I am renowned, both personally and with those who look after my health, for being incredibly calm, compliant, patient and willing to try everything. But today I thought that might all change.
I approached this session, as I do most, with intense apprehension: even after 3 months, I still don’t really have a feel for my psychologist and find our time together confusing and inconsistent. We left our last session very tearfully with the start of an hypothesis suggested by the psychologist: was my intense suicidal ideation triggered/maintained by a sense of hopelessness and not knowing how to move forward? (Or that’s what I understood it to be, anyway)
We started this session with what felt like a peculiar inquisition come careers advice session. The psychologist (I’ll refer to her as J from here on) first asked what I thought about her hypothesis. I expressed that I wasn’t really sure but felt it worth exploring. Which triggered the following exchange… (obviously not word for word, but from my fragmented, biased by emotion memory!)
J: So tell me how you move forward.
Me: What do you mean?
J: Well, we discussed that maybe your suicidal thoughts were due to you not being able to make the big life decisions that move you forward, so tell me how you do that.
[I’m kind of confused and thrown by this but don’t want to seem stupid or non-compliant]
Me: Do you mean if I didn’t feel this way?
J: Yes. Hypothetically, if you didn’t feel this way, what would your next big life choice be?
Me: My career.
J: So, tell me what you do.
Me: I’d have to decide between going back to my Masters or going into a caring profession.
[I start crying]
J: Right, so what is the next step.
J: Researching what?
Me: What either entails.
J: Right, and that means?
Me: Um, career paths, training, qualifications, requirements…
J: Be more specific. What’s the next step?
Me: Well, I guess making enquiries and applications, but…
J: Applications to what? Which do you choose?
[I’m now sobbing, hopelessness and dread growing. This is all going wrong. Therapy is my last hope and it’s all going wrong!]
J: You’re crying, aren’t you?
[I now seriously consider walking out]
Me: Because you’re firing questions at me that mean absolutely nothing when I currently live minute to minute, unsure whether I can survive the next hour. All I can hope for right now is to learn how to deal with this, how to make life bearable. But you want me to tell you how to apply to be a nurse. I could go away right now and submit an application for a nursing degree – they wouldn’t take me and I wouldn’t be capable of starting it, but the logistics of applying aren’t a problem. I don’t understand why you’re doing this.
J: I wasn’t trying to set you homework to go and apply for anything. I was just testing my hypothesis. If it was correct then you shouldn’t have been able to answer any of those questions.
[So why didn’t you stop sooner?!]
J: Do you think it’s correct?
At this point I was ready to give up on therapy entirely. I walked into the room fragile and tearful, having hit my head repeatedly in distress in the morning and suffering growing pains, aches and lumps – and now I was confusingly been subjected to quick-fire career questions.
Luckily, things took a turn at this point. I explained that actually I hadn’t just had a breakdown at the end of a degree when I needed to make a choice – I realised then that I’d obviously misunderstood her hypothesis for being regarding hopelessness due to illness, not classic graduate indecision or inability to take the next big life step – but whilst in the midst of a Masters degree at one of the top universities in the world, with good connections and on track to do a PhD. In fact it started MUCH earlier than this. She agreed that her hypothesis (which she now explained was a psychological formulation, which she’d been testing out) couldn’t be correct and we then started looking at how far this stretched back.
With befuddlement at how she had not remembered or how we had not discussed this already, I talked her through the basic history that I’ve recounted dozens of times over the past 18 months, with the added extras of more recent revelations.
She then explained that although she’d been requested to treat me for EUPD and as such focus on emotional regulation and management, she actually saw me as presenting predominantly and overwhelmingly with incredibly severe depression – none of the classic fluctuation of EUPD – which needed to be tackled differently. I said that I wasn’t fussed with labels, and she said that she wasn’t either but in terms of treatment plans it mattered and we needed to be on the same page – although she said that she is well aware that the depression could be masking personality issues, it’s so severe that she feels that it’s the depression that needs to be dealt with first, if I was in agreement. I said that I was – confused as all I’d ever asked was that I be helped to learn how to make life not quite so painful (and described my ‘pain’), and this seemed to fall under this remit. But it finally felt like we might have reached the end of assessment, after almost 3 and a half months.
J said now we would work on my history, narrowing down when the mental health difficulties began, and noting all serious and/or upsetting life events. She likened it to how people have picked apart Robin Williams’ life, trying to uncover factors contributing to his illness and events running up to his suicide…but that we wanted to do the same before my death. (I’m still caught a little off-guard by her bluntness!) My homework would be to get started on this, roping in my care coordinator if she’s willing – finally something I can work on! This again left me with confusion and a bit of disappointment as this sort of stuff was supposed to have been handed over to J several times over, and I had thought we’d discussed a fair bit of it, but it doesn’t matter…getting it all written in one place will be useful and at least this finally feels a bit more substantial. A bit more like we’re doing something.
J emphasised that with this line of therapy, working on the severe depression, there will be light at the end of the tunnel. It’s a bloody long, twisty and dark tunnel in my case, but she hopes that we’ll be able to find the light together. After an horrific start to the session, I left feeling finally that J and I might at least achieve something from therapy…or try to, anyway.
Although, with the current track record, this could all change next week…