Where I’m at

Things feel a little scary at the moment. I’m coming off my mirtazapine in preparation for getting pregnant, and I’ve left my therapy group. Intellectually I have no qualms about these decisions – after all, I can always go back on ‘safer’ antidepressants or find alternative therapy if I need to – and emotionally it feels good to be saying, “I am normal enough. I am well enough. I have my issues, but I have the strength to deal with them within me.” But emotionally there’s also the fear that comes with any venture into the unknown.

Meds-wise, things are easy enough to explain. My GP has agreed it would be better to start reducing the dose sooner and take longer coming off the drugs, than do it all in a month as my psychiatrist had suggested. So I’ve spent three weeks at 45 mg with no ill effects on my mental health, and I’m now enjoying some lovely withdrawal symptoms, having dropped to 30 mg two days ago. Dr Right has also emphasised that no one will expect me to go without antidepressants if it turns out I need them, but it would probably be a different drug. Unfortunately, the main ones used in pregnancy – sertraline and Prozac – are SSRIs, but we’ll cross that bridge if and when we come to it. She thinks SSRIs are more likely to work for me than they did ten years ago, because I’m in such a different place now, and I think that at least if they do Bad Things to my brain I will recognise the early warning signs and know what to do about it.

Therapy-wise… I’ve previously written a lot about what I learned from therapy, and why I don’t think Group Therapist’s approach was right for me, even if I haven’t been able to sum it all up neatly. I am very grateful for the things GT taught me. I definitely don’t agree with all his opinions and beliefs about my issues and about mental health in general, but even where he ‘got it wrong’, it’s been helpful to bump up against a different perspective and that’s been a chance for me to clarify and reconsider what I do believe.

At the same time I’m 100% certain that walking away was the right thing to do. It’s funny, but I don’t think the ‘official’ reason I gave for leaving the group – that therapy in a group setting didn’t work for me – had much to do with it in the end. Once I’d committed to my decision, a lot of that fear seemed to melt away and I was able to participate fully and connect with people in my last few weeks. I left with the sense that actually, this was a group of people with whom I could have worked on learning to trust – but that my problem was with Group Therapist and perhaps psychoanalysis in general. It’s a shame I didn’t feel able to articulate this in the group to him, but I need an approach where practical stuff can be incorporated and where the good as well as the bad in me is understood as important.

I’ve spent most of the past decade struggling to get mental health professionals to take me seriously, and having to fight to get any help. GT was the total opposite, which lured me in at first. But having someone ignore your achievements, dismiss the things that have helped you, and assume you must be feeling really depressed and worthless when actually you’re fine – my issues are cyclical – is no better. And that last sentence sounds very critical, but in fact one of the best things GT did for me was get me to recognise that and push me to a place where it’s no longer about communicating how much I’ve suffered, but refocusing on what I need to do to continue my recovery. I think I’ve finally come to terms with how badly the NHS let me down in the past and I feel ready to move on from this. Was that GT’s intention? If so, he played his cards very close to his chest.

What am I focusing on now? Two main things, really – one is depression relapse prevention, which ties in a lot of threads from other issues I’ve been writing about (perfectionism, mindfulness), and the other is learning to trust people and reach out to them more. I will write more about both of these things at a later date.

Looking back over group therapy part II: the unfinished symphony

I was in group therapy from June last year to this March. That’s nine months. Long enough to have a baby – which, I hope, will be my next nine-month project.

When I joined the group, it was in quite a state of upheaval. Three members had left (one abruptly), two newbies had replaced them, and things had only just resumed after GT being on sick leave. I felt that because of this, it took a long time for the group to ‘gel’ and for me to see any benefit. So today I’ve been surprised to find this gem in my description of the very first session:

One thing that really struck me was the various comments made about the importance of looking at things from an emotional perspective as well as a rational one. That emotions aren’t and shouldn’t have to be rational. That it can be dangerous to have too rigid a view of yourself, of your issues or of what caused them. This all seemed to tie in with something I feel is very important at the moment – that any framework I hold for recovery needs to be flexible. Figuring what helps and what doesn’t, how my problems developed and how I can move on from them, is very important but it’s even more important that I stay mindful and pay attention to how I am now, to what is helping now. Fixed ideas about my illness and about recovery are very comforting because they help me feel in control but what happens when that framework doesn’t, in fact, quite fit? At best it chafes and at worst it shatters.

What a very timely reminder! I don’t agree with GT’s view that “rationalising” is an unhealthy defence mechanism, I think it has its place, but mindfulness and listening to my emotions whether or not they make sense is going to be very important in the way forwards.

In my write-up of week three, I discussed how issues I thought were buried and gone were in fact preventing me from participating:

I knew the group was unstructured, but I’d envisaged it as something established, pre-existing, alive that I could slot into. Instead, it feels like something we all have to forge from scratch. I hadn’t realised how much I was counting on this. I hadn’t realised how much I still feel the need, in new social situations, to observe for a while to make sure I don’t do or say anything ‘wrong’. By and large, this doesn’t cause me too many problems but it’s making the group feel impossible. I ended up zoned out for a lot of yesterday’s session and couldn’t believe it when GT said the 90 minutes were up already.

This is interesting on several counts. Firstly, it illustrates the way the group environment can magnify mental health or relationship issues – which is supposed to help you work on them, but was one of the reasons I decided to leave. Secondly, it highlights how difficult it was for me to engage with the group, and thirdly, for all I’m not sure I agree with the approach, I learned something useful about myself here. In many ways, the past year (including the assessment sessions) has been a process of me learning to what extent I still find it difficult to trust people and feel I need to protect myself from them, and that’s one of the main things I want to work on now.

Learning to trust is a theme I expanded on in my post about St Philip and Harry Potter. There’s too much good stuff in there to pick out any one quote, but if you haven’t read it already, I recommend the whole post. Read it. It’s got Harry Potter in. You won’t regret it.

In August, I described how much better I’d become at coping with conflicting needs, which I attributed to the therapy and/or my recent mindfulness practice:

In the past, these kinds of conflicts have involved denial. For example, suppose I found myself needing to take on more work and earn more money, but also feeling really exhausted. In the past, I would pretend one of those needs didn’t exist. I would either push through my exhaustion, possibly making myself ill in the process, or I would bury my head in the sand about the money issues and overspend on top of not earning enough. Likewise, if there were multiple things I needed to do and I didn’t have time and energy for all of them, I would convince myself it was possible, I could do all of them, and ignore my need for time off and rest. This doesn’t lead to an episode of depression every time but it does set up a bit of a vicious circle where I yo-yo between neglecting one need and neglecting another.

Over the past week or so the conflict I’ve been facing is that I need/want to earn more money so I can better support my partner financially when she loses her job, but at the same time, the whole situation is actually making it harder for me to work. I’ve prayed about this and I can see that money is not the most important thing right now. My partner needs emotional support more than she needs cash in the bank, and I need to take care of myself so that I don’t make everything worse with another five weeks of sick leave.

Meanwhile, the last session before the summer break gave me an interesting perspective on my ‘inner critic’:

Group Therapist referred to the authority voice that’s within us all, the harsh, controlling voice that, in my case, tells me I’m not good enough and pushes me to achieve more and more. He said we think that voice is coming from a place of strength, but actually it’s weak. I immediately found myself thinking about bullies being cowards. When that voice is at its worst, when it makes me feel really bad about myself or pushes me to the point of illness, what is it if not a bully? And if it’s a bully, doesn’t that make it a coward? CBT taught me to ignore the voice and look at things more rationally, but now I feel as though I finally have some proper ammunition (“You’re just a coward!” is a pretty good comeback). And the idea that strength might have more to do with accepting myself, warts and all, than with the pursuit of perfection is also a helpful one. Trees can be felled and uprooted in a hurricane, but reeds only bend.

