I don't know what has been happening with me this week that I haven't been able to do this post until now. Maybe, I've just have been trying to avoid thinking about things in case they affect me for the worse, as I'm pretty fragile at the moment. But, here, at last, is an update on what happened at my session last week with the big confrontation. If you haven't read about what happened yet to necessitate a confrontation with my new psychologist, then I strongly recommend you read the previous few posts or this one might not make much sense at all. This week, I decided to record my session on my phone (shh!). I felt that with everything that has happened and the confrontation that was going to happen, I'd like to be able to listen over it afterwards. So instead of trying to tell you what happened, I'm going to more or less let you read the script yourself! (Grab a cuppa. If you have friends you could even act it out!)
The session didn't get off to a great start as I was half an hour late due to road works and an urgent trip to the loo once I finally arrived with the inevitable IBS squits that come with an impending psychology session. This is the first time I've ever been really late for a psychology appointment as far as I can remember. NP started things off by asking me about sick leave from work again and I said I was still off and didn't think I'd be in work next week. She asked if I think the doctor will sign me off again. I said I did and I explained that my doctor knows me well and knows I wouldn't ask for time off if I didn't need it and had actually been suggesting it to me for a while.
Next she asked if there was anything I'd like to talk about today. Deep breaths... and in I went.
I asked her first of all if she had read the email and letter that I had sent her a few weeks ago. NP said she didn't read it all at the time and that she had asked around in supervision and needed to tell me that she is not going to be able to read everything I send her. She said:
"It's important for you to bring things like that to the session. It's not that I don't want to, it's just my job is nine to five and I just can't read those things all the time.” She then said that because she'd already done the referral to the mental health team on the Friday before she got my email, she didn't read the letter at the time but she did go back and read it all at another time. I said I understood that she may not have had time and it was a long letter but I did feel that the cover email wasn't that long.
I asked her: “Did you read that?”
NP: “Emmmm, I didn't read all of the email... and I didn't read the letter at all.”
Me: “Oh... OK”
NP then expressed that because the referral to the mental health team doesn't really work that way and they have specific questions they want answered, she felt she had given them all the relevant information and had given them a reasonable summary so didn't need to read it.
Me: "So you didn't know that I had said to you that I felt the week was going to be really difficult and I was worried about how I was going to cope and that some contact between the sessions would be helpful?"
NP: "No, honestly, I didn't read that until the week after. But I did say to you before I had so many commitments that week that I wouldn't have time and that to see you twice would have meant cancelling with somebody else. But I didn't read it either way." (I don't remember her saying this)
Me: "I understood that you might not have read the letter but I felt sure you would have read the email."
NP (interrupting the end of my sentence) said something about how she got it on her Blackberry and because she only read a bit of it at the time and because she had already done the referral, she just thought it was a 'done deal' and the email was marked as read (seems to be a bit of a feeble attempt at trying to make an excuse if you ask me).
Me: "I think at the time I thought you must have been annoyed with me because you didn't write back and because I had specifically asked a question..."
NP: "Right... the part I read didn't necessitate a reply."
Me: "I understand that."
NP: "So that is worth communicating: I'm not going to be able to read everything and it is worth keeping those things for here. That's going to be important. In extraordinary circumstances you should ring the receptionist."
She then asked me if I had the number and I said I didn't. She asked me what I normally did and I said I usually emailed T (In your face NP, T didn't have a problem with reading my emails!). NP wrote down the number for me...
NP: "So what was the other thing?"
I explained how I'd seen the psychiatrist last week and that he'd said I'd be seen by unscheduled care team the next day until I would be seen by primary care team.
NP (interrupting me again): "I don't know if you'd meet the criteria for primary care team and it wouldn't be the psychiatrists place to make that decision."
First of all, what's the criteria for primary care if it's not for someone like me? The trust website says it's for people with mild to moderate mental health problems such as depression and anxiety.
Me: “Right. Well, anyway...”
I continued telling her about the missed call and that I hadn't heard from the unscheduled care team. I said I'd rang the team myself and that the woman was unfriendly and unhelpful etc. then that I was at the doctors on Friday and that I'd heard the conversation between my doctor and a lady from the unscheduled care team. I said she'd said NP told them I was just trying to get more and more people involved in my care and that there wasn't any real risk.
