Psychotherapy Is Hard

I did eventually manage to get to sleep at about 3am this morning. I woke when the alarm went off at 9am; I had set it just in case I did get to sleep to make sure that I got up in plenty of time to get to the bus stop to catch the bus to the hospital for today's psychotherapy session.

Psychotherapy is not for the faint-hearted. In order to help one to make progress you have to commit to it wholeheartedly and invariably this means you will enter territory that you would rather avoid. This is not a new experience for me having undertaken a year of psychodynamic psychotherapy from May 2008 to May 2009. I learnt a lot about myself during that year and I had to delve back into my early life to find the triggers that had made me the person that I was and helped to explain why, having become so depressed, I was finding it so difficult to return to a normal happy life.

A more CBT approach is being taken with the psychotherapy that I am currently undergoing. the main aim of this therapy is to get me to stop the self-destructive pattern of anger suppression that I developed as a young child, with the aim that I learn to express my anger in a normal manner rather than turning it in on myself.

Deliberately trying to invoke a feeling of anger in someone cannot be easy, yet that is what my therapist has been doing over recent weeks. Today, he managed to bring about such anger in me that it was a physically painful experience for me. For the first time I realised just how much I had been turning that anger back in on myself and the the harm it has done. For the first time I realised how much it had affected my emotions over the years and how much and how often I had given way even when I knew I was in the right because I didn't want to get angry.

Anger is a normal emotion. There will always be thing that make us angry and we should learn how to deal with that anger when we are young. For some, anger is used as an excuse to be violent towards others. For others, anger causes raised voices and sometimes hurtful exchanges. For me, anger has become something which I am so afraid of that I strive not to show anger to others resulting in me turning it in on myself.

It's not easy to change things that have been part of me for 50 years. But I am working to make that change and that is why I can say

Psychotherapy is hard.

One More Session To Go

Today was my penultimate psychotherapy session. It was difficult; in fact, it was very difficult. I know that I am not ready for it to end, but end it must because that is the way of things on the NHS. There is never enough of what is needed.

As a former manager myself (though not in the NHS) I am well aware of the necessity of management of some kind, but I wonder how much more could be done for the patients' benefit if the multiple levels of management and the ridiculous amount of paperwork, results tables, protocols, and sundry other government and management requirements were to disappear overnight.

Mental health has always been a poor relation. It is not glamorous, nor is it seen as being of significant importance to this country. Yet the fact is that approximately 25% of the population will suffer with mental health problems at some time in their life, and a significant proportion of the population is unable to work because of mental health problems means that is should be seen as important. It is likely that the proportions will rise over the next couple of years because of the global financial crisis which has resulted in so many losing their jobs and the uncertainty that so many others feel.

As with everything else, this government has promised to do something about mental health provisions and yet their solution is far in the future and a least cost option. There is much evidence to show that psychotherapy can do much to make a change to the lives of those with mental health problems, particularly depression. But it is necessary to ensure that the right sort of therapy is provided for those that need it; and it needs to be available from the start, not when the situation has become so bad that the sufferer cannot work and their life has fallen apart. The government plans for there to be 10,000 therapists offering CBT in the next few years, but the Layard Report which brought about this decision by the government actually said that 30,000 were needed and that was before the financial crisis which is likely to increase the number of those needing help.

And CBT is not the global panacea that many seem to think it is. I am sure that it does help some people, but what is not widely reported is the number of people who are made well for a few months but then regress and have to rejoin the waiting lists for treatment of some kind. There is no point in offering a treatment that encourages people to change their thinking about the here and now if it is the long-distant past that is the root cause of their problems.

I know that I have been lucky. I have been receiving psychodynamic psychotherapy for a year now and it has made a significant difference to me. I have started to regain some of my self-confidence, and my weekly appointments have meant that there has been a little bit of routine in my life which has helped me get some structure in my life. But I know that there is still much work to be done to deal with the problems that led to me becoming ill. I need to understand how things that happened to me long ago and of which I had no conscious knowledge can be put behind me and I need to be helped to move on with my life. However, that is not going to happen because next week I will be saying goodbye to my therapist and I will be left on my own. I am being abandoned. Not because I am 'cured' but because the resources are not there to help those who need help.

Stage Fright And A Request For Help

Tomorrow is the big day and I have started to develop a bad case of anxiety. I still have a little work to do on the lecture, but it is mostly cosmetic in nature, and I also have to finish off the PowerPoint slides but that won't take much more than half an hour to do and is mostly a matter of copying and pasting information and then changing font sizes or adding in a few words. None of it is going to stretch my intellectual or computer skills. Which is just as well because I only had a couple of hours sleep last night, and the night before, and I am not overly optimistic about how much I shall get tonight.