The idea that I ‘bully myself’ turned out to be one of those bees in GT’s bonnet that he repeated so often, I stopped paying attention to it. Indeed, for the past couple of months I’ve felt that GT was completely wrong, and that my inner critic’s intentions are good – it’s misguided, but something I developed to protect me from getting hurt as a result of doing something ‘wrong’. So it’s refreshing to look back and see a different perspective. Whether I like the bully metaphor or not, I have to agree that the voice is coming from a place of cowardice, of fear, and that strength has far more to do with being able to live with my flaws.

During the summer break, I realised that while I’d got so much better at coping with episodes of depression (there’s an earthquake metaphor there which I love), my experience of “not being depressed” hadn’t changed much in a decade:

It still feels like one endless, exhausting struggle to stay on top of things. I am ruled by to-do lists and never seem to have enough time for the things I’d really enjoy – and this is persisting despite all my best intentions and all my mindfulness practice during my last episode. There’s a part of me that doesn’t believe working too hard makes me ill, that thinks my depression is purely a brain chemistry issue and the relapses will always come, but even if this is the case, my perfectionism is still stopping me from having the life I really want.

That’s something I’ve been working on a lot over the past few months.

* * *

This post is an unfinished symphony because I’ve realised that trying to summarise a year’s worth of therapy, and everything I learned from it directly or indirectly, is not how I want to spend my blogging time. It’s a mammoth undertaking (much more so than I thought it would be!) and it’s draining me. I already know what I did and didn’t get out of therapy and where I want to go from here, even if I find that hard to articulate. I’ve decided to publish what I’ve written anyway, in case it’s of interest to me later or to others, but now I’m going to refocus my blog on moving forwards.

Looking back over group therapy part I: the assessment

Already it’s been almost a week since I left my therapy group. It’s sad to go, because I’d come to really care about that group of people, and to connect with one or two in particular. But at the same time I don’t regret my decision. I learned a lot during my time in the group, but it was keeping me stuck, and I have no doubts that saying goodbye was the right way to move forwards.

I want to write some sort of summary of my experiences in group, to look at what I’ve learned directly and indirectly and come up with a road map for the future. I’m not really sure of the best way to do that, so these posts are something of an experiment as I look back over my blog.

First, to set the scene, this is what I wrote about my individual assessment sessions with Group Therapist in February 2011:

The NHS psychotherapy service, [compared to my previous person-centred therapy with F], really is traditional. The guy who’s assessing me has a couch in his office (mercifully, he hasn’t asked me to lie down on it). He doesn’t say much, as apparently my silences and the things I say to fill them are important. When he does interject, though, it’s to say things that probably have a lot of truth in them but that make me squirm. He asks about my dreams and draws parallels between apparently unconnected areas of my life. I have gained some potentially helpful insights from sessions with him already, but those insights were stated by him and I thought, “OK, yeah, that’s true actually,” rather than me discovering them for myself as I did with F. I find things much harder to take in this way. Maybe there are things I’m not yet ready to learn about myself.

On the plus side, I think he has a really good understanding of my issues. It’s obvious he’s carefully read the reams of questionnaires I had to fill in and remembered what was in them (not exactly rocket science, but it’s surprising how many people fail to do this…) He seems to ‘get’ me and squirmy things I’ve pushed out of my mind notwithstanding, the things he says about my problems are perceptive and accurate. He takes my issues far, far more seriously than any mental health professional I’ve ever seen before.

On the negative side, I feel he doesn’t really acknowledge how far I’ve come and the progress I’ve made in my recovery. I don’t think he disputes it; it’s more as though he feels it isn’t relevant. He makes references to my self-harm and my bulimia when those things are 6+ years in the past. He isn’t interested in whether or not I know my thoughts and feelings aren’t rational, and there’s an interesting spectrum here. The CBT I had was all about learning to challenge my thoughts and look at things rationally – a skill I find quite useful but sometimes invalidating. My approach since therapy with F has been to try to find a balance between validating the way I feel and not losing sight of rational fact. C, however, is at the other end of the spectrum where rationalising masks the true issues and should be avoided, at least in the therapy room. I feel that in a way, therapy with him is a bit like the CBT in that one model is rigorously adhered to and everything else is discarded, much like the similarities between the far left and the far right (oops – humour is a defence mechanism and also best avoided in the therapy room). He says I’ve been pulling myself together all my life and I suspect – though really must ask whether – he thinks a lot of the help I’ve had before has only changed things on the surface. He takes my issues far, far more seriously than any mental health professional I’ve ever seen before.

It’s really interesting to read that back now. A couple of sessions into my assessment, I already had a handle on what would turn out to be the advantages and disadvantages of the whole experience. I loved how seriously GT took my issues, that he’d obviously read my questionnaires closely and remembered what was in them, and that he seemed to understand what I struggled with. He was the first NHS professional who, I felt, recognised the extent of my problems and was willing to help me for as long as it took. At the same time, he didn’t seem to acknowledge my strengths or show much interest in the things that had helped in the past. His ‘style’ of therapy was uncomfortable, and so very different from what had worked for me before – I was open to trying something new, but I still worried that perhaps he was adhering to a model just as rigidly and inflexibly as my CBT therapists had refused to budge from theirs. You’ll notice that the final disadvantage I gave was also one of my advantages: “He takes my issues far, far more seriously than any mental health professional I’ve ever seen before.” This turned out to be a real double-edged sword.

Probably one of the first things I learned from GT was that I have a cycle of pulling myself together and falling apart again, which he compared to bingeing and purging:

I’ve been thinking about what my therapist said about my lifetime of ‘pulling myself together’, and he’s right. As I look back over the years I can see a pattern of falling apart then picking myself up and putting the pieces back together again. Sometimes this is in very big ways (breakdown during finals, took years to rebuild my life), sometimes very small ways (oops, I took on too much last week, I’ll take it easy this week), and everything in between. I suppose the question is how much of this is normal. I’ve observed before that trying to find a balance in life isn’t something you can do once and stick with it; things constantly need reassessing and adjusting. That has to be normal, because a tightrope walker can’t just find his balance at the start then plough across the rope regardless. I guess what concerns me is how difficult and counter-instinctive it is for me to find balance and how much I’m still wobbling around all over the place. Does this mean I need more therapy, or is it just a question of practice? I feel I’ve been practising for years and not improving.

I love the feeling of getting back on track and starting to pick up the pieces (which is where I am with my debts right now), but then I get carried away and take on too many things, and the cycle repeats itself. Perhaps what worries me most is when I first realise it’s all too much, I force myself to keep going and it’s very difficult to acknowledge I can’t cope.

Knowledge of this cycle has been very useful to me. It’s allowed me to take a step back and look at the big picture of my struggles rather than constantly hone in on the details of coping in the moment. In particular, I’m much more aware of the “bingeing” and “must keep going” phases of the cycle and this has helped me to make more sensible choices. I’m very grateful to GT for this piece of information.

My comments on tightrope walking and how to maintain a balance, though, came entirely from me – and were very perceptive. Whereas GT seemed to view my cycle as purely pathological, I think some falling apart and picking up the pieces is going to be inevitable in life. What I’ve come to realise is how my difficulties in ‘set shifting‘ (thank you, Katie, for teaching me that term!) cause me to wobble more than most people. At some point, I’d like to find out more about the cognitive remediation therapy that Katie mentions.

