I had a psychology session last Tuesday and we mainly talked about what he was going to include in the report he was writing for me to support my return to uni.
He emailed me the report on Thursday and this is what he has said... obviously I have changed some details...
I began working with GP in February 2012. At that time GP was being assessed for inclusion in a dialectical behaviour therapy (DBT) group. The assessment indicated that that treatment was not appropriate to meet her needs at that time. We began working together in individual psychology sessions in March 2012 and I have continued to work with GP on an individual basis since then. We currently meet together on a weekly basis in the outpatients department.
GP has a history of low mood, anxiety, hopelessness, avoidance of seeking help or actively addressing problems, and self-harm. GP has reported that her self-harm has a variety of functions – sometimes her self-harm has been in order to gain a sense of control over her emotions or the demands she has faced in the environment, on other occasions it has been with the intent of dying. Due to family stressors, debt problems and the end of a long term relationship, GP's self-harm escalated in the summer of 2011. This led to her being detained under the Mental Health Act (1983) between August and October2011. After discharge GP continued to struggle and was admitted again under the Mental Health Act (1983) between November 2011 and July 2012. Initially GP found it difficult to engage with mental health services and these admissions were problematic, including periods in Psychiatric Intensive Care Units to manage the risks GP presented to herself.
Since being discharged in July 2012 GP has had further admissions to hospital. All psychiatric admissions are listed below.
11th August 2011 – 24 October 2011
17th November 2011 – 31 July 2012
8th October 2012 – 9th October 2012
12th October 2012 – 19th October 2012
25th October 2012 – 15th November 2012
6th April 2013 – 10th April 2013.
It is important to note that admissions since October 2012 have been brief and informal (not under compulsion of the Mental Health Act – GP chose to be in hospital and was not detained at these times)(although I wasn't given much choice, I was basically told either go informally or we will section you). These admissions were with the purpose of supporting GP during periods of crisis as she learned to manage her self-harm independently.
To her credit GP has worked hard to understand the function of her self-harm and to reduce the frequency and severity of such acts. She has consistently engaged in psychology sessions to reflect upon her experiences and has increased her coping skills substantially. GP also has a community psychiatric nurse with whom she has worked since 2011 , a consultant psychiatrist and she has also worked with a number of occupational therapists. Her contact with these team members is less frequent than with myself. GP has recently been discharged from Occupational Therapy due to the progress that she has made. With that support and also in psychology sessions GP has developed a greater sense of agency and has markedly increased the activities that she engages in, including physical exercise.
GP's mood and sense of self has steadily improved since April 2013. Prior to this she found that she made some progress, but also that this would deteriorate at times. In April 2013 GP took a serious overdose and required admission to the medical Intensive Treatment Unit followed by a brief psychiatric admission. This precipitated a significant turning point for GP and she has since this time consolidated the gains that she made previously and is now more consistent and active in managing her mood and risk to self. GP does still occasionally report acts of self-harm, but these are relatively minor compared with what went before.(obviously I haven't told anyone about the swallowing of things - but that has been over a month now)
A significant and beneficial change that GP made was moving to her own flat in February 2013. Prior to this GP had been living with her parents. While living with her parents GP was somewhat isolated, spending long periods in her room avoiding contact with her parents. Since getting her own flat GP has been increasingly active in her recovery. GP has identified that in the past she had significant problems with avoidance of emotions and situations that triggered strong emotions.
During psychology sessions GP has worked hard to identify how her core beliefs, or schemas, have interfered with her achieving her life goals. GP is now addressing these issues proactively and has increased the range and frequency of activities she engages in. Her mood is now more stable and periods of low mood are less protracted, less threatening to her sense of self and she is more active in taking steps to improve her mood, e.g. through seeing friends and family, keeping on top of tasks such as house work and addressing her debt problems (GP's debt problems resulted from a period of low mood in which she spent money impulsively to try and improve her mood). In the past GP had drunk alcohol to try to improve her confidence and mood, but this often led to impulsive acts of self-harm. GP has worked hard for several months to limit her alcohol intake and she is now able to go out with friends and enjoy herself without drinking alcohol. GP has to my knowledge no problems with other drugs. I feel this bit makes me sound a bit like an alcoholic and perhaps that I take drugs but I don't have any problems with them.
