No Pterodactyls Here

It's Tuesday. Tuesday is psychotherapy day and in the past I have written about the butterflies in my stomach that seemed to be the size of pterodactyls as the awful hour approached. I used to try everything I could on a Friday morning to keep the anxiety under control but usually it was in vain.

When I was having psychotherapy with J last year I found that I rarely had any signs of anxiety until he called me into his office, at which point I would be overcome with such gut-wrenching anxiety that it was possible to see the physical effect that it was having on me. J always used to say that to see me like this made him feel as though he was torturing me.

But one thing I have noticed since I started group psychotherapy just a month ago is that there don't seem to be any particularly signs of anxiety at all. It still isn't the most comfortable experience in the world but there is no stomach churning, no feeling of butterflies, and definitely no pterodactyls.

Just Filling You In

Yes, it's really true, I am back blogging again and I have been amazed to receive comments from some old regulars because I had thought that everybody would have forgotten me.

I'm afraid that I don't have a particularly good excuse for not blogging, just complete inertia on my part. The depression has been relatively stable over the last few months although there have been a couple of blips but nothing that I haven't been able to cope with.

When I last posted I was talking about all the Christmas presents that I was knitting. I'm pleased to say that all of them except one were ready and given in time for the big day and the one that was late was only a few days late. Since then, I have continued with my knitting but I have started to work on a new project which may take me a while but will, I hope, be of great benefit to new knitters (I'll tell you more in another post).

So, what have I been up to? My crochet classes on a Thursday evening fill up almost as soon as they are put on the website and four courses have now been completed. And I have now started teaching knitting on a Tuesday evening. I still can't believe that I am being paid to do something that I love so much and I am glad that I am able to impart some of my knowledge to a new generation of knitters and crocheters.

As regular readers will know when I was receiving psychotherapy last year my therapist referred me for group therapy. I joined a group at the end of January so my Tuesdays are now quite busy. It's a quick lunch then on to the bus to take me to the hospital where the group meets, and hour and a half of talking and then across the road to catch a bus to the shop where I can indulge in a couple of hours knitting before the knitting class starts.

The biggest change, however, is my move to new accommodation. I now live in a basement flat situated in a house which provides accommodation and support for 21 people with mental health problems. My accommodation comes free of charge because I provide night cover for the residents. On the evenings that I am teaching one of the day staff takes care of the evening routine until I return at about 10pm. The job is not exactly demanding requiring me to only 'work' for a couple of hours each evening, and once completed I am free to return to my accommodation and go to bed whenever I want.

It seems that for the first time in many years that I am having some good luck for a change and that I do seem to have a bit of a future.

Thinking About The End Of Psychotherapy

I'm not coping with this hot weather very well. I have lots of windows open but there is nothing much in the way of movement of air so it isn't helping me to keep cool. It's too hot to contemplate cooking which I probably couldn't cope with even if it weren't so hot, and I don't have anything that I can just throw in the microwave to heat up. Going without food is not a good idea so I have ordered a pizza to be delivered later when the temperature has hopefully gone down a little and the thought of eating something is not quite so unpalatable.

I think that it is unpalatable thoughts that have been part of the reason that I have started to go downhill into the depths of depression again. These thoughts invade my brain at any time that I am not actively concentrating on something else, and it is the difficulty of maintaining concentration that is inherent in depression that allows these thoughts in.

I live alone and spend most days isolated from the rest of the human race. Part of the reason for this is that I find it very difficult dealing with new people and have done for most of my life. The consequence of this is that I am alone, but that is not the same as being lonely. I don't feel lonely, just alone and as I get older this seems to get more difficult to deal with.

I have made efforts to change things. Recently I have joined the knitting group that meets at I Knit London a couple of times a week. It's not exactly local but close enough to home for me to make the journey at least once a week and sometimes twice. The ladies (and the couple of gentlemen) who meet at this shop for knitting, having the odd drink, and partaking in a lot of conversation, not all of it about knitting, are an incredibly friendly group and have made me feel very welcome.

My joining such a group would have been something unthinkable this time last year and I still find it difficult to believe that I have taken such a step. I still suffer great waves of anxiety when I set out to go to the group, but having to make a fairly lengthy bus journey to get to the venue does allow me time to try to relax. I know that I have most difficulty with group situations when I have to walk in on a group that is already present so I tend to arrive early so that the members join in ones and twos after I am already present and for me this is a more comfortable situation.