In my next assessment session, GT stated that I use the cycle to avoid feeling. I’m still not sure to what extent this is the case, but I had to acknowledge that one emotion – shame – is problematic for me:

I could write pages about all the different ways I take care of myself when I’m depressed, but with shame there are really only two options: block it out or make changes in my life to make myself acceptable NOW.

There are some other conclusions in that post which I now think may have been erroneous, or at least overstated. I’ll look at those later, when I write about the period where I started to suspect the therapy group wasn’t right for me. For now, I’ll skip ahead to the goals I set for treatment:

I want to be able to let myself experience what I’m really feeling, and know that I can cope with it.

I want to break the cycle of taking on too much, falling apart and putting myself back together again.

I want to get close to people and let them support me without being frightened that my desperation and neediness will scare them away, or that they’ll take advantage of my vulnerability. (People can’t always be trusted, so I guess this also comes down to trusting that I will cope if someone does screw me over, and still being able to reach out to others afterwards.)

It wasn’t long after this that I decided on group therapy. I didn’t see GT again for some time, but I’d like to mention a post I made in the interim. In The one about coping skills, I recognised how being betrayed by people I thought I could trust had rekindled my difficulties in reaching out to people, and acknowledged the impact this was having on my ability to cope:

Yesterday, I said I had not forgotten my healthy ways of coping. I saw pain/stress/dodgy mental health as outweighing those coping skills not because I’d lost skills, but because my circumstances had changed – either life is just more stressful now, or my mental health is inherently worse. I suspect now that this may have been a little white lie.

In 2007 [I was] daring to develop my career after years when simply making it into any kind of job was an achievement. I was winding things up with my private therapist and felt pretty damn well recovered. But perhaps the biggest difference of all is that I had and used a support network. I was an active member of a depression forum, a fantastic group – I thought – of people. I was also working on talking to the people in my life about how I was feeling. The usual pattern was I would sound things out online first, then venture on to the scarier task of face-to-face conversations. I was aware of a need to lean on the internet less and develop my real-life relationships more, but I saw this very much as something within my grasp, as a continuation of a journey that had already been set in motion.

In early 2008, I was very badly betrayed by the owners of that forum. To be strictly accurate, the betrayal had occurred about nine months earlier but I was only just discovering the web of vicious lies they had spread about me while being warm and supportive to my face. On the surface of things, I coped with it very well. I recognised that this was about them and not me; I had not done anything to deserve it. In therapy I had come to realise that I wasn’t a bad person after all, I wasn’t fundamentally unlikeable and I hadn’t done anything to cause the bullying and abuse of my childhood, and when it was put to the test, this view of myself held up. I was also able, for the first time, to confront the bullies and feel proud about it.

It has taken some time to spot the damage that was done, the extent to which I have stopped trusting people and stopped reaching out. I planned to join some sort of more private forum, but there was never really anywhere that seemed right. There was always a tangible reason why a place wasn’t right and it has taken a long time to recognise that perhaps those were only surface reasons. It has taken even longer to realise that my plans to develop my relationships with real-life people, to be more open with friends and relatives and lean on them more, got shelved somewhere along the way.

This realisation has also been very important in helping me figure out what I want to work on and where to go from here.

A few weeks before joining the group, I met up with GT again and we discussed my current episode of depression, leading to some unexpected (but, I feel, accurate) conclusions on self-care and validation:

I suggested that actually, I take care of myself far better when I’m depressed than I do most of the time. I can make sense of depression and I know, through past experience, what helps when I’m feeling this way and what doesn’t. Although my self-critical thoughts increase, I recognise them as part of the illness and in a way I’m forced to stop, or at least slow down, and look after myself. My therapist commented that perhaps becoming depressed after a period of pushing myself too hard could be a healthy thing.

My suggestion then led us in two interesting directions. One was to do with validation. He observed that almost as soon as I realised I was depressed, I began to think about what could have caused it. He agreed with me that this can be useful in terms of understanding how to get out of the dark place and how not to end up there again, but I also agreed with him that my need for self-understanding runs deeper than this. If I can make sense of the way I feel, I can cope with it. It’s when I can’t find an explanation for a strong or negative feeling that I really struggle. I feel that I have no “good reason”, I “shouldn’t” be feeling that way, and then I start to question whether I really am feeling like that at all.

Finally, following my last individual session, I pondered what needs my perfectionism might be serving:

I have a very firm idea in my head of how I ‘should’ be. When I’m depressed and non-functioning it’s a million miles away, which is oddly easier, because when I’m well it’s tantalisingly close. If I just push myself a little bit harder, if I just stretch myself a little bit more, I’ll be there. I’ll be ‘good enough’. Well done! The problem is that deep down I know I’ll never be there because the goalposts move. It’s always ever so slightly out of reach.

Why do I operate this way? I think a large part of me believes this is what’s needed to motivate myself. That if I didn’t set myself so many goals, if I didn’t always push myself, if I didn’t hold myself up against an image of a Moon Tree who’s just slightly better than I am now, nothing in my life would ever improve. And then what? I’ve been trying to think about a different way, a way where I trust myself, where I am mindful and allow myself to be motivated by what I truly want. I’m not talking about hedonism here – there needs to be a way of taking future needs/wants into account as well as present ones, and of resolving any conflicts. I have an idea that this could work, and that maybe it’s how ‘healthy’ people operate, but I’m not sure of the specifics yet.

The first paragraph sprang from a discussion with GT, but the ideas in the second paragraph – about why I still operate in this way, and what the alternative might look like – are all my own. I don’t think I ever brought them up in group therapy, possibly because I sensed he would disapprove. But that’s a topic for another post, because I’ve reached the end of writing about our assessment sessions and it’s most definitely time for a break.

Catch-up

It’s been a few weeks since I’ve blogged, so here’s a short catch-up post. (It’s got bullet points and everything to stop it from turning into an essay…)

1. I am definitely saying goodbye to my therapy group, and my leaving date will be 28 March – just two sessions to go! In contrast to how he reacted when I first raised the issue, I’ve been pleased with Group Therapist’s response. Although he hopes I’ll change my mind and thinks staying in the group will help me, he’s been very respectful of my right to make my own decisions about what I need.

2. I started feeling a bit low a couple of weeks ago, following a very busy week at work. I decided to take this seriously rather than plough on regardless, and I took steps to reduce my workload. I am now 100% back to normal and enjoying a week’s annual leave – my first since September. When you’re self-employed and don’t get paid holidays it can be difficult to make yourself take time off without a ‘good reason’, but I’ve realised that simply needing a break is a good reason. Go me!

3. I’ve been reflecting a lot on ways I can reach out to other people more, which I feel is my main issue at the moment. My Christian faith is going to be very important here. More on that in its own blog post soon.

4. I’ve found a book with an excellent-looking chapter on core beliefs that I also intend to work through. However, I definitely haven’t ruled out the option of getting individual therapy if I need it.

5. OH and I have an appointment at our local fertility clinic on Maundy Thursday, and it’s looking likely we’ll be starting treatment in a few months, although I need to taper off my mirtazapine first. I’m going to discuss a back-up plan with my GP in case coming off the meds makes me depressed again, and if I get pregnant I will be referred to the perinatal mental health service. I’ve told my parents about our plans to start a family using donor sperm and they were fully supportive. Hurrah!

That’s all for now, folks…

A decision

I’m pretty sure I’ve made the decision to leave my therapy group. I’ve talked about it, written about it and reflected on it a lot over the past couple of weeks and it’s come to seem like a no-brainer. It just isn’t working for me, and I’m not at all happy about how Group Therapist has handled my concerns and desire to leave.