GP's urges to and acts of self-harm have decreased in frequency, intensity and severity consistently since April 2013. While there were problems between October 2012 and April 2013, these were in my view a necessary part of her journey towards recovery as she learnt about her vulnerabilities and developed new ways of coping. She now reports feeling more confident in addressing any difficulties that she experiences, she is more able to take care of herself and seek and accept help as required.
I will remain as GP's clinical psychologist for the foreseeable future. We will review our work together in December 2013 and may agree to continue sessions after that if we agree that these would continue to be helpful. I also foresee that GP will have access to community mental health team support for the next year as a minimum. This support will include a community psychiatric nurse, consultant psychiatrist and crisis support.
In the time that I have known GP she has consistently maintained that her studies at the University were not a significant problem in the mental health difficulties she had experienced. GP is in my opinion highly motivated to return to study and practice in training. While she is understandably anxious about the potential return to study (whether she will be allowed to return, whether she will be able to pass all assignments), she is in my view committed to completing the course. I have no concerns about any risks GP may present to others in practice because to my knowledge there are no grounds for concern. While GP’s experiences of mental health services have at times been less than ideal, she has maintained that this would not affect her judgement and she would signpost and make referrals to services as necessary. In our organisation, employees who have experience of using mental health services are welcomed on the basis that being an ‘expert by experience’ can enhance service delivery. I believe that in future, GP’s experience of mental health difficulties and using mental health services could enhance her practice as a social worker. For example, I have over the past year observed an increase in GP’s ability to reflect on her experiences and with support and guidance this will in my view enhance her ability to operate as a reflective practitioner.
It is my opinion that GP is currently fit to return to study and practice in training to be a social worker. It is my view that being able to work towards the goal of qualifying as a social worker will enhance GP’s recovery as it will give her purpose. Currently GP is keeping herself busy with leisure and intellectual interests and in my view this has formed a strong foundation to return to study. She is more able to set approach goals to address problems and challenges and is less likely to avoid difficulties as she did in the past. As avoidance was in the past a significant contributory factor in her difficulties, this indicates that GP is now coping differently and more effectively than she was in August 2011. I fully support GP in her application to return to study and commend her for the work that she has done to recover from the significant difficulties that she previously experienced.
Over all I am happy with what he has written. There are some bits I would have possibly not said, and I did ask him to take the bit about the OD in March/April out. But he said he felt it was necessary that we were transparent with what was being said and what was going on.
Even though it's a good report and he fully supports me I have a really bad feeling about being able to go back to uni. I have a feeling that they are going to say no to me going back.While he does support me in going back I still have my worries. I got the feeling at the 3 way meeting with the course director and the psychologist that the course director was quite negative and had a few concerns. In the past they have come across as being all supportive and then turning round and saying basically the opposite. When I was first admitted back in the summer of 2011 they appeared that they couldn't be more helpful and told me to concentrate on my self and not to worry about the course as I would be able to go back. Then they contacted my psychiatrist and basically gave a whole list of reasons why they thought I shouldn't be going back to uni that year. Then basically being told I was unable to go back made me lose it big time and I ended up being readmitted only about 3 weeks after being discharged and being in for 9 months. So the possibility of being told I can't go back is a real big worry for me as I am worried it will make all those feelings come back and the suicidal feelings return. I am worried I am going to decline again and end up in the position I was in last time.
I worry that they will see that me being stable-ish since April isn't a long enough period of time. I worry that they will see the amount of admissions and worry about my stability. They only knew about the times I was under section and that ended in in August last year.