The strength to join this group has come about as a direct result of the psychotherapy that I have been undergoing since last December. This therapy was originally meant to finish at Easter but my therapist felt that further long term therapy, this time in a group setting, was needed so after having referred me to the mental health trust's psychotherapy services for assessment as to suitability for group psychotherapy, he decided that our sessions together should go on for longer.

This therapy is now approaching its conclusion. It will come to a close at the end of July, so with me being unable to attend one session because of my impending day surgery, I have four more sessions with this therapist. During our last session he asked if I was concerned about the impending termination of therapy. I replied in the negative, but I am now not so sure. I think that it is almost certainly one of the factors in my descent back into depression.

After such a difficult termination of therapy last year it is perhaps not surprising that the impending termination of therapy is playing on my mind. I know that it is going to be difficult, but I am being seen by a very experienced therapist, a senior consultant psychologist, within the mental health trust, and he is aware of how I was left feeling abandoned after my previous therapy. I also know that he is going to do everything in his power to ensure that I am not going to be left hanging as I was before.

I have made significant progress over the last few months. Psychotherapy is still something that I find difficult; I just don't like talking about myself and my feelings. However, we have worked hard on certain aspects of my behaviour and I am now much more aware of when I am moving into difficult territory and am therefore more equipped to deal with it.

I'm certain that I will still find the end of this therapy very difficult, but I know that it is only a matter of time before I enter a new phase of therapy, this time in a group setting. The talking therapies are regularly offered as the answer to so many of the problems that those with depression are faced with, but it is important that the therapist is well qualified, and because many of those who are most in need of such treatments have no means of paying for therapy and must rely on what little is available on the NHS, it is important that as many good therapists as possible work for the NHS.

In four weeks time I am sure that I will be sitting here contemplating my final therapy session with J. He has made a tremendous difference to the way that I am over the last six months and has helped me come to terms with so much that has happened in my life. I will, of course, thank him, but that seems so little when I consider what he has done for me.

Psychotherapy And All That

I've had a busy week and it's only Wednesday. Other people probably wouldn't see it as a busy week, but as I rarely leave the house other than for my weekly psychotherapy session, to have been out for prolonged periods on three consecutive days has been almost unheard of for a considerable time.

I've already written about Monday's activities, so here is an update on what has been happening over the last couple of days.

Yesterday saw a return to psychotherapy after a two-week break while my psychotherapist was on leave. I have always suffered with terrible anxiety before my psychotherapy sessions but over the last month or so I have found Tuesday mornings less of an ordeal. I still leave the house far too early for my 11.15am appointment, but being early for any appointment is not something that I am really concerned about. On arrival at the hospital I got myself a cup of tea from the kiosk and went outside to the garden to sit in the sun while I drank my tea.

It was very apparent that Spring has finally arrived in the hospital's garden. When I was last there the trees were still barely in bud and only a couple of daffodils had managed to force themselves into bloom. Yesterday, the trees were covered in fresh green leaves and in addition to there being many more daffodils, there were tulips and several shrubs in full bloom.

Eventually it was time for me to make my way up to the 4th floor for my appointment. At this moment I was still calm but the moment that I took a seat to await my psychotherapist calling me to his office, the anxiety started to begin. I had a few minutes wait, all the time willing myself to relax and being partly successful. But it was all wasted because the moment that my psychotherapist said hello and I walked into his office anxiety swept over me in painful waves. And as I sat it my usual chair my therapist was aware by my body language and the pained expression on my face what had just happened.

What was to follow was even more difficult to deal with. After a brief discussion of how I had been since I had last been for therapy, the intensive work began. The probing, the answering of questions, the raising of emotions and being encouraged not to suppress them as I have done for most of my life but to allow them to come out was painful both mentally and physically. It was a hard session yet at the end of it there was a vague sense of success in that I had allowed these feelings out rather than having used them as a weapon against myself.

The session ended with a brief discussion of my feelings about the assessment appointment that I was to have today to find out whether I am a suitable candidate for group psychotherapy. I said that I wasn't particularly concerned about the assessment as I had been through this process before, but that I was aware that some difficult things could come up and that I felt that I would be able to deal with them.

Today arrived and after a bad night with only a couple of hours sleep I was very anxious. I arrived for my appointment about half an hour early and having reported to the reception desk I sat in the waiting area and attempted to read to take my mind off what was to come. Eventually the psychologist with whom I was to have the appointment came to meet me and after saying hello and shaking hands we went to her office for the assessment to begin.