The strange thing is that although I am building up to a truly horrendous case of stage fright, I am also rather looking forward to giving this lecture. It is the subject matter that made me agree to this in the first place; the user's experience of therapy. The mere fact that a 'user' is being asked to talk to people who are going to be among the therapists of the future to explain what it is like to go through therapy seems almost unbelievable.

Writing the material for the lecture has proven to be quite traumatic at times. My first experience of therapy was not good, and led to me distrusting therapy and therapists as a valid means of getting relief from depression. I have to say that the psychodynamic psychotherapy that I am undergoing at present has helped to change my mind about that. And the reason that I have changed my opinion is because of the massive difference in the therapeutic relationship that I have with my current psychotherapist compared with that which I had with my first one.

One of the things that I have been asked to provide for the students is a list of reading material giving a user perspective on therapy. The problem is that I have not read any books that are written by users; all the literature out there seems to be written by psychiatrists and psychologists and the books are written for the therapist, although some do provide a little useful information for the person who will be undergoing therapy. This is rather a sad state of affairs because it means that the patient/client/user (whatever they may be called) starts off at a disadvantage. They have no clear idea of what the therapy is going to be like, what they will be expected to do, and the kind of effects that it may have on them. I believe that this is part of the reason that so many people give up on therapy when they do actually manage to get it. Nobody bothers to tell us that the process is going to be difficult and that there are going to be times when we feel very uncomfortable talking about things with someone who is a stranger to us.

When I was discussing this with 'S' when we met a couple of weeks ago, he suggested that I might consider writing that book that doesn't seem to be out there at the moment. And it is something that I am seriously considering. It won't be a massive tome, nor will it be particularly learned, but if it can help people to understand what therapy can and cannot do, and help them to prepare themselves for the therapy experience, then it will be worth the effort.

The reason that I am writing about this, is that I need the help of fellow bloggers who have had the experience of therapy whether it be good or bad, and it doesn't matter what sort of therapy it has been. In fact the wider the range of types of therapy the better as far as I am concerned because then it will be possible to help more people. I know that bloggers who write about their mental health problems embrace the anonymity that blogging allows, and I am no different in this. I would like to ask any blogger who would be willing to help me in this enterprise to either contact me by submitting a comment to this post or by emailing me at madsadgirl@gmail.com. Because all comments on my blog are moderated, anyone who offers to help by submitting a comment can be assured that their comment will not be published if they ask for it not to be.

How Blogging And Psychotherapy Have Given Me A New Opportunity

As you know I don't look forward to Friday's very much. Friday is psychotherapy day and psychotherapy is hard. I can only speak about the type of psychotherapy that I receive, psychodynamic psychotherapy, and I can assure you that it can be very traumatic at times when looking into your long gone past.

However, I am aware that I am very lucky to be able to receive this sort of psychotherapy, and not on a short-term basis, because it is not that common on the NHS. Even though there have been times when I have needed a whole box of tissues to cope with the tears that have been shed in some of the sessions, I have learnt an incredible amount about myself and why I am the way that I am. I think the the worst of the digging into my past has been done, therefore psychotherapy sessions are a lot less emotional now, although there are still things that are discussed that are likely to lead to tears.

Yesterday's session required just one tissue; the tears were few, but I believe that a lot was achieved. I always have great difficulty in talking at the start of a session. I could probably count on one finger the number of times that I have actually been the first to talk at a session, but I usually manage quite well once I get started. Yesterday was no different to normal and my psychotherapist eventually got things going by commenting that I looked quite sad when he came to collect me from the reception area and wondered why this might be.

I wasn't aware that I looked sad, and I didn't feel particularly sad, for on Thursday I had an email that may well change my life. Well, it may give me the opportunity of doing something that will enable me to change my life. As a result of writing this blog, I have been approached to give a lecture and take part in a seminar entitled "The User's Experience of Therapy" as part of a postgraduate degree in Mental Health and Wellbeing at one of the London universities.

This blog really has changed my life. I have found a means of expressing my thoughts which avoids me having to have a conversation with myself; I have through a casual mention of the blog to my GP become involved in promoting patients' access to their medical records; and now the blog has been responsible for this new opportunity.

I am very nervous about doing this, and I have plenty of time to work myself into a real state of anxiety before it happens at the end of February, but I am also rather looking forward to it, because I believe it is very important that people understand what it is like to receive therapy and how it can do much to help, but how it can also, in the hands of an unsympathetic therapist, cause much damage.

