Tag Archives: assessment

Therapy 2021: Session 4

Date of session: 26/01/2021

Please be aware that some of the content may be triggering. Please take care πŸ’š

Before this session I had homework to do. I left it until the last minute due to feeling ill and tired most of the time. I also knew it would be hard as it involved identifying emotions at some level. This is an area I find hard and frustrating. I also had to build a new safe place to use to do this. This I resented. I did it the night before.

At the start of the session, as always, I was asked how I’d been over the last week. I said about the pain and tiredness. She asked how I’d been doing with the self harm and I replied I still hadn’t self harmed since before Christmas. She was pleased with this. I am less so at this time. She also asked how my dissociation had been which I always find hard to answer as I’m not always aware when I’m dissociating. I explained a couple of things and she said it sounded more like acting mindlessly rather than dissociating. I’ll agree to disagree here but hey ho.

We then moved on to look at the new safe place I had created and went through all its sections and the different senses that related to it. I won’t discuss my safe place at this time as I’m not sure it is a wise thing right now. She was happy with the place I’d created and the use of senses. She then asked about emotions and feelings in the body. This is where I had difficulty and this made me feel uncomfortable and annoyed (anger and annoyance I can identify, though not always accurately in others). She now wants me to keep going through the safe place when I’m not stressed to see how it reduces feelings and calms me. Then move on to practicing it when I think of a mildly irritating scenario. At the moment I’m in a constant state of anxiety so we will see how we go.

After this she wanted to discuss next steps. She had, had her supervision meeting and discussed about doing further trauma work with me now I wasn’t self harming (a prerequisite I had been given). It was now decided it was still to unsafe to do the trauma work online due to my high score on the DES (Dissociative Experience Scale) as she wasn’t in the same room as me. I understand this to an extent but it feels like I have to somehow get better so I’m the right level of ill. I can’t be too ill, but I can’t be too well.

The above led me to having to make a decision. We could do another couple of sessions winding down and then leave it until face to face was an option or I can join a trauma information group in March for eight weeks and next weeks session would be my last individual session. I explained I would have to consider the timing of the session and how it would impact on my family as its a two hour course. I had some less than pleasant comments in response that left me incredibly upset, including “the group will go ahead with or without you” and “you’re lucky to be offered this so soon”. I don’t dispute how lucky I am, I just needed to consult others as I’m not the only person it will effect. She knows of the difficulties at home. I was told to just be assertive.

After the session I was in tears. I felt some of the comments were unfair. I had not turned it down flat, just explained that I wasn’t sure I could do it due to the issues in my family. But then I was an awful person. I feel now something that may be paranoia but also may not be, which is that this has all been to leave me without support and the world knowing how awful I am. I’m still not feeling great in regard to this. I have considered emailing the psychologist but I’m also scared too. It has triggered a lot of feelings of fear of abandonment.

I have managed to arrange that I will be able to attend the group of the offer is still open. We will see what happens next week.

Therapy 2021: Session 2

Date of session: 12/01/2021

Please be aware that some of the content may be triggering. Please take care πŸ’š

This session was an incredibly difficult one. I still feel very unwell from the session even after over 24 hours after the session. Many things were covered.

We started the session by looking at how I am doing with not self harming. At the time of the session I was on day twenty eight since I’d last sef harmed. I explained it was still causing me extreme anxiety that people will become ill. I explained I’m trying to keep going over the rational side of things but it is hard, especially before sleep. We talked again about the rational side and things I can do to make my bedtime easier. She then set me the hardest thing I could think of doing at this time. She wanted me to wish for her to become ill each day.

As soon as she said this to me I felt physically sick. The thought of saying that I want anyone to become ill is just so against what I think and feel and do. I’m still finding it hard to comprehend and my first day of trying it has left me feeling even more physically unwell. I understand the point is to show me I don’t have the power to make people ill but I’m still scared.

