Sunday, 5 February 2012

Psychiatric assessment and New Psychologist (session No. 7)

So much I have to tell you about! I said about a week ago that I hoped it would be an uneventful week so I could catch up with telling you about some stuff. It's actually been so eventful that I'm going to have to put last week's stuff on the back burner in order to attempt to explain all of this week's stuff. I need to tell you about the last psychology session and how it went after the fiasco with New Psychologist not replying to my letter and email where I asked for help and her general attitude about Adam being the answer to all my problems etc. First of all, I will tell you what else happened between the previous session and this week's, besides her ignoring my email etc.

If you remember, I sent her the email on the Thursday which was now ten days ago and I had also sent it to my doctor who I was due to see the next day. So on the Friday (nine days ago now), I went to see my lovely doctor and she had read the letter. She was obviously quite concerned about the fact that I'd been having thoughts of hanging myself and wanted to know all about this. I don't know if I've actually talked much about this with you, but the thoughts started about two weeks ago when I was driving home from my mum's house. It's like something in my head clicked and all of a sudden, with everything I looked at I was thinking: “Could I hang myself on that?” The thoughts just seem to arrive and when they do, I can't get it out of my head. I think through in my head how I would do it; what I would use and wonder how it would feel in the moment when I take the action and can't go back. Would I regret it and want to change my mind and die wishing I hadn't done it, or would it feel right? How long would it last before I passed out? How painful would it be? And so on. It's not just a fleeting thought. The thoughts bring a strong urge to act on them. 

I have had this in the past and found myself taking steps towards making it happen, but feeling detached from what I was doing all the while. I have tied dressing gown chords or a rope around my neck and pulled it tight as a way of testing how it would feel. This doesn't happen often. You may remember a period last year where I did that but it settled down again after I told T and she helped me with some discussion of what parts it might be and we started doing some work towards EMDR with the parts most in distress. I think them even knowing they were being acknowledged and that there was hope helped to take the 'crisis' away a bit.

So it's started up again a few weeks ago and has been really scary and disturbing when it happens. At the start the thoughts would mainly come when I got into bed at night and tried to sleep. I haven't been able to get to sleep most nights before three or four a.m. More than a couple of times the thoughts have lead to actions towards getting ready to hang myself. I'm scared about it. Over the last week the thoughts have become a bit more spread out across the day. They seem to be arriving at various times and are more persistent. So I talked with the doctor about the thoughts and that I was really worried about Adam going away and that I was going to be on my own and she felt that it was important that I get referred to a psychiatrist urgently. She said she would do this and that I'd probably hear from them soon. She also prescribed me some sleeping tablets and antidepressants. 

I didn't hear anything that weekend but my doctor rang me again on Monday and said that I would need to go down to see her again because psychiatry don't accept urgent referrals unless the patient has been seen that day (she obviously didn't get round to doing it on the Friday). So I went to see her again on Tuesday and told her that things were the same and that I had gotten up in the night and put a rope around my neck and then after a while went back to bed. She asked me if I would sit out in the waiting room while she rang the referral people to see what they thought should happen so off I went. Once I got to sitting and waiting, I started to feel a bit scared and wondered if I was going to get locked away. Part of me started to panic a bit and I was wondering if I should do a runner and get out of there while I could! I could hear her on the phone through the walls (so much for patient confidentiality) explaining everything I'd told her. Eventually she called me back in and said I'd hear from them by phone and would be given a time to go and see someone today. She asked if I'd be OK until then and sent me on my way.

I got a call telling me to go to the out of hours at 6pm that evening, which I did and was met by a nice young man who introduced himself as Dr Something. I wasn't sure what kind of a doctor he was until the end of the assessment when he said “have you any questions?” and I asked if he was a psychiatrist. He looked a bit embarrassed and said he probably should have told me that. Well, I guess I kind of assumed since it was quite clearly a psychiatric assessment he was doing. I basically had to tell him my entire life story and was in there for probably an hour answering his questions. When I was telling him about my family and family member X who works in one of the mental health teams he said kind of coyly “Is that [so and so]?” Sigh. He said he knows them (and I've since noticed he really knows them cos they're Facebook friends) but assured me of my confidentiality. Still. It's a bummer. It's always a risk that my confidentiality won't be upheld. I don't believe it would ever be intentional, but people do talk about patients in front of other colleagues and might not be aware of the link. Arrgh! My life seems to be full of annoying coincidences!

