Finished DBT

I was originally meant to be doing the full year of DBT, but due to me passing all my units at uni (yay!) and going on fieldwork next year, I ended up only doing the six months. Which meant I still completed all four modules; mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance, I just won’t be repeating it for the second time round.

I had my last individual DBT therapy session with my psychologist yesterday. When I think about twice when I’ve overdosed/self harmed and ended up in hospital when I had to stop seeing a psychologist, the same when I just thought a psychiatrist was going to stop seeing me, and the rest of the time when I didn’t even properly end with a psychologist, it’s weird not to feel that sense of loss, dread, abandonment and feeling of being ripped apart that I usually feel in ending with a clinician. I guess I just didn’t really feel that sense of connection with her. And it got pretty repetitive and monotonous go go through the same thing every session: diary card, chain analysis, looking at where I could’ve used those DBT skills.

I think I’d feel a much bigger sense of dread and loss when it comes time to be discharged from the mental health clinic and stop seeing my community MH nurse. I was resistant to the idea of seeing a community nurse at the time when I was relapsing with my eating disorder last year, but now that I’ve been seeing her for over a year I’ve come to appreciate being able to just talk to her about whatever’s been going on in my life.

So now that I’ve finished DBT how did I find it? Well perhaps I’m not quite as scathing as I was before starting it. I can see where some of the DBT skills can be helpful when trying to get through a crisis or when trying to deal effectively with other people. At the same time though, I still feel like it doesn’t help me understand myself better on a deeper level and why I feel a certain way then react how I do, and learning the DBT skills doesn’t address if I’m motivated or not to use them in the first place. It’s also quite scary for me that because DBT seems to be regarded as the best damn thing since sliced bread for those who have BPD, now that I’ve completed it, it’s kinda like “Well what now?” So many times when I’ve been in the ED or psych ward, I’ve been told that doing DBT is the solution. Now I’m left wondering “What’s your solution for me now?”

Last psych appt

Yesterday afternoon I was seen by the doctors, and my community nurse/case manager also sat in on the meeting. I was asked whether I wanted to be discharged that day or the next, I chose to be discharged that afternoon. Though I still wasn’t great, I at least felt a little better than when I came in and I guess there wasn’t much point in staying any longer. We also discussed my medication, I still remain on 200mg of Pristiq and 50mg of Seroquel XR but have also commenced on 450mg of lithium as a mood stabiliser. It was either lithium or sodium valproate, but according to the doctor the latter has a greater chance of hair loss, weight gain and sedation occurring as side effects.

Spent this morning in tears as I emailed a uni lecturer about something totally unrelated, and in her reply she again brought up an incident last year which resulted in a general miscounduct and me getting into a whole load of trouble. It feels awful that I continue to have that held against me by a lecturer I will again have this semester despite me completing the disciplinary action that was dealt to me and having damn well learnt my lesson. I then attended the last session with my psychologist at the eating disorders program in which I cried some more both talking about this situation with my uni lecturer, and then saying I felt “A bit sad,” when she asked me how I was feeling about it being the last session. It’s the first time I’ve ever admitted to feeling anything other than indifference towards any psychologist I’ve seen as I’ve always been ashamed of feeling attached to or having any emotional connection to others, especially when it’s not reciprocated. Though it wasn’t easy attending knowing it’s my last appointment, I’m glad I did and handled it much better than I did the last time I had to change psychologists. It’s quite embarrassing when I remember how I spent the second last session crying, refused to come back for another session or to see the psychologist I was being transferred to, overdosed and ended up in hospital thus never having a proper concluding session, then wrote him an angry email about how useless therapy is.

I’m starting DBT next week with the group component running on Tuesdays and my first individual therapy session is on Thursday. I’m really nervous about DBT and how full on and strict it seems. At the end of my assessment sessions for DBT I was given a contract and asked to sign it, with rules such as not being allowed to miss a certain number of group or individual sessions, having to complete the homework, rules around interactions with other clients and your therapist not having contact with you for 24 hours if you’ve self harmed. I also have a lot of ambivalence about whether I really do want to change and to stop self harming or not, and so much fear when I think about doing so. Plus I’m hesitant about starting all over again with yet another psychologist knowing that if I do develop a connection it will feel like another loss when we have to cease therapy, especially after weekly appointments for a year. 