We also looked back aty results from the Dissociative Experience Scale (DES) that I completed in the last session. It came out pretty high at 85% out of 100% which says I’m dissociating a lot of the time in different ways. We looked at specific questions I scored highly in more detail so she could get a bit of a more in depth understanding about my dissociation. Problem with this though is that when you dissociate quite often not aware of things so it was tricky.

We also completed the IESR questionnaire which looks at the effect of trauma on my life. This consisted of twenty two questions related to how much certain things, linked to trauma, effected me in the last week. I scored fifty three which is apparently quite high and suggests PTSD (Post Traumatic Stress Disorder) which is stressing me to the point it impacts on my immune system. So it’s nice to know I score highly somewhere… πŸ˜• Above thirty seven identifies PTSD. Apparently it was not surprising I scored highly. It was a difficult questionnaire to do.

All the things I’m doing now are working towards starting proper trauma therapy. I’m feeling really apprehensive about it all at the moment. Life is feeling extremely difficult and I’m working on finding new ways to cope. We shall see how things go.

Therapy 2021: Session 1

Date of session: 05/01/2021

Please be aware that some of the content may be triggering. Please take care πŸ’š

Today was the first session of the new year after having a two week break. Its been a hectic break that has brought up a lot of issues.

Before Christmas it was decided that I would try and stop self harming. I haven’t self harmed since the day before our last session on the 16th December 2020. That means I havent self harmed for three weeks. She was pleased with this. I have struggled with the anxiety this has brought me.

With an OCD element to my self harm, it means stopping creates anxiety especially surrounding the health of those who are special to me. I believe if I don’t harm myself they will get ill. This has been tested greatly as my mum became unwell and was hospitalised only days after stopping. My friends son has also been unwell and this has added anxiety of whether I’ve caused his illness.

Within the session today we discussed this and did an analysis of all the times my mum has been unwell and whether my self harming behaviour could of been related. Obviously, when you look at it rationally, it turned out it was just a 50/50 chance. Rationally my self harm wasn’t having an effect. Also she pointed out that I was trying to manipulate the facts to fit with my thoughts or as she put it “your OCD”. It has given me a lot to consider. I can see the rationality but believing it is hard.

We also did a questionnaire to start working towards trauma therapy. As I have experienced dissociation she wanted to see how it effects me. The questionnaire we did was called the DES or Dissociative Experience Scale. It was interesting to go through as it made me see that maybe some things I experience are dissociation rather than normal. I didn’t get the results today but will discuss next session.

I don’t know what the sessions ahead will involve but I’m sure they won’t be easy. Thanks for all the support I get. I feel I’m learning a lot.

Therapy 2020: Session 3

Date of session: 16/09/2020

Please be aware some content may be triggering. This post will be discussing self harm. Though I will try to avoid discussing methods it may become apparent with other things mentioned. Please take care. πŸ’š

Today’s therapy session has left me feeling annoyed and frustrated. If I’m honest there is also a bit of resentment in there too I think. I feel like I’m repeating everything from my assessment and it has become obvious that this is because the psychologist has not read the background mentioned in the assessment. I understand I have to explain a little but when she said she had no awareness of my living situation or my issues at home this annoyed me. Why did I bother with the assessment? Surely it’s there to help them know something about me before it is discussed. Like I said I understand going through some things but the basics at least should be noted.

I also feel I’m getting no new methods to help me. Everything is a repeat of things I already know and understand. For example today when asked at the beginning I mentioned my issue with sleep. She then asked if I knew about and used sleep hygiene to which I responded that yes I did know about and use it. We then spent nearly fifteen minutes going through each item of sleep hygiene to find out I’m doing it all, which I’d already said, and that it was not something we should focus on. When a session is limited to 50ish minutes and there are a finite number of sessions this feels wasteful.

We also discussed my self harm. This was also documented in my assessment but seemed to be a revelation to her. We discussed the seriousness of the current level of self harm. We looked at how things could go wrong with the self harm I am doing and how even a slight mistake could end my life. In all honesty I think she was expecting this to bother me. It didn’t. With my current mood that would be a blessing. She asked me how important stopping was to me and the honest answer is that at this time it doesn’t bother me that I’m self harming. Then I think she wanted to make me bothered by telling me we would definitely not be doing trauma therapy with this level of self harm. I’m angry about this as the assessment knew all this and still recommended trauma therapy. Plus my psychiatrist believes without trauma therapy the things they want to be better for me to do it won’t get better without it.

