Psychotherapy Experience - Part Four

Another thing no one tells you about therapy is often the big changes happen afterwards. I felt my group sessions were too laid back and too loosely structured for me to benefit. I went away thinking that all it had done was bring up painful memories and cause me to struggle even more. 

It must have been a week or so after the last session that I could sense something wasn’t right with me. I was starting to become aware of a place inside of me I didn’t know existed. Now, hear me out because this sounds a bit crazy, but it’s all metaphorical, and I can strongly visualise it in my mind. Before therapy I was aware of a great, big, aching emptiness within me. It has been the reason I have engaged in a lot of unhealthy behaviours, to try and fill that void. Where there seemed to have always been nothing, suddenly there was something. Small at first and barely recognisable. I had always visualised myself standing on the edge of a giant hole in the ground, that went on as far as I could see. I had always assumed that jumping over the edge meant that I had truly given up on life. There was something drawing me to step out into the void and see what was down there. So one day, I did. What I found there, was myself. Not all of me, but all of the negative and painful emotions I had tried to hide. In attempting to bottle it all up I had created a kind of other entity in my own mind. It scared me to death. 

After a long and drawn out summer I found myself exhausted. It was as if I was doing battle with my own soul. That girl I had found at the bottom of the void, I wanted to get rid of her, along with all my pain. I sort of saw her as some kind of adversary. All this fighting landed me straight back in the hospital. I sat in that dark place cursing my therapist for encouraging me to be more introspective. When she offered me a place in another ongoing therapy group I wasn’t exactly impressed, but part of me thought it couldn’t possibly make things any worse. 

Joining the second group was strange. It was like returning to a new school year, but all your classmates have morphed into different people. There was one girl from the previous group and I stuck to her like glue. We both described a sense of failure that we had had to return. It was as if we were having to resit the course. It took everything I had to be optimistic. I knew I had to try and get the most out of it. 

I poured all my effort into digging deep into that dark place. I talked and talked and talked, in the hope that it would lead me to getting rid of that girl in my soul. Over the next year and a half I went off sick from work time and time again. I would go through a cycle of struggling to keep up with life, starting to crack, having a breakdown, getting hospitalised, getting released and having a sudden realisation about my life. Lather, rinse, repeat, ad nauseum. What I didn’t realise was that this internal struggle, causing me all these problems, was actually taking me through a long and drawn out healing process. There was still one thing I couldn’t crack.     

I was at a stage now where I had to do this on my own. I had thoroughly used up all my resources. It is important in therapy to know when you’re done. Even though I still hadn’t defeated her, I just knew. Around October time I discussed my decision with my therapist. We agreed that I wouldn’t carry on therapy in the new year. She was encouraging and realised that I had gotten everything I could from her. I needed to take a leap of faith. She promised me I could remain under their team for a while, until I was sure I could make it on my own. I would still see the psychiatrist for updates and medication reviews. I also had a meeting with the head of service who arranged for me to be put on the short waiting list for Dialectical Behavioural Therapy (DBT), so that I could gain more skills for coping with my emotions. This was a shock to me as before DBT wasn’t available in my area for outpatients. The final session came and went and I steeled myself to go it alone, out in the real world. 

January. It happened in January. Since leaving therapy I had been expecting it. I knew now that the biggest realisations happened post-therapy and that change usually came about after a breakdown. And it was one hell of a breakdown.  

Psychotherapy Experience - Part Three

One thing they never tell you about group therapy is how much you’ll cry for others. It is thought that some people with BPD have higher levels of empathy and compassion for others as a result. It’s heavily debated, but I feel like I have a very strong sense of it. When I see people in emotional pain it’s almost as if I am feeling it myself. That often leads to me avoiding people when they are upset or angry, in order to cope. Being trapped in a room with emotional people, would have scared the hell out of me back when I first started. It was a bit like exposure therapy in a way. I would have to learn to allow myself to feel the pain of others and not shy away. There really was some serious pain and trauma in this group. Because of confidentiality and not wanting to trigger anyone reading this I won’t go into detail, but so many topics were covered. We often found ourselves crying together. Fighting back the emotions became our enemy as we tried to navigate painful memories and allow ourselves to feel in the safe space we’d created. 