Plenty of food for thought over the next couple of weeks.

Why Aren't GP Mental Health Referrals Hitting The Spot?

Today has been another day of blurred vision and very sore eyes. Reading has been difficult, and knitting all but impossible.  All of this means that I've been feeling low again.  

I have, however, been able to keep up to date with the blogs that I read on a regular basis, mainly because I can enlarge them enough to make reading them easy.  Two of these bloggers, Jobbing Doctor and Geepeemum have written about the difficulties of referring patients with psychiatric problems to see consultant psychiatrists or getting help from mental health crisis teams. These are problems that are often written about by bloggers with mental health problems too.

I have been relatively lucky when I have been referred for specialist help, but I am well aware that this has been the exception rather than the rule as far as mental health patients are concerned.  In the early days of my problems I was living in Cambridgeshire.  Whenever my GP referred me to see a psychiatrist I saw one, but that was in part because the psychiatrist was a personal friend of my GP, who was also the psychiatrist's GP, so my referral possibly did not have to face the hurdles that other referrals may have encountered.  But even though I saw the consultant psychiatrist whenever my GP considered it necessary, it did not mean that I necessarily got the best help from other mental health professionals.  This was particularly the case with the CPN who caused me so much angst that I came close to suicide after seeing her for a number of appointments.

Since moving back to London I have been referred by my GP for psychotherapy, and again I have been lucky.  I happen to live in an area of London which is served by a well known psychiatric hospital which happens to have a fairly large psychotherapy department.  Even so, I was warned when my GP made the initial referral that it could be a long time before I had an assessment, let alone received psychotherapy.  Luck was again on my side because I had an appointment for assessment within a few weeks of the referral and once it was decided that I was a suitable case for treatment (such a brilliant film title, and one that I have always wanted to use when writing on this subject) I was again warned that it would be many months, perhaps even a year, before a psychotherapist was available.  Fortunately I didn't have to wait too long for a psychotherapist to have a vacancy, and I have now been going for psychodynamic psychotherapy for six months now.

I know that I have been very lucky with the referrals and the treatment that I have received.  The problem is that not everyone who needs this kind of help is quite as lucky as I have been.  If certain cancer drug treatments are considered to be a post code lottery, then specialist treatment for those who suffer mental health problems is even more so.  Treatment should not be a last resort; it should not be necessary for someone to have to admitted to hospital in order to get the treatment that they should be getting as a right.

If the money that has been wasted so far on the infamous Connecting for Health had been put into Mental Health, then perhaps there might not be quite so many bloggers bemoaning how they feel that they have been abandoned by the NHS because they have a mental illness rather than ordinary physical illnesses. And the problem is that we are only the tip of the iceberg as far as people who need this help are concerned.

The government keep telling us that it is wrong to discriminate against those with mental health problems, and yet they themselves are doing just that by not making sure that this country's mental health services are properly funded and available to all those in need of help.

Things Didn't Go According To Plan This Morning

Even though I was exceedingly anxious this morning when I set out for the hospital for my regular psychotherapy session I was determined to have another good session.  I was going to try and start talking as soon as we were seated.  I knew what I wanted to tell my psychotherapist about.  I was going to start with my meeting with There and Back last weekend, and move on to something that I am going to be doing next Wednesday evening which is a totally new experience for me (well new in as much as I haven't done it for a very long time).

I walked to the bus stop and didn't have long to wait before the bus I wanted arrived at the stop and I boarded it.  As has been the case for many months now, there are huge stretches of road being dug up for the water mains replacement programme, so buses are on a diversion at the moment.  But that is not all, because the road onto which they are diverted also has one lane out of action for these road works, the bus has to stop at traffic lights that are controlling the single alternate lane working, the lights are at the bottom of a very steep hill and the bus can barely make it up the hill.

Anyway, I was sitting comfortably on the bus indulging in my usual habit of looking out of the window to see what was happening on the route, when I suddenly became aware that my mobile was ringing in my handbag.  You will understand how unusual this is when I say that there are ony a handful of people who know the number so I don't usually expect it to ring: the phone is really for emergencies.  I scrabbled around in my handbag and managed to grab the phone and open it before the caller had rung off.  It was somebody from the hospital phoning to tell me that my psychotherapy session had to be cancelled because my psychotherapist wouldn't be in because he had an emergency at home.  They had hoped to catch me before I left home, but I left a little earlier this morning because I knew that there were likely to be delays because of the buses being on diversion.

