Psychology assessment outcome
 

I had the second part of my psychology outcome. She said they won't work with me on an individual basis whilst I continue 'to engage in life threatening behaviours'. I don't engage in them though. My harming is not that 'bad'....it is no where near bad enough. She said there is a 20 week group course I could go on based on DBT but only group work, with no individual therapy, but before she would do the referral then I need to commit to it by making a decision to 'stop or significantly reduce my harming because there is no point if I don't want to stop it' and I need to get rid of and not replenish my excess med supply or allow myself to entertain suicide as an option.

She said there is no point working with me individually or even in a group if I could impulsively overdose (which I have not done for about 2 years) or accidentally cut too deeply because 'we can't do psychology with a dead person'. I don't know what to do. I have two weeks to think about it and she wants me to make a decision, she says being willing to 'give it a chance and see how it pans out' is not committment enough. I don't think I can commit further than that though. I can't promise to give up or even reduce my harming. I can't. I said I would give it a chance but that is not enough. Without the promise to try and stop the harming and get rid of all my excess meds and having a detailed argument for why this 'WILL help me' then they won't take me on the group.

Maybe I am too ****ed up to be fixed. Maybe I should have lied....I knew what they *wanted* to hear but I was trying to be honest, I thought it was for the best, honesty is important in working towards getting better right?? I feel like they are giving up. Maybe they should. I honestly, genuinely don't know how to make that committment or decision in the two weeks she has given me though. I agreed to the assessment (they sent out about four 'are you sure' letters you had to send back, I went to the first, then it got carried to another and I went to them. And that was really hard for me....does that not show I at least WANT to try??

I know it is not perfect....I don't know how to suddenly promise to stop harming though. If psychology won't accept me without that, and psychotherapy have indicated they won't either then what does that leave? Nothing. I am hurting my friends and family and I hate myself for it. I hate what and who I am as well.

I don't know what to do anymore. It feels like I am finally, totally, out of options because I don't know how to give up my self harm, but to get any psychological help then that is what I have to do. I always thought you would get psychological help to do it but apparently that is not the case....you give it up to get the help. And I can't do that. I don't know how or even if I want to. I am scared about who will get hurt if I do. If I just make it 'enough' then it will be ok....right?

Their priorities do seem really wonky, and has little understanding of the compassionate psychology of the dynamics of sense of personal power and supporting you to gain a healthy sense of that. As in, your self harm etc seems to give you a sense of control, albeit unhealthy, and if you have that taken away before you're supported to have a healthy sense of control, recovery won't be a full and deep one. It's not about meeting where you really are, and that makes me sad.

Have you thought about Mind or similar for counselling?

I think your health system is screwy. Aren't they supposed to help you so you CAN give up harming? Though I agree with them and not you on the fact that it's life threatening. you constantly downplay your harming but I know how bad it is. And i'm all for you getting rid of your excess med supply! I dont' really know what to say, I can't fix it :( I wish you were here and then I could help but the stupid ocean is in the way and that sucks! I love you heaps and want you to get any help you possibly can!

Why should they let you on a course to help you stop harming if you have no intention of stopping? That makes no sense to me at all. Its not fair on them, the system and others who may be waiting for a place who do want to try. This may sound uncaring and hard but this is the situation you are in. Its called reality!

Would you accept a course of life saving cancer treatment costing thousands with the knowledge you wouldnt try and get well? I doubt that.

Yes you have to make a choice and yes its time to take some responsibility for your health. Its as simple as that. There is nothing more to it.

You need to ask yourself why you wont reduce your harming and get rid of your pills. If its because you dont want to be well then dont accept the course. If its because you are frightened that you cant do it then perhaps that can be worked on. However YOU and ONLY YOU can decide that you are going to try!

They did not say promise to stop, but they said to make a commitment to reduce significantly. This is your starting point. They DO NOT expect you to stop and be cured before you start. That would be plain stupid. But in order for this to work there needs to be commitment from you because no amount of therapy or pills can beat your will if it is intent on keeping yourself in this same situation.

You see Emma recovery is a two way thing. I dont mean to patronise but they cant make you better. You have to switch that switch on in your head that says im going to try, before they can help you.

