Some time ago I was referred by my GP to the mental health service in my city. I received an appointment to undergo an assessment and was recommended to undergo a few weeks of Cognitive Behavioural Therapy.
This should have begun after a wait of around six to eight weeks but there was a mix up with my notes. The person who did my assessment wrote to my GP to inform me that I'd been put forward for this treatment (luckily my GP had a copy of the letter) but due to an administrative error it was never carried out. I left it for some months before I chased this up because I'd been told that waiting lists were unpredictable so it wasn't until about four months later that I began to really think there was a problem.
When I chased it up everyone was very apologetic, I received a second shorter assessment over the phone and was given my first appointment.
I had my first appointment a month ago and unfortunately I wasn't impressed. I wasn't very well at the time as my morning sickness was at it's worst so I wasn't in an assertive frame of mind or I would have voiced my concerns at my first appointment.
To begin with my appointments are at a doctors surgery local to me. The waiting room is filthy. There is mud all over the skirting boards, the smell is horrendous and there is dust everywhere. Luckily while I have issues with cleanliness they tend to revolve around my own home so I can cope with it. I can't imagine what a patient with cleanliness issues might feel like though, I don't know how they would even bring themselves to sit down.
Both of the rooms that I've had my appointments in have been cluttered and messy. They are just normal GP's consulting rooms, so they are not at all conducive to therapy and don't lend themselves well to a relaxed atmosphere.
When I start each appointment I have to fill in a form where I answer questions with a number of the 1 being good 10 being awful type thing. Like the ones you used to do in women's magazines only with questions relating to your feelings about your symptoms.
My problems started when I had to do this to because the therapist asked me to restrict it to how I had felt in the last two weeks. The problem with this is that my OCD flares up when I am working, which I wasn't and when I have people around to visit my house, which I didn't or when I have to leave the house unattended for an extended time, which I hadn't. Because I'd been so ill with the pregnancy I'd spent the last fortnight in bed or on the sofa. I hadn't had the OCD related anxiety because I hadn't been facing my fears - so when answering the questionnaire I ended up with a result that showed I was 'normal'.
If I'd been on the ball at the time I might have pointed this out but I was feeling so unwell I couldn't bring my thoughts into focus.
The therapist talked about my issues around guests. I have an anxiety issue about guests coming to my house because I'm scared of contaminating them if I cook or serve a drink to them. We decided this would be a focus of our therapy and that was pretty much the end of our session.
Due to other medical appointments I had for the pregnancy, I didn't go back for a month. My second session was yesterday. I'd considered what had been going on and decided that I would tell the therapist that I was concerned that my main issues, which are around work and work based situations, would not be dealt with because they are not currently part of my life.
The therapist explained that because CBT is a practical therapy it can only focus on the here and now because you need to put what you've learnt at therapy into practice in your daily life to see if it is working.
The therapist asked me if I agreed that this was reasonable and I said no. Now this is the scary part for any mental health patient. I'm always worried that if I argue or complain I'll be viewed as difficult or uncompliaent or that my health problems are worse then they actually are. Also when you feel unwell your energy and confidence are low so arguing back is difficult.
I pointed out that while I could understand the therapists position - it didn't help me. My major life damaging issue is my work. I pretty much had to quit work because I was on my last nerve. When I look back now it's clear to me that I got help before I broke down. I think I was three to six months away from a total breakdown. I convinced myself and others that leaving work was for the best and that it would enable me to help my husband with his business, which it has, but I think deep down I knew I was headed for the cliff edge with no way back if I went over.
I then argued that while I won't be working for a while because of the baby, if I ever do find my self in a position where I want to go back to work I won't be able to because my fear has now got so bad that I cannot even bare the thought of filling out a job application.
The therapist suggested that this is where I would use medication but I pointed out that I was on medication while I was working, and while it was a big help it is by no means enough to help me get over this hurdle.
We kind of went round in a circle over this and the therapist reiterated that CBT can only be applied to the present. The therapist gave the example of someone coming to therapy with social anxiety related to OCD. Part of CBT is goal setting where you try to achieve a particular goal to overcome your anxiety. The therapist said that if someone had started their therapy in May they couldn't set a goal of wanting to start a college course which began in September because this goal would fall outside the three month therapy course. Each person is allocated around six sessions about two weeks apart depending on their assessed need level so for someone starting their therapy in May it would be finished by August. For this imaginary person the goal of starting a college course would have to be a personal goal not directly supported by therapy.
I was a bit taken a back by this because it merely highlighted how therapy isn't really, in my view, going to help me or others in similar positions. Unfortunately life isn't neat and tidy and events don't happen to order. Those of us who need help cannot guarantee that the issues that plague us are going to fall conveniently into the time period that the NHS allots us to have our therapy. So me and social anxiety college person are buggered.
I asked what my choices would be if I wanted to go back to work and the therapist said I'd be offered medication or the chance to have more CBT, but only once I was actually in work.
I pointed out this was a bit of a chicken and egg scenario, I can't work because I need therapy but I wouldn't get the therapy because I wouldn't be in work.
The therapist tried to press me to agree that I understood and thought everything was fine which I refused and I moved the conversation on to the rest of the session. We are focusing on my issues around having guests over which I am grateful for and am going to commit my all too. However I don't feel happy and I feel like there is a big cloud on the distant horizon of what I am going to do if I want to go back to work.