NP (Looking surprised for a moment): “Well firstly, I wasn't aware that there was any risk and I don't think I said that to anyone. I had a phone call from unscheduled care and they told me you are already in primary care because T is part of that team and their job is to refer people in so they don't need to do anything because you're already in the trust.”
Firstly, I'm pretty sure I told her I'd been having thoughts about hanging myself and had done some of the preparations to do so and if she had of read my letter, she would have known these thoughts were ongoing and scaring the shit out of me and secondly, what a load of fucking bollocks about me already being under the primary care team so their job is done... is NP just going to accept that then and not push for me to get more help?
NP mumbled on about various phone calls she had made that week and who she had spoken to. I told her the woman on the phone said she had spoken to her twice and that she was very clear that NP had thought I was just being manipulative.
NP: "But you said they did contact you?"
Me: "Well, I had one missed call on the Wednesday morning but there was no number left and no way I could get back to them... You know, I just think that's unacceptable. I was at the psychiatrist because of the scary thoughts I was having. I don't have thoughts like that all the time and I was really worried about the week and how I'd cope and what I was going to do and for them to say they'd contact me the next day and then to just 'tick that box' and say “Oh well, we tried.” is not really following their duty of care!"
NP: “Well I don't know what their protocols are.”
Excuse me, but protocols aren't always the answer to everything. If someone says they have been having overwhelming urges to go and hang themselves and then when you go to ring them the next day, they don't answer their phone, do you need a protocol to tell you that perhaps you should leave a voicemail or try again or even at least ring the patient's doctor to let them know? That's called DUTY OF CARE.
Me: “And then when I heard what she said about you, I thought, either she has misunderstood something you've said or...”
NP (interrupting again): “So what did she say again?”
I repeated what the conversation between my GP and the woman was again and that she'd said NP felt I was just trying to get more and more people involved in my care. I said that it was very clear that it was not in a 'good way' trying to get more people involved.
I said “That's not what I'm doing, I'm trying to get more help because things are so difficult. I'm not always like this. I don't know if it's difficult for you to see that because you've only met me, but normally I cope well. I get on with life, go to work and try to keep a normal life. I wouldn't ask for help if I didn't need it.
NP: “I didn't say that. I didn't say that. I didn't say that... I'm trying to remember what it was I did say to her”.
Me: “Well, my doctor actually apologised to me for what the woman had said.”
NP: “Mmmm... well, what I'm baffled by is your doctor ringing up and saying you're at risk, why they didn't try to set up something with emergency care...”
NP went on a bit about why my GP was insisting on unscheduled care etc. I think she was trying to veer the focus away from my point. I explained AGAIN that my GP was ringing unscheduled care because that's who the psychiatrist had said I'd be contacted by and my GP admitted he didn't know the procedures. NP said that unscheduled care wasn't the right team for someone in crisis. I explained again what the psychiatrist had suggested and we went round in circles a little bit talking about why who thought what team should be best for me (is it really my job to know how all the teams work and who is most appropriate?).
Me: "Now I just feel like in being assertive and asking for help when I knew I'd need it has just been taken as me being manipulative and asking for attention."
NP: "Did anyone actually say that?"
Me: "I don't know exactly if she said those words but it was very clear what she meant and from the way they spoke to me on the phone when I rang them myself, it was very disrespectful and..."
NP (interrupting again): "Do you think that's personal to you?"
Me: "I don't think I'm being paranoid."
NP: "Do you think it was only you they spoke to that way?"
Me: "Well I have phoned them in the past as a health professional and they haven't spoken to me that way."
NP: "But that's different, that's professional."
Me: "Yes. So why should they speak to patients in a completely different manner?"
NP: "I just wonder if it is different. They are gatekeepers of a service and have a remit and sometimes are... I don't know..."
Me (interrupting her now): "Well I wouldn't speak to a patient that way... and I don't expect to be spoken to that way either."
Me: "But at the end of the day, I can deal with people being rude or unfriendly but I don't expect that..."
NP (interrupting): "Or 'firm' and 'boundaried'. They've got their job to do and they're funnelling people into care..."