With regard to the self harm we also discussed about the use of DBT skills to help, in particular distress tolerance skills. I was able to explain that I find this unhelpful as my self harm is not impulsive which is what these skills seem to be aimed at. I was grateful that the psychologist agreed with me on this matter. I’ve not had much support with this idea elsewhere.

Currently I’m feeling trapped in a cycle which I don’t know how I can get out of. I feel like noone is taking into account what needs to happen to move things on or it is not being discussed between professionals. It’s making me lose hope. It’s making me wonder if there is any point to anything. We shall see how it goes I guess.

Technology was an issue again today with us being cut off but I did receive a phone call after this.

I was lucky that straight after I was able to have cat cuddles to help me calm myself.

One Year From The End Of DBT

The 18th December 2019 marks one year since I finished DBT skills group. A whole year. It feels both not very long and forever. So I thought why not have a look back at how it has influenced me.

Since finishing DBT my mental health has been really up and down. My year was going well until August time. I still had major mood swings and was self harming but I was coping and building up my life. This all changed. The truth is I came off some of my medication by myself, no tapering, just cold turkey. I had my reasons. And these were accepted by the mental health team when they found out. However it led to a major crisis which was picked up, maybe ironically, by the facilitator of the DBT peer support group I started attending in August. But this really is unrelated to how I have been managing with the DBT skills. I just wanted to give a bit of background information on my mental state.

So as I mentioned, in August I started attending a DBT peer support group. It was set up with my local mind with the support of the NHS Trust that runs the mental health services in my area. It was designed to be the follow up to doing the DBT skills therapy group. Only people who had done DBT could join. I’ve found it amazing. I love the people. Even the facilitator has BPD and done the six months skills group. Everyone is on a level and so supportive of each other.

We use the time to discuss issues and how we can use DBT skills in those situations. This is what I find particularly helpful and what I needed in the first place. I’ve found that I’m definitely putting the skills to more use now I have the support of the group. Some situations have definitely improved and there is more of a chance I will use the skills or ask for help than self destruct. I’m not saying I’m perfect but I’ve definitely seen improvements and found myself embedding skills into life rather than having to think “which skill can I use now?”. It’s become a little bit more automatic. Hopefully this will continue.

One area I still really need to work on is identifying my emotions. This is something I still struggle with. I really need a pocket book I can carry to refer too until its a bit more automatic. This would then hopefully allow me to bring those emotions more under control. I won’t say “not great” or “fine” or “it’s been a bit difficult” when asked how I am and be able to express myself more easily. Well that’s the idea…

Another thing I need to work on is finding a way to reduce my self harming. The thing is at the moment I don’t feel I’m at a place to work on it properly. I also need to get over the fact my self harm is not impulsive so the distress tolerance skills don’t seem to work for me.

Overall I’m finding the skills more useful now and having the follow up has definitely helped me. I’m seeing the point of them. I’m seeing their potential. Hopefully it will help things to improve.

For more information about DBT, you can look here.

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Dear GP

There is an amazing account on Twitter called Dear GP where people write letters to their GP about their encounters with mental health professionals in the same way mental health professionals write letters about their patients to their GP. You cam visit the website here. I thought I would have my own go at this below after an encounter with a member of staff who is no longer involved with my care.

Dear GP

Today I met with care coordinator P. She was casually dressed in jeans and trainers. She seemed disorientated and unsure about what was happening. She did not know where she had to be and was indecisive of her next steps. She appeared very disorganised and had not booked a room or remembered that she was meant to be attending my psychiatrist appointment.

Before the psychiatrist appointment, P appeared to disappear and it soon became apparent she was making secretive actions with the psychiatrist. She made no eye contact when I entered the room and was distracted and on her phone throughout the appointment.

