Fourth day of CBT

My therapist had a long talk with his supervisor about me. He revealed it suddenly, as though he wanted to say something else but couldn’t, and just as suddenly tried to explain himself, in anticipation of my own anxiety about breaches of confidentiality. But I’m not an ordinary service user. I know mental health workers discuss cases with supervisors and, where appropriate, their teams. It gives me more confidence and faith in the system to know therapists are supported. His concern was misplaced.

I’m no longer participating in cognitive behavioural therapy. [Avoidant tendencies, check] This is more than how frustrated I felt on my third day. Maybe it has to do with my therapist’s “long talk.” He has noted several times during our meetings how anxious and upset I was talking to him as though it was unexpected of me to be anxious and upset talking to a complete stranger whose sole role is to judge, challenge, change, and support you. What did he want me to say? Correct; I struggle to trust strangers who smile at me on the street, muchless strangers who have the ability to section me.

I agreed to step up my care to a clinical psychologist who would be better suited to help me using alternative therapeutic models. So, in a way, I was right last week. I like to think that my therapist’s supervisor found my case so interesting that she wanted to meet me herself. [Narcissistic tendencies, check]

In truth, I felt both relieved and guilty.

When I offered to quit entirely, my therapist’s reaction was immediately and strongly NO. I wasn’t even testing him; I really do want to quit. I work in healthcare; I know how precious these resources are. Someone else needs him more. I’ve coped for years. I can cope for more. But, NO. Apparently, NO.

The Guilt: Why would the NHS want to help me?

I’m not a risk to others. I’m not a risk to myself. I obey the law. I don’t misuse substances. I am intelligent. I am independent. I am hopeful. I contribute meaningfully and financially to society through work, volunteering, and community events.

Flip the coin.

I have a personality disorder, and I don’t even have the decency to be a vulnerable child, an offender, or a woman who self-harms. I am Other. I am less than 1% of the general population. No NICE guidelines exist for how to help me.

Stick my smiling face up on a poster. It’s possible to have “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it” and still succeed. It’s possible to succeed and still be broken.

Or in my case, in exile.

JustEliza says she's 'spent most of my life trying to solve the puzzle that is me'

The Relief: I found me.

A step up the mental health ladder means that something must be really wrong with me. All my Stigma bells rang when my therapist suggested I see the clinical psychologist instead. I knew the sorts of people who needed clinical psychologists. I never imagined myself one of them. Not even when I agreed.

Later that day, I devoured commissioning guidelines and service frameworks and, finally, diagnostic criteria on personality disorders. One link, after another, and then: I found me.

Take that, Clinical Psychologist. I’m one step ahead of you. I’m weak in the knees, fuzzy in the head, and filled with a sparkling mix of intimacy and revulsion at this discovery (and doesn’t that pretty much confirm it all). I have my ICD-10 code. I have my “emotional anatomy.”

Now, the reconciliation can finally begin.


Read on the NHS Choices blog.

The Little Penguin

If you watched BBC recently, you might have seen an animated short titled "The Little Penguin" by World of Happy.  For just a short time, you can view it again on BBC Iplayer. I hope they leave it up for longer, but if you can't find it, try youtube. I hope Giles Andreae doesn't mind me sharing the story here, as it's a very short, beautiful (albeit highly optimistic) lesson on one of the principles of Cognitive Behavioural Therapy: challenging negative thoughts.

There was once a little penguin who was frightened of the water.

"This is no way for penguins to behave," said his father. 

"Be gentle," said his mother, "for all of us have fears that others may find hard to understand. Come little penguin, come into the water with me" 

"But what if it's cold," said the penguin, "What if it's dark and deep? What if there is a big fat scary monster? What if I can't swim?" 

"Ahh," said his mother. "But what if it is light and beautiful? What if all your brothers and sisters are there? What if there are fish for you to eat and friends for you to play with? Come little penguin, take my hand." 

And with great courage and great trust, the little penguin slipped into the water, and, for the first time in his life, he felt the joy and freedom, wonder and delight, that every penguin's heart is born to know.

Read on the NHS Choices blog.

Third day of CBT

In the dream, I am worrying. I look at product after product on the shelf, until I forget I am standing, or where I am standing, or who I am. I've become simply a vessel for image after image of Possibility in the form of Sugar. I worry, visually, and then I wake, because waking is easier than making a decision. Than acting on a belief. Than believing anything at all.