Me: "Well that's different... if they're doing their job... but at the end of the day, it wasn't done last week. It was a really hard week and I asked in advance for help and during it... and I wasn't given it."
NP: "Did you seek help elsewhere apart from professional care?"
Me: "I rang Lifeline."
NP then asked me if I'd heard from the befrienders yet and I said I had just met them and she asked how it went. We talked about this a little bit (I will update you on that later) and she asked if I'd heard from the alternative therapy treatment yet and I said I had an appointment for the following Saturday (all great things and I am grateful for these but they weren't in place at the time I was having this crisis and so were no help in that situation.) I felt NP had tried to steer the conversation away from the issue again by asking me about the befrienders and I was still feeling upset about this. I humoured her with the conversation and answered her questions but I was determined not to leave the session without having said my piece and feeling like I had been understood so I brought it up again...
Me: "I just feel like, what happened last Friday was such a huge thing for me and I don't know if that's how you feel about me or not, but if it is, then it's a serious problem."
NP: “If I feel what you're saying the unscheduled care person said? What is it she said again?”
(How many times do I need to repeat it? I felt she was testing me now to see how solid my story was or something)...
Me: “That I was just trying to get more and more people involved in my care”
NP: “I didn't say that. It's not even the type of thing I would say. One thing I have wondered about myself is why only professional input? Because there were other things you weren't interested in exploring...”
Me: “Like what things?”
NP: “Like talking to your husband, or your friends, or doing some distraction techniques yourself...”
She obviously hasn't listened to me because she has jumped to a conclusion that I wasn't interested in these things. I explained that to her:
Me: “Well, where you talked with me about things I could do myself: I am happy to try these things and have been and I didn't have a problem taking them on board at all. I think I just felt defensive and I know this is my problem but I felt like I had been coping for a long time and that you were just telling me basic things which I felt at the time weren't the answer. And we talked about that already, but even though I felt annoyed, I thought I would do them because if they help then that's a good thing.”
NP: “I appreciate what you're saying. I think people often only come to services after they've been throwing all their efforts at things for a reasonable time, but I also think in times of crisis, people might know all of the things they should do, but might not do them and it is a bit of a reminder... If I was looking back, I might say I probably should have done that and also explored how you were missing T. Because you did say that you were finding that difficult, so perhaps I should have left more time to explore that.”
(I couldn't have made that more clear actually at the time)
Me (trying not to cry): “Yes. And I think I was feeling frustrated because I felt like I wouldn't be having so much of a hard time if I could just talk to someone about how difficult things are and I felt like I just needed to have somebody understand and I felt like it was all practical stuff, which I'm not saying isn't useful, but it wasn't what I needed at that time.
NP: “That stuff is going to be vital. But yes, I might say, I felt I should have put that in a bit more. But some of it is finding out what works for you. People are very different in what helps. It is a difficult thing and this is an enormous event... your therapist changing; that is unsettling... no?”
I felt a bit patronised now, It seemed she was just saying this because I'd basically slapped her around the head with my previous about how I needed someone to understand. It didn't seem genuine. Not that I didn't appreciate that she was trying. I nodded and returned to her accusation about me not being interested in other avenues of help...
Me: “And what you were saying about friends and family... I don't really have friends so that side of it... there are not people I can talk to... and my family... it's very complicated. It's just not an option to talk to family about the way things are. From years of experience of the attitude of people in my family towards others' problems: it's just not an option to talk to them about it."
NP: “I think it's important though that you can use these people as distraction and companionship, not so much to talk to about your problems.”
I explained that I do that and that in the difficult week I had seen Katie twice and visited my brother in law and his family. NP asked if there are any people that I have shared interests with and I talked about how I get on with my sister in law quite well and that she has a little girl who I spend time with.
Me: “Like, I'm not sitting at home wallowing in things. I'm trying and I'm happy to do any little things that I think will help. I asked for help from the service because I feel like I'm trying everything that I can.”
NP: “In a way I think you and I could easily start having a conversation about services and how they're organised... and that's not therapy. That's not what you want. In a way it's the voluntary and community sector who do this other part of it. Services are quite rationed.”