P made some abstract comments that only just related to the conversation between me and the psychiatrist. She was keen to please the psychiatrist and back up his treatment plan despite knowing the issues with this way forward, which had been discussed previously. P then showed that she had been trying to rid herself of responsibility and discharge herself from my care with no input from myself. This was overruled by the psychiatrist. She seemed disappointed in this course of action and did not make anymore conversation and avoided eye contact for the rest of the appointment.

At the end of the appointment, P decided to arrange another appointment but was inflexible in this leading to no date being set and no forward treatment plan being set.

I thank you for sending P to see me but I think that going forward there may be no working relationship unless her behaviour becomes more open.

Regards

Jo

To share your own experiences feel free to share in the comments or on Twitter, Facebook or Instagram.

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They’re Not All Bad

I realise I’m quite often pretty scathing about mental health professionals but some of them are OK. Some do an amazing job and are let down by their colleagues. Quite often our bad experiences overshadow the good and we get into a negative view of all professionals, which is understandable.

I’ve had a few good experiences with different professionals. The negatives with these professionals only come when they are let down by the system they work within, otherwise they are amazing and make all the difference. When someone is caring and takes time with you it makes you feel valued and has a positive effect.

The first professional I found that was great was my art therapist. This was the first major mental health professional I worked with. At the time she was part of the young person’s service which was part of CAMHS (Child and Adolescent Mental Health Services) and worked with those aged 16-25. I was 20 when I started working with her. She treated me on a level with her. I was training to be a teacher and she treated me like a professional as well as a patient. She didn’t patronise me and went at my pace. Her main work was to get me to communicate and she did well with this but at my pace. She made herself available between sessions if I needed to leave a message or write a letter to help with the next session. She’d talk me through situations. She tried to teach me it wasn’t all my fault and at times I almost believed her. The main thing that sticks with me though is that the young person’s service was disbanded so all over 18 were to be taken on by adult services meaning I’d lose my therapy. However she fought for me and told them it ws totally the wrong time to take it away from me and that she needed to continue her work with me. This led to me having a further 18 months with her. Leaving her was hard and I miss her a lot. I still have the card she gave me at the end of therapy.

Another mental health professional that gave a good impression was a psychiatrist I had in adult services. She is the one that diagnosed me with BPD (Borderline Personality Disorder). She always valued my opinion and explained things when asked. She wasn’t perfect in that she didn’t discuss my diagnosis with me before it appeared on my notes but she was happy to go through it after. She was also a consistent presence for nearly a year before she moved on. This makes a difference.

The next professional who I had a good relationship was a care coordinator of mine, L. L was very proactive in my care and worked hard to get things sorted for me, not only with my mental health but my physical health too, even spending ages on the phone to a hospital trying to sort an appointment for me. She didn’t make me feel like our time was limited, it was always as long as I needed to talk. She took an active role. It was sad when she moved on.

My current care coordinator is also great. She’s not been involved in my care for long but has already shown me how great she is in that she gave me direct contact details for her and allows me to text rather than talk on the phone. She doesn’t mind me messaging between sessions and is quick to reply even if it is to tell me she’ll get back to me properly later. She’s also always on time or early for appointments which makes all the difference. I’ve kind of thrown her in at the deep end with my crisis but she hasn’t made me feel bad about it. I hope we can work together for a while.

Unfortunately these professionals are the exception rather than the rule. It shows as these are four out of many professionals that I have encountered. Hopefully things will improve and we will get more professionals that want to help rather than make us feel like an inconvenience or stigmatise us more. If we can be part of the education of professionals I think it would help them to be more empathetic and understand us more.

Have you had any good experiences? Feel free to share in the comments or on Twitter, Facebook or Instagram.

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Screwing Up

This is a personal piece. Please be aware some of the content may be triggering.

I have screwed up majorly. I have pushed people away and withdrawn from others. I didn’t mean to. I just am either too much or not enough. There is no balance. I warn people and they say they can’t see it and then when it happens they recoil in horror. I tell them they need to tell me as I’m not skilled at picking up social cues but they don’t and just ignore me. I know it’s my fault but it hurts.

