Everytime I See The Community Psych Services I Cut Afterward

[GWhizz]

*trigger warning*

Well I just had my 5th meeting with my community psych team. The objective here being to get more supports. The 1st time I met their social worker, and though I didn't have a lot of faith in her at that point - I decided to give her the benefit of the doubt and not let 1st impressions get the better of me (she did some questionable things during our 1st meeting). I've since had 4 or 5 further meetings with the team there (different professionals on occasions) and 4 out of 5 of those times I have self-harmed afterwards. The common denominator is that each time I was dismissed by them. Today I finally began a psychological assessment. Instead of stating the purpose of the assessment, what it would entail etc and that I could maybe take a break here and there if I felt overwhelmed... she repetitively told me that I didn't have to do it if I didn't want to, that I didn't have to continue with their services, that I could just try continuing doing what I've been doing already!

Everytime I have met one of the team there and was told 'you don't have to come here' or 'you can just try doing what you're already doing and see how it goes' I've self-harmed. I'm not blaming them. But each time my partner has called them afterward to address this and just how dismissed I've felt and how hopeless it makes me feel when I truly believe this is my last hope. It's a lifeline I've waited ages to get seen for. And they're telling me to go off and continue doing what I've already tried - which obviously has not been working very well or else I wouldn't be there in the 1st place!

I called the social worker after I'd self harmed. I didn't tell her I self harmed. I just again stressed my utter confusion to her. That I wasn't going there because I'd nothing better to be doing. I asked why they keep telling me to basically just go off and continue to struggle alone! I said I knew this was a voluntary service and that I was there out of my own free will, that I have the choice to consent or disagree to their assessments etc. She basically just reiterated this to me - that the psych was probably only trying to let me know that I had the option not to go through tedious assessments etc. I know this! But I'm doing this for my family too - not just myself. I thought avoiding it was what got me to this breaking point - why go back?! To wrap up our call, she tells me 'I'd obviously like you to come next week but you know I can't force you, you don't have to but it probably would be good'. Well now I'm even more confused by this ambiguity on top of the fact that the psych today closed our meeting with yet another 'you don't have to do this, even next week you can change your mind - it's not too late'.

Am I the only one who feels like they'd rather not do their job and just get down to the task at hand and address my real issues rather than giving me a free and super tempting free pass to quit before I even try?! Honestly I don't think I can go back there next week after this. Not to feel like this again. I tried so hard not to turn the anger and sheer frustration inwards on myself again today. And now the guilt of this is unbearably overwhelming.

Thanks for reading.

 

[Kefira]

I'm so sorry you were triggered and that you have to deal with this. That sounds strange and disconcerting, like they're trying to be nice but just really trying too hard. I've had a lot of problems finding providers I click with and it's super frustrating to work through for me.

If you do decide to go back next week maybe you can make a plan to help prevent yourself from harming afterwards? I'd also recommend being honest with them if you do back- just make it clear that you understand you're there by choice, they have consent, but that when they over emphasize it you find it distressing because you're trying hard to be there and it seems dismissive or like you're more invested in it than they are? I know it's been addressed afterwards, but if you can find the words to stand up for yourself in the moment perhaps they'll better understand. I don't know. Obviously you want to keep going with this and see if it can help you, so that's all I can think of to do without better knowing how the system works there.

Either way I hope you feel better soon and try not to hold onto the guilt. I also had a backslide lately into self destructive behavior and I find at least for me feeling guilty about it only makes it worse and makes me more likely to continue. You aren't alone in this. :hug:s if you'll have them.

 

[joeylittle]

Am I the only one who feels like they'd rather not do their job and just get down to the task at hand and address my real issues rather than giving me a free and super tempting free pass to quit before I even try?! Honestly I don't think I can go back there next week after this. Not to feel like this again. I tried so hard not to turn the anger and sheer frustration inwards on myself again today. And now the guilt of this is unbearably overwhelming.

Ugh. I went through something similar when I was in a new city and trying to get access to a hospital-sponsored DBT program. I got turned down by 5 major hospitals in a large urban area - I was either not depressed enough OR I was too depressed for outpatient and I needed to be admitted. That was the shape of every intake conversation I had. Tell them I'm coping, I'm not depressed...tell them that I was chronically suicidal and self-harming, I needed to be kept away from the other members of their DBT group. It was so painful, so frustrating, and I was where you're at - it got to a "not again, not ever" place. Luckily that was right at the time my other search (for a therapist) finally worked out, and so I had some support at last.

Try and keep breathing. Can your partner go in with you? If that's a bad idea, I think what @Kefira said - go in there and tell them that you understand this is voluntary, not required, you've got the memo, thank you, and that you are there because you want and need help. If the next thing out of someone's mouth goes like your phone call, and they say "well, that's good you know that, because you really aren't required to be here --" cut them off firmly with "I know. I want to be here. This is my fifth (or whatever) time back, and each time I've been so discouraged by the speech you are about to give me that I've left, gone home, and hurt myself. I would like to stay and get help."

If you can stay calm, it will go a long way towards getting them to understand. And at that point, if they just mutter about it not being required, then know this: they are really bad at what they do, and you should not look for them to help you out - you deserve better care than that. Much better.

