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.