I had been sent a very long questionnaire to fill in in preparation for this appointment some weeks ago, and armed with this, and all the other records that the mental health trust has on me, the psychologist had a lot of information, so some of the most difficult things in my past did not need to be gone over again. There is no doubt that this was probably the less emotional assessment appointment that I have ever had, and while there were tears when I was asked about the circumstances of my husband's death and at a couple of other points in the 90-minute appointment, it was not the traumatic experience that the first assessment appointments had been just over two years ago.

The result of today is that I have been put on the waiting list for group psychotherapy and hopefully in a couple of month's time I will be invited back for a couple of appointments with the psychotherapist in charge of the group before actually joining the group for regular therapy.

Tackling The Mental Health Minefield Part 8 - OT? What OT?

(This post continues the story from Tackling The Mental Health Minefield Part 7 - The GTN Story)

Having to spend a long period in hospital, and these days anything more than a week can be considered a long time, means that there can be a lot of empty hours to fill. When that hospital is a mental hospital then one can expect to be mobile and the empty hours can seem interminable. Mental illness can make it difficult to concentrate, or to be able to do something for a long period of time. My experience of mental illness is depression and I have tried many things to deal with the hours of the day. I read, I study, I do crossword puzzles, I knit, I do embroidery and I make cards. Sometimes I can't do any of these things for more than an hour at a time and sometimes I can spend all day on one of these activities as long as I don't encounter any problems. Problems are very difficult to deal with and so I end up putting whatever it is I am doing aside until I am feeling a little better and can deal with the problem.

During my stay in hospital, life soon settled into the routine so loved of such organisations. Breakfast would be served at about 8am, meds and obs at 9am, lunch served at about 12.15pm, meds at 1pm, dinner at about 5.15pm, meds at 6pm and night-time meds at 10pm. I expect that it is pretty much the same in any hospital.

Visiting hours were 2pm to 5pm and 6.30pm to 8.30pm. The difference between visiting hours in a mental hospital and an ordinary hospital is that there are very few visitors; most patients have no-one visit them from their admission to the day that they are discharged.

So what do patients do during the rest of the empty hours in a day? Well, there are of course ward rounds, but while these may take a considerable time during the day, the patient only attends ward round for a limited time. Most of my visits to see the consultant psychiatrist and whoever else was in the room (see Tackling the Mental Health Minefield Part 6 - Throwing The Christian To The Lions) were no longer than about 10-20 minutes twice a week.

While I was on the admissions ward there was nothing organised for us to fill the empty hours. As is common to most accounts of time sent on mental wards, we were expected to spend most of our time in the communal areas. These were the TV room and the dining area/day room. During my time on the admissions ward I went in the TV room twice; both occasions being for ward meetings. The dining area/day room had tables and chairs sufficient for 12 people, but the ward could take up to 16 patients, which meant that if the ward was full it was impossible for everyone to be able to sit down together at meal times or during other periods of the day. So I spent some time in the dining area/day room particularly when I had made myself a hot drink or for meals, sometimes I would read a book or doing sudoku puzzles. I had always found sudoku puzzles impossible to do even though I understood the requirements for completing them because I have number dyslexia. However, one of the patients that I was on the admissions ward with spent time explaining how to do them and I became hooked. Most of the rest of the time I spent in my room trying to catch up on sleep that I wasn't getting at night or reading. There were no organized activities for us to take part in.

When I was on the second ward, there was an activity semi-organised for each morning (Monday to Friday) between the hours of 10-11am but these rarely took place. The two which did seem to be regular events were a session of creative writing on a Tuesday morning and a group psychology session on a Thursday morning.

The first Tuesday that I was on the ward (I had been on the ward for five days then and in hospital for two weeks) two occupational therapists approached me when I was in the main corridor of the ward walking from the laundry room with my arms full of the washing that I had just done, and tried to get me to join in with the creative writing. I took my newly laundered clothes back to my room and went to the OT room to wait for the OTs to round up any other patients who could be dragged along. They were unsuccessful, so there I was sitting in a room with two OTs and all they could suggest to me was that I might like to write about what had led to me being in hospital. Now maybe I was just being over-sensitive, but I really didn't think that was a very good thing for me to be doing at that time. So I thanked them very much and left to go back to my room to read my book.

I was absent from the ward on the following Thursday morning as a result of being on my first attempt at home leave. I arrived back on the ward at lunch time so I missed the group psychology session. The following week however, I was persuaded to join three other patients from the ward and one of the nurses at the group psychology session and spent an hour away from the ward with one of the psychologists and his trainee psychologist. Each of the patients were given time to talk about how they ended up on the ward, the other three having been present at the previous week's session they went first and then it was my turn. I was asked a number of questions which I have to admit I answered only briefly and then I was asked about my depression and how long I had been suffering from it and how I had ended up in hospital. I answered at length and what I had to say somewhat surprised the other patients who had no idea that I had been suffering for so long or that this was my first admission to hospital.