Outpatient ED treatment

I’m always relieved and a bit surprised when I eat adequate amounts of food and I don’t gain a load of weight. In hospital when I began refeeding, I gained 4 kg in a week. Even the nurse was surprised at how much weight I gained in such a short time- “How is that even possible? You must really want to get out of here,” she said. And because it’s happened before, there’s a part of me that’s afraid that’s going to happen every time I start eating more. But it hasn’t.

These past three days I’ve been eating well and my weight has remained at what I think is possibly my body’s set point. On Friday when I saw my psychologist we talked about weight and the fact that while I’ve managed to maintain the weight I was discharged from hospital with, I’ve also been controlling it so that it hasn’t gone above that number. Technically my current BMI is just under the “healthy weight range,” but I am naturally petite anyway. I said that I may be okay with it if I gained a couple of kilos from eating what a person is supposed to eat in a day- regular meals and snacks that are balanced and nutritious. What I can’t justify is gaining weight for the sake of gaining weight or if I gain weight from overeating, eating lots of unhealthy foods and/or bingeing and purging. My psychologist is fine with that, which makes me so glad I’m getting outpatient treatment for my eating disorder instead of inpatient treatment. Instead of inflexible and ridiculous rules being imposed on me, I get to have a say in my own treatment and recovery. Which means for me eating regular and balanced meals and snacks throughout the day, and if I gain weight that’s okay, but if I don’t gain weight that’s okay too. What recovery and good treatment doesn’t mean to me is being forced to eat to the point of almost vomiting, and being forced to gain a certain amount of weight and punished if I don’t.

Though being in hospital was such an awful experience, it’s almost a good thing it was so bad, because it serves as an additional motivator to be well and stay out.

Psychologist not the right one

I did give it a go. I mean, this was my third time meeting with this psychologist, though the first in terms of seeing him on his own. But I think it’s enough to determine whether I feel I can work with him or not. Unfortunately I just don’t feel I can.

I already had my reservations from that first time when I felt misunderstood and pushed into treatment I wasn’t keen on. And today I think he pushed too hard too soon for me to talk, given it’s our first actual session together. If you’re going to ask me to talk to you straight off about the reasons around my OD which I feel quite embarrassed and ashamed about, no I’m not going to do so. It takes time for me to open up and whomever I’m seeing, I need them to understand that.

He was also rather blunt. Yes, I know sugar coating everything and treading too lightly isn’t going to be the most helpful. But a bit of sensitivity wouldn’t go astray either.

About halfway through the session I could feel myself reacting by putting a barrier up and becoming oppositional. My responses were more abrupt. My attitude became one of indifference. I again grew resistant to the idea of therapy and change. Within this mode I stubbornly told him that I don’t want help and that I’m fine with how things are. That it’d be a waste of time coming back and he’d be better off seeing someone who actually wants the help and is ready to change.  When asked whether I would come back for another session I said ‘no’. He told me he’d send a letter to my GP and I’ll discharged back to her.

How do I feel about that? Rather sick with anxiety really. I’m aware I’m choosing to throw away this opportunity for free psychological therapy that’s not limited by a certain number of allowable sessions. I know I’m lucky in that many people don’t get this kind of help. Just last week in the courtyard at A St I was reminded of this, listening to a woman sobbing to a nurse that she needed to see a psychologist but was still on a waitlist.  But at the same time, I don’t see much good in seeing someone I don’t feel at ease with and cannot open up to. In a medical setting it wouldn’t matter so much, but within the context of mental health being comfortable with the person you’re seeing is important. Within the public system you don’t have to pay and the number of sessions is based on need, but you’re stuck with who they give you. In the private system, the advantage is that you get to choose who you see, but it’s costly and limited to ten sessions per year.

Don’t really know where to from here. I guess I’ll just have t see how things pan out.

Met K

I met with K, the replacement psychologist for I, this afternoon. She acknowledged that yes, she is temporary while the psychologist I am meant to be seeing is away, so I may not want to go into the deep stuff when I won’t have the opportunity to get to trust her and see her for a longer period of time. And so we talked about general and some rather light hearted stuff. Stuff which included my cultural background, what I do when I’m not studying, where I did my prac placements, countries I’ve visited and would like to visit, and my cute little Maltese-shihtzu puppy. She also explained that when people are discharged from hospital they usually offer a psychiatrist appointment as follow up. “Psychiatrists can have some helpful things,” she said, which I struggled not to laugh at, but was told that ultimately it’s my choice whether I go or not. I see her again in a fortnight.

