Tuesday, 31 January 2012

New psychologist: sixth session

The session was last Thursday, so as you can see, I'm a little behind on my blogging and I have LOADS to tell you about. I will try to pace it all over several posts so as not to scare you away. Just to warn you also, it's a longun and includes a lot of 'she said', 'I said'.

The session started with a catch up of what I had been doing since Tuesday. I talked about my trip to the hospital to get my diagnosis of genetic blood disorder confirmed (which I will tell you about in another post) and New Psychologist asked about the chronic fatigue symptoms: what kind of activities I can do; how I manage work if I have chronic fatigue; if it's just a physical thing or a mental thing as well; what adaptations I have put in place to help me cope with the tiredness; how did I feel after I went for a walk last week etc. I was waiting for the advice: do exercise anyway; try to have a structure to your routine. I would have probably strangled her if she had tried that because I explained that I do try to do small amounts and take regular breaks and then make the most of good days. Thankfully, she didn't offer any unwelcome advice this time, just lots of questions so that was a relief. 

I tend to feel like when she's asking me questions her tone and wording is that of not believing me or trying to catch me out. I admit, I'm probably being paranoid about this. I may be picking up anxiety from her and interpreting it as dislike or not believing me. For instance in relation to the fatigue and my saying I can do ten or fifteen minutes then need a break: “Is it certain types of activity you're talking about because I'm wondering how you manage work if you're saying you can only do small amounts?” 
To me, I felt like she was saying: “This doesn't add up. If you can only do small amounts then how do you work? I think you're lying.” 
To be fair, I've just assumed that's what she meant. She was probably just genuinely wondering how I manage work and looking to understand things better. I don't know if her wording isn't great at times and maybe, combined with her blank expression and tendency to interrupt, I guess it all just adds up to make me look for signs of anything negative from her. If she'd said to me: “It sounds like you're saying you can only manage small amounts. How does this affect your work, if at all?” I'd probably have felt better about it. By the way, if you're wondering how on earth I do manage work, it's because the chronic fatigue symptoms are mainly physical tiredness and muscle pains and my job is pretty sedentary, so I am sitting all day anyway. Not that it's not exhausting anyway, but I do get through the day.

I got to talking about examples of a bad day (physically) and started to tell her about a trip to a shopping centre I took on Tuesday. I mentioned something about Adam as he'd been with me and then new psychologist stopped me mid story, as the mention of Adam's name had reminded her that she wanted to ask me more questions about Adam. That's OK new psychologist, my story wasn't important anyway! She wanted to know how Adam's mood is because I'd mentioned once that he was having a lie in. I explained to her that Adam does struggle sometimes: he has few friends and little support and that the way I am has an impact on him. I tried to say that this is why I don't want to ask him for more support than he's already giving me but I got as far as the word 'don't' before she talked over me by saying that if it's a crisis though, it's important I can ask him for help. ARRRGGHHHH!!!!!! I HATE BEING INTERRUPTED. As well, she was just completely disagreeing with me. I try to tell her that I can't ask Adam for more support than he's giving me because he is struggling too and she tells me that it's important I do ask him for help. She's just not hearing me really. He's doing all he can and it's not enough. It's not his problem; it's not my fault. Why can't she understand that?

