So I started psychotherapy in August 2015. It was part of a multi-pronged approach to cut me out of the fast-setting glue that had been holding me in place since about February. In this post, I go through my experience with mental health intervention last year and reflect on the uses and limitations of psychotherapy as well as the similarities and how it differs from psychoanalysis. It’s about 1800 words long.
***TW this post relates an incompleted suicide attempt***
At the time, I’d wasted April to early August trying to go through the NHS Mental Health service. So far, I’d been diagnosed twice and had endured week after week after week of sitting in a dingy Regency-era upstairs room – the sort with windows you can belly-flop out of, which curiously manage to let negative amounts of light into the room despite their size. Were you expecting me to relate what actually happened in the room? Well, that was pretty much it. I turned up five minutes before my appointment religiously every week, and sat there, and got told by the mental health nurse “we are assessing you, it takes time” but nobody actually seemed to be carrying out any kind of assessment and everyone assumed someone else was doing it. When I asked about a diagnosis, I was told “we don’t like to label people,” followed by “we are assessing you, it takes time” and my all time favourite that makes me want to tear my limbs off, “what is normal?” (oooooh, it’s all so profound, if you’re 13 and love arguing over semantics).
Curiously, whilst they were reluctant to label me (because that would involve them doing some work), they expected me to be able to label anyone and everyone else who I’d ever come into contact with (friends, relatives etc), whilst simultaneously being discouraged from any awareness of my own condition or any action that might actually get me out of the vat of superglue I was drowning in.
The whole process was aimed at people with the intelligence and understanding of a two year old. Or someone with learning difficulties. I suppose it’s not that long since they stopped speaking slowly to people like I, and while they’d reached a point where they are aware that we (patients) can understand simple conversations, they don’t seem to have arrived at the shocking realization that mental health problems, even the severest ones, can affect individuals across the intelligence spectrum, and therefore that treating everyone like the lowest denominator was incalculable. The public mental health system purposely makes you defer responsibility for your mental health and wellbeing to someone else (a “mental health professional”), rendering you helpless, demanding your deference and submission, and simultaneously blames you for everything that’s gone wrong in your life, therefore invalidating you and refusing to intervene until harm has occurred, rendering you even less able to help yourself. It’s a dangerous negative cycle to get caught up in.
After fifteen weeks of this, I snapped. I had been left in severe distress for five months by this point, since I first got referred to Mental Health services, and I was ready to chew my own arm off and throw it at someone in sheer frustration. I became suicidal because I could see no end to this situation, the people who should have been able to help me were standing around the vat of glue staring at me, remarking “oh look, someone’s drowning” but no-one would throw me the lifering. The glue was setting and I felt like I was trapped with no chance of escape. After my husband frantically phoned the emergency mental health crisis line and got no answer three times, he physically intervened to stop me suffocating myself with a carrier bag, and he literally dragged me out of the house at 3am and dragged me on a walk until I started moving my own feet and eventually keeping pace. I hadn’t left the house for 3 weeks by this point.
I’ve commented before about how bipolar depression is different from unipolar because it affects your motor function – it literally makes you grind to a halt, a side effect most of us are too static to notice when we’re in that state. I came across it in a piece of research in September and was astounded – it explained so much. On reflection, the mental health team seemed unable to recognize this, or the hypomania, and hadn’t offered any actual intervention or even a crisis plan by this point.
Once I was actually moving, I found it difficult to stop and I started speaking again, something I hadn’t done for several days. By the time we got back to our house, I felt a little better. But feeling better is only the train station between north and south, a scary precipice that only pretends to offer stability. We went back to bed. And I felt myself reinflating inside.
I didn’t sleep that night, I didn’t sleep for a week. By the Friday we were sufficiently worried that I contacted a private psychiatrist and paid around £350 to get my mental temperature taken. Since there were no private psychiatrists in a 100 mile radius, this happened via videoconference. I got a diagnosis letter and then started the uphill fight to actually get my doctor to prescribe me the medication I’d been recommended. I finally got to sleep.
I started both psychotherapy and EMDR. I got about four weeks into EMDR and decided I didn’t really get on with the woman doing it (she was nice but there was something off about the whole thing). I continued with psychotherapy.