Then we began to talk about life on the ward and I raised the subject of the 'protected hour' that we were supposed to have everyday between 11am and lunch. As this is going to be the subject of another post in this series I won't go into too much detail here, but from being someone who pretty much kept to myself on the ward although I did talk with a number of the other patients, I suddenly found that I had become a spokesman for not only those patients at the group psychology session but also those who weren't.

So, at the end of this post I go back to the subtitle that I used. OT? What OT? I know that some things that traditionally come under the title of occupational therapy involve cost and money is something that seems to be in short supply in mental health services, but the significant lack of anything that could be termed as 'helpful' in making the empty hours pass more quickly for the patients was alarming. The wards had televisions, and a small supply of books, but nothing much else. The result was that some patients spent most of the time in their rooms and socialised only at meal times. It is probable that the nurses wrote up their notes on the patients on each shift and commented that the patients didn't seem to do much, but it has to be said that there really wasn't anything to do. I would have loved to be able to do some knitting, but knitting needles were not allowed on the ward. I understand that they could be used as a weapon if used in public areas, but if I was to knit in my room and return the knitting to the staff when I had finished for the time being would certainly have helped me considerably.

I was lucky: I was only in hospital for a month but by the time that I left I was desperate to do some knitting or something other than read a book and do sudoku puzzles. As far as I am concerned this is an area what definitely needs something done about it. I know that some patients probably wouldn't want to partake in anything but there are definitely some who could almost certainly be helped considerably if there was something to help to pass the time in an environment that is not always conducive to improving one's mental health.

Psychotherapy And Termination

As usual for a Thursday night I had to make do with just a couple of hours sleep last night. But for all that I was quite alert when I left the house this morning to make my way to the hospital and my psychotherapy session. And I was fine until my psychotherapist came to fetch me. From that moment on I started to get into a panic and by the time that we got to the room that we use my heart was pounding and before I knew it tears were running down my cheeks. I don't know why I was like this, maybe it was because of the way that I have been feeling for the last week or 10 days.

My psychotherapist let me get myself together again and then started the conversation by asking if I had thought about the termination of the therapy that I have been undergoing. I haven't; probably because I know that I am not yet ready for this eventuality, but there is a problem with the fact that I am not ready. I have known from the start that this therapy would only be for one year and the end of that period is approaching. I should have been prepared for this subject being broached because of something that my therapist asked me last week, but I suppose that I didn't want to think about it because I don't think that I am ready to end therapy.

It is about six weeks until my year is completed, but Easter is going to fall within this period and that means that I will not have therapy on Good Friday. So today we talked about the termination of our therapeutic relationship and how that made me feel. That was easy to answer. I feel like I am being abandoned. Though I have made a lot of progress over the period that I have been having psychotherapy, I know that there are still a lot of things that I need to come to terms with before I can say that I can cope without it. And that is an achievement in itself.

When my GP referred me to the hospital for this psychotherapy, I was sceptical about it. I was not sure that it was the right thing for me, possibly because of my horrific experience with the first therapist that I saw all those years ago. The two assessment appointments that I had at the hospital were very traumatic but the psychologist who carried out the assessment thought that I was a good candidate for this type of therapy and that it would help me. He was right; it has helped because I am able to do some things that would have been impossible a year ago. But I am still not at the stage that I want to be and this means that I need to continue with therapy of some sort so that was the next thing that we discussed.

One of the three possibilities was sort of dropped almost immediately. I don't think that my therapist thinks that it is right for me, so although he offered it as a possible option, it formed no further part of our conversation. The other two possibilities have given me a lot of food for thought. He could refer me for group psychotherapy at the hospital that I attend now. This would mean that I would be taking part in the same sort of psychotherapy but in a group rather than as an individual. There are merits to this but also one major difficulty. The difficulty is that I am not sure how I would cope in a group as talking to other people about myself and my feelings is not something that I find very easy. The other possibility is that I be referred for full-blown psychoanalysis. Unfortunately this would not be available on the NHS so I would have to pay for it, but my psychotherapist does feel that this could be the way forward for me.

Obviously this is going to form the basis of my psychotherapy session next week, at least to start with, and it is something that I need to think about and investigate in the meantime. I wish that I didn't have to stop therapy with my present psychotherapist because I have got used to him and I feel that we have been getting somewhere. But it has to happen and I will have to accept that. But I can't help feeling that I am being abandoned and that whatever happens I will have to start all over again.