I’ve experienced therapy that has helped me before and I know what it’s like. A good therapist to me, or perhaps a therapist who’s a good match for me, is someone who helps me to feel at ease and to open up. Someone who doesn’t tell me how to make sense of my problems, but helps me to come to my own understanding. Someone who balances self-awareness with practical ways of changing. Someone who (dare I say it?) demonstrates normal social skills instead of that clichéd analytical silence which is supposed to help with transference but so often comes across as rude and uncaring.

I do understand how psychoanalytical therapy is supposed to work. I know it’s meant to be a difficult process, that it’s normal not to see any benefit for a long time, but that the theory is when change does come it will be all the more profound for it. I also know it’s likely that some of the things I feel about Group Therapist are transference and more a reflection of my own issues than his ability or otherwise, but I just don’t want to work in this way. It seems unnecessarily painful and risky to me.

My financial circumstances will soon be changing for the better which means that, should I need therapy in future, I can go private and see someone of my own choosing. The option of group work also still remains open to me through A’s charity.

You’ll notice that I said “should I need therapy”. I’m not planning to jump straight back into something, because my mental health is really good at the moment and I want to allow the dust to settle. Given the recurrent nature of my depression and other issues, though, I doubt I am done with therapy for life.

Baptism by fire

My therapy group on Wednesday was very, very difficult.

Not surprisingly, we returned to the topic of my difficulties engaging with the group, and the fact that I’m questioning whether group therapy is the right approach for me. We talked about gender a little first, and whether the fact that it’s a mixed-sex group is a problem, but then Group Therapist said something that really upset and angered me.

He said that me wanting to leave the group is basically just avoidance. I explained that I feel as though to get much out of the group, I’d need to have already overcome the issues I’m there for in the first place – and he said I should let the group help me overcome them, and that he thinks group therapy is the only thing that will help me with said issues.

Ouch.

The thing about letting the group help me is interesting. I hadn’t really thought of it like that, but I think he has a point there – although another member of the group did then immediately say that they didn’t know what to do to help, and that they felt quite powerless in the situation. Not the most encouraging response.

But the reason I’m so angry is that when I was assessed, I was offered a choice between group or individual psychotherapy, and I was told either would help me. When I found that a difficult decision to make, Group Therapist reassured me that it wasn’t irrevocable, and that if one approach didn’t work for me I could go back on the waiting list for the other. (I also feel as though he nudged me towards group therapy a bit by offering me a place in this group before I’d made my mind up, though I appreciated the information at the time.) Now that I feel group therapy isn’t working, I’m a little shocked that he would go back on his word, dismiss my reasons for wanting to leave as not valid, and imply individual psychotherapy wouldn’t actually help.

I’m also upset by his assertion that I’m just being avoidant. I understand that giving up on a particular type of therapy, when you’re finding it difficult and think another approach might work better, could be about avoidance but it could also be a healthy and appropriate treatment decision. It may even be a little bit of both. From my point of view, to understand all the different factors at play you have to tease them out and examine them closely (and isn’t that what therapy is supposed to be all about?) We haven’t really done much of this, and I appreciate I’m not making it easy by finding it so hard to open up in group, but that GT thinks he knows best anyway I find arrogant and unhelpful. Maybe he’s calling my bluff, trying to draw me out that way – but if so, I wish he’d f*** off.

It was early on in the 90 minutes that he said it, and the rest of the session involved a lot of silence. I’m normally OK with silence in the group. That is, I find long silences difficult to break, but they don’t make me particularly uncomfortable or uneasy. This time was different. The silence seemed oppressive, thick and heavy, suffocating. I was literally finding it difficult to breathe. Then GT suggested we all share how we were feeling in order to ‘move things on’. Nobody did. I couldn’t find the courage to speak up about how hurt and angry I was with GT, and whatever anyone else was thinking, they didn’t want to share it either.

One of the things that concerns me most about group is that I’m not usually like this – or not to this extent. Yes, I find it hard to open up to people, and I’m cowardly about confrontation, and that undoubtedly makes life difficult for me, but I’m not normally this dysfunctional in my relationships. The psychoanalytical group environment brings all my issues to the surface and magnifies everything. It’s meant to do this, I know that, so that we can really understand my issues and tackle them at a deep level – but not all therapy works this way, and I’m questioning whether it’s necessary.

I’ve written before about some of the things I’ve preferred about person-centred therapy, which has helped me in the past. But one aspect I didn’t really touch on is the environment. By being flexible to my needs, and though unconditional positive regard, my person-centred Ts created an environment that felt safe and nurturing, and where it was as easy as possible (not that it’s ever easy) for me to engage with them and to change. It was all about bringing out the best in me and often about getting as much as we could out of the time available. Psychoanalytical group therapy could not be more different.

I think one disadvantage of the person-centred approach, at least as I’ve experienced it, is that sometimes issues can get missed. Certainly the biggest problem I had with F was I sometimes felt her view of me was too positive – that she didn’t always ‘get’ how much I was still struggling during relapses. So it’s not that I think person-centred is good and psychoanalytical is bad. I think they can both be valid approaches to treatment, with their own strengths and weaknesses (and I think the same of well-conducted CBT too). What it comes down to is which is going to be best for me, and there’s no easy answer to that question.

I had a bit of an epiphany today, though. One thing I’ve learned through therapy with GT is how much the environment makes a difference – and to what extent I use changing my environment as a way of tackling problems. For example, when I was really struggling with B/Ping after dinner, I started spending my evenings in places where I wouldn’t binge – I would go for a walk or to the library or visit friends. When a bitchy or stressful work environment caused a relapse of depression, I changed jobs (I’ve done this twice). When I’m pulling from my eyebrows a lot, I cover them with a scarf or hat so I can’t access them. Leaving the group for (possibly person-centred) individual therapy would also be an example of this. I don’t think there’s necessarily anything wrong with this, and I don’t regret any of the decisions I’ve just described, but I do think I’m probably over-reliant on tweaking my environment and I’d like to be able to cope better in difficult situations rather than having to leave. Maybe that’s what GT meant about avoidance. Harumph. Two epiphanies for the price of one. Anyway, the original one was:

One of the things I don’t like about GT is I feel he sees the way I am in group, in a difficult environment that brings all my issues to the surface, as somehow ‘truer’ than how I am in situations where I’m able to cope just fine. I think he sees my functioning normally in the right setting, or when my mental health is good, as a front and not as the real me. I realised today that I cannot agree with this. For an environment to bring out the best in me, that ‘best’ has to be there in the first place. It’s all within me, the good and the bad. I need this to be understood and while it sounds ridiculous to suggest that a therapist wouldn’t understand that, I do feel the things I’ve achieved and the progress I’ve made with my mental health over the past ten years, before I started working with GT, get discounted. I could be wrong. This could well be transference. And the only way to know for sure is to discuss it with him… which brings me back to my original problem.

I think the person-centred counselling was about a series of increments. Baby steps, tackling the easier issues first, starting from an encouraging environment. The one danger with that approach is that as things get harder and scarier you may step off the ladder. By contrast, my psychoanalytical group is baptism by fire. If you can address your problems in that environment you’ll probably be sorted everywhere. The question is, can I take the heat?