She then suggested that/asked if it's a problem that I have of not being able to ask people for what I need because of my history. She wondered if I feared blame or feel ashamed and that perhaps there are psychological reasons why I can't ask for help. Now, she has a point here. I do feel a lot of fear about asking for help. As I said to you my dear readers in a previous post, I asked for help as a child a number of times and was rebuked, or the adults were so overwhelmed at the situation that they withdrew from me and I was left more alone. This taught me not to trust other people and definitely not to ask for help. This is why it is so hard for me to ask for help. She's right. Where she is going wrong is that she thinks I won't ask Adam for help because of this. Maybe that's my fault for not explaining the dynamic of our relationship better to her (or maybe it's her fault for not giving me the space to do it), but Adam helps me a lot. He tries to understand that things are difficult. I don't tell him every single detail but he knows that T's leaving has been really hard and he's supportive of that. He cooks for me and cleans (a bit). He makes me cups of tea all day long and gives me a hug when I ask for it. He's a man though; he's just one man. He can't provide everything I need and I do hold back from telling him everything (like that I self harm, my eating problems, the problems I have with intrusive images etc) because he is too close to me. It is too painful for him. He is affected by my pain. My pain becomes his pain. I don't want to hurt him. I already affect his mood and he's admitted that my issues have a big impact on him. It's not fair to expect him to be my only source of support. She'd understand that if she would listen to me long enough that I could say it. 
She also didn't seem to be picking up on the fact that I am asking for help. I've said to her that I need more help than just psychology and that wasn't easy to ask. Now I feel she is turning it back on me to suggest that Adam be that support and she won't respect me when I say that he can't. I can't see a way out of this misunderstanding. That is what I was thinking at that moment.
She then confused me by bringing out a typed up sheet that she had put together of potential other sources of support. Although I was confused, I was really pleased about this. Maybe she heard me after all. Or maybe she is just trying to make sure Adam is being used most effectively but she did understand after all that Adam is not enough. Anyway, it's a good thing. The list contained four things which she talked through:
  1. Befrienders which is set up via Lifeline. She acknowledged that I'd said I didn't find Lifeline helpful and I said that I'd only tried them twice but hadn't been that enamoured of them. She seemed surprised that I'd only rang them twice and in my pessimism I wondered if that was because she doesn't know that the way I have been this month is not how I always am. I don't live my life in a crisis. I wondered if she thinks that I went to T every week before she left and said I need to see her more and that I ring Lifeline every time I feel one ounce of negative emotion because I'm just a weak person who needs to realise that life is hard. Of course, I could be completely wrong about this. This was the point where she told me that she has had contact with Lifeline for work reasons and always found them to be reasonably professional. Of course she would find them that way, because she's ringing them as a professional. They're not judging her as just another time waster. (I acknowledge that I may be being harsh; I'm sure there are some brilliant people working for Lifeline. Unfortunately, the two people I spoke to weren't, and in my opinion, two out of two bad experiences doesn't bode well for future calls... also, if you need advice, you'll probably love them). Anyway, she said that she can refer me for befriending support which Lifeline organise. I'd already read about this on their website and thought this could be something good so I was interested in this suggestion.

  2. Complementary therapies. She had found details of an organisation funded to treat people with a history of trauma. She talked about physical therapies like this being soothing and suggested that something like foot reflexology could feel safe for me. She also talked about how adversity as a child can interrupt the hard wiring in the brain which teaches a child to feel soothed by actions such as rocking or soothing physical contact. She said that these tactile things can help to replace that lost learning and can be very useful (probably would be good for someone like me with disorganised attachment). 
  3. Referral to a primary care psychiatric team. She said that this could open up an opportunity for psychiatry to help me find a medication that might be suitable (I've been procrastinating about starting an antidepressant for various reasons) and that I'd have contact with a community psychiatric nurse also and possibly social workers. 
  4. Group therapy. She said that this would be something to think about in the future but that it wouldn't be appropriate at this stage in my treatment. That's interesting isn't it? I don't think I'd relish the thought of group therapy anyway. I think it would be the end of me!
She asked me what I thought about this and I said that it was really good to know there are options and that I'd consider all of them and was especially keen for number three. She sounded, again a bit surprised by my interest and then warned me that she doesn't know if psychiatry would accept a referral to see me at the moment because I may not qualify. Why wouldn't I qualify? What the frick do you need to have wrong with you to qualify for help?! She said she'd try anyway. She also said she would make referrals to the befriending and complementary therapy organisation herself because she wanted to check them out and speak with them to make sure they would understand me. I thought this was very good of her and was pleased that she would take the time to do that for me (Yay, she's not all bad! Maybe there is hope for us after all). I have already heard from both the befriending people and the complementary therapy people and have appointments for both set up. Speedy service!