Also, in the report he talks a lot about how it will be beneficial to my recovery in going back. I am not sure if it's the best thing to say or to place an emphasis on. It may well be beneficial to my recovery, but, I don't think they need to know that as it could look as though it is being said it's the only way in which I will recover and it could possibly look as though some of the blame is being given to uni. Maybe not, maybe it's just the way in which I am reading in to it. I sent it to my friend and she said I am reading too much in to it in terms of what it says about the alcohol, so I am probably doing it with that as well.
I just don't feel positive about it at all. And I know if I am not allowed back it is not going to be good for my mental health. Obviously I will do what I can to prevent relapse, but this is going to be so huge that I am not sure if I will be able to cope. But can I say this to anyone? It may come across as being threatening and trying to manipulate the situation, and I'm not. I am just really worried.
I have a psychology session tomorrow. I am freaking a bit about it. I sent an email to the psychologist from an email account I don't regularly use and the sender name comes up as Golden Psych. I wasn't aware of that. So now I am worried that he will come across my blog. I don't think he is very tech savvy, but all he would need to do is google Golden Psych and up comes my blog in the search engines. The top 3 hits are to do with me and my blog. I do tell him most of the stuff I talk about, but he doesn't know about the extent of the self harm. And, I wouldn't want anyone I know reading my about my inner most thoughts. Some things need to remain private. Well, private in the blogosphere where over a 100 people read my blog a day. But none of you actually know the real 3D, breathing version of me. You don't have a correct mental image of me. You don't know who I am. There is no one I know who actually knows about the things I write in here. Friends have snippets, family have snippets (fewer than friends), ok my psych team know probably more than everyone else, but there are still things I like to remain private. So, I will see how things go. I think he would probably mention it if he did come across it, his line of questioning about the self harm would possibly change so I could probably figure out if he or anyone else did. Also, I can't see why he would want to read this. He spends an hour a week with me, I doubt he or anyone else would want to spend more time on me than they already do. They have other patients and other people who need their input, probably in all likeliness more than me.
The meeting with uni is on Wednesday. I am dreading it. I have been trying not to think about it too much as when I do the urges and bad feelings and thoughts start. So, yes, I am avoiding it. It is working for me though. I did find some old Diazepam in a drawer the other day. 10mg pills. They are some of the stash that I brought back from Asia with me 3 years ago. I thought I took them all in an OD 3 years ago but I found an unopened packet. I did take one the other day, but I am not sure if it had any affect. It is probably after its use by date now so perhaps they aren't as affective. But you would think that 10mg would have some affect on me, but I didn't notice anything. I also have PRN Quetiapine. 25mg. Shit. But they are there if I need it. I will probably take some before this meeting on Wednesday. Or half of the 300mg pills I have left over from when an old prescription got filled. I took one pill before going to the dentist last time and I was floating. It was brilliant. But at the same time I was falling asleep in the waiting room, so perhaps only half a pill is a good idea.
I seem to have a lot to freak at at the moment. Uni being one. The other my physical health. I am seeing every little thing as all symptoms of what could be something serious. I talked about the problem with my eye possibly being something serious, possibly a tumor. I have the scans on the 13th September. Quite nervous about it. But my gyne problems are back as well. I thought with going back on the Metformin that it would sort it out. But it hasn't. I don't understand how for over 2 years the combination of Metformin and the pill helped and I didn't have any problems. So why are the problems back now. It has me worried that it could be something all related and that a tumor is causing my hormones to be all fucked up. I know I am crazy right. My body is really letting me down at the moment.
So yeah I am stressing a bit at the moment. And yes, I am having quite strong self harm urges. The urge I am battling with right now is to swallow something. I am picturing the cupboard behind me where I know I have things. I am struggling to get it out my head. But I can't, I can't give in when the urges are strong. If I can't deal with this then how am I going to deal when I have 4 assignments due, a presentation to plan and a dissertation to write.
Am I fooling myself? How the hell am I going to manage with this course?