Unexpected A

I had an unexpected opportunity this week to discuss my group therapy situation with someone totally impartial. To cut a long story short, at around the same time as I was referred to the NHS psychotherapy service, I made contact with a local charity which runs short-term therapy and art therapy groups. At that time I didn’t know that the NHS would also offer me group therapy or that ongoing treatment would come through so quickly, so I planned to use the charity as a stopgap. I have since twice turned down a place in one of their groups because of my NHS therapy, but twice asked to stay on their waiting list because I wasn’t sure I was going to stick with my current group. So the lady who runs the charity (I’ll call her A) suggested I might like to come and have a chat with her about what I feel I need right now, and it seemed like the ideal opportunity to talk things through.

I went to see A on Wednesday afternoon and found her very helpful. She confirmed that many of the problems I’m having with the group, how difficult and awkward it is and how the environment seems to bring out the ‘crazy’ in me, are a normal part of the psychoanalytical process and don’t mean the therapy isn’t working properly. They are the price for what, hopefully, I will get out of therapy – a very deep understanding of myself and my issues. She also said that not everyone can tolerate what I’m going to call the side effects of psychoanalytical therapy, and there is no shame in that. It’s not for everyone. We agreed that it has to be my decision whether I want that kind of very intensive, in-depth therapy and deep understanding, or whether I’d prefer something with a more supportive and practical focus.

We then talked about the biggest problem I have in group, how hard I find it to open up and participate at all, in more detail. I realised that I rely on a complex and largely unconscious set of cues to tell me whether someone is ‘safe’ or not, and if just one person in the group is not ‘safe’ to talk to on a particular topic, I can’t bring it up. As a result of this (and perhaps because I was very clearly able to open up to her), A suggested that maybe individual therapy would be better for me. She encouraged me to discuss this in the group, while being very understanding of how intimidated I felt by the prospect.

I then brought up this issue:

There are many areas of my life that I think I’m reasonably happy about when I’m well, but when I’m depressed they not only get me down, but I view them as a likely cause of my depression. Is this just the ‘depression talking’ (distorted thoughts and beliefs) and me grabbing at straws to make sense of things, or are these real problems that I’m refusing to tackle and which do indeed make me ill?

A agreed with me that depression can make you see all sorts of ‘problems’ that weren’t there before, and she said how I am when I’m well might be a better guide. Do all my issues completely go away when I’m not depressed? I had to admit that they don’t, that my problems trusting or relying on people and letting them support me are pretty much a constant - but that when my mental health is otherwise good I usually feel quite happy managing by myself and as though I can cope that way. “When I’m depressed…” I started to say, and suddenly I realised that it’s a real problem when I’m depressed, it can’t just be a twisted-thinking-type symptom, because when I’m depressed I need more help from other people and that’s when my difficulties in reaching out – and, I suspect, the emotional connections I haven’t made when I’m well – really come back to bite me on the arse.

A took this one step further and suggested that although I feel able to cope by myself when I’m well, perhaps the fact I’m not talking things through with other people much means issues don’t get properly resolved, and then they build up, ultimately bring my mood down again. I don’t know whether this is the case, but I acknowledged it as a possibility. She said human beings aren’t designed to function alone, we need to lean on others to some extent, and I agreed with her on this. Maybe there are some people in the world who truly don’t need anyone else, but deep down I know that I’m not one of them.

We talked a little about how I could learn to trust people more and A suggested thinking carefully about who I trust, and how I can tell whether someone is trustworthy, and how I can test that out. I think that ties into my ‘safety’ cues, in a way. In some way I am already doing this, already deciding who can be trusted and with what, but the rule book is wrong and it needs to be rewritten – no small feat when it’s written with the emotional fabric of my life.

Still, the rule book isn’t always wrong, and I was feeling quite proud of myself that I’d judged A as very trustworthy and been able to open up to her. Then she suggested I come back and see her in a few weeks once I’ve talked to Group Therapist, and I realised what I was afraid of with her. As far as I’m aware, A doesn’t provide regular counselling; she works with people on an ad hoc basis. She also told me that if I leave the NHS group, and for example go on the waiting list for individual therapy, she’d be happy to support me in the mean time. This is brilliant, but my fear is that I will ask for too much. Without the structure of weekly or fortnightly sessions, I don’t know how much support I’m ‘allowed’ or would be seen as appropriate. It feels as though if I asked A (or anyone who was supporting me) for more than she could give, and had to be turned down, this would be The Worst Thing in the World. It feels as though it would destroy me.

Come to think of it, the one thing that nearly did destroy me – what made me want to end my life ten years ago – was when my then best friend walked out of my life because I had become too needy and she couldn’t cope with my depression. J was probably the first person in my life that I let myself rely on and that risk didn’t pay off for me. Rationally, I know the situation is very different. I know a mental health professional telling me they can’t see me as often as I would like, at a time when I have good coping skills and multiple avenues of support, is not the same as a one-and-only friend leaving for good when I had very little else. But I learned – or perhaps had reinforced – that asking for too much from others is bad, bad, bad and wrong, wrong, wrong to the extent that it would cost you your friends and possibly your life. That’s the kind of black-and-white place I was in back then, and I’m a lot more rational now, but the mind remembers the pathways it’s forged.

A suggested I get in touch once I’d spoken to my therapy group, but I knew if I left that office without making an appointment I would probably never contact her again. I told her that tends to be my pattern, so we’ve set a date to meet in three weeks’ time.

And I went to my therapy group that evening. It was difficult. I missed last week’s session because of the funeral, and it turned out someone in the group had admitted right at the end that they might have a drug problem, so everyone wanted to talk about that. I felt so frustrated and, yes, left out that everyone’s focus was on this other woman. The 90 minutes dragged on with no good opportunity for me to bring up what I needed to say. I prayed. I didn’t mean to pray, but it kind of slipped out (inside my head) and you should be careful what you pray for. With five minutes to go, another person mentioned that they find it hard to open up to the group and that was my cue. I shared that I find it very difficult too – to the point that I’m questioning whether group therapy is for me.

There wasn’t time to discuss it very much, so at the start of next week’s group, all the focus is going to be on me (gulp!) Group Therapist did say though that he wondered if it might be a gender issue. That I find it hard to open up because there are men in the group and it’s facilitated by a man. I don’t think it’s a gender issue. I have as many male as female friends and on balance I’m no more scared of the men in the group than I am of the women. That said, the coward in me is wondering whether requesting a female therapist (if I decide on individual psychoanalytical therapy) might be a way of avoiding saying that I’m not sure whether Group Therapist is a good match for me either.

To be continued…

Of psychiatrists and therapists

I saw my psychiatrist last week, and she’s discharged me back to my GP. I’m reasonably happy about this. With my mood and energy levels stable, it doesn’t seem like the best use of my time or NHS resources to have me trekking out to the hospital every couple of months. In an ideal world, I’d like to remain on her books without regular visits to see her, and to be able to phone for an appointment when and if I experience any mental health issues, but the NHS just doesn’t work that way.

I did ask whether my recent episode had changed her opinion about me taking antidepressants in the first trimester of pregnancy. It hasn’t, although she now wants me to be referred back to her as soon as I become pregnant, even if my mental health is good. She seemed to be saying that I could wait until I’m actually pregnant to come off the meds, but I’m a bit confused about that because she also said I should reduce the dose gradually over a month to avoid withdrawal symptoms. Surely that would defeat the object of not having mirtazapine in my system during the crucial first month when the embryo is developing and the risk of miscarriage high? The thing is, my main concern isn’t getting through three months of pregnancy without medication – that’s a relatively short period, and I know some women find the hormones actually help their mood – but coping without meds for potentially months and months of failed fertility treatment. Anyway, I’ll see what she’s written in the letter to my GP and what my GP and the fertility clinic advise.