I attempted to talk at this point and explained that I feel like the last several years I've just been keeping going because I hope things are going to get better. I feel that at the best of times my purpose in life is to get through each working day and come home. I said, if I believed that things weren't going to get better, there's no way I would keep going. I said, the only thing that keeps me going is the goal of getting through each day. NP butted in mid sentence with a statement: “Your relationship is important though...” I stopped in my tracks to see if she had something else to say but she didn't, so I attempted to pick up from where I'd left off and again she interrupted me: “Is it not?” I sighed. I tried to explain that Adam is important but that sometimes I feel like he would be better off without me. She said: “Does that mean that some of the time Adam can bring you a bit of relief from your difficulties, but if things are really hard it adds to them because you feel you are holding him back?” Hurrah to be understood! Yes, that's right NP, now you are getting it... aren't you?
I said, "I do feel like there's hope for me to be better than I am, but I feel like I need more help. I feel like I've been using as much resources as I have." NP responded by saying that she wanted to talk more about my resources and review them. Sigh... She said it is essential for her to have it in her notes that we have gone through this early stage of making a plan for me in a crisis. She said: “I agree, none of them are going to take away your distress completely but even a 5% improvement would be alright”. She said it's important to do these things to help me get a handle on the emotions. 
I'm starting to see what's going on now. She has said a number of times, small comments to suggest that she feels embarrassed about the advice for coping techniques. Once she said that when she was training she felt embarrassed that there wasn't more she could advise people to try when in a crisis than things like deep breathing etc. but that they really do help. She's said a few other comments like this and now I'm seeing that she feels I am annoyed because she's trying to help me with minuscule tips like this (which I am) and she's a little bit embarrassed about having to give them to me as well, even though she does believe they are helpful, BUT she has to do it as a professional obligation. When she said “It's an essential thing that I have to do. If I don't have this down in the notes in the first few sessions I have with you, it would be a bit unprofessional” I started to realise that my resistance is not going to get us anywhere because SHE NEEDS TO TICK THAT BOX. She may also believe they are helpful techniques, but whether or not I do, she has to go through it anyway. 

Now I never said they wouldn't help me at all, I just felt concerned that this seemed to be all she was focusing on. I wanted her to understand that these things wouldn't make everything better and that I need to be understood and empathised with. So really, if my theory is correct, what I need to do is just go along with this process as willingly as I can and help her get a list of 'what I'll do if I'm feeling overwhelmed' in her notes so that if I do turn up in the morgue, she won't be held responsible. OK I'm with you now NP. Maybe I should try and have it all done and written down in a list before I see her again on Thursday.

So off we set, discussing things like relaxation techniques, watching TV, writing things down, having internal conversations etc again while she jotted them down. She also gave me a page from a DID book which had an example contract for a client to make. I told her that I have that book at home (Dissociative Identity Disorder Sourcebook by Deborah Bray Haddock, if you're interested) and she didn't seem surprised so I wondered if T had either told her, written in my notes that I had it when I brought it in to show T, or perhaps it belonged to T. Anyway, that's not important. I'm glad to see she is doing her homework anyway and even more glad that she is reading a book that helped me so much.
She also asked me how I had gotten on with the relaxation CD she had given me. The CD is a man's voice and works through each area of the body, asking you to be aware of that part (she had been nervous about giving it to me for this reason). It starts with the toes, so you have to bring all your focus to your toes and without moving them just be aware of how they feel, without any judgement. The process moves from the toes, to the foot, then the ankle and up the leg and so on and by the end of the CD it has incorporated deep breathing and helps to relieve stress and tension. I tried the CD twice after she gave it to me as the first time didn't go so well. I explained that I struggled to stay focused with it both times and that the first time I tried it I had either zoned out or fallen asleep once it got to focusing on my pelvis area. She said that a lot of people report that they fall asleep when listening to it and that maybe that's just because it's what the body needs at that time (or maybe listening to a man asking me to think about my genitals was a bit much?)
I found also that I was getting annoyed with myself for losing focus at times when listening to the CD and she said I was very hard on myself and judging myself a lot. I thought that was an empathic thing to say and reminded me of the NP I had thought she was during the first few sessions. She asked if I had internalised this attitude from someone who was like that when I was a child, like a parent. I agreed that I am sure it has something to do with it. I also told her that the CD had triggered some intrusive images. I tend to avoid thinking about my body as much as possible and being suddenly aware of parts of myself in this way had brought some disturbing images into my mind. NP asked what happens if I get these and I said I try to push them out again. She asked what would happen if I just held them there. I said that sometimes I try to be open to them and look at them to see what they are but that often it's just an instinct to shut it off. Sometimes I try to tell myself 'there is nothing so bad that I couldn't know what it is' and I try to reassure myself that it is OK but it's like another part of me just can't. NP said, “Mmm... that's brave Candy.” (Yay for empathy and listening!) She said she thinks it's good that part of me is at that point but it seems another part is more wary and not at that point. She said, good for me for persisting. 

