it today. There are more days. Recovery is slow, but it is worth it. Getting out of the rut will be the best thing you ever did.

What happens after a breakdown?

As you may have guessed from my post recent posts, I’ve been going through a tough time. At the beginning of January my emotional breakdown peaked and I was admitted to hospital, for a week of respite. I’ve spoken a lot about when things start to break down and when I’m deep in a crisis state, but never about what happens after. Usually when people come out the other side of a crisis, they aren’t just miraculously better. The mental and physical toll of being in such a state, really can have an affect on you. It’s this that I want to talk about today.

About a week after I was discharged was when I finally came out of my crisis. I remember laying in bed feeling absolutely exhausted. I had been feeling anxious and out of control for so long, all I wanted to do was sleep. Being signed off from work, I had no reason to leave the house and therefore no reason to take care of my personal hygiene. My friends went out of their way to try and include me and invite me to things, but I simply declined. With no motivation to get out of bed and no drive to socialise, I was quickly declining again.

For you to understand the behaviours you need to understand what was actually happening to me. For the most part of my life my moods can fluctuate quite dramatically. I go between two mental states; deep depression and chaos/anxiety. As I approach a crisis these two states, with differing BPD symptoms, have more of an effect on my life. After the crisis these fluctuations are still present, continue to cause me trouble and could potentially affect my recovery.

In the deep depression phase my baseline mood is extremely low. I would go as far to say it is dysphoric. It feels like the world is a dark and lonely place. I feel like I’m weak and that I’m a failure for not being able to cope. My self esteem drops and I bully myself at every opportunity. Physically I am also drained and often it’s like walking through custard. When you combine all of these things, it leads to not taking care of myself. Not showering, eating badly as I don’t have the energy to cook, staying in bed all day and not taking part in my usual hobbies.

In my chaos or anxiety phase my emotional arousal reaches a high. It’s a bit like mania in the way that my brain is buzzing with activity and I can make rash decisions, but in no way am I ever euphoric or joyful during this phase. Often I am filled with panic and fear about my future or sometimes even the next few hours. I worry that I am making the wrong decisions and that will ultimately lead to my unhappiness. Because of my heightened emotional state I can become irritable and angry. My social anxiety increases causing me to withdraw socially. I become emotionally fragile, so I can easily take things personally or misunderstand. Physical effects can include appetite changes, excessive nail biting, digestive problems and exhaustion.

When these moods are fluctuating uncontrollably and my BPD symptoms increase, it becomes difficult to function in society. The empty feeling inside is unavoidable. I try everything and anything to fill it, which leads to unhealthy coping mechanisms; like drinking and binge eating. My anxiety often causes me to want to run away from the situation and start over, without the ghost of my past. I mean literally run away. Once I had my bags packed and ready to disappear into the night, when my partner was at work. I had nowhere to go, but I was going to do it. It puts pressure on my relationships as no matter what they do for me, I don’t feel loved. If I don’t make the effort to intervene here, I could make some pretty catastrophic decisions. This has often been the reason I have struggled to keep a job or relationship in the past.

With all this going on it can be easy to slip straight back into a crisis. You will often have to take positive steps and actions in order to stay on the road to recovery. In my next post I will be talking about the self-care needed in order to do this. It’s important to note that recovery isn’t necessarily one simple route. There will be dips and setbacks. What matters the most is that you find the strength to dust yourself off and try again.

Out of Darkness. Xx

What's it like to be hospitalised? (Part two)

TRIGGER WARNING: Content that covers topics of self harm, suicide, hospital environments and family issues.

I was admitted on the Friday and had a review with the consultant on the Tuesday. I was at boiling point. I had been holding so much in that my kind and understanding facade was starting to crack. The consultant was one of the most dismissive men I had ever encountered in the mental health system. He asked me why I had been admitted to hospital and I explained I had been actively suicidal. He then proceeded to tell me that nothing was going wrong in my life so I had no reason to feel the way I was and promptly offered me no help whatsoever. How could someone that gets paid so much to care, simply not? I finally erupted. I don’t remember much of what happened next but I was seeing red. The rage prickled my entire body and I found myself shouting that they didn’t care and that I didn’t see a point to anything in life. I stormed out of the room and kicked the wall until I felt the anger subsiding. I don’t act like that, ever, but I felt I had been pushed over the edge by the complete lack of care.