That’s the easiest part of this post out of the way. It’s going to be much harder to write about group therapy, because I’m still struggling to make sense of how I feel about it and what I want.

For some time now – maybe since about November? – I’ve been questioning whether the therapy group is right for me. The first reason is that I just don’t feel I’m getting much out of it. That might be an odd thing to say when my mental health has improved so dramatically, but I honestly don’t feel the group has had much to do with it. In the past, when therapy has helped, it’s been obvious to me how and why it’s helping. Talking about the bullying, and coming to a new understanding of what happened to me as a child that doesn’t place the blame on me, cured me of social anxiety disorder and there’s no doubt in my mind that that’s why I no longer have difficulties socialising and making friends. On a less radical scale, learning some CBT techniques for coping with depression has made depression easier to cope with (duh) so that it no longer has such a devastating impact on my life. With the therapy group, everything’s more tenuous. I have developed some new insights which may well have helped me to change but the link is far less obvious. This is something I need to explore further.

The second reason is that I’m not sure whether group therapy of any kind is the best approach for me, or not as the main mode of treatment. In the past one of the things I’ve really valued about therapy is that it’s a space just for me, where I can be ‘selfish’ and talk through whatever I need to talk through, without having to worry about other people’s needs or whether I’m monopolising the conversation. In a group I don’t have any of that. Arguably, group therapy is the ideal place for me to learn how to get my own needs met in a mutually supportive environment, how to get the balance right between giving and taking, but it can feel like a catch 22 in that to get the therapy in the first place I already have to resolve the issue to some extent. I don’t talk about my own problems as much as I should, both for this reason and the one below, and that may be one explanation for why I’m pretty sure the recent improvement in my mental health has little to do with therapy.

The third reason has to do with the psychoanalytical orientation of the group and the NHS service, and it’s the hardest to pin down. I guess I can sum it up by saying that for a long time I’ve been preoccupied by the following questions:

There are many areas of my life that I think I’m reasonably happy about when I’m well, but when I’m depressed they not only get me down, but I view them as a likely cause of my depression. Is this just the ‘depression talking’ (distorted thoughts and beliefs) and me grabbing at straws to make sense of things, or are these real problems that I’m refusing to tackle and which do indeed make me ill?
The psychoanalytical therapy I’ve had so far has been known to stir up difficult and painful stuff and I have subsequently relapsed into depression (I’m thinking in particular of the individual assessment sessions with Group Therapist here). Is this stuff that needed to be addressed, and would have made me ill sooner or later anyway, or is dwelling on things which don’t bother me in my day-to-day life unhelpful and misguided?

What I would really like is to be able to talk these questions through in a safe and non-judgemental environment. The problem is, I don’t feel Group Therapist is a safe person to discuss this stuff with, not only because he’s implicated, but because psychoanalytical theory (to the best of my knowledge) has set views about this. It’s all about the importance of the subconscious, of issues we’ve pushed out of our minds which continue to affect us, and of the need to stir up difficult and painful stuff and for things to get worse before they get better. From my perspective, though, I don’t think these are questions that can or should be answered easily. I don’t think there can ever be a ‘one size fits all’ answer that applies to every person and every situation, and I also think the answer in any one situation is unlikely to be black and white. It’s quite possible, for example, that when I see myself as well I am brushing a particular issue under the carpet, but that at the same time it’s not as big a problem as I think it is when I’m depressed, and is only a minor factor in me relapsing. I don’t know, I might be doing Group Therapist a disservice here (trust issues, much?) but I’ve seen him work very hard to persuade other group members of things and I don’t want to put myself in a situation where I feel pressured into accepting a particular explanation or belief. Another thing I’ve really valued about the therapy that’s helped me most – which was all person-centred – is that I did have the space to come to my own conclusions. Even if Group Therapist is right about everything, I feel it’s more likely to ‘stick’ if I have that opportunity to realise things for myself and not feel as though they’re being forced on me.

I became disillusioned with the NHS approach to CBT because I didn’t feel it was flexible enough – I was taught helping coping techniques, and the practical side of things was good, but there wasn’t the opportunity to talk about painful childhood experiences if I needed to, nor anything else to try if a thought record / behaviour experiment didn’t help with a particular issue. The psychoanalytical service seems to be just as inflexible, just at the opposite end of the spectrum (I know I’ve made the comparison with communism and fascism before). Now that my mood and energy levels are fine, what I really want to do is focus on the practical stuff – make sure I’m taking good care of myself, make sure I’m not pushing myself too hard. Since the fatigue went away, I’ve been doing a lot of that. I read a self-help book about body/eating issues and am implementing the ideas in that which are really helping. I’ve admitted that on mirtazapine I really do need nine hours of sleep most nights and am making sure I go to bed early enough. I’ve acknowledged that getting overwhelmed can be a big problem for me and so prioritising is vital, and I’ve found a prioritising system that seems to work. I’ve recognised that the long days teaching in another city were really draining me last year so this year I’ve arranged to only ever teach one workshop in a day, not two. But this is all stuff I’ve done and figured out on my own, because my therapy group is emphatically not about taking practical steps.

What are the reasons for staying in group therapy, then?

1. As I said above, I can’t be sure that the group hasn’t helped. I’ve left a lot of therapists in the past and I don’t want to cut and run again for what may be the wrong reasons.

2. I can’t afford to see someone privately at the moment, so the group (or individual therapy at the same service) is my only option for a long-term talking treatment. I could access shorter-term counselling through a local charity, but with my mental health being so changeable and cyclical, and with one of my main goals being to understand why I relapse and whether it can be prevented, I feel I really do need something long term.

3. I really like some of the others in the group and can relate to them a lot. Contact outside the group isn’t allowed and I would very much miss them.

4. The idea of having to discuss my issues with the therapy and reasons for wanting to leave in front of the whole group – a place which still doesn’t feel safe even after seven months of treatment – is extremely daunting. I’m worried that Group Therapist will pressure me and the other patients will be upset or think they’re to blame. OK, this isn’t a good reason for staying but the group does feel a bit like Hotel California sometimes…

5. I’m worried that if I leave the group and decline the option of individual psychoanalytical therapy – especially if I’m not arranging my own counselling straight away – I’ll be viewed as ‘non-compliant’ and this will cause problems accessing NHS mental health or fertility treatment in future.

6. I’m also worried that if I leave the group, then relapse and need more support, I won’t be able to get it and may really regret my decision.

According to WordPress I’ve written close to 2,000 words. I will leave this now and allow the dust to settle in my head, but any comments or feedback would be welcome.

P.S. If you follow me on Twitter you may know that I recently suffered a bereavement. I’m not blogging about it publicly for privacy reasons but I do really appreciate all your support. The death was expected and I’m coping with it well but it’s still a sad time for me and my family.

Group therapy, caring and fatigue: an update

It’s been about three weeks since I last posted about what’s been going on in my life, and a lot has happened in this time. This could turn out to be quite a lengthy update… but I will try to keep it as concise as possible.

In a comment on my previous post, Chananth suggested that perhaps I wasn’t letting my therapy group support me much. She was right, of course, and I recognised this was something I would need to change. I went to therapy that evening hoping to bring up the issue – but quite early on in our 90 minutes, another member of the group began talking about something that took up the entire session. I didn’t like to interrupt as it was obviously something she found very difficult to talk about (which was partly why it took so long – there was a lot of rambling and diversions!) but I left feeling frustrated that she got all the support, while I was in crisis and no one knew. It had me questioning more than ever whether group therapy is a good approach for me.

