Good(?) News And A Question About Support

[Sandstone]

It seems that I will be starting CBT for trauma in February. I'm not counting on it, experience has taught me never to expect the local NHS to do as they say. It won't be with the trauma specialist they had promised as he has no capacity. Instead it will be a Psychologist who did an assessment last February. I found her OK - calm and thoughtful, and apparently knowledgable, so if it happens it may well be productive.

Before that though, there is to be a meeting to discuss what support I will need outside therapy. I have no idea.

I know that on two occasions getting into stuff in therapy has "made" me suicidal, but not a clue how it could have been avoided. And again, experience has taught me that asking for help from the NHS tends to be ignored and that I then feel much worse. I can't help thinking that this is my problem and I need to deal with it, even though I know that in practice that tends to up with me drugging myself into oblivion.

There must be a standard approach to this - can anyone recommend anything I could reasonably ask for?

I had thought it was the job of the therapist to teach and mentor me in skills to manage myself, but it doesn't look as though it will work that way.

 

[illusionist]

Hi Stenni. One of the best things my councillor said to me on my first day was that I will find my own ways of dealing with this....it got stuck in my mind. It was also very important to me to do that, Its the way I naturally am in life. Try telling yourself that, leave a note somewhere as a reminder.......I WILL FIND MY WAY, look at it every day. Ask your therapist what you can do, by way of self help, the more you do for yourself, the more likely you are to remain focused. Come on this site by way of support and to learn . I went through a time of turning to alcohol during those two years of counselling, I hated myself for it, absolutely hated myself, so I stopped. I knew I had to feel the pain and be able to process things, I couldn't do that if I was intoxicated, and it does make you feel worse, doesn't it? It is a hard, hard thing to go through but you will learn things about yourself, positive things, as well as things that you would rather not learn or realise......but in order to do anything about it you have got to see these things for yourself. I went through councelling without much guidance. I don't know what they call it but things that I said were reflected back at me, to make me question myself, look at myself, you do realise a lot, believe me. Please feel free to pm me....and good luck.

 

[seedling]

My therapist did a suicide prevention plan with me when I first started talking about suicidal feelings. We went over things that helped me
during those times, who helped me during those times and what I would do if I felt that way again. He asked me to keep the plan in a place where I could get it out easily if I needed it.
For me just doing a plan helped me think of the things I'd written down even if it was just the feeling of being afraid I might get suicidal. I was able to think "oh, yeah, I have that plan and X, Y, Z is what I would do."
One of the things I wrote down as helpful was hugging my dog. It doesn't have to be rocket science.

 

[Sandstone]

But the thing is, this meeting is six weeks before I start therapy. I'm reasonably stable at the moment, but only because I've cut my life down to almost nothing, and steadfastly refused to think. That makes it very hard to visualise what I might need in crisis, or even to believe that I might reach a state of crisis.

I tend not to know that I'm struggling anyway - it comes up on me from nowhere, and it's only afterwards that I can see how it all built up. When I do get to desperation, the very last thing I'd do is ask for help. I don't think either of the therapist I was seeing at the time knew it was coming either. Even the good one told me that I look so self-possesssed I was one of the hardest clients she'd had to "read". But afterwards, both she and my GP said they thought I could only tackle my traumas in an in-patient setting.

I think I need to ask for something that will help me avoid getting to the desperate stage , but I don't know what that thing is, or how other people could possibly provide it. But I have to look involved and grateful - I can't lose this opportunity, because I think it's my last.

The dreadful therapist did get me, as homework, to construct a list of distractions. She never mentioned it again, so at the time I assumed she had written the idea off. But I can't see how learning a poem by heart, which was the only thing I can recall on the list, would make any difference when I am deep in self-loathing.

One of the best things my councillor said to me on my first day was that I will find my own ways of dealing with this

This, and its friends "You have to tell us what you want" and "Everyone is different, so we have no standard approach" drive me crazy, in both senses. They seem to be the standard UK NHS approach, and I'm sure they are meant to be empowering. But I don't know how to do this. If I did, I would have done it by now. I'm used to doing things for myself, I used to be highly competent and self-sufficient. I'm asking for help now precisely because I can't find my own way and don't know what will work. There is reams of research out there - it seems reasonable that the professionals should be the ones who know about it and distill the best from it. I thought my bit of the job was to work with them to apply it to me,but they seem to want me to become a one woman research lab.