I’m not entirely sure how psychotherapy works, but truthfully talking about my life and issues  seemed to have a positive effect on me. At the start of therapy I had felt like I had no sense of who I was or what I wanted from life. I simply did whatever would make other people happy or what I thought was the right thing to do. I wasn’t living for myself at all. I had given up on me a long time ago. It felt like I was always wearing masks to hide the nothingness and confusion underneath. I always thought there was no one underneath, like I was just born wrong and empty. The first year of therapy gave me an awareness there was someone underneath. It taught me that it was okay to be angry and it was okay to be upset. I learned that if I started crying, I could stop it in time to get on with my life. It also gave me the fight to continue on despite feeling as if I would never get better. I suppose in a way it gave me hope. 

Meeting like minded people who were also struggling was one of the greatest gifts. I had grown up feeling so alone, as if no one truly understood. But these girls did, and the therapists too. A bond had formed between us. The only disappointment was that a year had passed and it was almost time for the group to end. I couldn’t believe it had gone so quick. I had talked about so much of my past, and the more current issues I was experiencing. Getting it out into the open felt really good and allowed me to start analysing my unhealthy behaviours. 

The last session was really emotional. We all gave each other cards and tried to secretly exchange our numbers. We knew we weren’t supposed to, but something about the end of group just seemed so final. In the world outside of therapy we felt alone. You don’t usually run into others that have experiences like that; at least not that are going to share their issues openly. There’s plenty of people online, but those sorts of communities can be incredibly toxic and triggering. The ending felt like I was losing some much needed allies.

Psychotherapy Experience - Part Two

The strange thing about group therapy, is in my experience, you never know what to expect; even if you’ve been through it before. Each time for me has been different. There are many contributing factors including the way the therapists interact and how the patients react to this. Also the mix of patients and how we interact with each other. Our all-girl group consisted of 6 young people with similar issues. Although we were encouraged not to label ourselves, most of us were forthcoming with the fact we suffered from BPD or borderline traits. The issues in our lives were similar. Unstable moods, feelings of emptiness, chaos or depression, struggles with self harm and drug and alcohol misuse were discussed often.

The therapists were very laid back and allowed us to lead the sessions and come up with topics of interest. They simply guided the sessions and asked questions to make us think more deeply about what was being discussed. It felt odd for the therapists not to be in control, as they had been when I had other talking therapies. The lack of structure made me uneasy at times and made me question whether talking about all this emotional baggage would really help me. In my head I had aired these emotions out again and again. Surely I would have nothing left to talk about? I had decided that my past wasn’t unhappy or traumatic; just the usual misery we all go through. I heard the stories of the girl’s around me and I felt like my pain was nothing compared to what some of them had suffered. I was more than happy to ask questions and give them support, but when it came to myself I preferred to keep quiet.  

Three months had passed and I found myself growing attached to the people around me. I felt I knew more about my fellow group members than their nearest and dearest. Despite my worries about letting my emotions out, I continued to try and relate my experiences with that of the others. Sensitive topics would come up and I would find myself straining every muscle in my body to stop all the emotions from pouring out. I had learned to push it all deep down as a child, but as times got harder I started to run out of room. After particularly stressful events I would find myself becoming overly emotional and self destructive in order to cope. The pressure would build until eventually something explosive would happen and temporarily decimate my ability to look after myself. After years and years of this happening I had developed a fear of this happening in front of other people. So in a way the group was a minefield for me, but I knew it was only a matter of time.

I was relieved when it finally happened. One of the girls had been discussing her relationship with her dad and his narcissistic tendencies. It touched a nerve in my own experience and I began to feel the void in my chest opening up. I could feel the dark clouds moving in and I felt myself panic. I gripped my arm, digging my nails in too hard. The therapist noticed my struggle and asked me to open up about my relationship with my dad. I think I made it about half way through a sentence before I felt my voice break and a wave of emotion that I thought would drown me. I don’t know how long I must have bawled my eyes out for. I was so embarrassed, but the group and the therapists seemed pleased with me. They had noticed me holding back all this time. I confided in them that I was always afraid if I started crying that I wouldn’t ever stop. Not little tears, but that full on ugly crying where you sob until you can barely breathe. Although small, this was the turning point for me engaging properly in therapy. Now the girls had seen me cry, it was less scary.

As the weeks went on I began to realise that my pain was valid. I learned my childhood had been traumatic and confusing for me. I learned the misery I just assumed was part of life wasn’t nothing because others had it worse. I recounted hurtful moments that before I would’ve thought would kill me if I ever spoke about them. The girls around me kept me strong enough to relive those moments and to really be allowed to grieve, as I hadn’t ever. We became fiercely protective of each other and were always supportive. It was different from being friends, it was more than that. I can’t think of a proper word, but it was like we had been through so much together, like we’d known each other for years. I finally started to fit in amongst the others and felt free to discuss my true feelings.

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.