Now there’s a question…

As I mentioned in my last post, I really am struggling to cope with my return to work. My anxiety levels are ridiculous, I feel constantly nauseous and exhausted, I can’t think straight, I dread going to work, I’ve had trouble with thoughts of self harming and my mood is quite low.

This is not a) unexpected or b) a disaster. It’s fairly par for the course, really. When I started socialising again post-weight restoration I felt anxious, depressed and out of my depth. When I moved up to Newcastle I felt anxious, depressed and out of my depth. When I moved from a house share into my own flat I felt anxious, depressed and out of my depth. Basically, I have trouble coping with any big upheaval to my life. I am stable and able to function within my normal routine, but any disruption destabilises me and it can take me a good few weeks/months to recover.

No one ever believes me when I tell them that my panic attacks don’t always, or even often, have a psychological trigger. My body seems unable to distinguish between physical and psychological stress, so I react in the same way to hunger or tiredness as I do anger or anxiety. In a vulnerable state anything can set me off – a car backfiring, for example. I have learned over the years to control my reaction, so when I feel that shock of adrenaline and start finding it hard to breathe I just tell myself that it’s a panic attack and I will be fine. I do relaxation exercises or use DBT distraction techniques. That diffuses the panic attack before it can overwhelm me, but what those things DON’T do is stop my body from being terribly over-reactive.

People say that over time, you can desensitise your body and teach your nervous system that there’s nothing to freak out over. This doesn’t seem to be the case for me. It’s probably something to do with my tic disorder (which was diagnosed by a neurologist, not myself!) – Tourette syndrome is a neurological, not psychological problem, which is often accompanied by OCD, general anxiety, sensory over-sensitivity and aversions. Whilst therapies like CBT can teach people to cope with these symptoms, they can’t be cured. I’m mostly quite accepting of this – I spent years looking for the non-existent “root cause” of my anxiety in therapy and no insight ever made a difference to my general physiological sensitivity, before I was finally diagnosed with a tic disorder four years ago. In a way it’s a relief, because it means that I don’t have to beat myself up for being unable to cope with stressors which other people take in their stride. It also helped my parents to know that my problem was not their fault (not that I ever believed it was in the first place, but they did blame themselves) but a random genetic quirk.

On the other hand, it sucks. Every time I go through a big change in my life I have to put up with the embarrassment of seeing my mental health temporarily go south. I say embarrassment because it IS embarrassing, given the amount of time I spend singing the praises of recovery on my blog. Things have improved, slowly. We all know how well my attempt to move to York in 2008 went, whereas when I moved to Newcastle nearly a year ago I DID have a few minor lapsing into eating disordered behaviours, but I got back on track quickly. Even better, since starting my new job three weeks ago I’ve had anxiety and self harm urges, but no eating disordered thoughts and no lapse into SI. Definitely an improvement. Oh look, I was just saying that I feel embarrassed when I start struggling and now I’m trying to cover it up 😛 I am predictable, if nothing else.

Anyway. I am attempting to get over my embarrassment by waffling on about it, which has helped because everyone I’ve spoken to has told me that it’s really hard adjusting back into a working routine. It’s tiring and stressful for anyone, let alone someone with long term mental health problems who has been unemployed for years and suddenly finds herself in a position with a lot of responsibility involved. So I’m not judging myself for having a hard time anymore, and I am not panicking. Well, my body is, but my mind isn’t, if that makes sense. My body is on edge, but I understand what is going on and I am quite happy to put up with it for now, because all the evidence suggests that with time, I will adjust.

However, regardless of my new, relaxed attitude, I still need some support until things settle back down again. Eight months ago when I was struggling to adapt to moving into a flat by myself I saw the local mental health team for an assessment, and they put me on a therapy waiting list. I’ve reached the top of it now, and have an appointment in a fortnight. But in typical Katie style I am having second thoughts.

The therapy I was put down for is CAT, cognitive analytic therapy. In simple terms, the idea of CAT is to go through your life history with a fine tooth comb, find any unhelpful patterns you keep falling into and work out where in your past they came from, and then move on to finding “exits” to these patterns – new ways of doing things which help you stop falling into the same ruts. In theory it’s a good therapy, and there is evidence that it helps people with depression avoid relapses. In practice, I’m not sure it would be helpful for me. For a start, I’ve been in and out of therapy for years, and I know myself fairly well. I can identify self destructive patterns and problem solve them myself. I’ve been doing this for years, particularly the last two. Secondly, I don’t think my past has much to do with my problems. I think certain events (being bullied and raped) definitely made things worse, but they didn’t cause my eating disorder or anxiety. I clearly remember a point (before the rape) when I felt baffled by what was going on in therapy, because I understood how being bullied had damaged my self esteem and I had made peace with the experience – but I was still terribly anxious and self destructive. I didn’t understand that my anxiety was innate, not learned or based in trauma. The tic disorder is far more of a cause than any past event.

