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.

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.