Friday, 15 August 2008

Fridays Are Hard; It's Psychotherapy Day

I have mentioned several times in this blog that a significant proportion of the population of this country don't know how to deal with meeting someone with depression. In recent years there has been a lot of emphasis on the fact that depression is a form of mental illness, and it is mental illness that people are scared of.

My first encounter with depression was more than 25 years ago, when I suddenly started to suffer periods of unstoppable crying, night after night of being unable to sleep, a total loss of appetite, and a loss of interest in my work, which was totally out of character for me. I was serving in the RAF at that time, so eventually I paid a visit to the Station Medical Centre (SMC) and saw the Senior Medical Officer (SMO). The SMC acts as a GPs surgery for service personnel on the unit, and the SMO is the equivalent of the senior partner in the practice. I was prescribed anti-depressants and the SMO requested my boss move me to a less stressful job for a few months so that I could regain my equilibrium and pleasure in my work. It all worked, less than four months later I was back to my old self and the depression was something that I forgot all about.

Almost 10 years ago, my husband died very suddenly a few days into our holiday abroad. Fortunately, my parents were on holiday with us, and we were staying in a hotel where we had stayed many times before, so the staff knew us very well. We also had a number of friends who live on the island, and hotel manager phoned them to let them know what had happened.

The next few weeks passed in a bit of a haze for me. Some things I can remember as though it was yesterday, while there are other things that I cannot remember at all. About two months after my husband died, some of my colleagues began to get very worried about me. I would walk about as if in a trance, I would fall asleep at my desk, and they noticed that I was rapidly losing weight. They were ready to tell me to go to see my GP when something happened that scared me so much that I made an appointment myself.

I was diagnosed as suffering from depression caused by a grief reaction; something that was not unexpected considering what had happened. Anti-depressants were prescribed, at a very low level to start with but being increased over a period of a couple of weeks. I had to see my GP every week so that he could assess how I was doing. After a couple of months it was decided to change the anti-depressant as the first one did not seem to be having much of an effect. This change seemed to make a big difference and I started to look less haggard, began eating a little better, and being able to sleep at night rather than at work.

About a year later my last remaining great-aunt died, and her death was followed a few days later by that of her brother, my great-uncle. I hadn't been sure whether I would be able to cope with one funeral, but a double funeral was out of the question and my parents decided that it was best if I did not attend. At about this time, my GP decided to refer me to see a psychiatrist at the local Mental Health Trust.

This was the first time that I started to be really afraid about what was happening to me; after all, psychiatrists look after mad people, don't they? To this day, I really don't remember too much about this meeting with the psychiatrist, although I did find it disconcerting that the door to the building had an intercom entry system, and that I had to sign myself in and out of the building. The fact that it was a dark and dingy Victorian building, that in no way looked inviting, didn't help to alleviate my distress at the situation either. However, the psychiatrist turned out to be a very nice man, and although I can't really remember much of what I said in answer to his questions, he did tell me that he thought that I could benefit from counselling from a CPN.

A week or so later, I received a letter giving me a date for my first counselling session. I attended at the time requested and found myself being asked to fill in a questionnaire that seemed never ending. I can't remember how many questions there were, but it seemed that many of the questions seemed to occur several times, each time expressed in slightly different words. I might have been depressed, but I wasn't stupid. Anyway, after I filled in the questionnaire, the CPN asked me some questions and then asked me to start talking about myself and my life with my husband. It was difficult, but I tried. Further appointments were made for me to see her weekly, and I attended another three or four sessions, but a very close friend and colleague at work saw the effect that these sessions were having on me and after careful questioning decided that I needed to see my GP. An urgent appointment was made and I saw him less than an hour later; the result was that he decided that the counselling should stop because it was obvious that it was having a very detrimental effect on me and my depression was becoming worse. Although I saw the psychiatrist several times over the following years and always benefited from seeing him, counselling was not suggested again.

When I moved to London I registered at a new practice and saw the senior partner. After a slightly dodgy start, caused by him making a comment without realising the effect that it was going to have on me, we got along well. He was concerned that I had been suffering from depression for so long without any real sign that I was getting better. I seemed to have sunk into a depression after my father died that I just couldn't climb out of, so towards the end of last year he decided to refer me to our local MHT for psychotherapy. He told me that the service was severely stretched and that it would probably be some considerable time before I got an appointment for assessment to see whether they could offer me anything, and that it was likely to be a year or more before I started to receive any treatment.

Although so much of the population suffers from mental health problems and so many could benefit from the so called 'talking treatments' they are incredibly difficult to get from the NHS. There are many psychotherapists in private practice, but how do you choose one, how do you know what type of psychotherapy is right for you, and how much will it all cost? For most of us, this just isn't an option that we can afford to even look at, and I knew that it was impossible for me, so I resigned myself for a long wait for treatment on the NHS. Perhaps the most worrying thing about all this is that I live in London, and London is one of the few places in the country that you stand a reasonable chance of getting the psychotherapy without having been admitted to a psychiatric hospital first.