All that is going through my head is how much I must of hurt these people. I hate myself for it. I’m not excusing my behaviour but I don’t always realise when I’m doing or saying something wrong. If people let me know I could try and talk to them and make things right but I don’t always get the chance. I understand that maybe they get too hurt by it but when they just ignore me without telling me I’ve hurt them I feel worse. I know that’s selfish as it’s not really about me but it would help others too as I could learn what I’m doing wrong instead of just guessing. Also I really want them to know how sorry I am and I dont get the opportunity to let them know.

People say I’m being paranoid. That I need to understand that people might be busy or not well. I understand this I do but I can’t help going through everything I’ve said and done to the point I make myself sick. It makes me push away further if they do come back. It also makes me try to not get too close to new people. Though I fail at this massively. I get caught up in it all too quickly. My feelings for people go to an extreme and I’m desperate to talk to them and help them. It all becomes too much again and again people ignore and hate me.

I want to ask what is wrong with me but we all know. I’m just not cut out for friendship. I deserve to be alone.

It’s not just friendships I screw up though. It seems I destroy my support systems and the help I’m being provided. I reach crisis point and they say its too much. They can’t help me. I trust them and ask for help and it backfires. I’m pushed further away when what I need is reassurance. They wonder why people don’t talk when they’re suicidal but what other option is there when you’re scared you’ll lose everything anyway. Why try to make yourself better? For people that say they are good at working with people with BPD they seem to forget the fear of abandonment part that can cause further crisis. It feels like they’ve helped me hit self destruct again. But then at the end of the day it is my fault. I should never of asked for help instead of acting on the thoughts I was having.

So there you have it. Why I’m a screw up. Don’t worry I hate myself more than anyone else.

For further comments please use the comments, Twitter, Facebook or Instagram.

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Self Harm Etiquette For The Medical Profession

This is a blog post for anyone working in the medical profession. This includes Doctors, GPs, Nurses, Healthcare Assistants, Paramedics, Support Workers, Psychiatrists, Care Coordinators, Psychologists, Pharmacists, Admin staff and Receptionists. Basically anyone who comes into contact with a person who may have self harmed (therefore could also be useful for police officers too).

It has come to my attention that some of the people we want to help us deal with self harm can be some of the least useful with their comments and actions regarding dealing with self harm. Therefore I thought I’d put some tips together specifically for them and any professional that needs to help with self harm.

1. Don’t comment on it in front of other patients

This may sound really obvious. Patient confidentiality is key. Bringing it up in front of other patients without permission is wrong and can cause harm to the person who is self harming, the relationship between patient and professional and possibly even the other patient/s who could hear about it. You never know where this information will go. Unfortunately I know it happens. I’ve seen it happen.

2. Don’t guilt trip us

I’ve had this happen with a former GP. I was told I obviously didn’t love my parents over my self harm. It was awful. I didn’t return for treatment until two years later after a suicide attempt. This isn’t the only impact it can have. Self harm is not a selfish act. It’s a way of trying to keep going. It’s a way of coping. Most people who self harm probably already think about the perceived damage they do to others. To be guilt tripped by a professional is more likely to make the situation worse and even cause the patient to withdraw from seeking help, maybe until it is too late.

3. Don’t mimick self harm behaviour

Again this is something I have encountered and not just with one professional but many. It seems some can’t bear to say the words “self harm” and so use actions like using their hand to mimick cutting across an arm. Not only is this not clear communication, it can be triggering. It is a difficult topic but it is one that needs to be dealt with sensitively and professionally. Yes you do need to ask, but please use words rather than miming actions.

