A Challenging First Day

Last Thursday I attended my first group therapy session, something I have been waiting almost 10 months for. The week preceding the first session brought with it a mounting anxiety, which continually increased in intensity, culminating in a feeling of nausea and panic when the day finally arrived. Throughout that morning I had an almost continuous internal argument, convincing myself that I should abandon the therapy before it had even begun, with the knowledge that whilst in the long-term this course of action would be detrimental to my state of mind, in would at least in the short-term go some way to curbing the wretched anxiety I was experiencing. Despite a pounding heart and an inability to think straight, I forced myself out of the house, onto the bus, and into the waiting room of the West London Psychotherapy Department. Before entering I lingered outside on a bench, not wanting to go in too early and spend any extra time than was necessary in what was sure to be an uncomfortable situation. After eventually entering the building, and composing myself in the toilets, I proceeded into a waiting room which contained the 4 people that I would be sharing my most personal and painful thoughts and feelings with over the coming months.

I realised that the worst thing I could do would be to sit in silence in the waiting room, as the anxiety would only escalate, and the awkwardness of the situation would be heightened. I therefore introduced myself and engaged in the usual pleasantries and introductions, which would in turn make the start of the actual session slightly less terrifying. As it happened there was a lady who was also attending for the first time, which ensured that I didn’t feel completely alone, as we were both in the same boat. Over the next 90 minutes (which at times both dragged and raced by) I mainly listened and took everything in, contributing only the occasional comment or reaction in response to what someone else had said. As a result of my difficulty in opening up, and my discomfort at engaging with new people, it will inevitably take a few weeks before I am confident enough to begin talking about myself and my illness. The other members of the group were incredibly welcoming and made me feel very at ease. On the one hand they encouraged me to open up about anything I felt comfortable talking about, whilst on the other hand they also reiterated that if I merely wanted to take a backseat and simply listen to them speaking, then that would be perfectly ok as well.

Not knowing what to expect, I quickly realised that the sessions would be very fluid, and the therapist would be taking a hands off approach, essentially acting as an arbiter, and an occasional provoker of debate. I was hoping that there may be some attendees who were of a similar age to myself, but the rest of the group were quite a bit older. However, I soon dismissed this from my mind, as at the end of the day we are all in similar positions, regardless of age, gender or background, and that this shared unifying knowledge is the most important factor. Some members the group had been attending for 18 months, whilst others had been coming for only 6 months. Not everyone starts their 2 year course at the same time, and it is inevitable that I will meet a variety of different people over the next couple of years, as new members join the group to replace those that have moved on. For now though I welcome the fact that for the first few months I will have consistency and stability in those that I engage with, which is crucial in facilitating an environment where it feels comfortable to open up.

I continue to find great difficulty in thinking positively, and the usual doubtful thoughts creep into my mind, such as “this isn’t going to help me”, or “there must be a better alternative”. However, a couple of the long-term members of the group  were unequivocal in their explanations of how the therapy has helped them, and this acted as a source of comfort and slightly reinforced the knowledge that I was doing the right thing. It was also very apparent that some of the group had not sought help with their mental health until late in their life, and therefore I feel some relief having started the process as early as I did (back in my early twenties). I have no idea what the coming months will bring, and how the therapy will play its part in my life, but the most significant thing is that I forced myself into that waiting room last Thursday lunchtime, despite every fibre of my being screaming at me to run straight out of the door. I’d like to tell myself that the hardest part is over, but I know that I haven’t even touched the surface yet, and when I begin to open up to the group about myself and my experiences, that is when the real hard work starts. I will need all my strength and resilience to ensure that I don’t give in to the desire to hide away and bury myself within the protective bubble of ‘avoidance’, rather than facing the challenge head on.


Group Therapy

About 10 months ago I ended a 9 month course of 1-1 psychotherapy. Whilst it was useful to have a weekly meeting with my therapist where I could talk through any issues or struggles that I was going through, the course ended whilst I was still in a bad place, and therefore I didn’t have the chance to determine whether psychotherapy would ultimately prove a helpful tool for me. I fully appreciate that the NHS is oversubscribed, and that there are people on long waiting lists anticipating help, and so it’s only fair that they should have a similar opportunity as me to receive therapeutic support. However, I don’t believe it was conducive to improving my state of mind to cease the therapy when I did, as I lost the only outlet where I felt able to open up about almost anything (other than this blog of course). Continuing the therapy for another year may not have made any significant difference to my wellbeing, but it would have been desirable to persevere until I felt mentally ready to end the treatment. Within a few weeks of finishing the course I asked my doctor to re-refer me as I was still failing to cope with my mental health. It took about 10 months to get a review appointment, and whilst I have become accustomed to long periods of waiting, it doesn’t ever get any easier or less frustrating.

The psychotherapist I met with for a review recommended that I try group therapy as my next step, as this is something I have not attempted before, and he hypothesised that engaging with other people with mental health issues could prove rewarding, as well as potentially addressing some of the social difficulties that I find myself with. Group therapy has always been something I have steered clear of, and I have repeatedly pushed for 1-1 treatments. I have always reasoned that opening up about the most personal of inner thoughts and feelings to one person is hard enough, but to do so to 7 or 8 strangers is a prospect that causes my pulse to race at the mere thought. Of course my rational mind realises the advantages of striving towards this group undertaking, and how it is absolutely the right course of action to pursue. Nevertheless, even though the first session is still 4 days away, I’m already getting the familiar sickening feelings of unease creeping through by body, and find myself questioning whether it is worth putting myself through this extra anxiety. But of course it is, and that is the knowledge that will ultimately drive me to turn up to the first session on Thursday.