Anyway, he was a lovely doctor and really respectful. He was respectful of my explanations of DID, even though I said I knew that many psychiatrists don't believe in it's existence and he acknowledged this. He said, it's not that they doubt the cause of the condition, the patient's integrity or the symptoms but that it is debated that the collection of symptoms is not due to a condition that should be named as such but is due to other conditions. I asked if he meant like complex PTSD and he agreed that that would be part of it. He said they question whether DID was a useful label to give the condition. I explained that it has been useful for me because I've always felt I was just a freak and now that I know a name for it I have been able to research it and discover that there are a whole bunch of freaks just like me (no offence to my DID friends; you know what I'm trying to say!) and it's helped me to understand myself. It was all very amicable and I felt that although he didn't personally express a view, he was respectful of my experience and believed me to be genuine, whatever interpretation he would have put on what is wrong with me. 

I explained that I feel I need more support both in the immediate with Adam being away and me being in a crisis, but also in everyday so that this wouldn't happen again and that I could see more progress rather than just surviving. He agreed and said that he felt for me there is much more hope that for the one other person he had met with 'a diagnosis of DID' (lol) because he felt I had been managing for so long on so little support as just one clinical psychology session a week (even though he did emphasise that it is great that I have the privilege of that service) and that I should definitely be seeing a psychiatrist regularly and have other support in place (finally! Someone who gets it!). He said he would be referring me to the 'Primary Care Team'. 

He asked how I was going to cope in the meantime and we agreed that he would arrange for the 'Unscheduled Care Team' to contact me the next day and arrange to see me that week for support while Adam was away. I agreed that I felt I would cope better knowing there would be some support in place this week and that I felt that would help reduce my risk (just knowing I wasn't all alone). So I went home, feeling alone but with a little glimmer of hope that someone would ring me the next day and arrange for a little bit of support. I set my alarm early even though I still didn't get to sleep until after three, partly because I didn't want to miss a call but partly because I don't want to get into the habit of lying in, which is never going to help me get to sleep at night. My phone rang at 9am-ish and by the time I managed to set my tea down and answer it the call had ended. It was a withheld number and no voice mail was left. I spent the next few days permanently attached to my phone, hoping that any minute I was going to get a call from the unscheduled care team. No call. 

Things were really, really, really hard for me this week after Tuesday. I tried hard to keep busy on Wednesday and Thursday. Wednesday I met my friend for lunch and went to babysit in the evening. When I got home that night, the thoughts started up again and I spent hours thinking about killing myself and feeling so scared and alone. I eventually fell asleep at about 3am and then had to get up for my psychology session at 7.30a.m. I won't go into a lot of detail about the session this week but remember how I'd been expecting a lecture about not emailing her? Well she didn't even mention it. In fact, she didn't ask me one single question about the letter, or how I'd been coping this week or anything. She just looked at me and did that really annoying psychologist thing where they refuse to be the one to start the session. I was already angry and didn't want to speak to her (like I'd told you before) and I didn't want to play her stupid game so I threw a curve ball in and reminded her that she never finished filling in her assessment form and did she want to do that. In my head I was thinking, 'I don't want to talk to her about my feelings but I know I can't sit here in silence so I'll answer the stupid form questions. That's something straightforward and I don't need to trust someone to do that'. The conversation went something like this:

Me: “I was wondering if you wanted to finish filling in your assessment form?”

NP: “We could do that. Is that would you would like to do today” 
Me: “OK” 
NP: “OK... erm.... anything else?” 
Me: “I didn't really come here with a plan of what I wanted to talk about”

NP (blabbered a bit about how sometimes people come with things that are in their mind that they might think they need to talk about, also about 'unconscious' and projections etc...)

Me: silence

NP: “I know from a note I got on my desk this morning that you have been referred to day treatment. Is that right?”

Me: “I haven't been told if I have.”

NP: “So have you been assessed recently?” (Now she knew I had, otherwise I wouldn't have been referred to them and she probably already had been told about it, so why couldn't she have just asked me when I sat down rather than playing the stupid mind games?)

I told her about seeing the psychiatrist on Tuesday and she mumbled a bit about what might happen (nothing very informative), then she told me that she thinks people will tell me I need to go to the 'self harm team'. She's mentioned this before and told me that if I saw them I wouldn't be able to attend clinical psychology anymore. Now, at this stage I'd be more than happy to get rid of her but I am not happy to give up my future with T. She understands me and obviously knows what approach works well for me (I naively assumed all therapist's know this, but I am now realising how lucky I was with T). 