Is there any other way for you? Can you get a therapist? You're being so strong, going in there as many times as you have. Don't let it feel like failure. I think it's heroic. Forgive yourself for the harming, there's nothing here to beat yourself up over. Keep posting here, because we've been where you are, and really: it's not you, it's them.

 

[GWhizz]

Thank you both for being so understanding. It's like I'm functional enough to work so maybe they see me as low risk. But if I told them how debilitated it really has me, they'd surely want to admit me. And this is where I'm caught - I can't afford this, to miss work or time with my baby. And I also do not trust the hospitalization system - it never helped before put it that way.

My T was away for a few wks and in the interim, I emailed her some stupid things which I'm now pretty embarrassed about. I said way too much about my trauma, stuff I don't feel I was ready to discuss or confront. She has told me in two emails to please make an appointment with her when I want to and feel able. But I don't want to or feel able now. I also can't afford to continue to pay her anymore and this is another source of shame for me. I know it should be a priority but it's adding too much other stress paying her so much yet feeling I'm not progressing at all. It would be good to have her support, especially through this. But I asked her not to email me and said I didn't want to text/call her as I really feel I'm burdening her. And I'm too proud to go back on my word if I'm honest and ask for her help.

I just feel like I'm sabotaging everything. I'm ruining a pretty good relationship and I have an inability to express my true feelings to anyone. The frustration of not being heard or being able to communicate is what's killing me.

 

[joeylittle]

It's like I'm functional enough to work so maybe they see me as low risk. But if I told them how debilitated it really has me, they'd surely want to admit me.

Yep.

What are their services? Sometimes you need to know how to describe yourself using the right clinical language. Annoying but true.

You should also write your T and tell her exactly what you said here - that you are feeling shame about what you wrote her, and that you are also unable to pay her anymore. This will be really hard for you to do. But when you write "It would be good to have her support, especially through this", it means (I think) that even though your brain is sending you lots of signals about fear, not deserving, going back on things, shame...you've got to remember that those thoughts don't come from you. They come from what's happened to you.

I'm just quoting my therapist - I am not at all good at this stuff either. Not at all. But intellectually, I do understand what he's saying, and he's right. And it's always easier to see in other people than in yourself, the ways we self-sabotage.

Can you try and reach out again to your therapist? And do let me know about the services the center offers; I'm pretty good at how to harness the power of clinical description. I'd like to help, if I can.

 

[GWhizz]

Thanks @joeylittle. They're basically a community mental health outpatient service though they are closely tied to an inpatient mental health hospital - hence my fear I'll say too much and they'll want me admitted - they've already pretty much given this as the only option to help me before when I told them just a little about just how bad things were getting (like when I overdosed back at the end of July).

The reason I've been referred to them was because I was initially diagnosed with ppd. Then after seeing my T for a bit - who is a psychotherapist - both her and my gp strongly urged that I went back to the maternity hospital to see a psychiatrist that deals specifically with ppd and issues triggered by childbirth etc. But I really didn't want to go at that time. And when I finally agreed I was past the point where I was still eligible to be seen by the maternity services - they'll only see you within 6 months of delivery.

Anyway both my T and my gp believed I'd strongly benefit from an official diagnosis so that treatment could be best appropriated. They felt that there was maybe a 'mild ppd, but that it was all triggered by underlying past traumas' now quite relevant as your own childhood impacts your parenting etc.

So I'm basically meant to be getting 'officially diagnosed' with what my T and gp already agree is ptsd or c-ptsd. This clinic also offers different therapies and treatments, such as mindfulness, group therapies, parenting supports, cbt, dbt and all the usual clinical psychology and psychiatry services one would expect - all free of charge under the public health system here. They do seem to offer quite a broad and potentially great range of services. It seems accessing them is the tricky part.

I guess another part of me feels I've let myself down. It's also like I'm being made beg for help. I want to show myself I can be strong and do this myself. I don't want meds or to rely on others. Heck I don't even want a diagnosis - that's why it's taken me a year to agree to go here. But I know what I'm doing isn't working. I know I can't do it alone and I can't afford private help which I'd probably get even if I were fine once I was willing to wave the money! I'm reassured that they're not pressuring me and that they don't just throw diagnosis about 'for the sake of it'. But being told by her yesterday that I didn't have to go through the assessment with her 'just for the sake of doing it' was another slap in the face. I'm easily pushed away. I'm not asking them to walk on eggshells with me though. Just to stop telling me where the exit is when I'm well aware. I'm going there because I know the exit is available if it gets too much, unlike being admitted to hospital and potentially losing that control.

I don't know what I could say to my T if I were to contact her again. I feel that she must think I'm being manipulative with all this back and forth push-pull relationship. She keeps telling me she is there for me to contact outside of sessions but that she also needs to see me regularly to work with me - she thinks I need that face to face, even though it's hard for me, she thinks it's most important. But I'm caught financially and she doesn't seem capable of truly understanding the weight of this on me in my decision to quit attending her. And no, I'm not expecting her to work for free in case it appears that way. I already felt awful having to accept a reduced fee negotiation with her previously. And I've promised to make up the difference to her in the future when I can afford to pay her back, even though she isn't asking for this.