I guarantee that all the people here who have started recovery will have faced this question. Its ****ing hard! Its scary as ****. But whats the point in getting treatment if you dont want to bother yourself? What will happen is that you will set yourself up to fail this course so that ultimately you can feel even nmore **** about yourself and probably end up harming even more seriously just to prove you are a failure and useless. THEY WILL BE AWARE OF THIS!

For this to work you MUST make a commitment to them, your family and yourself. They will know slips happen. They will know some wont make the full 20 weeks. They cant stop that. They cant ask you to be perfect. They cant ask you to self cure and they wont expect that. It is not unfair of them to ask for your commitment. They will tell you that your commitment to this program will make the difference between succeeding and failing. That ultimately without you on board they cant do anything.

Its big girl time and its your choice.

I think this is really the key. ^^

Crazy analogy coming up...

Imagine a group for people that are training to run a marathon...

Someone could turn up, and be totally unfit, but have a definite plan to run a few times a week. They aim to do a fun-run in a couple of months, and see how it goes from there. That would be OK.

But if someone turns up in high-heeled shoes saying they can't afford to buy trainers, refuses to do warm up exercises, and keeps telling everyone they hate running and would rather be at home - well it's never going to work!

I do understand what Matt and people are saying. I know recovery is a two way thing. I totally understand, accept and agree with the fact that recovery is not 'done' or 'given' to you. It takes work and effort and it is hard. I know that and I accept it. I went to the assessments knowing it would be hell if I was to get accepted but I genuinely thought that it would be 'therapy' in order to get to the cause and work through things so that maybe I could get to the point where I could see the point and maybe even (and this is uncomfortable) *want* to stop self harming. I did not expect it to be the other way round, where you stop or minimise the harming before getting help with anything else. My social worker and psych both told me that they excepted that was probably not going to be helpful for me and that they understood that was not what I wanted. This was a general referral and we (social worker/psych/htt) thought it would probably lead to individual therapy.

I understand that a course designed to help people wanting to stop harming when I do not feel ready for that is probably not going to help me and I also accept that I have no right to take up a space on such a course when I don't agree to engage in that ideology. I asked if I could not do something, some sort of psychological work to help me understand why the harming is such an issue and get to a point where I agree and want to reduce it but she said (very clearly) that they would not offer that. So I was (am) left with a situation where I either agree to reduce and stop my harming or get nothing.

I agreed to try it and to try and apply the skills instead of harming but she said that was not good enough! She said if I am not willing to guarantee I want to greatly reduce the behavuour then I can't do it, she wants me to convince her I want to do that before I can even try the course. I very rarely harm now....i.e a couple of times a month. I can't reduce that anymore at the moment. My harming is not impuslive. If anything I am acutely aware of the feelings that it is not enough. To me that is something that needs exploring via one to one therapy. It is not something that I can deal with by learning a load of impulse control DBT skills, which yes, would have maybe helped two or three years ago when it was fairly regular and often impulsive. That is not what I need at the moment. I told her that.

She said it did not matter and that nobody would work with me until I 'significantly reduced' the severity because it would be a 'waste' of their time just in case.

To be clear...I don't WANT to be this person anymore. I don't want to feel like this. I WANT to feel and be different. I want to be 'normal'. I just don't know how and I don't know how to promise to reduce my harming severity when anything less than that does not even count as me self harming. I told her I went to the assessment knowing they may want to address it and that I wanted help to understand it and be more in control of it.

I know what they want to do the referral. I can't do it though. Any option would have been difficult for me but this seems almost the reverse of what I was expecting. I genuinely don't understand how they can ask you to almost stop self harming before they will help with the feelings/thoughts/emotions behind it. I don't understand. The course would most likely not start till March either. How am I supposed to keep that control over self harm thoughts etc until then??

I REALLY wish person centred counselling was on the NHS! I think that could really help you. Meh. You need support, damn it.

Personal counselling IS available because i was offered it! I had a 3 week assessment and was put forward for one to one.

Ok now i understand the situation a little more. For your assessment did you have a series of interviews with a psychologist who asked you loads of questions about your past future and present, current state etc etc? Mine was over a 3 week period meeting once a week. It was like therapy.

Firstly i would say that if your current support group are insisting on one to one then you need to get them to help you appeal this decision. I dont know how it works but perhaps there is a way for your gp or whoever to ask how and what the decision was based upon. I think without knowing the reasons its hard to judge why they offered this to you.