My homework now includes The Workbook -- a collection of checklists interspersed with definitions and stereotyping -- which treats me like I, too, am just a checklist of symptoms just waiting to be defined. Did the person who wrote this ever have anxiety? I'm not sure she did. She might have realised how horrible it feels to battle intellectually with a form over whether "generalised anxiety is a problem for you."

I'm going to skip straight to Section 2: my own Five Areas Assessment. My therapist has now explained this approach to me 4 times. That's one for each time we've met, plus one extra when he was feeling especially pedantic. Essentially, our thoughts, physical symptoms, feelings/emotions, and behaviour all are linked and affect one another. This is basic science for someone whose post-graduate education focused entirely on theories of mind and behaviour, let alone someone who has already been labelled gifted. I'm not looking forward to the fifth time he explains it to me. If I interrupt, will I earn a new label? Difficult? Disrespectful? Impatient?

Shoot, there's another checklist already. I'm putting The Workbook away before I hurt it with my condescension.

We talked in circles this week, because we've finally reached the edge of his understanding of the human mind. I didn't think it would come this early in the process, and to be honest, I'm considering giving CBT up because of it. I feel deliciously mean just writing that, because essentially I just put my therapist, another human being, down.

Did you catch that? I'm being defensive. At some point, I shut the gate, and he's left standing outside, alone.

Cognitive Behavioural Therapy is meant to be challenging. It's good to have help, but we should all be doing this ourselves in the first place. But it's not as easy as thinking "Hmm, I am underestimating my ability to cope with this new situation. I feel unsafe and confused about what is happening to me. I am anxious." I know I can cope. I can make all of my problems disappear, one way or another, with distance and time. I don't worry about me.

I worry about you.

I worry, because I see you. I interact with you and I know you. My mind races through your life, calculating, estimating, testing, evaluating, predicting.  Is mind-reading so very wrong then, if I am always right?

I avoid you.

I avoid, because I would rather be alone than have the opportunity to manipulate you. And I will manipulate you, even if it's simply to counsel you. Knowledge is power, and power is responsibility, and I simply don't want responsibility for you.

There comes a point in your life when you realise you will never have what you want most. Is that what I'm grieving? That I won't ever be able to make everything right in the world? That I can't heal everything? I'm past adolescent, past puberty. I've discovered what I am capable of. I'm past exploring. I've recoiled.

My therapist challenged me this week. I reached the edge of my own understanding of my mind. I didn't think it would come this early in the process, and to be honest, I considered giving CBT up because of it. But that would be avoiding, again. So I challenged myself. I went home, and I wrote this, like I'm writing now. We talked in circles because I cannot resist shutting the gate. Because it's easier to be talked to about self-esteem, shaky hands, and shallow breathing than admit what I'm truly afraid of:

Hurting you.

Read on the NHS Choices blog.

Second day of CBT

Things I stopped doing because they made me feel bad:

Hearing the news

Listening to non-classical music

Reading crime thrillers

Watching violent movies

Developing friendships

Eating processed foods

Sometimes, I test the waters again. I rob a bank on a popular console game. I hear about a brutal murder-rape in the local news. I start reading a famous crime thriller series. I meet a friend for coffee. I microwave some chicken tikka masala. And the music tells me sweet dreams are made of these, but I know better. I’ve been having nightmares all week.

I’m not perfect at avoiding. But, I am practiced.

This week we talked about my past, and I've been paying for it all day in flashbacks, shaking hands, and racing thoughts. It’s been nearly twenty years since all of my bad habits began, but the penultimate one is not sharing how I feel, what I’ve experienced, with others. Complex trauma. Avoidant personality. Attachment disorder. I’m sorry; it’s just that… everyone else here seems identify with labels: Pregnant. Asthmatic. Diabetic. Bipolar. Obese. I thought you might want a label for me. Like Sociophobic. No?

In counselling, I realized being gifted meant more than being smart: it meant being differently human. In cognitive behavioural therapy, I am changing how I cope with being differently human.  And the rest of the time, I am unpacking just how different I’ve become, now that the worst is over.

The elephant in the room.

I am happier without you. Should I be happier without you? I feel guilty for this. I feel guilty for being alone so long, loneliness became my familiar. I feel angry, because you never found me. You never even looked for me. I never asked for you, so you never asked for me. And now they’re asking. Now you’re asking.

I have no idea how to answer.

I’m not even sure I want to.

Read on the NHS Choices Blog.