We talked on about potential strategies but I was feeling a bit fuzzy in the head now after talking about the images and I was having some in my head too. She picked up on the change in me and said that I seemed disengaged when she was asking me about things like could I watch TV etc. I don't think she made the link that it could have been what we were talking about. I didn't make the link myself really until afterwards. I guess she might have thought I just didn't want to go along with her list making.
We didn't get the list finished but as the session was coming to an end she said she wanted to discuss the time of our appointments. I said I also had something I wanted to ask her and so she asked me to go ahead. I explained that I was worried about how the next week was going to be because Adam would be going away on holiday for a week (lads trip away, which he has now left for) and I would be on my own. I guess what I wanted was that she could suggest some more support in the form of perhaps two sessions again, given that things are still really difficult, or at least a phone call or email during the week. NP didn't really get this and wanted to discuss why on earth Adam felt it was a good idea to be leaving me at this time. She wanted to know if I had talked to him about how I would cope if he went away and had I explained how difficult things would be after T left. I explained that I'd agreed to the trip because I'd thought I was coping quite well initially after T left. 

She asked me what I'd be doing for the week while he was away. She said, that I'd be at work during the day wouldn't I and I said that I wouldn't be going to work. She said: “Is that a good idea if you're going to be at home all day?” OK NP, please understand me here: IF I FELT LIKE I COULD DO WORK, I WOULD GO TO WORK!!! There's no point suggesting that I'd be better going to work than being home on my own if work is not an option for me. Again, I started to feel like she totally isn't understanding how hard things are at the moment. She asked if I thought my GP would be happy to give me a sick line and I tried to restrain myself from screaming at her and telling her again that my GP has been suggesting I take time off work to rest for months. She then asked me questions like: “Can you go with Adam? Can he go for a shorter time? Can he keep in touch with you by phone?” etc. When I answered that these things wouldn't be possible she again reminded me that it's only been three weeks since I started seeing her and T isn't long left and surely we'd known it would be difficult (how is that observation helpful now, NP?). She said “A week's a long time for a stag weekend.” I'd already told her it was his friend's birthday so this was further evidence that she wasn't listening; it isn't a stag weekend. 

It seemed she again didn't want to accept that Adam would not be the answer to this problem and that we needed to come up with some kind of other answers. She continued to ask me questions like how did I feel about this and does Adam know my care arrangements and what does he feel will happen if I need more support. She said “What does he think you will do if you become more distressed when he's away?” I wasn't sure what she was getting at with this. Ugh. He's not my mum! I was getting frustrated now. I tried again to explain things and said that I was sure it was difficult to understand and that our relationship is not straightforward. She didn't interrupt me this time. Instead she moved on and said: “Would you be able to ask anyone else for support?” HELLO? I'M ASKING YOU NP! I don't have anyone else! I shook my head and she kind of laughed and said: “It's more that. You're aware you might need more support but in a way, some of these things you close down yourself” WHAAAAT??????????? She elaborated on this by saying that she understood that my access to one service she suggested was blocked because of my family member who works there. She said she understood this and found the circumstances very interesting and she said “and you don't want to go to occupational health.” OK I didn't say that, I said I wasn't keen but I was open to suggestion. 