 

[digger]

I'm reasonably stable at the moment, but only because I've cut my life down to almost nothing, and steadfastly refused to think. That makes it very hard to visualise what I might need in crisis, or even to believe that I might reach a state of crisis.

Perhaps reread some of your threads/posts from when you were in therapy last year to help you identify some of the support you needed and didn't have back then that might make a difference to how you manage therapy this time. I think you've said before (apologies if I'm getting mixed up) that it is between sessions that you end up feeling overwhelmed, more than actually in sessions. Do you think they are maybe trying to anticipate this this time and help you to have things set up in advance, so that you hopefully don't end up in the same crisis you did last time?

it's only afterwards that I can see how it all built up

This could be useful to you, and them, to prevent the same thing happening again. Even if you can't see yourself at this point how someone could have helped, giving this information to someone else could help them to come up with ideas for you.

 

[Sandstone]

Even if you can't see yourself at this point how someone could have helped, giving this information to someone else could help them to come up with ideas for you.

Good idea - thankyou

 

[Sandstone]

Any other suggestions? I'm afraid that if I don't go in with some ideas I'll look as though I'm not co-operating. I've found in the past that if I say "What do you usually offer?" or " What usually works?" they don't like it and expect me to know what is specific to me.

Looking back at past stuff I realise that I didn't know the answers then and I still don't now.

 

[joeylittle]

You could discuss making a safety contract with the therapist. Essentially, you are agreeing (and signing a piece of paper, if that is meaningful to you) to take yourself to the hospital before you'd try suicide; or, there could be a series of steps - as in, I will do deep breathing for 10 minutes, I will do one distraction for 10 minutes, I will call a crisis line, I will go to the hospital.

Really, whatever you think will both address your particular kind of suicidality and will operate as a fail-safe.

I find it incredibly useful because it gives me a plan in advance for when I'm getting into those feelings: once you're in them, it's nearly impossible to formulate a smart grounding strategy. Also, if I've agreed to something, I have an incredibly hard time breaking my promise. I can't do it. So, with my therapist, our agreement is that I have to call him before I hurt myself, and if he is not immediately available I have to wait for him to call me. That was how he wanted to set it up. It gets refined depending on where we are in the work, how bad or not bad things are.

 

[seedling]

I tend not to know that I'm struggling anyway - it comes up on me from nowhere, and it's only afterwards that I can see how it all built up.

Maybe you could tell them that you need help figuring out what kind of help would address this. That you need help recognizing the signs that a crisis might occur.
Is there a way you could ask for assistance to review what is going on in your life at any given point and have them help you assess where you are at and if it's likely you will remain stable.

I'm not sure what they offer but I think telling them some of the things that you've written here might help them to see where you struggle to know what to ask for. It's hard to know what to ask for when you are trying not to think too much so you stay stable.

I know what you mean about getting help because you can't do it on your own. I know there's a lot of things that I do, and could do, to help myself. But I've always felt that I will not get out of this on my own.

Good luck.

 

[Suzetig]

I would second the idea of looking back at last time, getting a sense of how and when you knew you were struggling, understanding what the signs were that things were building up and as a first step writing these down somewhere. You can then use this list as a way of checking how you're doing, so even if you think you're fine, if x, y or z happens, you know you need to think about accessing supports.

You could also think of things you know work to relax or ground you, put a list of these with your checklist so you have both handy together. I wonder too if it would be worth journalling this time around both to get things out of your head and to provide you with a record of how your feelings change over the course of therapy and what you needed (and did or didn't get) at each stage.

 

[Sandstone]

ooking back at last time,

I've made three attempts to do so, by looking at my old posts

- on each I've given up in a state of panic. Anything that requires introspection terrifies me, because I hate what I see so much I start heading for self destruct mode.
First Psychologist - I was content with him as a person and a therapist, but generally distressed in sessions "You are too unstable for me to address trauma - see if some different meds help you stabilise and we will try again"
Second NHS therapist - I was always desperately upset and bewildered by her and our inability to communicate.After a year of weekly sessions I started pushing to address trauma. Within a month I took excess sleeping pills and then drove after leaving a session.
Third private Therapist - I liked, respected and generally enjoyed seeing her. After 6 months I started pushing to address trauma. Within a fortnight I took every pill I could lay my hands on and crashed the car.

a sense of how and when you knew you were struggling, understanding what the signs were that things were building up

With the second I didn't know I was feeling any worse than I usually did about seeing her. It always took me several days to recover from it , and I didn't feel any more distressed than usual in the run up.
With the third the only sign I could see was that I was taking sleeping pills and anti-histamines to avoid thinking. And I'm now not allowing sleeping pills in the house so that won't happen. They offered me some recently, dispensing only 3 at a time, but I knew that wouldn't be safe so declined, saying it would work out too expensive. The best safeguard I suppose is that I now know they don't work, as I had hoped, to keep me safe from doing anything; instead they reduce my judgement even further.