Later on in the afternoon I called to cancel the psychiatrist appointment meant for next Wednesday. “What’s the reason for cancelling?” I was asked by the receptionist. “Ummm….” I stalled, not expecting to have been asked. “Just so I can put it in the computer,” I was told. “Umm…I just don’t need to see him,” I answered. It’s not the principle of seeing a psychiatrist I object to, it’s that I’ve met him once and felt uncomfortable and he’s not someone I’m able to talk to. There have been a couple of psychiatrists I’ve found okay and would more willingly attend an appointment with. Unfortunately he isn’t one of them. While I was at A St to see K today, I saw that my psychiatrist whilst I was in hospital in October/November last year is now one of the outpatient psychiatrists at A St. See he was okay, why couldn’t I have been allocated to him? Instead I get allocated to the one I don’t feel comfortable with. Sigh.

Dr L provided me with new scripts today and typed up a letter, instructing me to hand it to the pharmacist. The contents of the letter basically asked the pharmacist to only dispense my medications weekly. That’s a big assumption to make, that I’d willingly hand over the letter to the pharmacist myself. Was very tempted to just not do so- how would Dr L know? In the end I did. I’d like to say it was my integrity and honesty, but really, it’s just me being afraid of the consequences I may have to face if I don’t and I’m found out. “It’s a good excuse to go shopping!” remarked Dr L of the weekly trips I will now have to make to this shopping centre. Except hey, I don’t have spare money to spend on frivolous things after spending $123 on Pristiq and Seroquel today. Yay!

Tomorrow I’m meeting up with M for lunch whom I first met when we were both inpatient in Oct/Nov. A social meet up with a friend? Well that’s something new. According to my diary records, it’s only been since February that I haven’t met up with friends. It feels a lot longer than that though 😦

Questionnaire

So I’ve mentioned in passing that in preparation for my upcoming psychologist appointment, I’ve been asked to fill out a questionnaire. There are pages and pages of questions in it.

Some of which I have no idea where to start in answering…

Some of which are oddly Freudian (thumb sucking in childhood must have some sort of meaning!)…

Some of which I’ve had a good chortle over and wondered about the relevance…

And some of which are just inappropriate.

Thanks for the ideas though, I hadn’t thought of that one before…! Out of curiosity, has anyone ever shot themselves with a gun with no intention to die?

As you may have noticed, I haven’t made much progress in answering these questions. I doubt I will in the next few days. Hope she doesn’t mind me coming in with predominantly blank answers….

Being made to get help again

It seems like I’m back on the ‘getting help’ bandwagon again. Huh. So much for my resolve to be rid of all services.

Received a call from the GP office this morning. 8:15am. Yep, not like I was asleep or anything… Was told that Dr L wants to see me and so I agreed to come in this morning. It seems as though she’s been bombarded with all these letters about me; from F Hospital telling her that I overdosed, from B Hospital telling her I’d recently been discharged, from the psychologist at A St telling her I’ve declined to see her, and another one from A St advising her how my medications should be managed.

Was asked by Dr L what I want to do if I don’t want to see anyone from A St. Could only shrug and shed some tears in response. She said she can’t comprehend being discharged from hospital following an overdose, slipping back into life where everything is the same, and deciding to accept no help whatsoever. And so she’s making me go see a psychologist again. Boo. Was told to either choose to go see the one at A St or be referred to a private one again, and come back with my decision in a week. I’m also about to become best buds with my local pharmacist, as apparently A St has advised her that I’m only to have weekly prescriptions. Yay, I can’t wait to become known to the pharmacy as the mental who can’t be trusted with more than a week’s worth of medication. FML. I’d complain about how humiliating it is, but then I’d probably get some smart arse commenting that I only have myself to blame for getting into this situation.

This afternoon I then received a call from K, the psychologist at A St. She told me she didn’t feel right leaving me be without any support, especially given my most recent hospital admission. I admitted I was upset and angry when I cancelled the appointment with her and “I guess” I could come in and see how things go. Not to mention Dr L is making me see someone anyway. Sigh. May as well go to the psychologist that’s free…

Both times I’ve spoken to K on the phone she’s sounded lovely. And that’s partly what scares me. I know she’s only temporary until I, the regular psychologist, comes back from holidays.  I’m afraid of getting to like her only to have her leave, like so many others before her. Knowing it’s unavoidable doesn’t make it hurt any less. I don’t have anyone in my life I can talk to about deep and emotional matters and it’s just so painful when that one person I do have disappears. It leaves me feeling all the more lost and alone. 😦