She then said that it's not advised that a therapist be the sole source of support for a client and that it could affect the quality of therapy. She's right about this, that's why I'm asking for more support. That's why I need a CPN or something else to support me. Can she not understand this?... Apparently not because she returned to her helpful suggestions about how Adam could better support me while he's away. Could I buy him a SIM for his phone so he could ring me... bla bla bla. She doesn't get it does she? I could tell you how the conversation went on but basically if you just insert a copy of all the other conversations NP and I have had about Adam up until now in here, you'll have an idea of what we talked about i.e. more talk of suggestions and then asking if I could explain to him that in future he should not go away for a week when my therapist has just left three weeks ago. That was the end of that conversation.

Before I left she said that she would like to see me in the mornings from now on, at 9am. Some of you may remember that I'd had an issue with dissociating in the sessions with T and that T had wanted us to meet in the morning instead of evenings as a trial to see if it would help. I didn't think it was helping and it was in fact making my working day very difficult as I then had to go to work afterwards and often wasn't making it into work. It's much better for me to come last thing in the day and then go home afterwards. I explained all of this to NP when we met and she said she was happy to see me in the afternoons, so I was surprised at her sudden change of mind. 

Unfortunately, when she said she wanted to discuss it, she actually meant that she just wanted to inform me of it. She said: “Is that OK?” and I asked if we could discuss it because I feel morning appointments are very difficult for me but she cut me off again and said: “I'm going to have to insist on that for a while.” She said it was important until we get the groundwork done and until she could get the 'safe place' work done and I know how to communicate with you safely and until I would start finding some of what she is saying reassuring (what does that mean and why does it have anything to do with the time of day??). I tried to explain again why mornings are hard for me and she interrupted me by saying: “I know, I know, I know, I know, I know... let's get some of the groundwork done though. I did want it in the morning initially and you said no, you wanted it in the evening and I said I'd try it, so this is the same thing. Now can we try it in the morning?” Whatever new psychologist. That was the end of the session. I left feeling annoyed and again not listened to.

When I got home I emailed her with a letter I had actually written the day before. I was feeling frustrated at the lack of support so I wrote a letter with a summary of all of my problems and what I felt I needed and I had sent it to my GP asking her if she could read it before my doctor's appointment the next day. I also wrote new psychologist an email. I will post the long letter later but here is the email I sent her:

New Psychologist,
I put this letter together before we spoke about this which I feel
explains how things have been for me lately and what I feel I need. I
think it could be useful for you at the referrals meeting if you read
it and I dont mind if you shared it.
I understand that you are trying to help me to come up with practical
ideas of how I can manage myself. I am willing to try anything no
matter how small it may seem and I am grateful. My issue is that I feel
I have been doing a lot for myself for a long time and would never ask
for more help if I felt like I could manage on my own. We seem to be
struggling to understand each other about Adam's role and how he can
support me. I wish you to understand that it's not just straightforward
and that he is supporting me in as much as is possible at the moment
and I don't feel I can ask for more than that from him.
You don't know how I normally am as we have only met this month and my
concern is that the way you see me now is how you think I always am and
that this may affect how you view me. It is really important to me that
you appreciate that I am doing my best and that when I say I need more
help at the moment, it is because I have already realised that I can't
get by on my own.
I am really worried about getting through next week when Adam is away
and I feel that I need some help with this. I know you have been really
good in seeing me twice a week because things have been so tough lately
and that this is just a one off thing but now I feel that things are
about to get harder and I'm not going to have any support again until
next thursday. It would be helpful to me if you could see me twice next
week or have some kind of contact with me before thursday at least. I
understand that it's not ideal as you say that you would be my only
source of support and that is why if I can get referred to psychiatry
etc it would be great for me but at the moment I am really concerned
about next week.
I really hope things will settle down soon and you'll have some peace
from me.
ps could you also just confirm that i am seeing you at [x] next
week? I just forgot what we decided on.