Thirdly, the appointment they’ve given me is during my working hours. I’m unconvinced enough of the potential helpfulness not to want to go through the hassle of re-arranging my shifts. And finally, if I strongly suspect that it won’t help, someone else would be much better off using my place, because the waiting list is eight months long.

Here’s the question: would I be better off going to this appointment even if I’m fairly sure the therapy orientation is wrong for me, just so I will have a bit of on-going support, OR should I try to be patient, get myself re-assessed and ask for something I feel would be more appropriate?

I am leaning towards the latter. Before I received the CAT appointment I had already rung the team to tell them that I had changed my mind and would rather be re-assessed, as I thought I had been too nervous to give them a proper idea of my difficulties last time (it was a scary assessment with two professionals vs one me!). I also know that I do much better with low-level ongoing support than with any structured therapy, because my problems don’t fit into the typical therapeutic approaches, being more neurological than psychological. Trying to squish myself into a theory has made me feel uncomfortable and misunderstood in the past. No therapy is better than poorly fitting or bad therapy. I was quite sure of my position until this bloody letter turned up this morning, offering me the appointment! I am stressed out enough to be tempted, even if I know it’s not an approach which will be of much use.

I guess there will always be people who would say “go anyway and see what the therapist has to say”, but I know what CAT entails and I also know that if I started CAT, the re-assessment would be cancelled and I’d have to wait a few weeks to get a new date if I decided that I wasn’t getting on with therapy. I feel like I’ve thought this through, but I just wanted to put it to my lovely blog commenters – can you see any glaring problems with my reasons for choosing the re-assessment? I’m going to phone them tomorrow if I can actually make up my mind…

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6 responses to “Now there’s a question…

  1. Hey Hun, obviously the decision is ultimately yours to make, but I’m just wondering what exactly it is that you /do/ want to get out of therapy. I’m guessing you have some idea as you seem pretty clear on what you don’t want to be doing. Naturally, because youve waited 8months, i would be inclined to say to go and see how you feel afterwards. Would a more few weeks make a huge amount of difference? Though only you know this.. I don’t think your reasons for wanting a reassessment are problematic at all, but I would also bear in mind a few non-specific factors – for example, you might get a really awesome therapist who despite the orientation could be very helpful. In an ideal world, he or she will try make an integrative formulation with you depending on your needs, rather than put you exclusively in a CAT box (hehee sorry funny image) and pursue a model that is glaringly unhelpful. Whether or not this works in practice, unfortunately my knowledge doesn’t yet extend that far.

    I hope this isn’t too rambly, i just thought I’d share my thoughts 🙂

    • The other thing I forgot to mention is that it’s the primary care team rather than the CMHT, so it’s more strictly constrained by the time limits and approach. I’ve had therapy with a PCT before, and it was twelve weeks of a lovely psychologist telling me I’d been referred to the wrong people and she didn’t know where to start because my issues were too complex. I don’t like being passed around, I would rather make absolutely certain I’m with the right people to begin with.

      Like I said, I do better with low level ongoing support, and the primary care team do have the option of a support worker for a few months, so I’d be more inclined to go for that. I don’t really want therapy, I just want some support! They are very different creatures…

  2. I’m beginning to think I wrote this post rather badly! I’m not self diagnosing, I have been told by the (many 😛 ) psychiatrists I’ve seen in the past that my anxiety is a neurological rather than neurotic problem, and I still have the letter from the neurologist about the tic disorder diagnosis. A few months ago when I was struggling with something more specific I had some phone sessions with my old therapist from Dorset, so it’s not typical of me to reject the input of others. She was very helpful, but I could only afford to talk to her for a few weeks. I’m not disagreeing with the results of my previous assessment here as such either – as I said in my post, I was very nervous and didn’t really give a good picture of what was going on, and I can see how they landed at the idea that CAT might be a good fit since they didn’t have all the information.

    I love baths though, if that’s any good!

    • Ahh that makes sense. It is also ironic, since I tried to make my reasoning as thorough and logical as possible purely so people wouldn’t think that I had some deep seated psychological reason for avoiding CAT! Looks like it backfired a little…

  3. I think it depends how certain you are that this isn’t right for you. If you’re 100% sure therapy isn’t what you’re looking for at the moment and that what you need is ongoing support, then I would cancel the appointment. (As you said, they’re very different creatures.) But if there’s any doubt in your mind, it might be sensible to go to the appointment (perhaps rearranging it so it doesn’t clash with work?), learn more about the therapy, raise your concerns and see how receptive the therapist is. I’m not sure getting “squished into a theory” (which I’ve experienced and it’s horrible) has as much to do with the type of therapy as it does with the skill of the therapist.

    On a related note, I’d love to know what the CAT service in Newcastle is like so if you do go to the appointment, keep me posted! 🙂

  4. Pingback: This Week In Mentalists – The Wedding Hangover Edition « This Week in Mentalists

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