From a document i was given by my old crisis team (Birmingham MHT) on how the assessment works (i still have it), it basically listed all the types of therapies available and what sort of needs a person would have to show to require it. from what i gathered they would take the information taken from your assessment and offer the best therapy available that best suited your needs.

Now perhaps one of three things happened here:

Firstly it could be the NHS in your area are not capable opf providing the correct service? either the assessor was crap, they have no money, they dont have the right option available to you due to resource or they just plain screwed up.

Secondly, it could be that the way you came across in your interview/assessment lead them to think that group therapy was the best thing? I dont nkow what you are like when explaining how tyou feel to the services, but many of us are bloody awful even when we think we are good! It could be possible that you came across less in need that perhaps you feel? Youve mentioned before about the humour and being misread. Im not saying you were silly or funny, but from what you have said previously i know you play yourself down.

Finally, it could be that they truely believe this is the best course of action for you? Again you would need to find out why. It could be they are right, or it could be related to reason 2 above?



note: You know sometimes one to one isnt all its cracked up to be; each therapist works in their own way, some CBT, some psychoanalytical and some god knows what. Im guessing you dont want cbt but want to know the root causes? This can be great to realise why you do what you do and where it stemmed from, but it doesnt mean it will stop you. There is a lot to be said for practical and cognitive approaches. Psychological gentle kicks up the arse and re-workings of old behaviral patterns. (sorry i dont read books on this so i dont know all the fancy terms, i can only speak from my heart so apologies for the lack of accuracy).

Find out why they chose this route for you and then decide what next to do.

Thanks Katie :)

Matt, originally the assessment was supposed to be just one appointment consisting of 15 minutes of those standard anxiety/depression screening tick box tests and then an hour of talking but after an hour and a half talking we had to stop and she arranged another appointment to finish which was what I had on Monday. She asked me about present difficulties etc, history, family history of mental illness, past treatments etc.

I think I was pretty honest with her but yes, I guess I was fairly joky although I tried harder not to be and even cried in front of her on Monday. The 'proper' DBT service of individual alongside group for 2 years of whatever is currently being closed due to funding cuts, or at least they are no longer accepting people from my area and are moving current patients from my area to a different centre. This group is kind of their attempt to put something in its place even if it is only a short term once a week group. The other service she said she could put me forward for would be an day therapeutic community the other side of the county where I could go for several days a week and have group and individual therapy for up to two years. A close friend literally started there last week though so that is not possible.

I asked her if I could do something like cognitive analytical therapy or psychoanalysis but she said I would a) have to be referred to the psychotherapy department (I did not know they were different departments) and b) they probably would not take me unless I stabilised and reduced the self harming because apparently it can make people more unstable when they start working on difficult things. It just feels like a catch 22 situation. She said she did not think CBT was appropriate (plus I have had individual and group courses based on it before) and she has to make a referral for a treatment that studies have shown 'work for people with your difficulties such as self harm'.

I saw my social worker today and she told me she thought I should try the group but I explained to her about what the psychologist wanted me to do and why I was apprehensive. I am a bit confused, she said it would not help if I was going into it expecting it not to help and then she told me that even if I got rid of all my medication then it would not be hard for me to just replace it over the internet so could I not just throw it away just to please the psychologist? She has already spoken to the psychologist about my self harming and explained that it is not generally impulsive and she agreed with me that the psychologist had misjudged that and also seemed to think my moods were very changeable and reactive, which again they generally aren't. The only other thing they have suggested is doing a 'WRAP' (Wellness recovery action plan) with me. But again, I have done them before and I actually find them more irritating than helpful. It is another superficial 'treatment tool'. A long form with questions like 'when I am well I am.....', 'when I am ill I am....', 'what helps me.....' and stuff like that.

It just feels like this is too engrained in me for something like that to help and it is frustrating me, and honestly making things feel pretty damn hopeless that this is all that seems available. I could ask for a psychotherapy referral but I will have to turn down this group if I do that and I can't see psychology offering it again if I turn it down and psychotherapy then say no.