So I got off the bus, crossed the road and walked to the bus stop to get a bus back home again.  Having coped with pterodactyl-sized butterflies in my stomach this morning, to suddenly find that I was not going to have the psychotherapy session that I had prepared myself for left me feeling very low and fighting away the tears.  This seemed such a strange reaction but I suppose that because I am now truly engaging in the therapy, to suddenly find that I was not going to have that opportunity to talk things through as I had planned left me feeling a little bereft.

I had started to write this post when a comment on this morning's post came in for moderation.  It was from 'alhi' from Random Musings from a Wannabe who felt that I had changed since she had been reading my blog and that she was considering seeking referral to a psychologist again.  There have been a number of comments over the last couple of weeks from people who say that they can see a difference in my posts; and I, too, have said that psychotherapy was definitely beginning to make a difference to me.

Psychotherapy is not easy.  It requires a great deal of commitment on the part of the patient and depending on the type of psychotherapy that is offered, can require a significant amount of work outside of the therapy sessions.  Treatment such as the type that I am receiving (psychodynamic psychotherapy) is not readily available on the NHS.  For many people the only thing that they will be offered is a short period of CBT (cognitive-behaviour therapy), but it was felt that this would be of no use to me as it would not get to the source of my problems.  

Evidence shows that the so-called 'talking treatments' can make a significant difference to those with mental health problems.  For some, such treatment is sufficient in itself to help them over their problems.  They are, however, the minority.  For many others it is a combination of drugs and psychotherapy that makes the difference, and I am one of those.  After taking various different antidepressants for 10 years, I have finally found a regime that is actually helping to make a difference to how I feel.  The problem is that the psychotherapy is likely to be time-limited.  Okay, so I wasn't only offered a meagre eight weeks of therapy, which is often the norm, but I know that I am likely to find that my psychotherapy comes to an end in a few months time and that this will happen whether or not I have reached a suitable place for cessation of therapy.  It will happen because the resources (that is suitably qualified psychotherapists) are not available for the number of patients that require the treatment.  What worries me is having my therapy stopped before I am ready to cope with all that the world will throw at me.

Friday Is Doctor Day

I've written before about Friday being a day of seeing doctors.  Friday morning sees me attending my regular appointment for psychotherapy, and my first appointment of the day with a doctor. This hour of talking about myself and my feelings and thoughts about things in my life is not the easiest hour of my week, but it is helping me.  My friend, Mr Smiley, has said that he has noticed a big difference in how I am over the last few months and I know that going through the psychotherapy is a big factor in this.

I have always tried to set myself high standards to achieve, and for many years I did just that. But when I lost the support of my husband, I started to lose confidence in myself and my ability to do many of the things that I had done without thinking previously.  It wasn't just the depression that I started to suffer when my husband died, but also the harassment and discrimination that I started to encounter from some people at work.  For years I managed to keep working despite all this, but eventually it had such an effect on me that work became impossible.  During this time my mother had died very suddenly, so in addition to all the problems that I had at work and with my health, I had to keep an eye on my elderly father from a distance of almost 100 miles.  When my father died a little more than two years after my mother, work became impossible and my GP sought early retirement for me on medical grounds.

I decided to move back to London when I retired, mainly because I was not happy in the home that I had shared with my husband, but also because I felt it better to get away from the area where I was likely to see many of the people that I had worked with, and I could not face constant questioning about why I had to give up work. With the move came a change of GP, and a year ago, concerned with the depressive state that I was in, my new GP decided to refer me to the local Mental Health Trust to be assessed for psychotherapy.  I was lucky, I didn't have anywhere near as long to wait for assessment as my GP had warned me that I could expect to wait, and after being assessed as suitable for individual psychodynamic psychotherapy and warned that I would be on a waiting list for some considerable time; I started therapy three months later.  

I have been attending most Fridays since the beginning of May and the six months of 'talking therapy' have definitely made a difference to how I am feeling.  I still have periods where I fall into that black hole of depression, but I find that I can climb out of it more easily now.  And after suffering for so many years, I think that we have uncovered some of the things that caused me to be the way that I am and possibly why my depression, which originally was thought to be a grief reaction, has continued for so long.

This afternoon, I had to go and see my GP for a check on my present state.  Regular readers will know that the GP who I had been seeing when I registered at the local practice when I moved back to London retired a few months back.  I had needed to see a doctor when my GP was away at a conference, so I saw one of his partners, and finding that I got on well with this other doctor, it was decided that he would take over my care when my GP retired.  So new GP has been seeing me at fortnightly intervals since taking over my care, so that he can get familiar with me and my problems and we can develop a relationship that I will be comfortable with.

