Therapy and Honesty

I started afresh with a new therapist last week. I have been referred to a Cognitive Behavioural Therapist (CBT) and have an initial 6 sessions.

The first session didn’t go well. I felt like the therapist was simply trying to boil down what he considered to be my problems into something that he could define, describe, measure and cure. I will concede that this process and the therapist’s insistence that I needed to ‘buy in because it works’ made me check out mentally a little bit. As you may know if you have read earlier blogs, I have a problem with public transport. Stripped down, actually the problem isn’t the public transport but the people on it. The therapist was adamant that exposure was the way forward. He also wanted me to write down what was going on for me at the height of my anxiety. I told him that in the setting of a quiet and calm therapy room, I could see the merit and think rationally about it. However in the grip of anxiety and panic I couldn’t imagine reaching for the paper to write it down.

I have worked on graded exposure over the last 18 months and whilst I have pushed myself beyond what I though I could do, I didn’t truly feel like I’d made significant progress (particularly here the public transport – other areas of my anxious life have improved considerably).

I have also been through enough different treatments and therapies over the years where I feel like I know what I need. And so this clashed head on with what the therapist was saying to me.

I left the first appointment thinking ‘screw this guy’ and ‘I can’t work with him’ and ‘I’ll ask the service to assign me a different therapist’. A couple of things that had resonated with me from that session though. The first had been when the therapist suggested, gently, that I might have been being obstructive almost as a safety behaviour. As much as I didn’t like hearing that, it is true that therapy is a two-way street and I have found that anything less than bringing your full self to proceedings and being ready to challenge yourself means you won’t get what you want to achieve from therapy. OK fair point. Keep an open mind, Greg. The second thing he emphasised was that he appreciated honesty and if I felt something wasn’t right or working for me, I was to talk to him about it.

As this Thursday’s appointment approached I wasn’t feeling great about going back. I realised that I was going in without a plan or any suggestions to change. In that moment I resolved to prepare to be honest and give the therapist a chance to hear me and reassess.

Honesty felt like a difficult one in this context. I thought back to other times I felt like I wasn’t happy with how things were going in therapy and found a theme. I hadn’t said anything because I was worried about hurting the therapist’s feelings. I felt like they would take my feedback to heart and feel professionally wounded. Clearly, this is a projection of my own feelings. It also talks to a lack of assertiveness – this is not self-criticism really, it’s an observation and something I am owning and working on 🙂

So what did I have to be honest about? What did I want to say? I went back and told him that I had been frustrated and that I felt like I hadn’t been heard in that first session. I told him that the exposure hadn’t changed the thought processes and I wanted to work on the those. I let it out. I wasn’t personal and I wasn’t emotional. I just stated what I needed and how I saw us working together.

The therapist, to his great credit, listened to me and thanked me for my honesty and told me he respected it. We agreed that our focus would shift towards the cognitive side of work and started on that immediately.

I left the therapy appointment much happier than I had the previous week. I felt like I was starting something significant. I felt inspired to do work outside of the sessions to try and maximise what I can achieve in these time limited sessions.

It remains to be seen how this works for me. The journey continues…

Mindfulness – Mental Health Awareness Week 2015

This week (10th-17th May) is Mental Health Awareness Week for 2015 and one of the focuses of the week is mindfulness. For the uninitiated mindfulness is described by NHS Choices as:

Mark Williams, professor of clinical psychology at the Oxford Mindfulness Centre, says that mindfulness means knowing directly what is going on inside and outside ourselves, moment by moment.

“An important part of mindfulness is reconnecting with our bodies and the sensations they experience. This means waking up to the sights, sounds, smells and tastes of the present moment. That might be something as simple as the feel of a banister as we walk upstairs.

“Another important part of mindfulness is an awareness of our thoughts and feelings as they happen moment to moment.

“Awareness of this kind doesn’t start by trying to change or fix anything. It’s about allowing ourselves to see the present moment clearly. When we do that, it can positively change the way we see ourselves and our lives.”

I have been drawn to mindfulness for a couple of years without being able to fully commit to it. Commitment is key to mindful practice yet I have previously been unable to master it or practice it regularly. Sometimes this has been because my anxiety was such that subjecting myself to even a few minutes of being in the present, and not distracting myself with radio, tv or other things was too tortuous to even comprehend. Other times I would simply forget for a few days and fall out of the habit.

But those moments where I could practice mindfulness I was learning to appreciate being in the moment. To be clear, mindfulness as I understand it is not about quieting the mind or chasing off unwanted thoughts. It’s about noticing. This video from the Headspace app (more of which in a minute) has an animation explaining this beautifully:

The Headspace app begins life free and encourages you to ‘take 10’ each day; i.e. carve out 10 minutes for 10 days to practice mindfulness in a guided way. I downloaded it a few weeks ago and, full disclosure, completed the 10 sessions over about 14 days. You then have the option to subscribe for further guided content where you can choose the length of time to practice. Since subscribing I have gone up to 15 minute sessions, and my daily practice has stalled a little; I did it yesterday, but realise I haven’t yet done it today and probably won’t now that I’m about to start work for the day. But, I remain committed to making this a daily part of my life. Good intentions…

And so what has mindfulness done for me? It’s hard to say at the moment. Inconclusive. I am getting better at not judging myself or my experience of it. I find that my internal voice is labelling things, sounds, thoughts and so on. However, as Andy (on Headspace) says during the guided practices, it’s perfectly natural for the mind to wander off. When you catch it, you gently bring it back to the moment. Your breath. The weight of the body on the chair or the floor. I am appreciating those small moments of practice though. We spend so much of the day thinking or worrying about the past or the future, we scarcely stop to check in with the now.