By the following week, I was coping by spending all my spare time working on Sirius, a strategy which allows me to cut myself off from my feelings (and yes, I know this is not a healthy strategy!) I went to group very dissociated / depersonalised, and spent most of the session staring at my feet, feeling numb and thinking how pointless it all was and how the group never helps anyone. I was very surprised when, towards the end, another group member asked whether I was OK since I hadn’t been contributing. I explained that I felt numb and as though I had nothing to say; I also acknowledged that this is a way I cope when it’s all too much. I was then asked what was going on in my life. I began to talk about the situation with my partner and her job and how difficult I was finding things, and once I’d started I couldn’t stop! It all came spilling out and by the end of the session I was very much in touch with my feelings again.

It was really useful to get some feedback and suggestions from the other group members. I often feel there is no one impartial I can talk to about my partner, as most of our friends are mutual friends, and the group provided that for me. But just as importantly, I am amazed that people noticed I was struggling and reached out to me. It feels incredibly rare that that has happened in my life. I could be wrong, and maybe it’s more that I ignore / dismiss it when people do stretch out a helping hand, but it feels overwhelmingly that I have always had to take the responsibility of asking for help and support myself. While I recognise that I do need to be responsible for getting my own needs met, I find it so difficult that I often end up struggling on alone. To know that people care and will sometimes reach out anyway – that seems incredibly valuable to me.

As a result of the discussion, I realised I was going to have to talk to my partner about my own needs. I’ve been so focused on caring for hers that mine have gone unheard and neglected. It was not an easy conversation to have as she was very upset and I was very frustrated and said some things I shouldn’t have. However, in the end I was able to communicate my needs, and as a result of this my partner has taken some really positive steps. She got in touch with the union to try to move things forward with Evil Employer (more details will follow in a password-protected post), and she’s seeking more help with her depression – her meds have finally been increased and she has an appointment with a local mental health charity on Thursday to find out more about their services. She’s not currently in a position to work or apply for jobs, and I fully understand that, but it does feel now as though a plan is in place to help her get back to that point.

It seems to be the season for confrontations because I also fell out with a close friend this week. To protect her privacy I won’t post any details here, but basically I hadn’t been communicating my needs to her – I got frustrated because she was trying to support me in a way that wasn’t helpful – my frustration spilled out and I really upset her. We have been talking things out by email and it seems to be going well so I feel hopeful that we can move on from this and develop a friendship that’s more beneficial to both of us. I really regret the way I handled things and I know she still feels very hurt but at the same time I feel encouraged that I can communicate my needs without it destroying the friendship (it just would have been better if I’d expressed them in a healthier and more respectful way! I was so desperate to avoid confrontation that I ended up causing one).

Finally, an update on my fatigue. I’ve been reading up on CFS/ME and have come to agree with my GP that I don’t have it, for two reasons: firstly I don’t have enough physical symptoms to meet the generally accepted criteria, and secondly my fatigue doesn’t have a clear onset. Most people with CFS/ME, I’ve read, can pinpoint exactly when they became ill whereas with me what were once classic episodes of depression have gradually become more about fatigue and less about low mood. It seems fairly clear that I’m living with the same recurrent condition I always have, and it’s just evolved a bit. Perhaps I will add fatigue to my sparkly turquoise magic diagnosis.

I do want to make it clear, though, that the level of fatigue I’m experiencing is comparable to someone with mild CFS/ME. It’s more than just tiredness. Last month, I was able to work but had to spend most of my weekends in bed recovering. This month, work has been extremely quiet, with the result that I’m only working part time, and I don’t feel I’d be able to go back to full-time hours as things stand. From what I’ve read, people with mild CFS/ME may be similarly able to work but have to spend most of their free time resting, and may need to take occasional sick leave. I’m embarrassed to admit this, but I often find myself struggling with things I used to take for granted, like going upstairs (especially if I have to do it twice in quick succession) or chopping vegetables standing up. I’m used to being able to walk for miles without getting too tired so this is hard for me to accept.

The blood tests my GP did mostly came back normal. I’m not anaemic, my thyroid function is fine and I don’t have diabetes, liver problems or coeliac disease. However, they did show my vitamin D is a little on the low side. My GP didn’t think it was low enough to be causing symptoms, but since I do have both the symptoms of a mild vitamin D deficiency – fatigue and generalised aches and pains – I’m now taking a supplement and you never know, it may make a difference. I have also just started reading a book about pacing and grading for chronic fatigue.

One last piece of news: my mood has continued to improve since my mirtazapine was increased, though I am still having the occasional meltdown. At this point in time I don’t think I want to switch to another med. I would rather try psychological approaches (like the pacing and my therapy) first.

A potted history of leaving therapy

In the decade before I started working with Group Therapist, not counting one-off assessment sessions (but including single sessions where ongoing therapy would have been available), I saw – and left – a total of 16 counsellors and therapists. There have been various reasons for leaving. Sometimes, as with the NHS, it was not my choice; other times I had valid reasons for quitting therapy and getting out was probably the best thing to do. All the same, it worries me that I have left therapy so many times. I think there’s a bit of an underlying pattern of me convincing myself I’m better before I am, of not wanting to get attached, of jumping so I can’t be pushed. At some point over the next few months, I intend to make a decision as to whether the group analytical therapy I’m currently having is the right approach for me, and I don’t want to make this decision for the wrong reasons – so I think it could be helpful to reflect on why I have ended therapy in the past.

Here, then, is my potted history of leaving therapists.

#1 : Uni counsellor whom I saw once on 9/11, and wrote about in Ten years. I was quick to jump to the conclusion that I didn’t actually need help and that she didn’t see me as needing help (in retrospect, I’m 99.9% certain I misunderstood her there).

#2 : Another uni counsellor some eight months later, when I was very unwell. I think he could have helped me a lot, but I had to stop seeing him when I left uni.

#3 : J, a counsellor based at a youth centre. I saw her for about five months without really getting anywhere; we sat in silence a lot, and if I did tell her how shit I felt, I only left feeling more shit. I desperately needed guidance but she was unable or unwilling to offer it. She occasionally tried to get me to talk about my childhood, but I was barely managing to stay alive as it was, and didn’t want to relive the bullying and abuse. I left when a referral for NHS group CBT came through.

#4 and #5 : Ran an eight-week CBT group on the NHS. Taught me some much-needed ways of coping with depression, but when the group ended I was told I shouldn’t need any more help or support as I’d now ‘had’ therapy. I was still too depressed to work.

#6 : Counsellor based at my GP surgery. Reminded me a lot of #1 and J and as such I didn’t expect great things from her. Again, I could have asked to see a different counsellor, but didn’t, partly because I knew I could only have six sessions anyway. Fearing a repeat of what had happened with the CBT group, I decided to keep looking for somewhere to access longer-term help.

#7 : Uni counsellor (during another attempt at a postgraduate course, which didn’t last long as I was still too ill to cope). Seemed nice, but at the end of our first session told me there was a six-session limit, so I didn’t go back.

Interlude : Spent a year believing I was on the waiting list for long-term NHS CBT, before discovering my psychiatrist had never actually made the referral.

#8 : Counsellor at a carers’ centre. My depression had now lifted thanks to meds, but my partner was very unwell and had attempted suicide twice, which I found difficult to cope with. I don’t remember much about #8, how many sessions I had or how and why it ended. Perhaps as my partner’s mental health improved I felt I no longer needed the support, or maybe I stopped seeing her because my referral to #9 had come through.