I have not been doing well recently so my social worker made me a psychiatrist appointment last week (funding cuts in my area also mean you no longer see your psychiatrist regularly and they do not prescribe medication, you have to go to your gp). I will try and talk to my psychiatrist when I see her next Wednesday and see if she has any bright ideas. I just don't know what to do and I also found out last week that my landlord is selling my flat (the one I literally moved into less than three months ago). I'm supposed to be aiming to go back to uni part time in October as well and I literally am seriously struggling to cope at the moment. Sorry, I know those last two sentences are slightly off topic. I'm just....lol, well I don't even know what.

jesus christ!!!

I REALLY dont get other country's mental health system.

You were being honest which should count for something!! you werent manipulating!!

An educated doc or therapist KNOWS that you cant wave a magic wand and erase years of destructive coping mechanisms.

obviously, you want the help or you wouldnt be asking for it.

and yes, there are plenty of cancer patients who try and give up until someone convinces them to fight for themselves. you NEED that. you need to be told that you are important enough to fight for yourself!! and a therapist is the one who ultimately will help you decide that!!

how do they possibly expect you to answer all their bs questions with a level head?? it's THEIR job to help level your head damnit.

im sorry Emma.
love you to pieces.
xxxxxxxxxxxxxxxxxx

I think your social worked was totaly wrong to imply you could or would get meds online. for one if you hadnt thought of it she could have implanted that thought and for two its a pretty stupid thing for a professional to say unless you have a history of ordering online and they are aware of this?

I think its quite telling that you are so insistant that nothing will stop you unless its this type of analysis youve not tried yet. Perhaps you should look into this.

I have on rare occasions bought medication online before and it would be in my notes.

What did you mean by your last two sentences? Look into the therapies? Or look into why I am 'insistent' on wanting something analytical?

Just wanted to clarify that I meant Person Centred Counselling as pioneered by Carl Rogers. Very good for developing self acceptance, and a good lead in to eventual deeper, and more directly practical proactive work.

Was wondering if you had thought any more about all this?

I have been thinking about it but I just keep going round in circles. I do want to try psychology and if that means the group then I want to try that it is just really hard. I tried to get rid of some of my pills yesterday and got rid of about a third of them, benzos before totally breaking down. I couldn't manage to get rid of the rest of them and even getting rid of that is making me want to harm more. Something in my head decided I needed to OD on the same number to punish myself. I didn't but it was really really difficult, the 'need' is still there but under control for now which I guess should be a good thing but it isn't. How am I supposed to get rid of the rest when getting rid of about a third has made me think and feel like this?

I know it is my choice and if I don't then I won't be allowed to do the group unless I lied but I really don't know how to. I'm sorry, I'm not meaning to be difficult. I'm just scared I can't do it and I'm scared I can't do the group and there is nothing else.

I'm seeing my psychiatrist tomorrow morning and then my social worker so I guess I will talk to them about it some more. I have until next Monday to decide. I just don't really know what to do.

I tell you what you do: you tell them what you did and how you did it and why you did it and how it made you feel. For someone who CANT give up or get rid of them you certainly did a bloody good job at starting.

It doesnt matter if you cried! you ended up getting rigd of a huge safety blanket without hurting yourself. sure its hard. Its not meant to be easy you silly sausage!

Im actually really proud! I really think you can do this and i think you just showed youself you are stronger than you think. Of course you will find a way to make your achievement seem meaningless in your head but thats all part of the process!

WELL ****ING DONE!

Emma, I am so proud of you for getting rid of a third of your pills. It must have been so hard to do...and then to have the strength not to harm yourself or take an od..you should feel proud of yourself. xxxx

Well done for getting rid of some. I do a form of CAT and I can understand why they would be reluctant to not let you do it before your self harm is under control. For me I hadn't self harmed in years and the therapy triggered off so much that it started again. I hope that you get to go to the group. x

Emma, i have to agree with everyone else. It must have been very hard for you, but you did it!

Really well done emma *high five*:-D

LOL....I just tried to call the crisis team because I am struggling with the same thoughts as a result of throwing away my medication. I don't just call them unless I have already tried my distractions, grounding etc etc. Apparently with 'your diagnosis' then I need to learn to take responsibility and just keep trying things. What the HELL is the point? I've tried, I really have. I've spent the last six or seven hours trying to 'behave' and when it go too much then I called the CRT just to speak to this stupid woman who basically told me I needed to 'take control and responsibility'. I am actually trying to, regardless of what everybody else ****ing thinks.

What the hell is the point though when all it leads to is NOTHING?