I just feel really stuck. It's like I'm hitting a wall everyway I go. And yes, maybe it's down to a personal self-sabotage, most of it. Some is circumstantial due to finances etc. But admittedly I know I push help away. I just don't know how to ask for what I need. I'm not even too sure what it is I need or how I'm truly feeling. Does that make sense? How can you express something when you don't even know what it is you're trying to communicate?

 

[joeylittle]

I think you are making more sense than you think you are, and you're communicating OK - it's just buried under some symptoms right now. I understand resisting getting help, that was the story of me for the last 20 years. I promise - if you can just keep holding onto this:

But I know what I'm doing isn't working. I know I can't do it alone

This is you, the solid core of you that is still there underneath the symptoms and the trauma. You need help to dig out. We all do.

So I'm basically meant to be getting 'officially diagnosed' with what my T and gp already agree is ptsd or c-ptsd. This clinic also offers different therapies and treatments, such as mindfulness, group therapies, parenting supports, cbt, dbt and all the usual clinical psychology and psychiatry services one would expect - all free of charge under the public health system here. They do seem to offer quite a broad and potentially great range of services. It seems accessing them is the tricky part.

OK. This is all really clear. And I'm assuming that in your country a therapist or GP can't do a diagnosis. But is it possible for your GP to do a referral, or actually give this place a call and set up an assessment appointment? Doctors talking to Doctors is usually a smoother process, as opposed to needing to self-disclose (where it's easy to inadvertently seem either OK or really not OK, when in fact, you're just symptomatic)

If your GP can't do that because of the way things are set up, then go in for the assessment. Do they start with the little "quizzes" and written tests, or right away with talking? If it's talking, then this:

The reason I've been referred to them was because I was initially diagnosed with ppd. Then after seeing my T for a bit - who is a psychotherapist - both her and my gp strongly urged that I went back to the maternity hospital to see a psychiatrist that deals specifically with ppd and issues triggered by childbirth etc. But I really didn't want to go at that time. And when I finally agreed I was past the point where I was still eligible to be seen by the maternity services - they'll only see you within 6 months of delivery.
Anyway both my T and my gp believed I'd strongly benefit from an official diagnosis so that treatment could be best appropriated. They felt that there was maybe a 'mild ppd, but that it was all triggered by underlying past traumas' now quite relevant as your own childhood impacts your parenting etc.

Is nearly perfect. Keep the narrative very, very simple.

Something like: "After I gave birth x months ago, I started struggling emotionally. I started seeing a psychotherapist and also talked to my GP. They both suggested I return to the maternity hospital to see a psychiatrist to help me with what they believed was ppd. By the time I managed to get back there, I was outside of the treatment window the maternity hospital offers - you need to be seen within 6 months of your birthing date. I spoke with my therapist and GP again, and disclosed some trauma due to (x) which happened (x) years ago. They believe it's likely I'm experiencing PTSD, and encouraged me to come here. I am seeking a diagnosis; but more importantly, your programs seem to be the right kind of help that I need. I can't afford any more private therapy at this time. I need help learning how to manage the symptoms I'm experiencing."

And then you'll need to name your symptoms, in short bits of information. Write all this out in advance, and even practice saying it. The key to a successful assessment (I believe, after having had a bunch of mine go wrong) is being simple and clear, without editorializing. So, it's not "I have a little trouble sleeping sometimes"; it's "I have trouble falling asleep at least four nights a week".

You're probably prone to minimizing when you want to feel stronger and maximizing when you are trying to be heard. (Or I'm just projecting because your story reminds me of me). Anyway, removing ALL editorial opinion from your symptoms is very, very important.

If you are asked to disclose attempts on your own life, you'll need to disclose the overdose. Keep it to the facts, honest and succint, and end with "I am not currently in any danger; I don't have any plans to end my own life. If I ever feel that way again, I will get medical help immediately".

For an assessment, it's all about the basic facts, no opinion, no doubting yourself or your right to be there. They haven't made that easy on you. Truly. But you can do this. You are making tons of sense, and it's just such a shame that the way we need to be for a solid assessment (clear, unbiased about ourselves, and brave) is the opposite of how we feel when we learn that we need to go for the thing in the first place. But there's an advantage to being good at public coping and seeming more together than you are, and the advantage is that you can basically keep your head together in order to give them the information. You just need to let the information speak for itself, without you judging it.

The one thing I'd seriously downplay (and not even bring up, unless it is your main problem) is the self-harming. There is surprisingly little taught about self-injury and the various levels of it. If you are a daily compulsive cutter, that's a huge problem and you need to tell them that. If you harm yourself when stressed, but not every time you are stressed, you aren't compulsive. Because it's a dangerous symptom, it can easily lead to being admitted, depending on the experience level of the assessor. So, I'm not saying lie about it, but as long as you don't believe you are utterly out of control of it, then wait til you're assessed and find your way into the programs. Then look for help with it.

Sorry. That's a book. I hope it helps, I don't mean to sound like queen of the world or anything. I just have done this runaround more than a few times.