To be upset re:therapy

[UndertheCedartree]

I've been trying to access therapy for many years. I've done IAPT level 2 & 3 and both times the 10 sessions left me in a state of having opened up but not enough time to resolve anything so just left to deal with it on my own. After the level 3 I had a mental breakdown. I was in hospital for 3 years and during this time I completed DBT with the aim that I could then start trauma therapy in the community once discharged. Unfortunately I've had to wait another 2 years so I've forgotten most of the DBT. Private therapists won't touch me as too complex. But anyway, I finally was able to start. It was my 2nd session today and I found out I am only getting 18 sessions (including last week). I'm gutted. I really don't think it will be anywhere near enough. And now I realise why last week and this week she seemed to be pushing me to talk about things before I was ready and why she is talking about finding solutions to my issues before I've barely had a chance to talk about anything. This evening I am feeling incredibly low. I feel so, so tired. I feel like giving up and so hopeless. I feel panicky and tearful and so bad. The therapist is also only a trainee and I feel like experienced private therapists won't take me on but then I'm seeing a trainee - does this make sense? I'm going to be left in an incredibly vulnerable position again. I already feel re-traumatised by being pushed to talk about things and without the benefit of having the DBT fresh in my mind as was the plan. I don't know what to do. My psych nurse has just left so I don't have her to talk to either.

So sorry you are going through this. If your therapist is a trainee, would it be possible to ask to meet with her supervisor for a joint session to explain how you are feeling and to try and get the right pathway put in place for you. I work in mental health and services are so stretched now that it really is just a sticking plaster. Could your therapist/supervisor suggest someone who could see you privately? Maybe you could get in contact with your nurses team and explain the situation and ask to be prioritised for her/his replacement so you knew you had that support coming. It’s so so tough right now with mental health services.

Hi,

Sorry to hear about your experience, frustratingly there just aren’t enough staff in teams so often less sessions are offered to manage the incredibly long waiting lists but the downside is that if people don’t have a “full dose” then they don’t feel they have the tools and more likely to relapse.

If having DBT, I’m assuming there’s emotion dysregulation present and guessing that’s linked to why private therapists say too complex e.g. concerned about risk increasing and not having a team around them to provide the right support.

I know this is easier said than done, but please still try to keep an open mind about therapy, trainees are very closely supervised (some trainees I’ve known have been better than some qualified staff due their previous work experiences) and if you feel your needs aren’t being met you can ask for a qualified therapist but it may mean a longer wait.

I wish I had an answer for you, if you get to the end and feel you need more then contact PALs. It won’t necessarily mean you’re offered more sessions but the more it gets flagged the more commissions etc. might review service provision. If wanting to refresh DBT skills I’d really recommend this: www.amazon.co.uk/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1684034582/ref=mp_s_a_1_1?crid=36C7C62CB6EL1&keywords=the+dialectical+behavior+therapy+skills+workbook&qid=1653073288&sprefix=dialetical+%2Caps%2C117&sr=8-1

YANBU - limited term therapy can be useful in some cases and, in terms of NHS funded therapy, occasionally necessary, but in the case of long term illness and deep trauma, it can be very damaging (as you know).

Do you have anyone except the nurse who's left - social worker, psych consultant, replacement for your previous nurse, anyone who's advocating for you medically? If so, I would speak to them and ask what the plan is for when you get to the end of this 18 session period if you're not yet ready/able to manage without support. If not, you could ask your GP to act as an advocate for you in ensuring your care is properly coordinated. It might also be worth speaking to some private therapists to see if they would be willing to kind of pick up where the NHS leaves off (if the NHS would allow sharing of notes and you were okay with that), with the idea that there'll be continuity of care but they're not taking you on from scratch? I've no idea if that's something they'd be willing to do, but it could be worth exploring.

Of course, speak to your therapist, too - part of your treatment has to be about enabling you to cope without therapy, so how and when you're ready to do that has to form part of the conversation and your previous experience post-level 3 means that's crucial.

Mostly, I'm just sorry our health service is so poorly equipped to handle mental illness. I know it's terrifying but please be a squeaky wheel - ask every week, "who is responsible for coordinating my care and who is going to listen if I'm not ready to have no support at the end of this block of sessions?".