One final thought about the impact of mindfulness on my own mental health. One of my ‘things’ is restlessness. If I’m not doing something, I can get anxious and start focusing on negative thoughts. I believe that mindfulness, with continued practice, will be an integral part of helping me to relax into a more momentary peaceful and calm state, more ready to deal with riding out the anxiety – letting time pass –  rather than being busy, and therefore distracted, all of the time. Let’s see how that works out…

You can learn more information on Mental Health Awareness Week here and over on Twitter using the hashtag #MHAW15.

Deficiencies or Strength?

It occurred to me recently that we’re constantly told, probably mainly by ourselves but also doctors and friends and family, that to have a mental illness is to have a major deficiency. Whilst on some level there’s possibly – possibly – something in that on a technical level, people who have a mental illness are the people who probably the people who least need additional negativity and stigma attached to their condition, given our proclivity to inward reflection and self-criticism.

In my case, as alluded to before, the negative reinforcement comes from myself. I should be able to go on trains and planes. I should be able to go to social gatherings and not be looking over my shoulder every five minutes. I should be in a better place in my career given my experience. Jeez, when I write it all down I realise I wouldn’t say that to anyone else. And yet I say it to myself. As far as I am thinking, I am failing at some important aspects of life or at least not meeting expectations.

It’s true, I wish the above wasn’t true. But I suppose the important thing is continuing the work and acknowledging my strengths.

And so I suppose this piece is about self-kindness. I can change those ‘shoulds’ to ‘coulds’. I can celebrate successes, be they minor to the everyday person. I can take great pride in the fact that, no matter the pace, I am gradually moving towards where I want to be.

Take the time today to remember that however hard things seem right now, you (we) have already been through tough times and come out the other side. Comparison and high expectations are potentially very damaging. Remember, those ‘normal’ people out there that we think have their lives together really don’t (despite what Social Media might tell you!). We aren’t burying our heads and pretending things are OK. We are some of the strongest people around and continue to be.

New Neighbours

Today some new people moved into the flat next to ours. The flat has been empty for a good few months and before that an old man lived alone.

I have noticed this evening the urge to reach for some old safety behaviours.

I have worried about neighbours in the past. I have moved house a number of times because I haven’t liked, or felt threatened by neighbours. This is, of course, all linked to my PTSD and the hyper vigilance that is a particular symptom for me.

I should also say that I actually met the new neighbours last week and they seem like perfectly nice people.

However, a sense of unease is upon me. The fear of the unknown. The change to the status quo.

And so I return to acknowledging the reaching for the safety behaviours:

• Thinking about staying away from the room adjoining the flat next-door, and staying away from the door
• Thinking about closing windows so no outside sounds can come in
• Thinking about having the tv/radio/netflix on constantly to manage what I can hear
• Thinking of how I can move house if things get unmanageable

The positive thing for me here is that I am recognising and acknowledging what is going on. By and large, I have caught myself when any of the above thoughts have cropped up, and not gone with it. I am watchful, I recognise that, but I am not giving in.

I also know that I am trying to get a sense of control when I can’t necessarily control what s going on. I can only control my reaction. I remind myself that what I am experiencing are just thoughts. I am under no direct threat. For me, this does feel like genuine progress. The real test will come if I do start to hear noise coming from there…

GPs and Mental Health – My Experience

I’ve been fortunate over the last few years that any time I’ve needed professional support for mental health challenges, I’ve been able to seek private treatment or access my work’s employee assistance program.

Currently, I am not working and find myself in need of help. So, with this I took myself to my GP surgery and what I encountered was not positive and I wonder whether I am actually going to get any support.

On a day-to-day basis I am generally fine however my life is limited in some aspects, particularly being in some public places and public transport. I know I have to address these issues in a supported environment to build on the progress I have made in the recent past. With this knowledge, I asked the GP for a referral for CBT. In fact, I said ‘Cognitive Behavioural Therapy’ just in case CBT meant something else. Here’s how the conversation went:

Me: Hi, I’d like a referral for Cognitive Behavioural Therapy.

GP: Cognitive….?

Me: Cognitive Behavioural Therapy…CBT.

GP: Oh! CBT!

LONG PAUSE. Really long. Awkward long. He appears to be looking at my history, but does not tell me this.

GP: So you’re still suffering with agoraphobia and panic attacks?

Me: Well not so much these days but…

GP: Fine I’ll refer you. Is your home telephone number still blah blah blah?

Me: No, that has changed.

Not joking, he spent longer getting annoyed with the computer because he couldn’t change my home number than he did on my consultation. But phew, they have my home number now!

That was Wednesday. Last night, around 8.30pm I get a call from the same GP saying that he has been told that he needs me to complete a GAD7 form and PHQ9 form before I can be referred and can I just come in tomorrow to do that? So presumably, if I don’t make the grade I don’t get treatment?

I must say that when I have heard people talking about their struggles getting support and treatment from their GP or CMHT, I have wondered from afar whether it was as bad as all that. It took a harsh reality check to show me that it was all that bad.

One memory from volunteering really sticks out in my mind. We visited a particular region’s NHS CCG to discuss mental health and stigma with the staff. The chief doctor who as part of his role had mental health provision under him couldn’t have been more disinterested and dismissive.

Is it true that all GPs know so little about mental health and how a service user needs support? That seem to be the overriding experience I hear from people. I find this all very backwards and worrying!