4. Be careful with what you say

Most professionals are careful with what they say. They think before they speak and take into account the individuals situation. That’s great if they know the patient. However without continuity of care, which is heavily missing in places, you may not know details or you may just be someone that only encounters someone briefly so has no background information to draw on. This means being careful with what you say. I’ve heard things that concern me. They may be useful for some but I can also see them as potentially inflammatory to the wrong person. I’ve heard “you’re scars look cool”, “just use your faith” and “what would your family think?” as common phrases among others. Let’s work backwards, the last comment can easily be seen as a possible guilt trip but it can also cause some negative emotions to surface, particularly if there is friction within the family. The middle comment is also dangerous as some people don’t have a faith and this may be because of trauma or abuse. It can also suggest unless you have a relationship with a god, you can’t be helped. The first statement may be the most troubling though. You’re reinforcing the behaviour. Yes self harm shouldn’t be something people feel ashamed of, but it shouldn’t be highly celebrated either.

5. Don’t judge or use stereotypes

Some professionals have a preexisting picture of what a person who self harms is. They may see them as frustrating and a drain on resources. They may see it as attention seeking. These stereotypes tend to grow over time within a staff member. I can see how hard it must be to treat someone who seems to be causing their own suffering. But it is a symptom of an illness. It is like an addiction. It is hard once you have started to stop. It can feel like all you have in the world at that time. It is a sign of distress. Being compassionate, non judgemental and just kind to the patient goes a long way. It can help the person to keep accessing help. Doing the opposite could push people away and leave them in dangerous situations.

6. Don’t compare us to other patients who have self harmed

Every person is going through their own unique experience with mental illness and self harm. Self harm is self harm. So it may not be as deep or as “bad” as someone else you have treated, but to that person the pain they feel inside is probably just as intense and unbearable. Hearing that we aren’t as serious as someone else because it doesn’t reach a certain level is heartbreaking and can have a negative impact. It can cause us to try and do more damage. It makes us think we aren’t good enough or that we don’t deserve help. Everyone, whatever level of self harm they present with, deserves support and compassion.

7. Don’t use the terms “superficial” or “attention seeking”

I hate the term superficial when it’s used to describe my self harm. It makes me feel like a rubbish self harmer and that I need to harm worse or more. It can encourage the behaviour and make things worse. The same can be said about the term attention seeking as it can drive the behaviour underground and prevent people getting help.

Those are just a few helpful hints for medical professionals. It might not be a regular thing you encounter but it is always useful to know how to help someone who self harms.

If you have any tips you wish professionals knew then feel free to use the comments or Twitter, Facebook or Instagram.

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Shutting Out The World

This is a personal piece. Please be aware some of the content may be triggering.

Things at the moment aren’t great. I’m not in the best place. My head is a mess and I’m not tolerating the world very well. Therefore I’ve been shutting it out.

I know this is not the best course of action but at the moment it’s what I can cope with. The world feels overwhelming. People feel overwhelming. Life feels overwhelming.

I don’t know what has caused this decline. I have theories. It could just be a depressive episode. It could be the disjointed care. It could be turning 30. It could be a number of individual things or all of them combined. I don’t know. And I guess it doesn’t really matter.

Shutting out the world means avoiding Facebook interaction. It means not messaging friends. It means not asking for help. Instead I have replaced it with self harm and thinking of suicide. I have spent my time dwelling on the fact that everyone would be better if I was no longer here and have been on a mission to prove it to everyone.

I’ve also been experiencing physical symptoms. My body aches. My head is thumping. And I feel sick. I either sleep too little or too much. I either have no appetite or binge on food. It adds to the mental difficulties.

I hate myself for the way I’m coping. I hate myself for doing what I logically know is the wrong thing. I see it as protecting myself but realistically I need people and I need help. What help they can offer I don’t know. I guess I won’t if I don’t ask. The thing is I’m put off asking at the moment by the fact I have no stable care. I feel a burden to everyone, including those paid to care for me. I know I’m just another caseload that they could do without.

So what would my advice be for anyone else feeling this way? I guess it would be to do what feels like the hardest thing, ask for help. You deserve it. You are worth it. Now I just have to try and believe it for myself.

If you are struggling the Samaritans are available 24/7 in the UK. If you are outside the UK then please check out the crisis help page which can be accessed via the menu. To follow my experiences you can do so on Twitter, Facebook or Instagram.

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