💛

That is a good idea to see if I can speak to the supervisor. Unfortunately, I don't think there is any other pathway. I just don't think proper therapy is available anymore. Noone will see me privately (I've tried) as they say I need MDT supervision. I will try and chase up a new care co too, thank you. I just wish I didn't go through years of inpatient away from my DC in order to be able to do therapy in the community only to find it's not actually available.

I don't have experience of DBT, but I have had CBT and worked whilst was going through it, however once it ended it stoped working and felt abandoned and in same place as before.

I assume that you’re seeing your trainee therapist in a community/vol sector service? I did this kind of placement and have worked in a complex trauma service (charity run, NHS funded), but imo if your case is as complex as you’re suggesting you perhaps shouldn’t have been allocated to a trainee? We would not have given high risk, high complexity cases to the trainee counsellors/therapists/couns psychs. Do they have any qualified therapists working for them or is their model trainees only for cost reasons?

Therapists would not do joint sessions with clinical supervisors as has been suggested. If the therapist is on a training placement, they will usually have an independent clinical supervisor outside of the service and the service ought to have a clinical lead in house who takes care of issues and allocates clients to therapists etc. It’s that person that OP needs to speak with if there’s a problem and she can’t work with the therapist allocated. Most services also will not recommend private clinicians outside the service - we were always told not to do that, as if it goes wrong you can be held liable for recommending someone.

I’m fully sympathetic to your predicament OP - NICE guidelines suggest 3-5 years therapy for complex trauma/CPTSD (assume this is what you mean by complex and you’ve had DBT but please correct me if I’m wrong) but no free services offer anywhere near it, not even where I worked which offered up to 2 years. It’s reprehensible, our mental health systems are repeatedly failing the most in need.

Unfortunately what you might be coming up against in the private sector is that there’s a huge amount of burnout in the mental health professions following Covid and many of us are having to be careful about taking on too many complex cases. I’m hearing that a lot (and am in a similar situation) and I’m turning a lot of people away just now who I know really do need help because I’m at capacity and know I don’t have the resources to see someone with high needs having gone through some of the experiences I had in practice during the pandemic times. I will, however, see complex trauma cases under normal circumstances - we do exist. I prefer a multi disciplinary team approach where possible, but I have worked with patients where this hasn’t been the case and I’ve simply ensured I’m very well supervised, by experienced supervisors confident with trauma work.

A few places you could approach for suggestions/signposting at least - difficult to provide recommendations not knowing where you’re based but these might be a start.

beaconhouse.org.uk/specialist-clinics/adult-trauma-clinic/

www.complextrauma.uk

ukpts.org

It is better to give someone no therapy than to get them to open up all the wounds and then leave them bleeding. Offering reduced sessions is just dangerous.

I have to say the very experienced psychologists I worked with as an inpatient were much better. But I almost feel it was always going to fail as my psychologist felt I wouldn't be able to cope with therapy without coping skills and that I needed to do DBT and then the therapy but it needed to start on discharge. But instead 2 years has passed. This is how the NHS wastes money. I was at an expensive hospital for 2 years for no reason now.

I don't think I'm going to get til the end. Oh and sorry I have that book and it's not great there are much better ones. Sorry I know I'm being negative, I do appreciate you taking the time to reply but I'm not feeling very positive.

It's a bit difficult right now as my DC's SW left too. I do have a consultant psych in theory but I've not seen them due to Covid. This has just worked out so badly. The time I would really need support i.e when starting new therapy I'm left with noone! I think I'm going to have to phone duty soon if I don't feel better. I'm having some really bad thoughts. I've not felt like this for a long time. Unfortunately, sods law my boyfriend who usually gives me a lot of support is in hospital. So I'm feeling very alone.

I'm not sure a private therapist would take me on after a short period of NHS therapy but it is worth asking the question. I feel like I'm not going to make it that far, though. I feel this is going to kill me. I will keep trying though.

I'm sorry you have struggled too. It is so hard.

I am seeing the trainee through an NHS Psychology team in the community. I only just thought of this as I wrote it - why am I seeing a trainee?

Yes, I did think finally I would be seeing someone for proper long term therapy. I have EUPD, Autism and complex trauma. I assumed I would get what I needed rather than a set number decided in advance. That is exactly the problem I've had with IAPT which they know.