I feel that NP is just trying to fob me off on a different team. She's also mentioned that the self harm team is mainly for people with borderline personality disorder and a history of self harm and that they could provide the input I need. Firstly, I don't have a diagnosis of BPD (whether I have it or not is not something she could possibly judge having only just met me) and the fact that she has now mentioned BPD at least five times in the last four sessions and hasn't mentioned DID once is making me feel very paranoid that she either doesn't believe in DID or doesn't believe me (even though she did tell me at the start that she did believe me... something has changed in her thinking and I just wonder if that could be what it is. Maybe I didn't 'fit' with her expert experience she thinks she has from working with the ONE other person she has ever met with DID/from watching 'Sybil'). Secondly, and I told her this: I don't see self harm as a big deal for me. It's one symptom of a number of things wrong with me and I need help to deal with the issue, not the symptom. I also said that I wasn't willing to move because I want to see T when she comes back. She said: “But that is the care pathway for people who self harm.” She mumbled something about how self harm tends to make health professionals anxious though but that no one could make me move there if I don't want to. Really? I find that hard to believe. Probably what they might say is that I don't have to go there but I can't continue to go to psychology either. 
So after that we moved onto talking about the assessment form that I had mentioned at the start. She didn't mention the letter or email issue and neither did I. I wanted to ask her if she thought it was reasonable that she completely ignored my email but I chickened out. I didn't even think until afterwards that it was strange that she didn't even ask me how I was coping with Adam being away. I felt angry with myself and still angry with her when I left the session. Nothing was dealt with. No issues were raised. I know it would probably have been pointless trying to discuss them with her anyway but I still felt a little bit disappointed in my lack of backbone.

I will save what happened after this for the next post, but you actually won't believe it when you read it. I'm sure you're going to think I made it up!


Pandora said...

Morbidly excited about your next post now!

Really, I don't get this woman at all. How dare she just ignore everything you'd said in that email?

Also. The BPD/self-harm stuff? I was diagnosed with BPD in 2009, and it was only after I tried to off myself in January 2010 that the self-harm team were even mentioned. That mention led, of course, to damn all. So if they don't do it for someone who has the diagnosis, why is she blathering on about it being the only path for someone who doesn't?! (For the little it's worth, I believe you - what I don't believe that you have BPD).

Until fairly recently, my mental health care had been appalling. Now, I have a good CPN and a good psychiatrist, and a great (if temporary) therapist. My point is that someone with 'severe' mental health issues should have all of these avenues open to them, not just one. Whilst that's sadly not allows what happens, to effectively tell you that Psychology is off limits if you access the SH team seems ludicrous.

Oh and by the way, you're totally right that SH in itself is not the issue: it's what drives a person to do it that's important.

On the plus side, I'm pleased that you got to see a psychiatrist, and that he wasn't an arsehole. I just hope that you finally did hear from the care team.

Take care

Pan x

Candycan said...

O dear, I hope you won't be disappointed now after me hyping up the next post. It might be really boring, lol. It's interesting what you say about BPD and the self harm team. It's good that you now have a good CPN and psychiatrist, it's just a pitty that it goes on luck whether you get a good one or a plonker. What does your CPN do btw? I just don't really understand their role but wondered if it could be helpful for me or not.

Ruth said...

Sounds like a lot going on. Some helpful, a lot not very helpful at all. After my diagnosis I am surprised less and less often. I am now intrigued by what you found frustrating and unusual. I am sorry to hear you are acting out part of the process. Are you in a situation where you can lock up all your rope?
I don't know if that would help. I remember putting my kitchen knives in hard to reach places to slow down my thoughts about following through. Hoping something gets worked out.

Ellen said...

Those suicide thoughts and actions are very worrying Candy. At the same time you don't have any decent help or caring going on. I know what you mean when you talk about a part being acknowledged and listened to by your former T. How much that helps. That's been my experience also. One of those parts is in severe distress, and the suicidal thoughts are the symptom. It's amazing how letting that part speak a bit helped me.

I wish you could find some helpful help. Would paying for someone be any kind of an option?

take care

JustEliza said...

Heehee, I can read your therapist like a book. Wish I could help you work through some of your feelings about therapy, because I've so been there (and through the other side). But a discussion thread isn't the place for that.

What stuck with me from your blog post is this:

"Nothing was dealt with."

How can you change that?

CimmerianInk said...

I'm going to read your next post in a minute here but I officially hate your temp. therapist. Seriously. She is...I don't have words.

I'm glad you got a nice psychiatrist to speak to you though.

I don't want to comment too much because I don't know what your next post will say, so I'll save it for that one.