The first few weeks will inevitably be the most challenging, and I expect that after a month or so has gone by I will have fallen into a routine and feel slightly more comfortable. It’s potentially a 2 year course, and so I’m in it for the long haul. What has helped greatly is the support I’ve had from work once again, and being given permission to work from home on the days I’m at therapy ensures that I can fully focus on the sessions, and go into them with a clear mind. It’s surprising how tiring talking for 90 minutes can be, and how the mind can be in overdrive for hours afterwards, ruminating on what was said and how I feel the session went.

Despite my unavoidable negative mindset leading me to view therapy as a defeat and failure of myself and my life up to now, I must also keep in mind the fact that I have waited almost a year to be in this position and to have this opportunity, and consequently I need to try to discourage that unfavourable thought process. A trademark attribute of depression is a need to focus upon the defeats, and ignore the victories. Winning a race would not elicit the response ‘yes I won!’, but instead ‘thank God I didn’t lose’. I’m sure this therapy course will have lots of defeats, and days where I feel that I cannot face it, but I’ve got to believe that along the way there will be some victories as well. I have so much admiration for everyone who competed in the London Marathon today, and this includes all of the runners taking part on behalf of mental health charities. The achievements of human beings are remarkable, and I will try to take inspiration from their triumphs and endeavours going forward. It may be a cliché, and an overused soundbite, but there is so much truth in the old adage that “a journey of a thousand miles starts with a single step”.



In The Waiting Line

The National Health Service is one of Britains’ greatest achievements, and an establishment that we undeniably take for granted on a daily basis. We are incredibly lucky to have it, and would miss it severely if it were to disappear. It’s an institution, a pioneering organisation, and doesn’t prejudice between people from different backgrounds, creeds, wealth groups or ages. But despite this, it is deeply flawed when it comes to treating mental health, and that needs to change urgently.

This inadequacy comes in two areas; speed and quality of service, both of which I have first hand experience of. The time taken to receive therapy or counselling is ludicrous. Last year I waited about 9 months from referral to my first appointment, which is utterly unacceptable. In that time the mental health of an individual can deteriorate severely, and therefore this wait is deeply troubling as it doesn’t seem to have the best interests of the patient at the forefront. I realise that its impossible for everyone who is referred for therapy to be seen immediately, but 9 months is too long for an illness that at its worst can make you feel unable to function or see any hope of getting better. You wouldn’t say to someone with cancer or a broken leg, ‘unfortunately you are going to have to wait 9 months for treatment’. It again highlights the lack of education around mental health, as well as a significant shortfall in funding for an illness which at the end of the day, can be a life threatening.

This article from the BBC News website shows the stark reality of waiting for mental health treatment, in this case in Wales. “In north Wales, Betsi Cadwaladr University Health Board patients can wait up to 26 months’ and ‘ At Hywel Dda University Health Board, current waits are between 54 weeks for cognitive behavioural psychotherapy and 119 weeks for psychodynamic therapy” Admittedly those are the worst case scenarios, but as my own experiences can attest to, 9 months is a perfectly typical waiting time, and in my opinion, this is disgraceful. As touched upon, these long waits can cause a deterioration in the patient’s mental health, due to the frustration and anger at the perceived lack of support available. Personally I have felt during these lengthy periods of waiting that there is no one to turn to, or nobody that can help me, and this contributed to a further downward spiral of feelings and emotions.

The other major issue is that most GP’s are relatively ignorant of mental health, perfectly willing to just put you on any old antidepressant and suggest that you “see how you feel in 3 months time”. Then if there has been no change they just increase the dose for another 3 months, and so on, until before you know it a year has passed, and you are no closer to feeling any better, or getting to the route of the problem. All this waiting is remarkably demoralising, and time is something a sufferer of mental health doesn’t necessarily have. It’s one of the few illnesses where time isn’t necessarily a healer. I actually visited a doctor once who had to get out a catalogue of medications and browse it to find one that he could suggest. When I asked him about its benefits, side effects etc, he just read them out from the book. This didn’t fill me with any confidence whatsoever, and he may have well just opened his laptop and typed ‘how to treat depression?’ into Google. Similarly another doctor responded to my plea for help with the suggestion  ‘why don’t you do an activity that you enjoy doing’. Really? Is that the advice that you have garnered after 7 years medical training? Besides that being one of the worst and most patronising comments to say to a person suffering with depression, it surely also shows a complete lack of understanding of the illness, as well as an inability to offer any meaningful medical advice. If it was as easy as getting a hobby, or doing an activity you enjoy, then depression wouldn’t exist. I came out of that appointment feeling utterly helpless and lost, thinking that if a GP couldn’t help me, then what hope did I have?

I’m not proposing the notion that the NHS doesn’t offer any support, but simply that it takes far too long and is not nearly thorough enough. A lucky few are able to engage in private healthcare, but the majority of people only have the NHS as a viable option. I realise I’m biased in this as its such a personal and emotive issue, but I suggest that a significant amount of money needs to be thrown at mental health, as well as training many more specialised metal health practitioners. We are at a pivotal point, with admissions for mental illness treatment increasing, and consequently the next 10 years are crucial to tackling the problem before the damage becomes irreparable. Around 90% of people who take their own lives have a mental illness, and if we have any hope of bringing this rate down, we must tackle the methods of treating the illness, and ensure that it is given a priority status. One of the core principles of the NHS was to ‘meet the needs of everyone’, and quite frankly this isn’t being done. The only way we can achieve this is by raising awareness, shouting from the rooftops if necessary. Elizabeth Wurtzel said: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.” Lets find that key, and lift the fog, before its too late.