Today's appointment was the first since we had managed to get my blood pressure under control, so it really was just a case of me reporting in and saying that I felt fine. I expected it to be a five minute visit, but I was wrong. When I was called through, I got to GP's consulting room and he opened the door just as I arrived and as I was walking in told me that he had a medical student with him, and asked if I would be happy for the student to stay during the consultation. I surprised myself and my GP by saying that I was happy for him to stay.

The consultation that I expected to last just a few minutes took a little longer than that.  After getting over the shock of me agreeing to the medical student staying for the consultation, GP decided to use me for a good teaching experience.  I think I coped with it all quite well. Tears were very close on a couple of occasions, but GP kept a close grip on things so that I never went over the edge.  I hope that the medical student gained from the experience, I believe that I managed to climb another hurdle and get over it without any harm.  My psychotherapy was discussed in general terms, we discussed the strategies that I use to manage my day to day life when I am feeling depressed, and how studying has been one of my lifesavers over the last few years.

So I have seen two doctors and an almost doctor (he takes his finals next year) today, and I'm not even ill. Well, I have the last remnants of my cold, but nothing worse than that today.  Maybe my life is starting to take a turn for the better after all those years of despair.  I will obviously be susceptible to depression whenever I encounter really difficult times, but I seem to be learning how to deal with it and come out the other side without too much harm.

All Is Not What It Seems

Usually when I start to fall downhill there is a reason for it; an upcoming anniversary or something that has triggered things in my memory. But, as I fall deeper into the black hole that is depression, this time I am not aware of anything that could have caused it to happen.

Yesterday morning I went off to my psychotherapy session as usual. I was pretty anxious as I left the house and even more so by the time that I arrived at the hospital. My therapist was aware that all was not well almost immediately (I think the tremors in my hands may have been a bit of a giveaway) and decided that the session would take a slightly different path to normal. The session covered how I felt when a period of depression started, how I felt as it deepened and how I felt as I was coming out of it.

For me depression has always had a deeply physical side to it as well as the mental effects. When I am at my worst, my head and body no longer feel connected; there is a significant sensation of numbness in the area of my neck and shoulders. When I get to this stage I find it difficult to concentrate on even the simplest things, my sleep pattern gets worse as the days progress, and I start to have dark thoughts; my mind takes me to places that I really don't want to be.

For the first time ever, the session was a real two-way conversation and as a result I gained a lot from it because of the questions that my therapist was asking and the answers that I gave helped both of us to understand more about me.

Yesterday afternoon I had an appointment with my new GP. This was an appointment to go through the results of my recent blood test, to check on my blood pressure to see if the recent introduction of medication to lower it was having the desired effect, and for him to get to know a little more about me. He has requested that I book double appointments for at least the next few months so that he can get to know me as well as possible so that he can effectively monitor me.

The blood tests showed that all was well, my blood pressure has dropped to normal levels, and we had a good chat about what sort of psychotherapy I was having, about my sleep problems, and how I cope with things when my depression gets really bad. We also discussed a programme that the local council and PCT jointly run for people suffering from depression, anxiety and stress. The result of this discussion is that he has referred me to this programme and hopefully I shall soon be joining a local art class. I've never been much of an artist, but I've always wanted to be able to draw and paint, and I think that this might be a good way to help me with my lack of self-confidence, and help with dealing with social contacts. So with a bit of luck I will soon have a regular art class to form an alternative to my OU studies, and hopefully it will also help me focus on those studies a little better.

So what is this post all about? On the surface it may seem to be about me and my depression, but actually it is about something quite different. It is about two doctors; both of whom helped me on a day when I was feeling very down. Neither of them have made me feel better, but both have helped me to understand why I am the way that I am and have helped me to find ways in which to come to terms with that.

So, why is it that there are so many people in government who feel that doctors are not doing a good job and therefore it is necessary for them to interfere in the NHS? The problem is the government are not talking to the patients about how they feel about the NHS and its staff. They listen to big business, and to people who have an axe to grind. If they really want to know how to improve the NHS they should listen to more people like me; real patients with real problems, who are getting excellent support from their GP, access to treatment for mental health problems, and who appreciate all that is being done for them, and they need to listen to the the kind of doctors who are looking after me. It is always those at the coal face who know most about the business, not those who sit in offices far away and who have no idea about what really happens.

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.