Thank you for the advice. Yes, the problem I had was a couple of private therapists said I needed to stay under the NHS as they have MDT. I gave up after that. I will look at the links, thank you.

I’m not that much of an expert
on therapy but it seems quite clear to me that if you needed three years in hospital you must need some pretty deep, extensive help. I think
you should talk to either your therapist’s supervisor or someone higher in whatever service they come under and explain your situation and how you are feeling. I know it’s probably much easier said than done though. Do you have any family members who could help fight your corner? Siblings? Parents? If all else fails, I know it will seem like a backwards step but could you see your GP and maybe explain that, if you don’t get more help and fast you will risk a major crisis?

Hi sorry to hear you’ve been going through so much. I have recently finished dbt privately and can message you the psychologist details if you like? I also just read Marshas book a life worth living which whilst not a therapy book did give me some hope

just giving you sympathy

xxx

I 100% agree with what you've said OP about changing therapist/stopping therapy too early. It's horrific to do that to someone. So many people like to compare mental health issues to broken bones and yet there's no way it would be seen as acceptable to tell a person with a leg poorly functioning due to a previous poorly healed break that it needed to be reset, then break it for the resetting and stop the surgery because "time is up". And do that multiple times!

Severe/complex trauma takes years to work with and it's - in my opinion - unethical to work with it in a set timeframe. Especially one measured in weeks.

I honestly don't know what to suggest, but perhaps it helps to know you have strangers on the internet who support you.

It is so difficult trying to get anywhere. I just phoned Crisis as I'm struggling so much. He just kept telling me to calm down and what was I worrying about. If I could calm down I wouldn't be ringing and I'm not worrying about something, I'm agitated as I've been traumatised! I tried to explain about the psychologist being a trainee and got a lecture about how educated and experienced they are. Like I'm insulting this lady! I mean if trainee are so educated and experienced why bother actually becoming a qualified psychologist, why bother going any higher? I worked with a fully qualified lead psychologist with years and years of experience and the difference is quite obvious. As surely it should be! I've nothing personal against the lady I saw today but I think she is out of her depth. She has pushed me to talk about the most severe things straight away without any understanding of re-traumatising me, without understanding DBT was put in place so I could then do this therapy but the DBT was now 2 years ago so I'm at high risk of my mental health deteriorating sharply. The man on the phone told me if they think this will happen they will postpone the therapy so basically saying I shouldn't tell them! I don't have any close family but I could speak to my sister in law. The one helpful thing is he is refering me to 'Sanctuary' - never heard of them before but they will phone me tomorrow and give me a bit of emotional well-being support.

Thank you. I've actually already done 2 years of DBT, it's complex trauma work I need now. How did you find the DBT? I hope it has helped you.

Thank you

Yes, it does help. My DD's play therapist is in agreement with what you said. I stupidly thought because I was seeing psychology this time and not IAPT and because my psychologist from inpatient had said I needed long term therapy that it wouldn't be a set number of sessions this time. Ultimately, I need what I need and no-one knows at the beginning how long that is. However NICE suggest much longer than 4 months! I wonder how many people commit suicide from being forced to do inappropriate short term therapy? I did last time but luckily was saved. It is how I know how very dangerous this approach is.

Have all your therapists/psychologists so far been neurotypical? I just wondered if it’s worth looking for a therapist who has lived experience of neurodivergence and therefore would find working with an autism dx less “scary”. So many private therapists won’t take on neurodivergent clients because their training doesn’t even cover the basics of neurodivergence, so most are working outside their competence the second a ND client walks in the room.

I wonder if taking a look at the directory on the site below might be worth it, if you are willing to go private?

www.neurodivergenttherapists.com

I have ADHD and work mostly with neurodivergence btw, ND is my specialism (and am openly ND at work) and I continue to be horrified at the lack of training and understanding of ND among fellow couns psychs!

Yes, as far as I know. Thank you, that is interesting.

This was me until 2018

Same list of diagnoses, IAPT didn't know what to

You can, in the meantime, brush up on the DBT techniques that helped you before by looking at one of the many websites about DBT online.

Breakthrough Trauma in bath were brilliant