I spent the rest of the day crying uncontrollably. I managed to sneak a plastic spoon which I broke in order to self harm. I hid in my room or in the toilet and cried so much my chest and face hurt. The world was a darker shade. “They don’t care, no one cares, they don’t care,” echoed throughout my thoughts. Before I knew it I was thinking about my how my dad left, how he never turned up for visitation, hours waiting by the window. Every single rejection in my life popped into my head. “You are nothing and you will always be alone, always be left.” I sat on the floor. I must have cried myself to sleep.

When I woke up it wasn’t so bad. All the emotions I had been holding inside had released. I made my way to the dining room and sat at one of the tables in a daze. I can’t remember what time of the evening it was, but the sounds were all muffled. I spoke to one of the other BPD girls who asked me what happened in the doctors meeting. I told her I just didn’t care anymore.
“You’ve just been defeated, haven’t you.”
She was right. I couldn’t fight anymore. I was totally drained from begging and pleading for someone to do something. From that moment on I felt lost. I knew I was going to be discharged in a few days, regardless of whether I was ready or not. It’s a shame that this has been a common occurrence for me. The doctors and nurses always try to convince me that there will be help on the other side, but community mental health services have been stretched to breaking point.

Going into my discharge meeting I had lost hope of receiving any kind of help. My partner had been invited to attend as often professionals will take what he says more seriously; It’s ridiculous. We were called in front of the doctor, the crisis team and staff from the ward. The doctor then proceeded to read all of my notes back to me, about why I was admitted and what I had done since I had been in hospital. He was literally reading from his computer screen and barely made eye contact with us.
“So she’s been taking part in ward activities.” He said.
“Umm, no I haven’t.” I interjected.

He peered over his screen at me in a disgruntled fashion.
“I haven’t taken part in any activities, because there weren’t any.”
He was practically fuming. “Well that’s the nature of this ward.”
“It’s okay, I just don’t want you to put down what I haven’t done.”

Honestly I’m not sure I ever saw a doctor lie like that so blatantly. The rest of the exchange was a chilly one indeed. After he read out my notes, very matter of factly, he moved onto saying that he would be discharging me with no further support. My partner tried to argue the case that if I didn’t get any help from the crisis team or a community team, that I would be back through the door a few months down the line. Now my partner is a very skilled critical thinker and can easily hold his own in a discussion. However, he was simply brushed aside and we were simply asked to leave. I honestly could not believe the unprofessional attitude of that consultant.

Though I was upset I would be receiving no support, I was so glad to walk out of those doors. Inside hospital I felt I was treated like a child; told when to eat and when to sleep. I found myself regressing back to a childlike state to match the environment. Admission to a short term facility will likely not be therapeutic. However, it is important to realise if you are in an unstable and unsafe place, then admission might be your only choice. I used it as it was intended, as a place of safety, where it was harder to make the poor decisions that might cost me my life.

My intention was not to provide a negative view on NHS short term psychiatric units, but a realistic one. I would like to say I’ve had different experiences that were more therapeutic, but the only one was my first admission, which was onto a different ward. I have heard from others that long term admission is often more beneficial, if that is what you need. Personally I would say that if you need a short term admission then simply treat it as respite. A few days where you can fall apart and then put the pieces back together safely.

Lastly before I end, I want to briefly mention the sorry state that our mental health services are in. Hospitals rarely have beds and there is little funding for activities, community teams are pushed to their limits and there is a dramatic shortage of registered nurses, thanks to tuition fees being raised to ridiculous levels. There is more money available and clinical commissioners and associated politicians, need to be thinking of the long term effects to services. You have a say in what these people do, to what is one of the most vital services in the UK. Treatment should always be free at the point of care and available to all, not just those who are rich enough to afford the private therapy costs. Read those party policies and manifestos, get out there and vote.