#9 : C, a trainee psychologist at the ‘long-term’ NHS CBT service. I had finally been referred and got an assessment quite quickly. I wasn’t currently depressed but was offered treatment for social anxiety disorder and depression relapse prevention. As they took no responsibility for my first psychiatrist’s cock-up, I had a choice of 12-18 months on the waiting list or agreeing to be treated by a trainee.

I’ve written about my therapy with C before – it’s the CBT for social anxiety I described in What’s wrong with CBT? She helped me set goals, supported me as I worked towards a couple of them, then discharged me. I had about ten sessions in all – hardly long-term. As for the ‘depression relapse prevention’, this consisted of telling me if I thought I was becoming depressed again, I should look for alternative explanations. I wasn’t happy about being discharged, but C was convinced I could carry on with my goals on my own, and I gave it my best shot. Unfortunately, without her support I couldn’t manage it.

Interlude : After a relapse of depression I was referred back to the CBT service. As a previous patient I should have been seen immediately, but it took a year to get an appointment. I gave up on the NHS for therapy and turned to the private sector.

#10 : B, a private clinical psychologist specialising in CBT. I could only afford to see him once a month, which he didn’t view as a problem. He said he didn’t understand why I had recovered, then got depressed again – looking back, this was probably something he intended to explore with me, but I thought he meant he might not be able to help as my problems didn’t fit with his CBT theories (I was starting to lose faith in CBT). He also said I had a deep, unmet need to be mothered – something I was unsure about at the time but know now to be absolutely true. I left after about four or five months (i.e. four or five sessions) when he set me some homework I was unable to complete. I could have gone back to discuss why the homework was so difficult for me, but only having one appointment a month seemed unworkable, so I began the search for a cheaper therapist..

#11 : F, the private therapist I’ve written about often. I initially saw her fortnightly for about six months and she helped me an incredible amount. Thanks to her I’ve recovered from social anxiety disorder, and I didn’t have a relapse of depression for about three years.

#12 : Clinical psychologist at the NHS CBT clinic, when they finally got their act together. I’d recently started seeing F, but #12 suggested I attend a few appointments with her as well so that I could make an informed choice about which route to take. This informed choice was made very early on when #12 failed to show up for our second appointment (and hadn’t contacted me to cancel).

Interlude : During my six months with F, I took a couple of short breaks from therapy. I found that sometimes there was nothing I wanted/needed to talk about, and paying for a therapy appointment when this was happening didn’t seem worth it, especially since I could only just afford therapy. The breaks were a mutual arrangement between us and I came back feeling refreshed and as though I had benefited from some time out.

When I took my third break, though, I didn’t come back. Life was going swimmingly, I found I was able to cope with problems on my own, and I was continuing to gain useful insight into my issues without needing to pay for it. Our arrangement was that I would contact F when I wanted to come back, so I just didn’t contact her. It never occurred to me to meet up to discuss ending therapy permanently. I did, however, believe that I could go back and see F at any time if I needed to.

About a year later, I was badly betrayed by some friends at the same time as a bereavement, and I did go back to F, feeling her support would be useful. I think I only had one appointment (it may have been two). I remember her telling me how well I was coping, which gave me the impression that perhaps I didn’t need further therapy. She then started asking me about a specific event in my childhood, something we had previously discussed in a lot of detail, and I didn’t see the point in going over it all again. Later, when I blogged about it, I realised there was a clear link between the invalidation I had experienced then and the way I was being invalidated (by myself and others) now, but at the time I was fairly unresponsive and F realised I didn’t want to ‘go there’. At the end of the session, she told me she hoped I had a wonderful wedding – as I wasn’t getting married for several months, I understood she didn’t intend to see me again. Looking back, it seems obvious there was some sort of misunderstanding, but I didn’t question this at the time.

#13 and #14 : Relationship counsellors with a national charity. I had a lot of problems accessing their services: sliding-scale charges I couldn’t really afford; lack of flexibility over appointment times and frequency when I was working shifts; appointments cancelled at the last minute; voicemail messages offering appointments which had already gone to someone else when I returned the call. In the end I simply gave up.

#11 : Not a numbering mistake. I went back to F when I had a relapse of depression, but as with the first time I’d gone back, it didn’t seem to work out. She kept telling me how well I was doing when I was trying to communicate that I was really struggling, and when I told her I was close to self-harming (something I hadn’t done for years), she just brushed it off. Ironically, now that I was ready to really engage with therapy again, she seemed to believe I was basically recovered and just needed a bit of encouragement and a reminder of what I’d learned before. Did I discuss this with her? Of course not – I told her I could no longer afford to see her, and left for good.

#15 : The Life Coach, an online therapist specialising in trichotillomania. For the same monthly cost as fortnightly appointments with F, she was able to offer me weekly sessions in a chat room with as much email contact as I needed in between. Although I knew the Life Coach had no conventional qualifications as a therapist, I jumped at the chance of this much support. At first I found her very helpful, but soon I started to feel overwhelmed by her constant emails and the many, many goals she insisted I set. I came to realise that she was constantly telling me what to do, and I got little say in deciding what my goals should be. This was all feeding into my issues with perfectionism and needing to be the ‘good little girl’ in a way that was not at all conducive to me growing as a person. For the first time ever, I raised my concerns about six months into our treatment. The Life Coach said she was essentially a goal-focused therapist and couldn’t work with me any other way. When I decided to leave therapy, she tried to force me to stay against my will and pay for another six months of sessions. Needless to say, we parted on bad terms.

#16 : Another uni counsellor, before I dropped out of my PhD. I liked her a lot. I was only entitled to six sessions, and she acknowledged this was far from ideal, but said she would help me as much as she could in the time available. After four sessions, I was feeling a lot better and we agreed I would leave the remaining two sessions for later in the year, when I might need them more. As it happened, my assessment with Group Therapist then came through and I went from that almost straight into long-term group therapy, so I haven’t been back to see #16 (and can’t now that I’ve left uni).

So, there you have it. There may have been more that I’ve forgotten; I’ve actually remembered about and added three since writing the first draft of this post. But let’s focus on the 16 that are here. What patterns can I see?

I have been let down a lot. I’ve had problems accessing therapy that should have been available, have been made to leave therapy when I still needed it, and I’ve also chosen to leave a variety of unsuitable therapists for a variety of good reasons. My chequered therapy history is by no means all my own fault. But the other pattern that really stands out is how little I have discussed problems with therapy with my therapists. Maybe in some cases these battles were not worth fighting, but in others it seems I’ve really missed out on help and support because misunderstandings were not cleared up.

I’m not yet sure whether group therapy, as the main mode of treatment, is right for me. I’m not yet sure whether analytical psychotherapy, as opposed to the person-centred stuff that’s helped in the past, is the right approach for me. But through writing this potted history it’s become abundantly clear that I need to discuss these issues with GT and the group before deciding to look for help elsewhere. I could spend the rest of my life running from one therapist to another because they’re not perfect. I don’t want that. So I owe it to myself to stay for as long as it takes to raise and discuss my concerns, and to collaborate with the professionals – I may be unsure about his therapeutic orientation, but GT has proved himself to be nothing but caring and trustworthy – when deciding what the best way forwards is.

It’s also encouraging to see that I have already made progress with this. I was able to discuss my concerns with the Life Coach, having never done that before. And while I rejected #6 and #7 before they could reject me, when #16 offered me six sessions I was happy to use them as a stopgap while on the waiting list for longer-term therapy. Admittedly I only used four of those sessions, and I can’t say whether I would have gone back if GT hadn’t come through so quickly, but hey, four is better than none.

(I just remembered another counsellor in between #12 and #13. I’m not going to add her to the list. You get the picture.)

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