More waffling about various teams and how they work, then she said very nervously and hurriedly: “So it is a bit about... as I say and I did think after when I found the email and I saw that you had asked for some help at the bottom of it and honestly, I didn't see it at the time... I did think 'Oh Gosh, [Candy's] not going to now trust me, because I did say that you could contact me... but I honestly didn't see it... but I did say that I would get back to you, if you ever did contact me and I would do that within twenty four hours... but I wouldn't always be able to cancel something...”
Was that an APOLOGY in disguise?!
Me: I wouldn't expect you to cancel something.
Me: I just thought at least...
NP (talking over me): But I didn't see it. I didn't see it... I didn't see it.
Me (talking over NP): and I understand now that you hadn't read it, but at the time I thought “she could have at least written back and said 'sorry but that's not an option'...”
NP (interrupting me): “Honestly, I just thought that what you were sending was the information for the thing and then because I'd already been with the psychiatrist to make the referral, I thought 'that's done'. But I would only be able to see you for extra sessions on a one off exceptional basis."
Me: “I understand that. And I wouldn't have asked if I didn't feel like it was..." (NP tried to interrupt me here with a 'but' but I raised my voice and kept talking) "but then I was thinking because you had..."
NP (INTERRUPTING AGAIN!): “But still I might need to say 'No'”
Me: "Yes but..."
NP: “...even though you're asking and you're asking in genuine need”
I let out a loud sigh and sounding frustrated and close to tears with my voice shaking I said: “I just want you to understand that I was just worried that because you had seen me twice the previous two weeks that you had thought that this is just the kind of person I am and that I'm always going to ask for more...”
NP: “No. Honestly, I attribute it to the transition and I empathise. I think it's a difficult time. If anything it was because as I'd said I was out two days doing something and everything else was squeezed in. And I hear what you're saying that you wouldn't be expecting it. I wouldn't always be able to offer another appointment, I could ring for a brief conversation.”
Me (really croaky voice now, trying so hard not to cry): “I think just that and everything that happened last week... it was just because... like... I told myself... I should never ask people for help and I should never expect that from people... and I'm just angry with myself that I... that I hoped it would be different.”
This was so hard for me to say. I really had to hold it together at this moment and admitting I felt this way to NP was huge.
Unfortunately, she responded with:
“Do you see the voluntary and community thing that I set up for you? Do you see that as help?” (she's referring to the befriending and alternative therapies, which I've said previously that I'm grateful for but these weren't set up at that time)
Me: “I don't mean just you. I mean, everything last week.”
NP: “That almost took me two days to organise those things... honestly.”
NP: “Just if you're saying about 'do people hear you?'. It did take a lot of work to sort those things out for you.
Me (almost in a whisper because I feel like I'm holding back a dam of pain and now with an added guilt trip on top of it): "I appreciate it."
NP: “That's not all to do with you; partly it's because I don't know my way around all of that and some of them are a bit hard to access. But you know, I did think about it”
Me: “That's why I felt confused because I thought, if you really think those things about me then why did you try to set those things up?”
NP: “No, no, I spoke to the trauma team before I did the referral for the body therapy and that's what they recommended and I spoke to the therapist to ask if it could be just reflexology that they do with you but they wanted the autonomy about that. I had read in the book which you yourself said you like and it talks about it sometimes not being great so I wanted to be cautious about it. So there was a reasonable amount of liaison needed and I'm not saying that to... I'm just saying, there was thought put into that... Who else did you ask for help?”
Me (choked up and voice all crumbly): “I think it was because of seeing the psychiatrist and being told that I'd be helped that week and I felt so much relief that I wouldn't... be on my own... and then just whenever I asked them on Friday, I was just treated like... I was made to feel bad for even asking... and that I'd thought that was what you thought about me.”
NP: “No honestly, I didn't say that.”
Me: “Does it not concern you that somebody would say that about you?”
NP: “About what I said?...Erm... it does, it does... it does. I wonder what would happen if I asked her?”
Me: “Well, I think that she made it very clear, what she thought you had said so obviously she must have misunderstood something.”
Me (now with a strong voice): "I know I'm sensitive but I always try and think 'what did the person actually say; am I looking at this the wrong way?' but there was no doubt that I didn't misinterpret that. And the doctor was annoyed with her on the phone and apologised to me for how unhelpful they were. I don't just hear what I want to hear, I know sometimes my feelings will go: 'Oh they mean this', I will try and say to myself: 'Maybe that's not what they meant; they said these words', but there was no way around what she said on the phone. It was clear.”