About 10 days after my GP referred me I received a letter from the hospital inviting me to make an appointment for assessment for suitability for treatment. So six weeks after my GP set the ball rolling I went for assessment, and after about an hour and a half talking with one of the senior psychologists he decided that another assessment appointment would be worthwhile and that it was likely that I would be offered psychotherapy. The next appointment was a month later, and at the end of the process it was decided that individual psychodynamic psychotherapy was the treatment that I was most likely to benefit from.

There are many different types of psychotherapy, some individual and some conducted in groups. Many people are offered short periods of cognitive-behavioural therapy (CBT), but neither this nor group psychodynamic therapy were considered suitable for me and my problems. Having been told that individual psychodynamic psychotherapy was what was being offered to me, the senior psychologist who conducted my assessments gave me details of what the therapy would entail and that I would probably have a long wait before a psychotherapist would be available to add me to their list of patients. One of the benefits that I had, was because I am unable to work at the moment, when a vacancy did arise, it would be possible to accept the time offered.

Having steeled myself for months of waiting, I was somewhat surprised, and my GP was absolutely stunned, that I was offered an appointment with a psychotherapist to discuss the possibility of starting therapy, just two and a half months later. I accepted the appointment, went to the hospital on the appointed day, and met the doctor who was to be my psychotherapist if that particular day and time were acceptable to me. As Friday at 10 o'clock was fine, without further ado the therapy started. It rather caught me on the hop, because I really wasn't expecting it to be so soon, and certainly not that day.

For those who don't know what psychodynamic psychotherapy is about, I will give this particular patient's view of what happens. Psychotherapists may be psychologists, some are doctors (in fact psychotherapy is now a compulsory element of the specialist training for psychiatrists), and some may be social workers who have undergone additional training in psychotherapy; mine is a doctor. My appointments are at the same time, on the same day of the week, and take place in the same room each time. Each session lasts between 50 and 60 minutes; the time varies slightly so that a convenient stopping point can be found. The relationship between the therapist and patient is somewhat strange, in that the patient is expected to reveal all about themself, while the therapist reveals nothing of themself. This may make the therapist seem remote for some people, but accepting that this is what the relationship should be is the first step to a good therapeutic relationship. For many, psychodynamic psychotherapy offered by the NHS is time-limited from the start; this means that it is decided that you will have a certain number of sessions, often 20 or 30, and that the therapist will move the process along so that certain stages in the process occur at specific times. I am lucky because I was offered psychodynamic psychotherapy that was not limited by time; in fact I was told from the start that I would probably be attending for more than a year.

At first the thought of talking about oneself for 50 minutes can be very daunting, and I found it particularly so as I had never been someone who let much out about themself to other people. Part of this was shyness on my part, and part a reluctance to talk about my work (which is the subject where many social conversations start) because I was not allowed to. This type of psychotherapy is not a two-way conversation; the therapist will often only speak if the silence at the start of the session is prolonged (and even after attending for three and a half months now, I can rarely start talking without prompting) or to suggest the possible reason for feeling the way that you do about some particular thing.

To start with the sessions are all about you, and your feelings; they are the way the therapist gets a feel for who you are, what your problems are, and hopefully what has caused these problems. They can be very traumatic, and can delve far into your past. You find out things about yourself that you never realised, and you start to understand why some things that have happened to you, occurred. Many things that occur in childhood or early adolescent years can be what sets the seed for mental illness in later life.

Some weeks ago, I had a particularly traumatic session. I found out something that had never occurred to me before. It has already helped me to understand why I am the way I am and it is helping me to talk about more things that have happened in my life, and how they have affected me, at subsequent sessions. One thing that you should always do is go with a good supply of tissues, for it is certain that the sessions will be emotional. I have actually managed one session so far where I have not cried, but it gets easier to talk each week as I bring out things that I have forgotten about or never realised before. To show how far I have progressed, I have been able to write this post without becoming emotional; just a few weeks that would have been impossible.

I hope this helps you understand why Fridays are hard for me, and that it gives you a little insight into something that you may have heard about but always wondered what it involved. Feel free to ask questions if you want, but be aware that I will obviously be quite careful how I reply.


Anonymous said...

Fascinating post; it's really interesting to hear your journey so far. I'm constantly frustrated by the difficulties I have in accessing psychotherapy for my chronically depressed patients. I've done quite a bit of psychiatry and it is always heartening to see the benefits of individual or in some cases group psychotherapy - but access is so limited. You were lucky, I think.

madsadgirl said...

I believe that I was extremely lucky. Not only did my GP warn me that I could be waiting for a very long time before I started therapy, so did the senior psychologist with whom I had the assessment appointments. I was really shocked when I was offered therapy so soon because I had been told that there was a great shortage of suitably qualified psychotherapists. I have been very lucky with my therapist too, because even though I am old enough to be his mother, I feel comfortable with him, and have probably revealed more to him about myself and my past than I ever have to anyone else, and that probably includes my husband. I can truthfully say that I am feeling better now than I have at any time in the last two and a half years, and it is the work that I have been doing at my Friday morning sessions that have made the difference.