It seems as though today is mental health professional “Let’s contact WFH day” and in the spirit of it all, D also emailed me back. It basically said that he appreciates what I’m saying and is still happy to attend an appointment with me should I decide to see a psychologist after all. Feeling bad about the “bugger off and screw services” email I sent him, I apologised, explained I was upset and irate when I wrote it, and informed him I’m going to see K after all, though I declined his offer to attend with me. I learnt that people are more likely and willing to respond to a civil email. Who could’ve known…! Ten minutes after I sent it off, I received a reply back telling me not to worry, he didn’t take it personally as he thought I was probably just upset when I wrote it, and wished me all the best. Well that’s that then with clinical psychologist #4. Surely if it doesn’t work out with #5 and #6, I’m allowed to quit then…?

Uni Meeting & Avoiding the Professionals

I had a meeting with the OT course coordinator/my gerontology tutor on Monday. Considering she’s been the contact person during all three hospitalisations in my over a year of studying OT, I was afraid of her thinking me too mental to do this course. After all, there’s been a couple of OTs I met in hospital who haven’t had the most positive response when they’ve found out I’m studying to become one of them. She was lovely though and accommodating and helpful. I don’t need something as drastic as being in hospital to ask for an extension on things if I’m struggling, she told me. Oh. But still, I’d feel guilty and hesitant in doing so. She also suggested getting an Access Plan done up through the Uni Disability Office, which is used to provide to lecturers and the such if I for example need an extension, without having to go into detail about my situation. If I did decide to go that route though, a letter from a medical practitioner or psychologist is required. Given my current, self-imposed situation of not having one, that poses a bit of a problem. And even if I did, I’m afraid of people thinking I’m taking advantage and using my mental health issues as an excuse. I was also asked by the course coordinator whether I have someone to talk to for support. “Err…I’m meant to be seeing someone,” I answered. Before I told them all to eff off. Heh.

Oh, and regarding the email I sent D? He hasn’t replied. Apparently if you tell someone to bugger off, there’s a good chance they will in fact bugger off. Hah, who could’ve known? I was curious about how he’d respond to my email, but never mind. I did receive a text message from my GP’s office this morning though informing me I missed their call and to please ring them back. I haven’t. Too much of a coward, I am. I know I’ll have to see her sooner or later for my meds, but I’m dreading being questioned on what the hell I’m doing by refusing to see a psychologist and psychiatrist and how I plan to stay safe and get well otherwise. Lol, beats me. Oh yeah, and the fact that the day straight after I saw her for an appointment, I went and overdosed on the meds she wrote me a script for. My bad :/ But, I am a pro at avoidance and if I keep putting the problem off, it’ll go away eventually, right?

Rejecting all services

I received a phone call from a blocked number yesterday. I correctly assumed it was K, the psychologist, calling me back after I had cancelled the upcoming appointment with her the day previously. I contemplated not answering, but was curious enough to want to see how this conversation panned out.

She asked me to clarify whether it was I couldn’t make the appointment on that particular day, or I didn’t want to come. “Uhh, I just don’t want to come,” I told her in a somewhat stilted manner. “Can I ask why?” she enquired. Not able to come up with anything better, I said “I just don’t want to see any psychologists.” She replied that she understood that it’s hard and that I wouldn’t want to see a psychologist, and asked whether I had any other support if not from them. Ummm. Think fast, WFH! I answered that I could get a referral from my GP, should I require it. She told me she’d bring it back to the team, and suggested keeping it open for a month in case I decided I would like some support. Fine. Don’t think I’ll change my mind, but okay.

I arrived home from uni today to find another letter addressed to me from A St. Oh goody, I just love correspondence from them. Find out that another appointment has been booked for me with Dr L, the psychiatrist I saw last time. Umm, pretty sure he just told me to go back to my GP. Haven’t yet, but I fully intend on calling A St again and cancelling this appointment too.

The rational part of me knows I’m digging my own grave by doing this and rejecting all services. My ‘fuck you’ to them will only end up hurting me in the end. But the angry, hurt, upset part of me is the one making all the decisions at the moment.

Later this afternoon I received an email from D, the psychologist I was seeing before. I hadn’t heard from him since the last appointment spent in tears, telling him I wouldn’t come to the next appointment, nor did I want to see psychologists again. His email read:

Dear WFH

I spoke with the MSC team on Tuesday about coming to see you over at MSC. I understood you would be at Uni on Wednesday and I arranged to phone you on Thursday. I had intended to come over and see you to talk about my coming to your first couple of appointments at A St. We talked about my doing this last time you saw me.