I sent that email to her last Thursday after the session, it is now Tuesday night and she hasn't responded to it or contacted me. I feel let down and it just confirms to part of me what they believed happens when you ask people for help. I couldn't have been much more clear about what I needed and it wouldn't have hurt her to at least acknowledge my email and let me know where my appointment is, even if she couldn't do anything else. I know she's been at work because, as I said earlier, I heard from the befrienders and complementary therapy service which she referred me to. I'm disappointed and a bit angry to be honest.

My general residual feeling about her after the last session is negative, although I do acknowledge that there were some positives here too. I just hope she can show a bit more of the qualities I need to see soon. I'm not asking for a lot. I will take advice, but I want to be heard too and respected.


Ellen said...

Of course you want to be heard and respected Candy. That is a minimum requirement isn't it.

This sounds difficult. It's also difficult to start a new relationship while in a crisis.

I cannot understand why she wouldn't reply to your email. If my T doesn't reply in a day, I get very upset, never mind several days. I don't get it.

Glad you got some referrals at least. Not being able to choose your T must be difficult.

Your relationship with Adam sounds complex, and it's too bad NP can't take her time to understand.

Thinking of you.

Pandora said...

Oh for Christ's sake. I think you have been exceedingly tolerant towards her, when you could have quite reasonably have lost it right in her face. That she can't even be arsed to respond to an email - a reasoned, polite one at that - must be so frustrating.

I learnt something from my NHS therapy, which is a bit of a laugh considering the gibbering mess it ultimately turned me into. That was that psychologists - even good ones - don't necessarily make good therapists. C, my NHS psychologist, was one of the most insightful people I'd ever met, but in retrospect I'm not sure he helped me much. My current therapist, Paul, is - as far as I know - not a psychologist, despite his knowledge of the discipline. And he's brilliant.

So I'm just wondering could she be brilliantly qualified on paper, but less brilliantly qualified in reality. Interrupting a client, turning things around on them - that's not good.

But, in her defence, maybe it'll just take time getting used to each other - perhaps she's exploring boundaries or trying to learn details of your personality/ies or something. Either way, I really hope things improve with her soon.

It's great to hear about the referrals, at least :) Wishing you lots of luck with them.

Take care

Pan x

Ruth said...

Hopefully the referrals will be helpful. My daughter is a massage therapist and she learned amazing things on how to help people that are sick or traumatized. That is something that I think would be interesting to investigate. I am sorry to hear you are having such a rough time with your new therapist. I can really empathize with that. My new therapist and I are still struggling and I have gone to him over a year. I hope yours goes better. Crisis complicates so many things.
Take care, Ruth

CimmerianInk said...

Ok, still catching up and again Yikes! Her constant interrupting and lack of response to your very thoughtful email has officially pissed me off.

I'm really glad that you got the referrals, so that's something.

You've been amazing and patient with her when I would've yelled already (well maybe only in my head)

Candycan said...

Ellen, you're right, at least I got some referrals. I don't think I'm all that hard to get on with so I never really thought not being able to choose my own therapist would be problematic. I really just need to feel that the person is on my side for it to work.

Pan, I just can't get my head around what is going on. She was great for the first two sessions, so she obviously does have the skills in her. It's like somethings just switched in her. Or something I've said or done or she's read has made her decide I'm a time waster and now she doesn't have the time of day for me. I don't know! I really hope it is just time that's needed.

Ruth, that's cool that your daughter can do that. It's very interesting, the link between mind and body etc. I've had reflexology done before found it really great.

CI thanks for reading! Maybe I'd be better off just yelling at her. She'd probably just yell over me though. Lol