NP: “Honestly, I, I, I didn't say that. I didn't say that... I mean, the time I spoke to them was only about my confusion that when they found out this person is already in the trust that they weren't going to do anything...”
Me: “About that: does that mean I'm not going to see a psychiatrist?”
NP: “Well, do you want to be put on meds?”
NP: “Well why don't you just ask your GP?”
Me: “She has prescribed me something but I just wanted to know if there was something other than an antidepressant because my GP doesn't understand my condition and I feel like a lot of the time it's not depression that's my main problem. I feel like there are parts that are depressed...”
NP (interrupting me again so I missed the first part of what she said) “...medication recommended for lots of other things. If you look at borderline personality disorder; I know that's not your diagnosis, but we don't really recommend any medication for it. Even though there are lots and lots of symptoms."
Me: "Well, I don't know anything about medication and my doctor doesn't understand what's wrong with me and that's just why I wanted to speak to someone who does know and maybe they'll tell me there's nothing... but if you can tell me that then that's fine."
NP: “So you'd be going to see a psychiatrist for medication?”
Me: “I just wanted to know if there were any other options than an antidepressant. I didn't know that I could ask you that.”
NP: “Well, no, no, no, I'm not an expert on medication and a psychiatrist is one. But why not give what your GP suggests a try first and if that doesn't work we could consider it”
I explained that I was on an antidepressant before and felt numb and that it held me back from progressing in therapy because I couldn't relate to anything and that's why I came off it. The session came to the end and NP talked about the time of our next appointment and although it's probably clear to you from reading this that I had put my point across, I think I still felt I hadn't really been heard because of her defensive responses and interrupting so before I left I said:
“I just don't want to spend another week feeling like that's how you feel about me”
NP: “Honestly, I didn't say that. I didn't say that. I didn't say that... I think the only thing I can think of that might have communicated that was that I said at one point that I had offered you three things and you had said you would like them all. But in tone, I didn't say... (etc etc)... I think I was factual. It depends how they interpreted that. Are you sure I was the only person she'd spoken to?”
Me: “Well she said your name”
NP waffled on about how she couldn't think how it could have been her etc.
Me: “I just want you to know that that's not the case. I asked for help because I really need it at the moment and I don't have a set plan of what I think I need. I don't know what there is and I am happy that you have referred me for the befriending and alternative therapies and hopefully anyway... hopefully things are going to settle down now and it'll be fine but I just feel really disappointed in how I clearly asked for help and I wasn't given any at the time... last week... I think I just wasn't taken seriously... and I feel really unhappy with the way the unscheduled care team have acted.”
NP was quiet for a moment and I hope that's because she had actually heard what I'd said at last. She then said that it sounds like some people have taken me seriously. I agreed and said that my GP surgery were brilliant and she agreed that this was a positive and so the session ended.
I felt upset afterwards. I cried a bit and listened over it with Adam and cried a bit more and he said he felt I couldn't have made myself more clear and that I did well to keep to the topic despite her attempts to divert the conversation. I felt happier after this and content that although she may have been defensive, I've said my piece and perhaps it has given her something to think about now. I think she will be careful in future how she treats me if nothing else. I don't know how I feel now about our relationship. In a way, I feel that if she is not cold towards me tomorrow and seems friendly, I will be able to move on and cope with having her as my therapist until T comes back. I wonder though if she can be OK with me. She never did say that she doesn't believe me to be manipulative or wot not and I may still feel I can't trust what she thinks of me. I guess we'll just have to see how it goes. I do know that I need to ask her about why she keeps mentioning borderline personality disorder to me all the time and has not mentioned DID or parts in weeks. I feel worried that she thinks I've made it up or doesn't believe in it and we as a whole feel that we need to hide the parts and try to talk as a singular person, which is difficult sometimes because not everything is easily explained in the singular when you have parts.
I've given up hope of any help from the NHS other than psychology. I feel kind of resigned now. At least Adam is home and things have settled down a bit anyway, but it doesn't give me much hope for if things go back into crisis in the future. I wouldn't want to be in that situation again.