I know how difficult it feels to start seeing a new person. I spoke with K yesterday and I understand that you felt that you didn’t want to go to the appointment arranged with her. I guess I’m writing to you to say, that both K and I really appreciate it is hard for you, but that you getting further help really matters. You are obviously unhappy about the contacts with services, but if there is anything we can do to make it easier for you to carry on working to help yourself with difficulties, we will gladly try and accommodate you.

I really meant it when I said that I would go to the appointments with you and I really mean it when I say that I believe that seeing a psychologist can help you. The difficulties you have can be helped and K genuinely wants to help you with that process.

Take care WFH

D

It took me a while to tee up a response to him. I may regret this later on, but I hit Send regardless:

D-

Yes, on Tuesday evening the nurse mentioned something about you intending to phone me. Then when I arrived back after prac on Wednesday, the nurse announced to me I’d been discharged without me having received prior notice.

I do not see why getting help matters, nor how seeing a psychologist would be helpful. There has been nothing in my experience that has proved otherwise. Thanks, but I do not wish to attend the appointment, nor do I intend on attending any further appointments with any psychologist or psychiatrist. Especially as K is only temporarily filling in, but regardless, I do not wish to see a psychologist. A St can remove me from their case load as I do not require any further services from them.
WFH
Perhaps my reply to what was a perfectly civil and compassionate email from him does have an angry undertone to it. Oh well. He’s said so himself that it’s okay for me to be angry at him, but not okay for him to be angry at me. Oh the luxuries of being the client. Anyway, I think I’ve emphasized my point. Curious to see how he responds to my email, if he does.

You’re discharged. Surprise!

After that psychiatrist appointment at A St and the appointment with D the day after that, I was adamant I would not attend any appointments with D again, nor would I commence therapy at A St once an appointment had been made for me. When my mother brought in a letter from A St informing me I have a psychologist appointment on 12 April, accompanied by an eight page pre-therapy questionnaire, a DASS and a K-10, I was close to just ripping the pages up, calling to cancel the appointment and crossing my fingers to never hear from them again. Slowly though, after it became apparent the doctors were quite keen on me having follow up after discharge and talking to a couple of nice nurses, I thought maybe, just maybe, I’d attend and see how it goes. That was before yesterday. After which it occurred, forget it.

I had obtained permission to attend my placement for a few hours and so I was away from morning until about 2:30pm. I arrived back at the hospital and was told by the nurse to clear out my room as “You’re being discharged right as we speak.” Umm. What? No forewarning whatsoever, except for Monday when I asked the doctor when I’d likely go home, to which she replied it’d probably be sometime this week. Yes, I wanted to go home. Providing it had been discussed with me and I’d been given prior notice so I could mentally prepare myself for what’s to come. Not when I’d been booted out with n0 notice whatsoever because someone sicker than me clearly needed the bed more.

“You’ve been discharged, but the doctor wants to talk to you before you go,” I was told by the nurse after I had packed my things. Lol. She does, does she? But I’ve been discharged so am not your problem any more! “Do you want to go home?” the doctor asked once we had sat down in an interview room. I almost laughed, had I not been so upset and angry. Clearly, it doesn’t matter, as I’ve already been discharged. And so, being ever the obliging patient, I tried my best to make their job easier. “Will you harm yourself once you get home?” “No.” Can’t wait to get home so I can cut. “Will you call a helpline or crisis number if you need to?” “I guess so.” Not if my life depended on it.

I had come in with some of my own medication, Pristiq and Seroquel. As expected, it was taken off me on my admission, and I was told I’d get it back when I left. Did I get it back? No. Instead the nurses told me they couldn’t find it. They attempted to search for it. Leaving me to wait there for an hour while they did. It took them that long to come to me with the conclusion that they could not locate it, and it had probably been discarded of. Great, so you’ve just wasted an hour of my time for nothing and thrown away medication I had paid for, that is not exactly cheap either.

Still, that hour of waiting wasn’t completely unproductive. I took that time to give a call to A St to inform them that I would not be making that psychologist appointment on the 12th. Apparently the psychologist will call me back today to reschedule an appointment. Lol, don’t bother. I either a) will not pick up the phone, or b) will make it quite clear I have no intention of seeing her, nor any other clinician.

I don’t think there’s ever been any mental health professional that has not ended up leaving me feel let down and/or hurt in the end. So as far as I’m concerned, I’ve had enough. The whole lot of them can get stuffed. I’ll go my own way.