While in hospital I wrote a list of the things that had increased my instability alongside the therapy. Reviewing them is a bit worrying, as several are seasonal and will be coming up soon after therapy starts in February

• Spring, when I always make large and impulsive decisions
• Anniversary of my son's still birth
• Overdoing Christmas - exhaustion and overwhelm hung on long after
  
• Mother's day and her birthday.

And some are ongoing

• Total inability to communicate to OH
• OH inability to reply when I did tell him stuff - I try not to tell him when I am distressed, but if i do, he is incapable of replying, so I feel my words are drifting off like tumbleweed.
• Need to push on faster with T - that is the point after all.
• Dreams becoming more alarming and distressing
• Lack of money
• Awareness of how useless I am

But some are not current any more, and I've cut my life down far more to prevent new ones coming in

• Asked to go on week away with support group - Fear of leaving sources of security and of spending long periods of time with people
• No support when told MH service I was going downwards
• No contact from MH Psychologist after assessment
• Being told I had to stop seeing private T if I wanted NHS trauma therapy.
• Duloxetine - no benefit from yet another drug, just constipation and itching.
• Cancellation of appt. with Psychiatrist and notification of move to a new one with no warning/ consultation.
• Work hearing re dismissal - though I keep getting letters I don't understand about pension.

a safety contract

That probably makes most sense - but doesn't relate to to pre-therapy meeting. I can see " I have no right to kill myself, because it will distress my family, so I will commit not to." But that does mean I'm committing myself to living with huge levels of pain. I suppose that's just the way it has to be. And I have to balance it again the belief that I have no right to exist (and am useless to my family anyway). I think it all comes down too - I've just got to grit my teeth and get through it, which is the way I've always approached difficult stuff.

 

[joeylittle]

@stenni, I actually think a safety contract can be a part of a pre-therapy meeting, because it is actually a level of baseline support. I could not even begin to talk with my therapist about some of my depression issues until we had formally addressed how I was going to deal with my suicidality. After a number of times in therapy hitting that same wall, I figured out that what I needed was a formal agreement with someone that there were steps that went before I "had permission" to do something potentially irreversible.

Again, though, this works for me because I have this really strange (kind of bigger than it should be) thing about not breaking a contract.

I think, for it to be useful for you (and not be stuck with living with huge levels of pain, as you say) you would need an assigned resource - whether it's the therapist themselves or a social worker - that was in a formal arrangement with you to be your "check-in"/safety contract person. It would be great if the support you could get would mean you don't need to navigate those hard, hard moments alone.

I think I need to ask for something that will help me avoid getting to the desperate stage , but I don't know what that thing is, or how other people could possibly provide it. But I have to look involved and grateful - I can't lose this opportunity, because I think it's my last.

I don't know what other kinds of support you can get, but would having the NHS also send you to a once-a-week group meeting of people with PTSD? Do they have those kinds of support groups where you are?

The dreadful therapist did get me, as homework, to construct a list of distractions. She never mentioned it again, so at the time I assumed she had written the idea off. But I can't see how learning a poem by heart, which was the only thing I can recall on the list, would make any difference when I am deep in self-loathing.

It doesn't help when you're too far gone to have the energy to do it - but usually the idea with a distractions list (it's straight out of DBT) is that you have a big list to go to whenever you feel yourself just starting to ruminate, or think dark thoughts. Right at the top of that downward slide is best. I ended up writing my distractions on cards, and had one box for "I'm ok but need to occupy my mind" (those were challenging ones) and one box for "I'm not so good", and a third box for "I'm a zombie". Those were the easiest. Like, "walk around the building once". With any distraction, you just have to commit to it for about five minutes. I'd call memorizing a poem a very advanced distraction.

They don't fix everything, but they put you back in the drivers' seat again so you can (hopefully) cope.
Can a pre-therapy support thing be getting some DBT classes? Because that really is all about how to navigate the world when you are under extreme emotional pressure.

Just throwing ideas at the wall, hoping something sticks.:)