Regarding the NHS (free) mental health team, I eventually got discharged because they’d had a very severe service cut and needed all the resources they could muster to deal with the backlash.
I paid for my own psychotherapy after taking time choosing a practitioner and spending the first week just interviewing candidates. It felt really good to actually have a choice over something, a refreshing change compared to the NHS’s prescriptive “you will have this and like it” nonsense where woefully inappropriate and underfunded services are foisted on “patients” by well-meaning but incompetent bureaucrats.
The first few sessions were more structured and established a history, then we delved into how to proceed. The psychotherapist’s approach was Gestalt psychology, the theory of perceptions and comprehension; see here for a discussion of how Gestalt psychology and Gestalt therapy mesh.
We worked on trying to make sense out of events. Sometimes he would prompt, other times I would arrive at conclusions by myself. At the end of some sessions I was given things to do at home (not exercises so much as thinking, for example “this week, just start recognising when people invalidate you.”
After five months, I can say it’s been incredibly helpful because now I recognize situations and feel more confident in responding from a stronger standpoint – for example, realizing my point of view is valid, it’s affected by my experiences, and that other people’s opinions are coloured by their own insecurities. This means when someone tries to invalidate a course of action, nine times out of ten I can smile and nod and go away and do whatever I want to, instead of feeling put down and starting to cry or shout or hanging up the phone. So I’m not changing the behaviour (which is a symptom of the deeper processes), but I’m recognizing the processes and consciously letting them take place. I’m not an expert on this but I think this is where CBT and mindfulness both go wrong (I did mindfulness for 2 months in 2014, and CBT in 2002 and 2005 which was so bad it took 9 years for me to even consider getting further help), because CBT and mindfulness both try and control the symptoms. Psychotherapy looks into the fundamental causes.
Having said that, I’ve found over the past two months my progress has ground to a halt and I feel like there’s not as much interpretation and as much explanation as I would like. I want to make sense of why I do the things I do and put my past traumas to rest, and for this I am now looking into moving into psychoanalysis.
Psychoanalysis is very similar to psychotherapy, except psychotherapy has less sense-making and moves at a faster pace over issues but a slower pace in terms of progress. As an example, I’ve been obsessing over my career for about 3 months now, and in psychotherapy I was directed towards using my teaching qualifications to work in a Steiner school (which is a moot point because you have to pay to train differently to work in those schools anyway), and encouraged to keep writing and to see the things I already do as a valid career (which has some merit but doesn’t pay the bills), whereas in psychoanalysis, I would expect us to work on why career is so important to me, why it matters so much for me to be doing the exact right job, getting at the fundamental value and motivations.
Psychoanalysis goes into much more depth examining the environmental factors which affect how we learn to behave (the cliche’d ‘tell me about your mother,’ for example) so you can use that understanding accordingly. Now that I’m in a stronger place from the psychotherapy, I want to move down into what happened to me and why and how it changed me. These are important parts of the PTSD and C-PTSD recovery process which make the difference between recovery and relapse.
Aside: The PTSD recovery ladder (because nobody tells you this shit when the plane crashes):
Soothe the pain (depending on the severity this will probably need medication).
Recover lost aspects of your self.
Find Meaning In Tragedy (incorporates sense making and benefit finding, which is not what it sounds like).
– Sense making: Putting the trauma into your wider framework, including reconciling it with your world-view.
– Benefit finding: Accepting how you have changed since the trauma took place, e.g. are you more compassionate now?
This is a very concise overview which I have re-written from Chapter 3 of the book Emotional First Aid by Guy Winch.
So that’s how I ended up in psychotherapy and how it has helped (and its limitations) for me personally. I obviously can’t speak for how effective it is for other people, but one thing I have been told categorically by psychiatrists is that CBT and minfulness are NOT APPROPRIATE for bipolar disorder if it’s confounded by PTSD or C-PTSD, and that it’s generally not appropriate for bipolar disorder on its own either. It is often offered indiscriminately because it’s cheaper than other therapies and more widely available, because people can train and practice faster in CBT and mindfulness so there’s more practitioners of this (in the UK, you don’t even need a degree to become a CBT or mindfulness therapist, and personally I find this deplorable because in my case, untrained “counsellors” have done MUCH more harm than good).